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Chest Pain - STEMIScenario InformationTitle:Myocardial InfarctionDate Created:1 February 2016Target Audience: FORMCHECKBOX PCP I FORMCHECKBOX PCP II FORMCHECKBOX PCP FORMCHECKBOX ACP FORMCHECKBOX CCPScenario Author:Will JohnstonAuthor Contact:C_johnston37@fanshaweonline.caScenario OverviewParamedics are Called Code 4 for a 56 year old male experiencing chest pain and shortness of breath in bed. On arrival the patient is experiencing typical signs of a myocardial infraction with ST elevation in leads 2,3,aVF (Inferior Infarct). The patient should be treated with ASA and Nitro before being transferred over to the hospital or PCI lab for further care depending on local protocols. Scenario Objectives, Summary, NOCPS, and ExpectationsLearning Objectives:Recognize the classic signs and symptoms of myocardial infarctionEmploy proper management of a patient experiencing symptoms consistent with a myocardial municate effectively with allied health professionals Associated NOCPs 4.3.c – Conduct cardiovascular assessment and interpret findings4.5.n – Obtain 12-Lead electrocardiogram and interpret findings 5.8.k – Administer medication via the oral route6.1.a – Provide care to a patient experiencing signs and symptoms involving the cardiovascular system6.3.b – Redirect priorities based on assessment findingsParamedic GRS1 Expectations:Situational Awareness: recognize the need to transport the patient for cardiac catheritizationHistory Gathering: illicit history of previous cardiac issuesPatient Assessment: conduct a thorough cardiac assessment Decision Making: treat the patient as a suspected ACS patientResource Utilization: work with partner to conduct thorough, efficient, and timely assessmentCommunication: communicate effectively with the receiving physicianProcedural Skill: proper placement of 12 lead electrodes Tavares W, Boet S, Theriault R, Mallette T, Eva KW. Global rating scale for the assessment of paramedic clinical competence. Prehospital emergency care. 2012 Dec 5;17(1):57-67.Scenario PreparationPatient RequirementsMoulagePatient InstructionsPatient should be made to look diaphoretic via spray bottle of water.Patient should be made to look pale via a lighter toned make-upPatient should be sitting in the bed breathing heavilyPatient should be agitated towards the paramedicsPatient states that initially thought it was just acid reflux took a tums, has gotten worse since thenAdditional Equipment and PropsPropsEquipment Bedroom furniture (side table, night lamp, bed)Glass of waterBottle of TumsBLS BagCardiac Monitor (with generator)Oxygen bagPhone for patchingStretcher Scene Set-UpPatient should be placed in the bedWater and Tums bottle placed on the side of the patient’s side tableLights should be turned on Bystander No bystander for current scenario Dispatch Information Dispatched Code 4 for a 56 year old Male patient complaining of Chest Pain and Shortness of Breath. Patient is negative for travel but does say history of heart problems.Patient Information Patient Name: Jim Sykes Age: 56Weight: 100kgGender: MaleChief Complaint: Chest pain and Shortness of Breath History of Present: Patient awoke at 330hrs with slight chest pain and nausea. Patient took 2 Tums thinking symptoms were related to GERD. Patient went back to sleep and awoke 440hrs with increased nausea, chest pain and shortness of breath. Patient was concerned with increase in pain prompting call for ParamedicsSAMPLE History: AllergiesSulfa medicationsMedicationsPantaprazole, ASA, Metoprolol, Amlodipine, Lasix, HCTZ, NitroPast HistoryGERD, Previous MI (2 Years Prior), Angina, HTNOral IntakeNormal Dinner at 1900hrsOPRST (If Applicable) OnsetStarted 20 minutes agoProvocationNonePalliationNoneQualityCrushing, “Truck is parked on chest”Radiation Radiates into Jaw Severity 9/10TimeNo change over 20 minutesAdditional InformationPatient states does not feel similar to Angina as Angina episodes do not usually include pain in Jaw Physical FindingsPrimary Survey:AirwayPatentBreathingLaboured and ShallowCirculationRapid PulsesAuscultation Clear apices to bases, no adventitious soundsDistal PulsesWeak distal pulsesShockDiaphoretic and paleSecondary Survey :Head UnremarkableNeckUnremarkableChestSymmetrical chest movementBackUnremarkablePelvisUnremarkableLegsUnremarkableExtremitiesUnremakableVital Signs, Expected Actions, and ModifiersPatient State 1:State: BaselineTRIGGER: Start of Scenario Vital Signs Expected ActionsHR120 SR12 Lead Electrocardiogram performedOxygen administered ASA 162mg – 350mg as per local protocolNitroglycerine 0.4mg as per local protocols SPO290 (95%)BP160/96CO240RR28Temp36.8SkinDiaphoretic PaleGCS15PupilsL+ R+BGL5.3ECGSinus Tach12 LeadINFERIORSTEMIModifiers If patient is given Oxygen, saturations mprove to 95%If patient is given Nitroglycerine Proceed to State 2If no nitroglycerine is given, remain in state 1Trigger Nitroglycerine is given (State 2) OR 12:00 minutes Scenario EndsPatient State 2: State: Post NitroTRIGGER: Nitroglycerine administrationVital Signs Expected ActionsHR 110SRCall to cardiac catheritization labSupportive care SPO292 (95)BP120/90CO2 37RR20Temp36.8SkinDiaphoretic PaleGCS15PupilsL+ R+BGL5.3ECGSinus Tach12 LeadINFERIORSTEMIModifiers If patient is given another dose of nitroglycerine, BP can decrease to 110/70Post Nitroglycerine administration patient should state that pain has decreased to 3/10, then 1/10 after second administration Trigger 12 Minutes scenario will end ................
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