Discuss, in essay format, the out—of—hospital management of ONE of the patients described below (choose either the cardiac or respiratory patient).
Include the following:1. An explanation of the pathophysiology of the chosen pathology, particularly as it relates to this patient. Include a short discussion ofthe epidemiology and associated risk factors.
2. Correctly and systematically interpret the 12—lead ECG provided. Comment on if, and how, this would guide the management of this patient.
3. Comprehensively describe the out—of– -hospital management of this patient. This should not be based solely on any one jurisdiction’sprotocols or clinical practice guidelines; instead you should discuss the general management, referring to national and international guidelinesand literature. Include any controversies/differences in management (again, ensure you reference your discussion), and considerregional/geographical/hospital differences that will impact on management.
4. Discuss the ongoing in—hospital care that this patient is likely to receive, as well as their prognosis and any potential complications of thisclinical episode.
5. Your essay should be in essay format, that is, it should include an introductory and summary paragraph, other paragraphs should eachintroduce a ‘new’ idea in your discussion (you may use sub—headings), all tables and diagrams must be referred to in the text (as well asreferenced if they are taken from elsewhere). If you use bullet points, use them sparingly and only as necessary. Check your spelling, and checkyour grammar. Use Vancouver referencing.
6. Please use 12—point font and double spacing. All comments will be made on the paper.
7. DO NOT plagiarise – you MUST acknowledge all other sources.
8. If you are not sure what is required, email me or make an appointment. Better to be sure than sorry.
CAA 206 Assessment Task 3 – Case StudyPatient Care Record – Ambulance Service (Patient 1)Name: Amit Singh Date of Birth: 21/01/1960 Age: 58Presenting Complaint – Chest pain and vomiting.History of Presenting Complaint – Patient works as an NBN installer and is travelling for work. He became ill while working at a remoteproperty, the client called triple zero immediately. Mr Singh describes a sudden onset of nausea and vomiting with pain in his chest, left armand jaw thirty minutes ago. The bystander describes Mr Singh quickly becoming pale and sweaty before vomiting.Past Medical History – Hypertension, hypercholesterolaemia and type two diabetes mellitus.Drug History – Perindopril, atorvastatin & metformin. Taken daily as prescribed.Allergies – None known.Family History – Father died aged 57 of a “heart attack”, brother had “stents” aged 58.Social History – Lives in Canberra with his wife and two children aged nine and eleven. Sedentary lifestyle travelling thousands of kilometreseach week. Diet appears poor, consisting of take away foods high in fat and sugar as he eats away from home. Twenty pack year smoker, quitten years ago. Mr Singh’s extended family live in India, he is engaged with his community and has many friends at his local Sikh Temple wherehe worships. Both parents were born in India, as was he, moving to Australia at age nineteen.On ExaminationPatient has capacity and consents to assessment.Pain using SOCRATES:Site: Central chest pain with discomfort in left arm and jaw.CAA 206 Assessment Task 3 – Case StudyOnset: Sudden onset thirty-five minutes ago while completing paperwork.Character: Chest pain is described as “heavy, like someone sitting on my chest”. It is constant and this is the first time he has experienced thispain. He rates severity as 7/10.Radiation: A tingling/numbness is felt in the left arm and jaw.Associated symptoms: Nausea, vomiting, pallor and diaphoresis.Timing: Thirty-five minutes of persistent non changing pain.Exacerbation/relief: Pain remains the same on deep inspiration, palpation and movement.Focused assessment:Inspection: Pallor, diaphoresis and in obvious discomfort with some anxiety. Vomit appears normal with no blood.Palpation: No abnormalities detected.Percussion: No abnormalities detected.Auscultation: No abnormalities detected.Observations:AVPU scale: Alert. Orientated to time, place and personRespiratory rate: 18SpO2: 97% on airHeart rate: 104bpm (regular, taken radially)Blood pressure: 142/87Blood glucose: 8.4mmol/dLTemperature: 36.4oCECG recorded on next page.It took you 30 minutes to reach the patient. The nearest Emergency Department is a small hospital with no cardiac facilities and is 45 minutesaway. The nearest pPCI facility is 3 hours and 50 minutes away. The helicopter can not fly due to weather surrounding the airport.CAA 206 Assessment Task 3 – Case StudyName: Amit Singh Date of Birth: 21/01/1960CAA 206 Assessment Task 3 – Case StudyPatient Care Record – Ambulance Service (Patient 2)Name: Ben Henderson Date of Birth: 12/10/1992 Age: 25Presenting Complaint – Difficulty breathing.History of Presenting Complaint – Ben has a twelve-hour history of increasing difficulty in breathing while at home having called in sick forwork as a software developer as he woke with dyspnoea in the night. His boyfriend called for an ambulance on arriving home at 17:30 as Bencould not speak and appeared “blue”. Over the past week Ben has had a cough and increased the use of his rescue medication. Today he hasused his inhaler “a lot” and has felt little to no relief.Past Medical History – Asthma, eczema and hay-fever.Drug History – Salbutamol, beclometasone. Previously has taken courses of prednisolone.Allergies – None known.Family History – None relevant.Social History – Lives with his boyfriend in a city apartment. Employed. No recreational drug use, non-smoker and occasional alcohol withfriends. Exercises and has regular contact with his asthma nurse.On ExaminationPatient has capacity and consents to assessment.Primary survey:Airway – Clear.Breathing – Rapid rate, central and peripheral cyanosis with audible wheeze without auscultation.CAA 206 Assessment Task 3 – Case StudyCirculation – Rapid pulse.Disability – Alert on AVPU scale and appears exhausted.Exposure –Tripoding position.Focused assessment:Inspection: Tripoding position, cyanosis to lips.Palpation: No abnormalities detected.Percussion: No abnormalities detected.Auscultation: Globalised expiratory wheeze.Observations:AVPU scale: Alert. Orientated to time, place and person, appears exhausted.Respiratory rate: 34SpO2: 90% on airHeart rate: 150bpm (regular, taken radially)Blood pressure: 119/75Blood glucose: 5.4mmol/dLTemperature: 36.8oCECG recorded on next page.It took you 12 minutes to reach the patient. The nearest Emergency Department is a metro hospital with all facilities and is 15 minutes away.CAA 206 Assessment Task 3 – Case StudyName: Ben Henderson Date of Birth: 12/10/1997
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