Clinical Cases in Paramedicine (eBook)

Sam Willis, Ian Peate, Rod Hill (Herausgeber)

eBook Download: EPUB

2021
John Wiley & Sons (Verlag)
978-1-119-62103-4 (ISBN)

Infos

Clinical Cases in Paramedicine provides students, educators, and early career paramedics with a diverse range of detailed case studies that realistically represent the conditions, scenarios, and challenges encountered in practice. Integrating evidence-based cases and expert insights from leading academics and practitioners, this engaging resource helps readers develop appropriate decision-making skills and apply theoretical concepts to practical situations. Organised by medical presentations and body systems, the text provides readers with a systematic framework that mirrors how paramedics assess cases in the real world. 

Throughout the text, cases of varying levels of complexity are designed to meet the needs of Case-Based Learning (CBL) and Problem-Based Learning (PBL) curricula used in paramedic training programmes worldwide. Each chapter contains six case studies-introductory, intermediate, and advanced-and features interactive learning activities, discussion questions, practical tips, and authoritative guidance aligned to national and international best-practice standards. Case studies illustrate scenarios related to trauma, medical emergencies, obstetrics, respiratory and cardiac events, minor injuries, drug overdoses, and many others. This comprehensive resource:  

• Features case studies of varying lengths and degrees of complexity to suit different readers, from student to professional  
• Suitable for use in many international programmes 
• Offers chapter introductions and summaries, practice questions, and additional online resources  
• Contains clinical, legal, ethical, cultural, remote and rural case studies 
• Includes a cumulative and comprehensive 'Test Your Knowledge' concluding chapter  

Those studying or working in paramedicine must keep pace with changes in the field using the latest evidence and expert opinion. Clinical Cases in Paramedicine is an essential volume for paramedic students and early-career professionals, as well as educators, lecturers, and trainers. 

SAM WILLIS is a Lecturer in Paramedicine at Curtin University and makes contributions to the profession through his innovative teaching practices and publications. He holds a number of professional registrations including as a paramedic and a Teaching Fellow with the UK Higher Education Academy. He is currently undertaking a PhD in the field of Paramedic Education.

IAN PEATE, OBE FRCN, is Head of School, School of Health Studies, Gibraltar, Visiting Professor of Nursing, Northumbria University and St George's University of London, Visiting Senior Clinical Fellow, University of Hertfordshire, Editor-in-Chief of the British Journal of Nursing and Consultant Editor of the Journal of Paramedic Practice.

ROD HILL is Professor of Physiology and Head of the School of Biomedical Sciences at Charles Sturt University. Rod has brought broad impact as a Fellow of the American Association for the Advancement of Science. Rod leads the Charles Sturt paramedicine team which offered the first university programme for paramedicine in Australia in 1995, and is the leading Australian programme in both graduate and undergraduate level paramedicine.

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Clinical Cases in Paramedicine provides students, educators, and early career paramedics with a diverse range of detailed case studies that realistically represent the conditions, scenarios, and challenges encountered in practice. Integrating evidence-based cases and expert insights from leading academics and practitioners, this engaging resource helps readers develop appropriate decision-making skills and apply theoretical concepts to practical situations. Organised by medical presentations and body systems, the text provides readers with a systematic framework that mirrors how paramedics assess cases in the real world. Throughout the text, cases of varying levels of complexity are designed to meet the needs of Case-Based Learning (CBL) and Problem-Based Learning (PBL) curricula used in paramedic training programmes worldwide. Each chapter contains six case studies introductory, intermediate, and advanced and features interactive learning activities, discussion questions, practical tips, and authoritative guidance aligned to national and international best-practice standards. Case studies illustrate scenarios related to trauma, medical emergencies, obstetrics, respiratory and cardiac events, minor injuries, drug overdoses, and many others. This comprehensive resource: Features case studies of varying lengths and degrees of complexity to suit different readers, from student to professional Suitable for use in many international programmes Offers chapter introductions and summaries, practice questions, and additional online resources Contains clinical, legal, ethical, cultural, remote and rural case studies Includes a cumulative and comprehensive "e;Test Your Knowledge"e; concluding chapter Those studying or working in paramedicine must keep pace with changes in the field using the latest evidence and expert opinion. Clinical Cases in Paramedicine is an essential volume for paramedic students and early-career professionals, as well as educators, lecturers, and trainers.

