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CCU Case Studies

CCU 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.

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CCU Case Studies

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  1. CCU 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. CCU Case Study The Macstrak Project

  3. CCU Case Study ENC is a 49-year-old (DOB: 27/04/56) working mom with no significant past medical history. The Macstrak Project

  4. CCU Case Study On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance. The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08:25. She is seen by the triage RN on arrival and her vital signs are as follows: BP 130/70, HR 74 and chest is clear. ENC continues to have chest pain which she rates at 8/10. The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. The Macstrak Project

  5. CCU Case Study 35 mg of TNK over 5 seconds is given at 08:50. ENC also receives UF heparin IV and metoprolol IV while in the ER. The pain resolves shortly after starting the TNK and the ST segments are normalising. The Macstrak Project

  6. CCU Case Study 35 mg of TNK over 5 seconds is given at 08:50. ENC also receives UF heparin IV and metoprolol IV while in the ER. The pain resolves shortly after starting the TNK and the ST segments are normalising. ENC is admitted to your CCU that same morning with a diagnosis of Acute Myocardial Infarction. She has UF heparin infusing intravenously on arrival. Clopidogrel is started that evening. ENC has no further chest pain or complications while in CCU but her CK and troponin levels remain positive. The Macstrak Project

  7. CCU Case Study ENC is transferred to a tertiary centre for a cath on 04/03/06 at 09:00. Her discharge diagnosis is Acute Myocardial Infarction and her peak CK is 1086, her peak troponin is 24. She is discharged on the following medications: ASA metoprolol clopidogrel UF heparin pravastatin The Macstrak Project

  8. MACSTRAK CCU CCU Case Study Patient Initials: F M L Birth Date:19 Day Month Year Gender: Male Female Centre:CCU ICU Date:20 Day Month Year E N C 27 04 56 X ENC is a 49-year-old (DOB: 27/04/56)working mom with no significant past medical history. The Macstrak Project

  9. MACSTRAK CCU CCU Case Study Patient Initials: F M L Birth Date:19 Day Month Year Gender: Male Female Centre:CCU ICU Date:20 Day Month Year E N C 27 04 56 02 03 06 X ENC is a 49-year-old (DOB: 27/04/56) working mom with no significant past medical history. On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance. The Macstrak Project

  10. CCU Case Study Past Medical History:<30 days >30 days MI ……………………………. Angina ……………………….. CABG ……………………….. PCI …………………………… CHF ………………………….. TIA/CVA …………………….. Diabetes (oral agents/insulin) ... None of the Above……………. ENC is a 49-year-old (DOB: 27/04/56) working mom with no significant past medical history. X The Macstrak Project

  11. CCU Case Study On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance. The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08:25. Patient Origin: ER EMS Walk In Dr.’s Office/Clinic (Direct) Other Hospital Inpatient Medical Ward Surgical Ward Other ICU Other: ……………… X X The Macstrak Project

  12. CCU Case Study She arrives at the ER at 08:25. She is seen by the triage RN on arrival and her vital signs are as follows: BP 130/70, HR 74 and chest is clear. ENC continues to have chest pain which she rates at 8/10. The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. VS at Presentation:(complete for all patients) Dyspnea/Rales:None Mild Mod/Severe Systolic BP: < 100 101-130 131-160 161-190 >190 Heart Rate:< 80 80-100 >100 X X X The Macstrak Project

  13. Admitting Diagnosis:(Check one only) Acute AMI (48 hrs) UA R/O MI UA RSCP NYD CHF Arrhythmia Aortic Dissection Non ACS Pericardial Disease Other: ………………… ACS CCU Case Study ENC is admitted to your CCU that same morning with a diagnosis of Acute Myocardial Infarction. She has UF heparin infusing intravenously on arrival. Clopidogrel is started that evening. ENC has no further chest pain or complications while in CCU but her CK and troponin levels remain positive. X The Macstrak Project

  14. Timeline:(AMI pts only - 24 hr clock or > 24 hrs) Symptom Onset: EMS at Scene: Hospital Arrival: First ECG:EMS Diagnostic ECG: CCU Case Study On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance. The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08:25. 0500 0750 0825 0805 X 0805 The Macstrak Project

  15. CCU Case Study Diagnostic ECG:(ACS pts. only)ST ST T Q No ACS ST-TV5-6……….…… ….. …... PacedII/IIIaVF…..… ….. ….... OtherV4R..done ... V7-9..done ... The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08:25. V1-4…………..… ..… …... LBBB IaVL………... … .…. …… X X The Macstrak Project

