er case studies
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ER Case Studies. The following is a series of case studies to review different patient types and how they are captured on the form. The information is provided in sequence to reflect the natural progression of a patient’s care. - PowerPoint PPT PresentationTRANSCRIPT
The Macstrak Project
ER Case Studies
The following is a series of case studies to review different patient types and how they are captured on the form. The information is provided in sequence to reflect the natural progression of a patient’s care.
As the case is presented, mark off the required information in the appropriate fields on your Macstrak form.
At the end of each case study, the form will be reviewed with the correct answers supplied.
If you have any questions, please refer to your Macstrak manual or contact us at the Macstrak Project Office.
The Macstrak Project
ER Case Study
The Macstrak Project
ER Case Study
KFD is a 62 year old (9/9/43) woman with no significant past medical history.
The Macstrak Project
ER Case Study
KFD is a 62 year old (9/9/43) woman with no significant past medical history.
On 08/2/06:
10:30KFD experiences chest pain while watching television.
The Macstrak Project
ER Case Study
13:30Her husband drives her to the ER where she reports chest pain associated with nausea and diaphoresis. She is triaged at level II.
13:35Nursing assessment reveals persistent chest pain and her vital signs are as follows: BP is 145/80, HR is 96 and chest is clear.
The Macstrak Project
ER Case Study
13:43Her first and diagnostic ECG is as follows:ST in leads II, III, a VF ST in
leads V1-4
ASA and NTG S/L are given.
13:50ER MD assesses KFD and finds she has no contraindications to reperfusion
therapy. The decision is made to treat KFD (weight 59 kg) with TNK.
14:0030 mg of TNK over 5 seonds is given. KFD also receives UF heparin IV and metoprolol IV.
15:00The pain persists and a repeat ECG shows persistent ST segment elevation.
The Macstrak Project
ER Case Study
15:15KFD is transferred from your hospital to a tertiary centre for a PCI.
18:00The clerk calls the tertiary centre to check on KFD. She discovers KFD arrived at the cath lab at 16:00 and angiography confirmed a persistent occlusion of the RCA. She had a successful angioplasty with her first inflation at
16:35. This gave her time to rescue PCI of 155 minutes.
The Macstrak Project
Centre:
Date: 20 Day Month Year
Patient Initials: F M L
Birth Date: 19
Day Month Year
Gender: Male Female
ER Case Study
KFD is a 62 year old (9/9/43) woman with no significant past medical history.
K F D
09 09 43
ER
MACSTRAK
X
The Macstrak Project
Centre:
Date: 08 02 20 06 Day Month Year
Patient Initials: F M L
Birth Date: 19
Day Month Year
Gender: Male Female
ER Case Study
KFD is a 62 year old (9/9/43) woman with no significant past medical history.
On 08/2/06:
KFD experiences chest pain while watching television.
K F D
09 09 43
ER
MACSTRAK
X
The Macstrak Project
ER Case Study
KFD experiences chest pain while watching television.
X
The Macstrak Project
ER Case Study
Her husband drives her to the ER where she reports chest pain associated with nausea and diaphoresis. She is triaged at level II.
X
The Macstrak Project
ER Case Study
Her husband drives her to the ER where she reports
chest pain associated with nausea and diaphoresis. She is triaged at level II.
X
The Macstrak Project
VS at Presentation: VS Absent
Systolic BP: Dyspnea/Rales: < 100 None 101-130 Mild 131-160 Mod/Severe 161-190 >190
Heart Rate: < 60 61-80 81-100 >100
ER Case Study
Nursing assessment reveals persistent chest pain and her vital signs are as follows: BP is 145/80, HR is 96 and chest is clear.
X
X
X
The Macstrak Project
ER Case Study
Nursing assessment reveals persistent chest pain.X
X
XX
X
The Macstrak Project
ER Case Study10:30 KFD experiences chest pain while watching television.
13:30 KFDs husband drives her to the ER where she reports chest pain associated with nausea and diaphoresis. She is triaged at level II.
13:35 Nursing assessment reveals persistent chest pain.
13:50 ER MD assesses KFD and finds she has no contraindication to reperfusion therapy.
10:30
13:30
13:30
13:35
13:50
The Macstrak Project
ER Case Study
Her first and diagnostic ECG is as follows:
ST in leads II, III, a VF ST in leads V1-4
XX
X
The Macstrak Project
ER Case Study
13:43 Her first and diagnostic ECG is as follows:
ST in leads II, III, a VF ST in leads V1-4
13:43
13:43
The Macstrak Project
ER Case Study
The pain persists and a repeat ECG shows persistent ST segment elevation.
X
X
The Macstrak Project
ER Case Study
ASA and NTG S/L are given.
30 mg of TNK over 5 seconds is given. KFD also receives UF heparin IV and metoprolol IV.
X
X
X
X
The Macstrak Project
ER Case Study
ER MD assesses KFD and finds she has no contraindications to reperfusion therapy. The decision is made to treat KFD (weight 59 kg) with TNK.
30 mg of TNK over 5 seconds is given. KFD also receives UF heparin IV and metoprolol IV.
X
X
X
X
30
1
The Macstrak Project
ER Case Study
KFD is transferred from your hospital to a tertiary centre for a PCI.
X
X
X
X
30
1
X
X
The Macstrak Project
ER Case Study14:0030 mg of TNK over 5 seonds is given. KFD also receives UF heparin IV and metoprolol IV.15:15KFD is transferred from your hospital to a tertiary centre for a PCI.18:00 The clerk calls the tertiary centre to check on KFD. She discovers KFD arrived at the cath lab at
16:00 and angiography confirmed a persistent occlusion of the RCA. She had a successful angioplasty with her first inflation at 16:35. This gave her time to rescue PCI
of 155 minutes.
14:00
15:15
16:00
16:35
The Macstrak Project
ER Case Study
KFD is transferred from your hospital to a tertiary centre for a PCI.
X
The Macstrak Project
ER Case Study
KFD is transferred from your hospital to a tertiary centre for a PCI.X
The Macstrak Project
ER Case Study
15:15KFD is transferred from your hospital to a
tertiary centre for a PCI.X
15:15