Inhalt

Preface vi

List of Contributors vii

Chapter 1 Respiratory emergencies 1
Jennifer Stirling Clare Sutton and Georgina Pickering

Chapter 2 Cardiac emergencies 25
Michael Porter and Joel Beake

Chapter 3 Neurological emergencies 47
Kristina Maximous

Chapter 4 Abdominal emergencies 74
Tania Johnston and Mark Hobson

Chapter 5 Palliative and end-of-life care 99
Alisha Hensby and Samantha Sheridan

Chapter 6 Medical emergencies 118
Tom E. Mallinson

Chapter 7 Non-technical skills 142
Georgette Eaton

Chapter 8 Trauma cases 161
Tom E. Mallinson and Fenella Corrick

Chapter 9 Paediatric cases 186
Erica Ley

Chapter 10 Patient-centred care in complex cases 203
Yasaru Gunaratne and David Krygger

Chapter 11 Legal and ethical cases 225
Ruth Townsend

Chapter 12 Mental health cases 242
David Davis Tom Hewes Lynne Walsh and Brian Mfula

Chapter 13 Older adults 261
Sam Taylor

Chapter 14 Obstetric cases 280
Aimee Yarrington

Chapter 15 Remote area cases 301
Steve Whitfield and Kerryn Wratt

Chapter 16 Mining emergencies 323
Paul Grant and Curtis Northcott

Index 348

Textauszug

Chapter 1
Respiratory emergencies

Jennifer Stirling, Clare Sutton and Georgina Pickering

Charles Sturt University, Bathurst, NSW, Australia

CHAPTER CONTENTS

• Level 1: Asthma
• Level 1: Chronic obstructive pulmonary disease (COPD)
• Level 2: Pulmonary embolism (PE)
• Level 2: Life‐threatening asthma
• Level 3: Respiratory sepsis
• Level 3: Smoke inhalation

LEVEL 1 CASE STUDY

Asthma

Information type

Data

Time of origin

17:08

Time of dispatch

17:10

On‐scene time

17:20

Day of the week

Friday

Nearest hospital

30 minutes

Nearest backup

15 minutes

Patient details

Name: Betsy Booper DOB:10/09/2002

CASE

You have been called to an outdoor running track for an 18‐year‐old female with shortness of breath. The caller states she has taken her inhaler to no effect.

Pre‐arrival information

The patient is conscious and breathing. You can access the area via the back gate of the sports field and drive right up to the patient, who is sat down on the track.

Windscreen report

The location appears safe. Approx. 10 people around the patient. Environment – warm summer evening and good light.

Entering the location

The sports coach greets you as you get out of the ambulance and informs you that the patient suffers with exercise‐induced asthma, but this is worse than normal and her inhaler has been ineffective.

On arrival with the patient

The patient is sat on a bench on the side of the track. She is leaning forward, resting her elbows on her thighs (tripodding). She says hello as you introduce yourself to her.

Patient assessment triangle

General appearance

Alert. Speaking in short sentences. She looks panicked.

Circulation to the skin

Flushed cheeks.

Work of breathing

Breathing appears rapid and shallow. An audible wheeze is noted.

SYSTEMATIC APPROACH

Danger

None at this time.

Response

Alert on the AVPU scale.

Airway

Clear.

Breathing

RR: 28. Regular and shallow. No accessory muscle use. Expiratory wheeze on auscultation.

Circulation

HR: 100. Regular and strong. Capillary refill time <2 seconds. Flushed cheeks and peripherally warm.

Disability

Moving all four limbs.

Pupils equal and reactive to light (PEARL).

Exposure

Bystanders have left. Next of kin are now on scene.

Temperature: warm summer evening – approx. 20 °C.

Vital signs

RR: 28 bpm

HR: 100 bpm

BP: 125/74 mmHg

SpO2: 93%

Blood glucose: 5.2 mmol/L

Temperature: 36.9 °C

PEF: 300 L/min

GCS: 15/15

4 Lead ECG: sinus tachycardia

TASK

Look through the information provided in this case study and highlight all of the information that might concern you as a paramedic.

• Aside from auscultation, which you have already done, what examination techniques should you incorporate into this patient assessment?
  • Inspection – observe the chest for an abnormalities such as wounds, scars, bruising, asymmetry and recession.
  • Palpation – feel for any asymmetry, vocal fremitus and tenderness.
  • Percussion – hyper‐ or hypo‐resonance.

