PMED 1010 Case Study It’s ...

Question

PMED

1010

Case

Study

It’s

1500hrs and

you

are

sent Code

4 to

a 72
-
year
-
old

male complaining

of chest

pain.

As you enter the residence you’re directed to the bedroom. During your scene survey you

notice

that

the

bed

is

made,

however

there

are

several

pillows

on

one

side

of

it.

You

also

note

that the head of the bed is sitting on two blocks of wood.

You

see

your

patient

sitting

in

his

bedroom

on

a

chair.

You

note

obvious

work

of

breathing,

and

that he is

clutching his chest. He appears pale in colour and diaphoretic. He is restless as he is

sitting in the chair, appearing anxious and distressed.

The patient’s wife informs you that he has not been sleeping well the past few days due to

“feeling short of br
eath at night”. He is usually an active man who works around the house

however she has noticed this past week that he is unable to complete most of his chores

because

he

starts

to

have

pain

in

his

chest
-
this

pain

is

usually

resolved

when

he

rests

and

takes

his Nitro Spray.

Today

the patient began to feel chest pain again,

but this time it was

while

he was at rest. He

took

his

Nitro

x3

sprays,

however

the

pain

did

not

go

away.

His

wife

became

concerned

when

she saw how uncomfortable he looked, so she

called 911.

He

is compliant

with his

medications and

takes them

as

prescribed.

Past

Medical

History

Angina

CHF

Hypertension

Diabetes

High

cholesterol

Vitals

&

Pain

Assessment

Medications

Metformin

Metoprolol

Nitro Spray

ASA

Furosemide

Atorvastatin

Allergies

NKDA

BP

172/95

O

Today,

while

at

rest

Pulse

68,

regular

P

Pain/discomfort

is

constant,

does

not

change

with breathing, movement or palpation

Resp

Rate

20,

regular

Q

Heavy,

ache

SpO
2

97%

R

Into

Left

arm,

upper

back

between

shoulders

and into jaw

Temp

36.7

S

8/10

BGL

6.8

T

Today’s

episode

started

~1hr

ago

Skin

Pale/cool/diaphoretic

Physical

Exam

Findings

Head and

Neck

JVD

present.

Trachea

midline.

Patient

complaining

of

pain

in

his

lower

jaw

(originates in chest and radiates up)

Chest

Fine crackles noted bilaterally in the bases on auscultation. Accessory

muscle use noted, 3
-
4 word dyspnea is noted when he tries to speak.

Patient complaining of 8/10

retrosternal chest pain with radiation to his

Left

arm and

jaw. Pain described

as heaviness.

Onset of pain

was at

rest

today,

however

throughout

the

week

he

has

been

having

pain

while

doing

chores. No trauma noted.

Abdomen

Soft

on

palpation.

No

pulsating masses

noted.

No

nausea

or

vomiting.

Back

“achiness”

described

in

upper

back

between

his

shoulders

Pelvis

Unremarkable

Extremities

Bilateral

pitting

edema

noted

in

his

ankles.

Strong

radial

and

pedal

pulses

noted

12
-
Lead

*Analysis= STEMI, with ST elevation noted in the inferior leads. Reciprocal changes

noted. Possible posterior involvement, where a 15
-
lead will be required for full

analysis.

Using the textbook, lectures, and your research, answer the following questio
ns

about the relevant pathophysiology and the patient described above. The marking

rubric is shown in Canvas.

1.

Explain

the pathophysiology of

atherosclerosis development and how it could

cause a

myocardial

infarction.

2.

Compare and contrast a
ngina and myocardial Infarction. Discuss the pathophysiology

of

each,

in
cluding the similarities and differences in typical patient presentation.

Does

your patient appear to fit in one of these categories? Explain your answer.

3.

Define

right

sided

heart

failure

and

left

sided

heart

failure
.

What are

the

“forwards”

and “backwards” effects of each?

. Based on

your

pati
ent information, do you expect

this patient to be in right
-
sided or left
-
sided failure?

Why?

4.

As the attending paramedic, what are your top 3 differential diagnoses for

your

patient? What are your priorities when treating and transporting this patient?

Using the textbook, lectures, and your research, answer the following questio
ns

about the relevant pathophysiology and the patient described above. The marking

rubric is shown in Canvas.

1.

Explain

the pathophysiology of

atherosclerosis development and how it could

cause a

myocardial

infarction.

2.

Compare and contrast a
ngina and myocardial Infarction. Discuss the pathophysiology

of

each,

in
cluding the similarities and differences in typical patient presentation.

Does

your patient appear to fit in one of these categories? Explain your answer.

3.

Define

right

sided

heart

failure

and

left

sided

heart

failure
.

What are

the

“forwards”

and “backwards” effects of each?

. Based on

your

pati
ent information, do you expect

this patient to be in right
-
sided or left
-
sided failure?

Why?

4.

As the attending paramedic, what are your top 3 differential diagnoses for

your

patient? What are your priorities when treating and transporting this patient?

winter-2023-patho-case-study-5ifjxphe-crzqvy0q.pdf

Dr. Sulabh · Accepted Answer

5
                                                            Case Study
1. 	In atherosclerosis there is a blockage of the flow of blood in the arteries. This further leads to the development of pain in the chest with the occurrence of myocardial infarction. Further, the patient is suffering from breathing problems and breathlessness. This patient has edema with deposition of fluid and swelling in the ankles. The ECG wave electrocardiogram analysis depicts an elevation in the ST wave in the graph with swelling in the limb regions. The ST-wave elevation is due to the occlusion and the blockage of the coronary vessels leading to alterations in the waves obtained in the electrocardiogram. According to the wave graph given in the question, there is a depression of the ST wave in graph I and graph II in the VL and VR region segment wave. Further there is an inversion and depression of the V1, V2, and V3 wave in the I, II and III ECG graphs obtained while monitoring the patient. Further is an inversion and shortening of the waves V5, V6, and V7 as observed in the ECG graph. The V6 wave is very short in comparison to the V4 and V5 waves and there is an observation of wave inversion also. There is observation of a crackling sound also leads to the observation that there is an infection in the lungs of the patient (Themes, 2020). Due to the observation of an ST wave elevation, this patient is showing the occurrence and prevalence of myocardial infarction. 
2. 	There are differences between the occurrence of angina and myocardial infarction. In angina, there is a prevalence of stress and exertion in the body. Further, the condition of angina can be relieved by providing a dose of nitroglycerin. Further, in the condition of angina, there is an observation of a T-wave inversion and depression of the ST waves with cardiac arrhythmias. In comparison in the condition of myocardial infarction, there is a prolonged condition of chest pain with the prevalence of problems during breathing, breathlessness, and diaphoresis. In myocardial infarction, there may not be an elevation in the ST wave but there is an elevation in the levels of troponin. In addition in the condition of angina, there is spread and movement of the pain originating from the chest to the left arm region. In myocardial infarction, there is movement and spread of the pain to the distant regions of the arms leading to discomfort. Further, the pain is felt in the jaw region, shoulders, back, and abdomen region of the patient.

PMED 1010 Case Study It’s 1500hrs and you are sent Code 4...

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