Assessment: Short Answer Questions Related to a Case Study
The ISBAR Handover:
Introduction: Mrs Helen Georgopoulos is a 64-year-old lady.
Situation: Mrs Georgopoulos arrived at the Emergency Department at 1130 hrs with central
crushing chest pain radiating to her jaw since 1100 hrs. Findings from the 12 lead ECG
recorded by paramedics showed ST elevation in leads V2, V3, V4. Aspirin 300mg
administered on route to hospital.
Background: Hypertension (Captopril 12.5mg bd); Hyperlipidaemia (Simvastatin 40mg
nocte); Type 2 Diabetes Mellitus (DM) (diet controlled) and Allergy – Penicillin.
– Airway patent
– Breathing: Respiratory rate 24, bilateral air entry, breath sounds clear. SpO2 on
room air 91%
– Circulation: Sinus Tachycardia 120 bpm. BP 110/60. Diaphoretic and peripherally
cool. Central crushing chest pain radiating to the jaw.
Character: crushing chest pain
Location: Central, radiating to jaw
Pattern: at rest, not relieved by SL Anginine Spray x 2
Associated symptoms: diaphoresis
– Disability: Alert & oriented. Pupils equal and reacting to light (PEARL); Equal strength
in all four limbs.
– Exposure: IVC Left cubital fossa.
– Fluid: NBM. NO IVF
– Glucose: 14.0 mmol/l
– Weight 88kg
1. Perform venepuncture to collect pathology – Troponin, UEC, FBC, TFTs, LFTs, BSL 2
2. Initiate supplemental oxygen if SpO2 < 93%
3. Attach Continuous Cardiac Monitoring
4. Record a 12-lead ECG
5. Monitor blood pressure and report systolic BP 2mm) V2, V3, V4
The diagnosis of Acute Anterior STEMI is made
Medications: Morphine 2.5mg IVI 2/24 (PRN maximum 4 x 2.5mg doses = 10mg total) Nitro-glycerine 600mcg SL (PRN maximum 3 doses); monitor systolic BP >100 mmHg Clopidogrel 300mg PO STAT Heparin 5000IU IV STAT As per STEMI reperfusion flowchart: Transfer to Cardiac Cath Lab for urgent primary PCI when ready
Question: (250 words) Critically analyse, and then concisely explain using your own words, each of the clinical manifestations and related pathogenesis for the following:
(vi) Central crushing chest pain with radiation to the jaw
(vii) ST elevation
(viii) elevated Troponin (35ng/L)
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