ER Case Studies

1. 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

2. ER Case Study The Macstrak Project

3. ER Case Study AB is a 48 year old (17/5/57) businessman. The Macstrak Project

4. ER Case Study AB is a 48 year old (17/5/57) businessman. On 2/2/06: 06:30 AB awakens with crushing retrosternal chest pain radiating to his left arm. The Macstrak Project

5. ER Case Study 08:30 AB’s wife drives him to the ER as he continues to have chest pain. He is triaged as a level II and placed in the cardiac room. 08:35 Nursing assessment reveals persistent, crushing midsternal chest pain lasting 2 hours. AB has no previous cardiac history. On examination, his BP is 140/70, HR is 72 and his chest is clear. He remains in mild distress with persistent chest pain. The Macstrak Project

6. ER Case Study 08:37 An IV is started and morphine is given. His first and diagnostic ECG is as follows: ST in leads II, III, a VF ST in leads V1-4 and I, aVL 15 lead ECG: V4R shows ST V7-9 shows ST Nitro 0.3 mg S/L and ASA are given. The Macstrak Project

7. ER Case Study 08:45 AB is assessed by the ER MD and thrombolysis is ordered. 08:55 Heparin IV (LMW) is started. Cardiac bloodwork is drawn including troponin and CK levels. 09:00 40 mg TNK over 5 seconds. 09:10 IV metoprolol is given. The ER MD makes arrangements to have AB admitted to the CCU. The Macstrak Project

8. ER Case Study 10:30 Chest pain gradually subsiding. A repeat ECG shows the ST segments resolving. Troponin level is positive and CK is 403. 11:15 Transferred to CCU, in stable condition, diagnosed with having experienced and acute inferior MI. The Macstrak Project

9. MACSTRAK ER ER Case Study Patient Initials: F M L Birth Date:19 Day Month Year Gender: Male Female Centre: Date:20 Day Month Year A B 17 05 57 X AB is a 48 year old (17/5/57) businessman. The Macstrak Project

10. MACSTRAK ER ER Case Study Patient Initials: F M L Birth Date:19 Day Month Year Gender: Male Female Centre: Date:02 0220 06 Day Month Year A B 17 05 57 X AB is a 48 year old (17/5/57) businessman. On 2/2/06: AB awakens with crushing retrosternal chest pain radiating to his left arm. The Macstrak Project

11. ER Case Study AB’s wife drives him to the ER as he continues to have chest pain. He is triaged as a level II and placed in the cardiac room. X The Macstrak Project

12. ER Case Study AB’s wife drives him to the ER as he continues to have chest pain. He is triaged as a level II and placed in the cardiac room. X The Macstrak Project

13. ER Case Study AB’s wife drives him to the ER as he continues to have chest pain. He is triaged as a level II and placed in the cardiac room. X The Macstrak Project

14. ER Case Study Nursing assessment reveals persistent, crushing midsternal chest pain lasting 2 hours. AB has no previous cardiac history. On examination, his BP is 140/70, HR is 72 and his chest is clear. He remains in mild distress with persistent chest pain. 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 X X X The Macstrak Project

15. ER Case Study Nursing assessment reveals persistent, crushing midsternal chest pain lasting 2 hours. AB has no previous cardiac history. On examination, his BP is 140/70, HR is 72 and his chest is clear. He remains in mild distress with persistent chest pain. X X X X X The Macstrak Project

16. ER Case Study 06:30AB awakens with crushing retrosternal chest pain radiating to his left arm. 08:30ABs wife drives him to the ER as he continues to have chest pain. He is triaged as a level II and placed in the Cardiac Room. 08:35Nursing assessment reveals persistent, crushing midsternal chest pain lasting 2 hours. 08:45 AB is assessed by the ER MD and thrombolysis is ordered. 06:30 08:30 08:30 08:35 08:45 The Macstrak Project

17. ER Case Study His first and diagnostic ECG is as follows: ST in leads II, III, a VF ST in leads V1-4 and I, aVL 15 lead ECG: V4R shows ST V7-9 shows ST X X X X X X X X The Macstrak Project

18. ER Case Study 08:37 His first and diagnostic ECG is as follows: ST in leads II, III, a VF ST in leads V1-4 and I, aVL 15 lead ECG: V4R shows ST V7-9 shows ST 08:37 08:37 The Macstrak Project

19. ER Case Study Nursing assessment reveals persistent, crushing midsternal chest pain lasting 2 hours. Chest pain gradually subsiding. A repeat ECG shows the ST segments resolving. Troponin level is positive and CK is 403. X X X X The Macstrak Project

20. ER Case Study Nitro0.3 mg S/L and ASA are given. Heparin IV (LMW) is started. Cardiac bloodwork is drawn including troponin and CK levels. IV metoprolol is given. The ER MD makes arrangements to have AB admitted to the CCU. X X X X The Macstrak Project

21. ER Case Study AB is assessed by the ER MD and thrombolysis is ordered. 40 mg TNK over 5 seconds. X X X 40 1 X The Macstrak Project

22. ER Case Study 09:00 40 mg TNK over 5 seconds. 09:00 The Macstrak Project

23. ER Case Study Transferred to CCU, in stable condition, diagnosed with having experienced and acute inferior MI. X The Macstrak Project

24. ER Case Study Transferred to CCU, in stable condition, diagnosed with having experienced and acute inferior MI. X The Macstrak Project

25. ER Case Study 11:15Transferred to CCU, in stable condition, diagnosed with having experienced and acute inferior MI. 11:15 X The Macstrak Project