• What adventitious (added) sounds might indicate asthma and why?

  Expiratory wheeze. This sound is made when air has a restricted path through the bronchi, due to inflammation and muscle spasm in the airways.

• What medicine (pharmacology) is likely to relieve the patient’s symptoms and why?

  Nebulised salbutamol – it is a Beta2, adrenergic agonist that relaxes smooth muscle in the bronchi.

Case Progression

You treat the patient with 5 mg of nebulised salbutamol and 6 L of oxygen. The nebuliser finishes and you remove the mask.

Patient assessment triangle

General appearance

The patient is now speaking in full sentences.

Circulation to the skin

Flushed.

Work of breathing

Normal effort of breathing.

SYSTEMATIC APPROACH

Danger

None at this time.

Response

Alert.

Airway

Clear.

Breathing

RR:16. Regular. Normal depth. No accessory muscle use. No wheeze or adventitious sounds.

Circulation

HR: 105. Regular and strong. Capillary refill time <2 seconds. Flushed cheeks and peripherally warm.

Disability

No change.

Exposure

No change.

Vital signs

RR: 16 bpm

HR: 105 bpm

BP: 128/78 mmHg

SpO2: 97%

Blood glucose: not repeated

Temperature: not repeated

PEF: 380 L/min

GCS: 15/15

4 lead ECG: sinus tachycardia

1. What kinds of questions would you ask this patient specifically related to asthma as part of the history‐taking process?

   See Table 1.1.

Table 1.1 History‐taking questions

Asthma history Does this feel like your normal asthma? Is this the worst it’s ever been? What time did this episode start today? Do you take your asthma medication regularly? What were you doing when it started today? What usually triggers your symptoms? When was the last time your visited your GP and/or went to hospital with these symptoms? Have you ever been intubated or been in ICU with these symptoms? Medication history What asthma medications do you take? How frequently do you have to take your medication? Do you usually have to take your inhaler while exercising? When was the last time you had a medication review with your GP? Have you had any recent changes in medication? Do you take any other medications? Have you had any coaching on the best way to take your inhaler? F/SH (family and social history) Does anyone else in your family experience asthma? Do you smoke? If so, how frequently? Do you drink or take any drugs recreationally? Who do you live with? What do you do for work? Do you exercise regularly? Are you under any particular stress at the moment? Past medical history (PMH) Do you have any other medical problems? Do you have any allergies? Have you had a cough or cold recently?

1. The patient is 160 cm tall, what should her predicted peak expiratory flow reading (PEFR) be? Her first reading was 300 – what percentage is that from predicted?

   (Hint: you will be required to look this up using the Australian National Asthma Council chart found here: http://www.peakflow.com/pefr_normal_values.pdf or by doing an internet search.)

   • 400 L/min.
   • 75%.

LEVEL 1 CASE STUDY

Chronic obstructive pulmonary disease (COPD)

Information type

Data

Time of origin

07:09

Time of dispatch

07:12

On‐scene time

07:30

Day of the week

Wednesday

Nearest hospital

15 minutes

Nearest backup

40 minutes

Patient details

Name: Dave Beater DOB: 21/09/1954

CASE

You have been called to a residential address for a 66‐year‐old male with difficulty in breathing. The caller states he has been breathless all night and has had a cough recently. He has seen his GP who prescribed antibiotics and steroids but he feels his breathing has got worse overnight.

Pre‐arrival information

The patient is conscious and breathing and is in a first‐floor...

Produkt-Details

• Erscheint lt. Verlag: 25.2.2021
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Notfallmedizin
• Themenwelt: Medizin / Pharmazie ► Pflege
• Themenwelt: Sozialwissenschaften ► Soziologie
• Schlagworte: Acute, Critical & Emergency Care • Emergency Medicine & Trauma • Intensive/Critical Care • Intensivpflege • Intensiv- u. Notfallpflege • Krankenpflege • Medical Science • Medizin • Notfallmedizin • Notfallmedizin u. Traumatologie • nursing • paramedic cases • paramedic case studies • paramedicine case-based learning • paramedicine cases • paramedicine case studies • paramedicine curricula • paramedicine problem-based learning • paramedicine problems • paramedicine training • paramedic training
• ISBN-10: 1-119-62103-8 / 1119621038
• ISBN-13: 978-1-119-62103-4 / 9781119621034