Clinical Cases in Paramedicine. Группа авторов
(Hint: you will be required to look this up using the Australian National Asthma Council chart found here: http://www.peakflow.com/pefr_normal_values.pdf or by doing an internet search.)400 L/min.75%.
LEVEL 1 CASE STUDY
Chronic obstructive pulmonary disease (COPD)
| Information type | Data |
| Time of origin | 07:09 |
| Time of dispatch | 07:12 |
| On‐scene time | 07:30 |
| Day of the week | Wednesday |
| Nearest hospital | 15 minutes |
| Nearest backup | 40 minutes |
| Patient details | Name: Dave Beater DOB: 21/09/1954 |
CASE
You have been called to a residential address for a 66‐year‐old male with difficulty in breathing. The caller states he has been breathless all night and has had a cough recently. He has seen his GP who prescribed antibiotics and steroids but he feels his breathing has got worse overnight.
Pre‐arrival information
The patient is conscious and breathing and is in a first‐floor flat/unit.
Windscreen report
The location appears safe. Greeted at the main door by the patient’s wife.
Entering the location
Wife escorts you up in the lift to the patient’s flat.
On arrival with the patient
Patient is sat in the tripod position and appears distressed. He makes eye contact when you arrive, but does not speak as is so short of breath. He has a productive cough that results in a string of green‐looking sputum that he manages to capture in his handkerchief to show you.
Patient assessment triangle
General appearance
Alert, and makes eye contact, but is acutely distressed. Can only speak in single words and is reluctant to talk. In tripod position, coughing.
Circulation to the skin
Pink face, breathing through pursed lips.
Work of breathing
Increased work of breathing – rapid and shallow breaths with accessory muscle use.
SYSTEMATIC APPROACH
Danger
None at this time.
Response
Alert.
Airway
Clear.
Breathing
RR: 36. Rapid and shallow, with accessory muscle use. Widespread bilateral wheeze noted on auscultation.
Circulation
HR: 110. Radial palpable – irregular. Capillary refill time 2 seconds.
Disability
Pupils equal and reactive to light (PEARL).
Exposure
The patient is in his own home.
Vital signs
RR: 36 bpm
HR: 110 bpm
BP: 150/90 mmHg
SpO2: 86%
Blood glucose: 4.5 mmol/L
Temperature: 37.8 °C
PEF: unable to record
GCS: 15/15
4 Lead ECG: atrial fibrillation
Allergies: nil
TASK
Look through the information provided in this case study and highlight all of the information that might concern you as a paramedic.
What is COPD?
COPD is a progressive disease and is characterized by air flow obstruction that is not fully reversible. The airway obstruction results from damage to alveoli, alveolar ducts and bronchioles due to chronic inflammation.
List the features of an acute exacerbation of COPD.
Increased dyspnoea.
Increased sputum production.
Increased cough.
Upper airway symptoms, such as a cold and sore throat.
Increased wheeze.
Reduced exercise tolerance.
Fluid retention.
Increased fatigue.
Acute confusion.
Worsening of previously stable condition.
Case Progression
After administration of 5 mg salbutamol via nebuliser, the patient’s condition improves slightly and he hands you a medical card that his ‘breathing doctor’ gave to him. The card states the patient is at risk of retaining CO2 and should only be administered with 28% oxygen to achieve saturations between 88 and 92%.
Patient assessment triangle
General appearance
Alert and more interactive.
Circulation to the skin
Pink.
Work of breathing
Increased work of breathing – breathing rapid, but not as shallow as before.
SYSTEMATIC APPROACH
Danger
None at this time.
Response