Practical - practice OSCE/scenario - ami PDF

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Practice OSCE/Scenario - AMI...

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Practice OSCE/Scenario – ? AMI

Clinical Presentation You are called to a 55 year old male with a sudden onset of chest pain.

Case Details Time of Day Weather Time to scene Time to Hospital Back up

Access/Egress Danger

1700 hours Fine 8 minutes 35 minutes An ICP is available and 15 minutes away. Nil issues Nil on arrival

Primary Survey Danger Nil on approach to patient Response Patient watches crew approach, looks anxious and states “I am thinking am I dying”. Patient is sitting on chair in lounge. Airway Patient talking normally. Breathing Breathing appears laboured. Circulation Radial pulse present – but weak

Vital signs Survey Respiratory rate Pulse Blood pressure Temperature BSL Pulse oximetry ECG

SAMPLE: Signs and symptoms Allergies Medications Past medical history Last ins/outs

Events leading up to complaint

18 66 regular 120/60 36.0°C 5.8 mmol 98% Sinus rhythm with ST elevation in lead II

States he developed chest pain whilst after having verbal altercation with teenage son. Now has nausea and vomited once prior to QAS arrival. Nil Lipitor High cholesterol Last ate at 1200 hours Last drunk a stubby of beer approximately 30 hours ago Bowels open this morning. Stated that he felt OK prior to this episode.

Respiratory assessment: Conscious state General appearance Speech Ventilatory rate

Conscious – orientated, GCS 15 Anxious Normal 18

PUB280 – Foundations of Paramedic Practice

Ventilatory rhythm Skin Pulse rate Breath sounds Pain Assessment Onset Provocations/Palliation Quality Region/Radiation Severity Timing

laboured Sweaty, pale and clammy 66 regular Normal - clear

After verbal argument. Not affected by rest or movement. Feels like a heavy weight on chest. Radiating into left arm – arm feels heavy. 8/10 Pain is still present and has not changed since onset. Not effected by movement. Is constant.

Perfusion Assessment Radial Pulse Pulse rate Blood pressure Skin LOC

Present but weak 62 120/60 Sweaty, pale and clammy Conscious and orientated – GCS 15.

Expected Course of Action Patient should be placed on high concentration oxygen. GTN (pertinent negative – erectile dysfunction use) Aspirin Reassessment after first GTN. SITREP ICP backup - ? AMI Recognise that patient is emergent time critical due to presenation

Reassessment BP Pulse Radial pulse Pain Breath sounds

95/50 50 Nil radial 8/10. Tightness/discomfort - still the same. Still clear

Expected Course of Action Should recognise that patient is deteriorating. No further GTN as patient’s physiological signs have deteriorated. Position patient supine with legs elevated. Additional SITREP – require ICP Code 1 Consider early transport.

PUB280 – Foundations of Paramedic Practice...