Clinical Cases in Paramedicine. Группа авторов
opioid medication, commonly 25 μg fentanyl or low‐dosage morphine.Treat any hypoxia with oxygen. If no signs of hypoxia then oxygen is not indicated.
Case Progression
300 mg oral aspirin has been administered, the patient has also received 2 sprays of sublingual GTN across a 10‐minute time frame and 25 μg fentanyl.
Patient Assessment Triangle
General appearance
The patient is less distressed, speaking in full sentences and not holding her chest any more.
Circulation to the skin
Normal.
Work of breathing
Normal.
SYSTEMATIC APPROACH
Danger
Nil.
Response
Alert.
Airway
Clear.
Breathing
RR: 18 bpm.
Circulation
HR: 70 bpm. Effort: strong. Heart regularity: regular.
Vital signs
RR: 18 bpm
HR: 70 bpm
BP: 125/85 mmHg
SPO2: 98%
Blood glucose: 5 mmol/L
Temperature: 37 °C
12 lead ECG: Sinus rhythm
1 The patient is still complaining of 2/10 pain. What treatment plans would you advise for this case?The patient should be given sublingual GTN and IV pain relief.We are treating this patient as having acute coronary syndrome (ACS), therefore we need to reduce her pain to salvage myocardial tissue.As long as GTN is not contraindicated, this should be continued and IV pain relief continued.A 12 lead ECG should be continued while the patient is transported to hospital, looking for any ischemic changes.The patient should remain monitored during transport and until handed over.Consider transporting to an ACS facility if recommended in a local protocol.
2 What are some risk factors for ACS that should be addressed in your questioning?Family history of ACS.Stress levels, e.g. work type, work/life balance, diet, exercise.Advancing age.Male.Smoking.Diabetes mellitus.History of prior ischemic heart disease.
LEVEL 2 CASE STUDY
Pericarditis and pericardial tamponade
| Information type | Data |
| Time of origin | 20:58 |
| Time of dispatch | 21:00 |
| On‐scene time | 21:10 |
| Day of the week | Tuesday |
| Nearest hospital | 25 minutes |
| Nearest backup | CCP, 15 minutes |
| Patient details | Name: David Bryant DOB: 27/12/1994 |
CASE
You are called to a 26‐year‐old male complaining of retrosternal chest pain and shortness of breath.
Pre‐arrival information
Patient is conscious and breathing, with severe sharp chest pain with no known cardiac history.
Windscreen report
On arrival on scene, no obvious dangers observed. Lights are on inside the house. Weather is fine, no rain, you consider nearest hospital and confirm if backup is available.
On arrival with the patient
On arrival on scene, you are able to gain access to the house and find the patient sitting
upright on a dining‐room chair, clutching at his chest.
Patient assessment triangle
General appearance
The patient is alert and he looks at you as you approach. He is sitting upright on a chair. Patient presentation is flushed and sweaty, and he is able to speak in full sentences.
Circulation to the skin
Patient appears well perfused. Skin pink, warm and dry.
Work of breathing
Nil increased work of breathing, air entry = L/R clear, nil adventitious sounds.
SYSTEMATIC APPROACH
Danger
No danger, scene feels safe and controlled.
Response
Patient is alert. He looks at you and acknowledges you as you approach. Patient says hello after you introduce yourself and partner.
Airway
The airway is clear. The patient is able to speak in full sentences. Nil blood or secretions coming from airway.
Breathing
There is breathing with spontaneous effort, equal rise and fall of chest, nil difficulty in breathing (DIB), some increased effort and work of breathing observed. Respiratory rate 26 respirations per minute – adequate ventilation.
Circulation
Strong, regular, palpable radial pulses felt.
Exposure
Nil evidence of trauma on head‐to‐toe assessment, patient denies trauma to chest. He is able to take a deep breath, but reports it increases the pain in his chest when he does so.
O (onset): patient states pain suddenly increased 4 hours prior to calling ambulance and has been gradually increasing in severity.
P (provocation): Pain is worse upon laying supine/flat, but is relieved by sitting upright.
Q (quality): The pain is described as a sharp, burning and at times stabbing pain that is isolated to behind the sternum.
R (relieving factors): Pain is not relieved by anything, but is improved by sitting forward/upright.
S