  16. CCU Case Study Reperfusion Therapy: NoNot Indicated: ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: ……………...... YesThrombolysis Here EMS Other Hosp X X X Drug:TNK/rtPA SK r-PA (reteplase) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other ............................... and/orPrimary/Rescue PCI Here Transfer Reperfusion Therapy Decided by: EP Consultant Dose:(mg/units) Duration:(min) Pt.Weight:(kg) X 62 X The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. The Macstrak Project

  17. CCU Case Study Reperfusion Therapy: NoNot Indicated: ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: ……………...... YesThrombolysis Here EMS Other Hosp X X X Drug:TNK/rtPA SK r-PA (reteplase) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other ............................... and/orPrimary/Rescue PCI Here Transfer Reperfusion Therapy Decided by: EP Consultant Dose:(mg/units) Duration:(min) Pt.Weight:(kg) X 62 X X The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. The Macstrak Project

  18. CCU Case Study Reperfusion Therapy: NoNot Indicated: ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: ……………...... YesThrombolysis Here EMS Other Hosp X X X Drug:TNK/rtPA SK r-PA (reteplase) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other ............................... and/orPrimary/Rescue PCI Here Transfer Reperfusion Therapy Decided by: EP Consultant Dose:(mg/units) Duration:(min) Pt.Weight:(kg) 35 X 1 62 X X X X 35 mg of TNK over 5 seconds is given at 08:50. ENC also receives UF heparin IV and metoprolol IV while in the ER. The pain resolves shortly after starting the TNK and the ST segments are normalising. The Macstrak Project

  19. TLysis Ordered: TLysis Started: GP 2b/3a Started: Transfer: Arrive Lab: First Inflation: CCU Case Study The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. 0840 The Macstrak Project

  20. TLysis Ordered: TLysis Started: GP 2b/3a Started: Transfer: Arrive Lab: First Inflation: CCU Case Study The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treatENC (weight 62 kg) with TNK. 0840 0850 35 mg of TNK over 5 seconds is given at 08:50. The Macstrak Project

  21. Diuretics……………………… Inotropes IV………………….. ETT/Vent…………………….. PA Line………………………. TTVP………………………… IABP…………………………. ACS: RSCP - Ischemia – Definite…. – Probable… CK (+ve)………………...…… Troponin (+ve)……………….. NTG IV………………………. Heparin – UFH……………..... – LMWH……………. Other Antithrombin………...… GP 2b/3a Inhibitor IV……...… Clopidogrel (or ticlopidine)..… Cardiac Cath……………….... PCI…………………………... Outcomes: VF/Sustained VT………….… Infarction (new/repeat)*(1) …... Thrombolysis (new/repeat)*(2).. Stroke*(3) ……………………. Major Bleed*(4) ……………… Transfusion………………….. Crs1: ……………………….... Crs2: ……………………..….. None of the Above……….….. RN Initials ………………..…. CCU Case Study Date: 02 04 03 ENC is admitted to your CCU that same morning with a diagnosis of Acute Myocardial Infarction. She has UF heparin infusing intravenously on arrival. Clopidogrel is started that evening. ENC has no further chest pain or complications while in CCU but her CK and troponin levels remain positive. D N D N N D Acuity: Shift: X X X X X X X X X X X X X X X X X X AW AW KD KD KD The Macstrak Project

  22. Discharge Diagnosis: Acute MI Unstable Angina Chest Pain NYD CHF Arrhythmia Other Cardiac Problem: ………….................. Non Cardiac Problem:…..….............………..... CCU Case Study ENC is transferred to a tertiary centre for a cath on 04/03/06 at 09:00.Her discharge diagnosis is Acute Myocardial Infarction and her peak CK is 1086, her peak troponin is 24. She is discharged on the following medications: ASA metoprolol clopidogrel UF heparin pravastatin Time: Date: 20 04 03 06 0900 Day Month Year X 1086 Peak CK: Trop: 24 The Macstrak Project

  23. CCU Case Study ENC is transferred to a tertiary centre for a cath on 04/03/06 at 09:00. Her discharge diagnosis is Acute Myocardial Infarction and her peak CK is 1086, her peak troponin is 24. She is discharged on the following medications: ASA metoprolol clopidogrel UF heparin pravastatin Discharged To: Cardiac Ward Med/Surg Ward Step Down Unit CV Surgery Other ICU Other Hospital Home Death Other:.............. Discharge Meds: ASA Clopidogrel (or ticlop.) Heparin (UF or LMW) Nitrates (po/top) B Blocker ACEI A2 Blocker Statin None of Above X X X X X X The Macstrak Project

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