Assignment 1: Case Study Analysis
Evaluate the case below and choose one (1) potential acute coronary syndrome diagnosis. Assignment 1: Case Study Analysis
Evaluate the case below and choose one (1) potential acute coronary syndrome diagnosis.
The case study will provide you with an opportunity to discuss:
• •? Key clinical signs of the case
• •? The pathophysiology of your diagnosis
o Pathophysiology of acute coronary syndrome
o Choose 1 coronary artery and relate signs and symptoms,
assessment and management including: ??Vital sign interpretation
??ECG
•?Current management practices
o Paramedic Management
o Hospital emergency management (first 24hours only)
•?A critique on the evidence supporting the management practices You are required to demonstrate a thorough understanding of the
pathophysiology and provide rationales for your diagnosis AND interventions.
It is expected that you research the condition from both text books and current literature. At least five journal articles are expected to be part of your literature search (Less than 10 years old). You will also review the clinical practice guidelines of at least two (2) Australian state clinical practice guidelines. The goal is to provide up to date evidence based practice for the management of the patient’s condition.
Higher grades will be awarded for evidence of extensive use of literature and a critical evaluation of the care provided for the patient.
1500 word limit
Situation: You have been called to a factory where you find Bob, a 35 year old man, is experiencing central chest pain radiating into his jaw. He is pale cool clammy and obviously distressed.
Background: The patient has no previous complaints of chest pain. PMHx: HT, Asthma, GORD, Type 2 diabetes Mellitis- diet controlled Med’n: Atenolol, salbutamol inhaler, Breo inhaler, omeprazole, paracetamol PRN,
Allergies: Penicillin
Comm. Diseases – Nil Known, up to date with vaccinations
Social Hx: Lives with partner
Family Hx: Father died of heart disease aged 41, mother died of breast cancer
Alcohol: Social
Smoking: 30/day
Assessment: When you arrive you find the patient looking distressed. Provide other signs and symptoms and vital signs giving a rationale for choice.
Vital signs:
Pain:
Appearance:
Other Signs and Symptoms:
You are expected to:
• •? outline your diagnosis and explain the pathophysiology behind your
diagnosis.
• •? provide an ECG appropriate to your diagnosis and explain why.
• •? outline the paramedic management of your patient, including the vital
signs and defend how these align with your ACS diagnosis from your understanding of Anatomy & Physiology and pathophysiology.
The case study will provide you with an opportunity to discuss:
• •? Key clinical signs of the case
• •? The pathophysiology of your diagnosis
o Pathophysiology of acute coronary syndrome
o Choose 1 coronary artery and relate signs and symptoms,
assessment and management including: ??Vital sign interpretation
??ECG
•?Current management practices
o Paramedic Management
o Hospital emergency management (first 24hours only)
•?A critique on the evidence supporting the management practices You are required to demonstrate a thorough understanding of the
pathophysiology and provide rationales for your diagnosis AND interventions.
It is expected that you research the condition from both text books and current literature. At least five journal articles are expected to be part of your literature search (Less than 10 years old). You will also review the clinical practice guidelines of at least two (2) Australian state clinical practice guidelines. The goal is to provide up to date evidence based practice for the management of the patient’s condition.
Higher grades will be awarded for evidence of extensive use of literature and a critical evaluation of the care provided for the patient.
1500 word limit
Case Scenario
Situation: You have been called to a factory where you find Bob, a 35 year old man, is experiencing central chest pain radiating into his jaw. He is pale cool clammy and obviously distressed.
Background: The patient has no previous complaints of chest pain. PMHx: HT, Asthma, GORD, Type 2 diabetes Mellitis- diet controlled Med’n: Atenolol, salbutamol inhaler, Breo inhaler, omeprazole, paracetamol PRN,
Allergies: Penicillin
Comm. Diseases – Nil Known, up to date with vaccinations
Social Hx: Lives with partner
Family Hx: Father died of heart disease aged 41, mother died of breast cancer
Alcohol: Social
Smoking: 30/day
Assessment: When you arrive you find the patient looking distressed. Provide other signs and symptoms and vital signs giving a rationale for choice.
Vital signs:
Pain:
Appearance:
Other Signs and Symptoms:
You are expected to:
• •? outline your diagnosis and explain the pathophysiology behind your
diagnosis.
• •? provide an ECG appropriate to your diagnosis and explain why.
• •? outline the paramedic management of your patient, including the vital
signs and defend how these align with your ACS diagnosis from your understanding of Anatomy & Physiology and pathophysiology.

