Читать книгу Clinical Cases in Paramedicine - Группа авторов - Страница 271

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

1 What is your initial diagnosis for this patient?The clinical presentation is suggestive of pericarditis. The patient has ECG changes indicative of pericarditis. Patient is febrile with recent viral illness. The 12 LEAD ECG = global or widespread ST elevation and PR depression throughout most of the limb leads (1, 2, 3 and aVL) and reciprocal ST depression and PR elevation in lead aVR.

2 What are some differential diagnoses that you may be considering?Differential diagnoses: myocarditis, benign early repolarisation, STEMI (occlusive myocardial infarction, OMI), pleurisy, chest infection, pleural effusion, pericardial tamponade, pneumothorax (spontaneous/tension), gastric reflux, recent chest trauma, pulmonary embolus (PE), muscle strain, abdominal aortic aneurysm.

3 Identify several causes of pericarditis. (Look up and list as many as you can.)Infections (mainly viral).Immunological – SLE, rheumatic fever.Uraemia.Dressler’s syndrome.Trauma.Following cardiac surgery.Drug induced.Illicit drug use.Post‐radiotherapy.

4 From the following, which best identifies pericarditis?Retrosternal chest pain (generally sharp/burning and often exacerbated by lying supine).Signs of infection (fever, rigors, rash, diarrhoea, vomiting, malaise).Shortness of breathing (particularly when lying flat).ECG changes (specifically PR depression, Spodick’s sign, global ST elevation).All of the above.e. All of the above (these signs can be found in isolation or can all be present during assessment).

5 Which of the following is your treatment goal for this patient?Reassurance, keep the patient in a position of comfort. Adequate analgesia, using paracetamol and opioids if required. Keep patient monitored. AJPIR (assessment, judgement, planning, implementation, reassessment).Non‐steroidal anti‐inflammatory drugs (NSAIDs) – aspirin, ibuprofen etc.Rapid removal to hospital.IV access, 12 lead ECG, oxygen and elevate legs.a. Reassurance, keep the patient in a position of comfort. Adequate analgesia, using paracetamol and opioids if required. Keep patient monitored. AJPIR (assessment, judgement, planning, implementation, reassessment).