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 KFD is a 62 year old (9/9/43) woman with no significant past medical history. The Macstrak Project

4. ER Case Study KFD is a 62 year old (9/9/43) woman with no significant past medical history. On 08/2/06: 10:30 KFD experiences chest pain while watching television. The Macstrak Project

5. ER Case Study 13:30 Her 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 and her vital signs are as follows: BP is 145/80, HR is 96 and chest is clear. The Macstrak Project

6. 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 ASA and NTG S/L are given. 13:50 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. 14:00 30 mg of TNK over 5 seonds is given. KFD also receives UF heparin IV and metoprolol IV. 15:00 The pain persists and a repeat ECG shows persistent ST segment elevation. The Macstrak Project

7. ER Case Study 15:15 KFD 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. The Macstrak Project

8. 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 K F D 09 09 43 X KFD is a 62 year old (9/9/43) woman with no significant past medical history. 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:08 0220 06 Day Month Year K F D 09 09 43 X 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. The Macstrak Project

10. ER Case Study KFD experiences chest pain while watching television. X The Macstrak Project

11. 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

12. 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

13. 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. 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

14. ER Case Study Nursing assessment reveals persistent chest pain. X X X X X The Macstrak Project

15. ER Case Study 10:30 KFD experiences chest pain while watching television. 13:30KFDs 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. 13:50ER 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

16. ER Case Study Her first and diagnostic ECG is as follows: ST in leads II, III, a VFST in leads V1-4 X X X The Macstrak Project

17. 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

18. ER Case Study The pain persists and a repeat ECG shows persistent ST segment elevation. X X The Macstrak Project

19. 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

20. 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 30 1 X The Macstrak Project

21. ER Case Study KFD is transferred from your hospital to a tertiary centre for a PCI. X X X 30 1 X X X The Macstrak Project

22. ER Case Study 14:00 30 mg of TNK over 5 seonds is given. KFD also receives UF heparin IV and metoprolol IV. 15:15 KFD 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

23. ER Case Study KFD is transferred from your hospital to a tertiary centre for a PCI. X The Macstrak Project

24. ER Case Study KFD is transferred from your hospital to a tertiary centre for a PCI. X The Macstrak Project

25. ER Case Study 15:15 KFD is transferred from your hospital to a tertiary centre for a PCI. 15:15 X The Macstrak Project