Case study Assignment
Assessable items Comments Max Grade Your Grade
CONTENT 70
• •? Introduces the assignment with a brief synopsis of the case and outline the writer intent
• •? Accurately identifies the key diagnostic signs and relates these signs to a set of plausible diagnoses
• •? Provides a plausible rationale for the diagnosis
• •? Selects one (1) most diagnosis and comprehensively
describes pathophysiology/pathology involved and
underlying mechanisms responsible for the diagnosis
• •? Accurately describes current management practices
and/or therapies and provides an informed discussion of
their benefits and limitations (from literature)
• •? Identifies correct ECG and discusses why it appears in
the diagnosis chosen
• •? Identifies areas of current research and how outcomes
are likely to aid the development of new therapies, prevention or management practices, detection methods etc (can be focussed on a specific aspect or generalistic)
• •? Critically reviews information and correctly identifies knowledge gaps or areas of debate (can be focussed around a specific clinical aspect of the condition)
• •? Provides a succinct summary section highlighting 2-3 key points as primary conclusions (based on evidence presented)
• •? Higher marks will be awarded for a comprehensive exploration of the topic, with consistently sound critical evaluation of concepts and personal synthesis of issues. 5
5 10 10
10 5 5 5 5 10
STRUCTURE 10
• •? Develops a sound and informative table of contents
• •? Main points clearly identified, discussed in a logical and
sequential manner and directly related to the table of
contents
• •? Paragraphs and sentences are well structured and linked
in terms of context and information content. Appropriate sentence length used with clear concept development and supporting detail provided with minimal repetition
• •? Clear development of themes and/or discussion “arguments” based on critical review of the literature
• •? Diagrams and figures used effectively to support text 1 3
2
2 2
PRESENTATION 5
• •? Well set out; clear, easy to read style.
• •? Grammatical and spelling accuracy.
• •? Within 10% of word limit 2 2 1
EVIDENCE OF RESEARCH 15
• •? Researched material is well synthesised into content, cited correctly and accurate details provided in a reference list conforming to Author-Date (Harvard or APA 5th) System.
• •? Limited use of text books, with only peer reviewed sources used
• •? Extensive use of primary references supporting critical evaluation of concepts and personal synthesis of issues, areas of debate
• •? Clear distillation of referenced material into own words, NO evidence of plagiarism 5
2 5 3
OVERALL GRADE 100
Additional Comments
[these are your notes which will be converted into prose for this assignment]
Potential diagnosis Pathophysiology Underlying Diagnosis Paramedic clinical practice interventions Critique of interventions from literature
Potential liver failure from paracetamol overdose Paracetamol is rapidly absorbed through the gastrointestinal tract with peak plasma levels occurring within 30-60 minutes of ingestion. Paracetamol is metabolized by microsomal enzymes which produces an intermediary metabolite, N-acetyl-para- benzoquinoneimine(NAPQI) which is conjugated with glutathione which is non-toxic and can be excreted by the kidneys. When glutathione reaches saturation NAPQI accumulates in the liver resulting in hepatic necrosis.
(Jelinek et al 2015) Clinical assessment
• •? Monitor for signs of hepato-
toxicity levels
• •? Cardiac Monitoring
• •? 1/24 vital signs eg BP. P RR
SaO2 checks
• •? Etc...
• •? (Jelinek 2015) Hepato-toxicity levels are dose dependent. And symptoms are dependent on this as follows Stage 1
Mild nausea, vomiting and malaise
Stage 2(24-48hrs)
Nausea and vomiting resolve Right upper quadrant pain Liver function deteriorates Stage 3 (48-96hrs)
Jaundice and encephalopathy Stage 4
Fulminant hepatic failure Renal failure
Coma, lactic acidaemia Myocardial damage
Critique each of the clinical practice intervention, defending is validity or not from the current literature linking this to the underlying pathophysiology of the potential diagnosis identified. (Referenced)
* Monitoring of the hepatic patient during transport allows for early detection and management of arrhythmias. (Ref1, Ref 2, Ref 3,..)...
Paramedic
Introduction (the introduction may be brief but should cover major concepts)
[all in prose, sort of like an essay introduction]
Introduce the patient.... [it is okay if this part isn’t much different from others’ introduction of the patient, consider SBAR format]
The issues have been chosen because.......
Diagnosis
[XXXXXXXXXXX] You will be not be graded on achieving my expected final diagnosis but on your ability to relate the signs and symptoms to a disease process and then on your suggested management and critique of the management that is defended from literature.
[make sure that you include the pathophysiology behind the diagnosis]
XXXXXX (Reference).
Paramedic Intervention and Rationale
[What paramedic interventions/treatment are you doing and why are you doing them] The interventions that will address the issue of potential arrhythmias are as follows.
--------------------------------------------------------------------------------------------------------------------------
Working example of transferring bullet points into sentences
1. Monitor for signs of hepato-toxicity
2. Continuous Monitoring of patients cardiac rhythm,
3. 1/24 vital signs eg BP. P RR SaO2 checks
4. Regular checks and management of neurological disturbances
5. 12 lead ECG
(Referenced)
--------------------------------------------------------------------------------------------------------------------------
[Intervention 1 in prose format, you will need to be more comprehensive in your assignment]
Monitoring of the hepatic patient during transport allows for early detection and management of arrhythmias as late stage hepatic failure leads to lactic acidaemia and myocardial damage and may result in ST-Twave changes, bundle branch blocks and sinus bradycardia (Jelinek et al 2015, Ref 2, Ref 3,.......).........
The interventions need to be critiqued from literature as to how they will be treating, monitoring or managing the diagnosis they have chosen. This will include their paramedic guidelines. The assignment is designed to help them understand their practice and be able to critique what they do in a constructive format. They are allowed to discuss management into the hospital for the 1st 24 hours to assist them with the assignment and understanding the disease process.
Conclusion (sort of like an essay conclusion)
We’ve discussed ....
We’ve identified potential diagnoses such as....
These potential diagnoses should be addressed by the paramedic interventions as described. [This is purely optional: acknowledge that it is not comprehensive if you like, BRIEFLY
mentioning some examples of what you might have looked at.]
Good writing is concise yet still easy to read and cover all of the content required.