Читать книгу Clinical Cases in Paramedicine - Группа авторов - Страница 245

Look through the information provided in this case study and highlight all of the information that might concern you as a paramedic.

1 Given the initial vital signs, what further assessment needs to be acquired as soon as possible?A 12 lead ECG.

2 What history would you like from the patient?A systematic approach should be utilised when assessing your patient. The pneumonic SAMPLE is widely used and provides the treating paramedic with the vital patient information (see Table 2.1). For this patient we have her signs and symptoms, next we need to enquire about any medical allergies, what medications she is currently taking, what is her past medical history, her last ins and outs and what the events leading up to today were.The patient’s pain also needs to be assessed, and there are many methods for doing so. One common method is using OPQRST (Table 2.2).

Table 2.1 SAMPLE mnemonic

S	Central chest pain, described as heavy, short of breath
A	No known allergies
M	GTN, clopidogrel
P	Suffers from angina, hypertension and high cholesterol
L	Had normal breakfast at 07:00 and moved her bowels this morning
E	Gardening when experienced sudden central chest pain

Table 2.2 OPQRST mnemonic

O	Onset of pain	Sudden onset while gardening
P	Provocation	Sitting makes it a little better
Q	Quality	It’s a heavy pain, like someone sitting on her chest
R	Radiating	To left arm and initially jaw
S	Severity	7/10
T	Time of onset	Begun at 09:50 and has remained constant

1 What would be your treatment plan be for this patient, given that she has not taken any medications and she has no known allergies?300 mg aspirin PO.400 μg sublingual glyceryl trinitrate (GTN) every 5 minutes if not contraindicated.IV access and administer 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.