Week 1 scenario - Wk1 tut PDF

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Dispatched code 1B to a 50 year old male who is unconscious.

The time is 6:30am. Winter’s morning. The Pt is located on the 5th floor of a residential apartment block. On arrival you are met by the son – he takes you in the lift to the 5th floor. In the lift the son says: “I was with him last night…he seemed fine…went to bed about 10pm…I just got back from a run this morning about 6am and found him like this…” Pt is a large male – he is lying supine on the floor beside his bed…still wearing his PJs. No apparent signs of fall/trauma. He appears pink and well-perfused. He has a loud audible snore. VSS: BP: 184/90 Pulse rate: 55 Respirations: irregular with a loud snore BSL: 4.7 mmol/L ECG: Sinus Bradycardia SPO2: 93% Temp: 36.1 Pupils: R) pupil blown GCS:   

Eyes 1 Verbal 1 Motor 1

History Allergies: Nil Medication: Lipitor and Metformin Past Med Hx:      

High Cholesterol, High triglycerides, Type II DM Obesity Smoker Drinker

Last in’s/out’s:  

Dinner last night – steak and veges Last BM/urination unknown

Events: last seen ‘well ‘ about 10pm last night

ECG:

Questions: 1. What would you be discussing with your partner on the way to the job? 2. What questions would you be asking the son in the lift? a. Sample b. Is he breathing? c. Last meal d. Medication e. Events leading up 3. What is your initial management of this Pt? How would you allocate your resources? Ie. What would you do as primary care officer? What would you get your partner to do? How could you use the son?  ABCD  Airway – likely obstructed – triple airway manover  OPA  ECG  Sinus brady  Neuro assessment – LOC, Pupils, gate, coordination, motor function (Violent ladies PMS)  Oxygen therapy – BVM if necessary (if hyperventilating)  Back-up SITREP  BGL  Extrication  At risk of hypoxic seizure  Transport - code 1  CCP on route – 50yo male GCS 3, give current situation – IMIST AMBO  

 4. What would your sitrep be? 5. What is your provisional diagnosis? What are some differentials? 6. Interpret the above ECG to the best of your current knowledge CVA – Stroke Likely hemoragic 7. A single response CCP arrives – what is your handover? 8. The CCP gets on the phone – you overhear him say “…mate I’ve got a possible RSI for ya if you’re interested?” Explain what he might be referring to and what the procedure involves… 9. How would you get the Pt out of there? Explain the logistics in detail. 10. The CCP asks if you can do a stroke referral – discuss the criteria as per QAS and explain how you would do one. 11. What would they do for this Pt at the hospital? Start from triage handover… 12. Explain the difference between a CVA and a TIA.

13. Haemorrhagic strokes account for what percentage of strokes overall? 14. What risk factors does the Pt have that are specific to CVA? 15. What causes a ‘blown’ pupil in the setting of a CVA?...