Читать книгу Clinical Cases in Paramedicine - Группа авторов - Страница 325

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 patient’s presentation and initial observation, what is a critical vital sign that assists in the diagnosis of the condition and needs to be acquired as soon as possible?A 12 lead ECG.

2 The patient is rolling in pain and unable to respond to the nurse’s questions. What strategies could you incorporate in your practice to ensure you gather all relevant information?Reassurance, the importance of which is often underestimated. This patient appears to be very unwell and it is vital that he is assessed thoroughly. This requires good communication and plenty of reassurance, while at the same time treating the underlying problem. Remember the patient is scared, he has never had chest pain before and is frightened of what might happen.

3 What history would you like from the patient?The patient appears to be having chest pain, so it is important to ascertain what type of chest pain this is. Cardiac chest pain can be fatal and needs to be treated and assessed appropriately. In this case we need to find out when the pain began, does anything make it better or worse, what it feels like, does it radiate anywhere, what is the quality of the pain, has he ever experienced this pain before and if so does he know what it was. Use the OPQRST mnemonic:Onset: What were you doing when the pain came on?Provocation: Does anything make the pain better or worse?Quality: How do you describe the pain?Radiation: Does the pain move anywhere?Severity: On a scale of 1–10, what number would you give the pain?Timing: How long have you had it?

4 What are some of the differential diagnoses for this patient?Trauma to the area – broken ribs, pneumothorax (tension).Pulmonary embolus.Muscle strain.Pericarditis.Myocarditis.Abdominal aortic aneurysm (AAA).Aortic dissection.

5 How would you treat this patient? (Use a bulleted list.)Pharmacology:Aspirin.GTN.Oxygen (to treat hypoxia).Antiemetic (anti‐sickness).Pain relief.Make the patient as comfortable as possible.Rapid removal to a cardiac cath lab.Lots of reassurance.Close monitoring for deterioration.Prepare for cardiac arrest.Thorough history taking.