Cardiopulmonary Trauma Case Study

Clipboard and stethoscope in hand, I walked toward the double doors that flashed emergency in bright red letters above. It was my first clinical shift as an EMT student, and first day jitters flittered around in my stomach, I had no idea what to expect. However, I was not expecting to witness the fragility of life. About a half an hour into my shift the rapid response alarm blared through the emergency room. I turned to my preceptor and quizzically asked what this meant. “A rapid response is a patient who is in need of immediate medical care and intervention. As an EMT who is part of the rapid response team you will be expected to assist with vitals and chest compressions. Let’s head toward the recess room, and I’ll explain more there.” Eventually, we reached the recess room, and the rapid response team was already there preparing for the arrival of the patient. A nurse was on the phone with the firefighters that were bringing the patient in. Seconds later she announced “It’s a STEMI”. Then fright ran through my veins. A STEMI is medical jargon for a segment elevation on an EKG. In other words the patient’s coronary artery is completely occluded. The patient is suffering from a heart attack. Prior to this, I had never seen someone who was having a heart attack. However, the thing that terrified me the most was that I knew I would be expected to perform chest compressions. I had only ever performed chest compressions on a dummy.

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

by Nurse J. After five minutes, the diazepam had no effect so Dr.T ordered two milligrams of hydromorphone IVP given at 4:15 in the afternoon. The patient received another two milligrams of hydromorphone IVP and five milligrams diazepam IVP at 4:20 p.m. because Dr.T was not satisfied with the patient’s level of sedation. When the patient appeared to be sedated at 4:25 in the afternoon, the reduction of his left hip took place. At 4:35 p.m., Mr. B’s BP is 110/62 and his oxygen saturation is 92%. The “conscious sedation” policy was not followed. He did not have supplemental oxygen and his ECG and RR were not monitored. Then, Mr.B’s oxygen saturation dropped to 85%. The LPN adjusted the alarm and repeated the BP reading. Nurse J and the LPN were very busy taking care of the other patients during this time. At 4:43 p.m., Mr. B was not breathing, had no pulse, BP is 58/30 and oxygen saturation is 79%. The stat code was called.

On Wednesday, September 7, 2016 at about 1541 hours while represent at Brooklyn Special Victim Unit, located at 653 Grand Ave, Brooklyn, Sgt. Smolarsky, SVU and I interviewed Ms. Ryan-Mary Roberts. The following is a detail description of what transpired;

A young professional hockey player collapsed during a game that had no previous symptoms or problems before the collapse. People began CPR and used an automated external defibrillator (AED) 3 times before paramedics arrived. This ultimately prevented him from dying from sudden cardiac arrest. He received an implantable cardioverter-defibrillator to correct his heart rhythms and was released without medications.

The client name is Johnny. He is an eight-year-old, low SES African American male. He identified himself as Black. He lives with a seven-year-old stepbrother and mother in an independent home in inner city of Milwaukee. The client was referred to intensive outpatient unit by his mother due to suicidal / homicidal ideations (almost daily), impulsive / disruptive behaviors and mood instability both at home and school. Mother was also worried about his sexualized behaviors towards brother, cousin and peers. The client’s behavioral and emotional problems started at the age of four. He has multiple inpatient admissions over the past three years (Mom believes at least five admissions). The client had a multiple trauma history including sexual and

The three major life-breathing concerns for a patient is a disruption of the airway, breathing, and circulation. When a patient goes into cardiac arrest due to pre-existing conditions or trauma, an EMT will initiate the steps of cardiopulmonary resuscitation (CPR) and hopefully using an available automated external defibrillator (AED). However, some patients due to having a terminal illness, age, or personal choice does not want to be resuscitated or have

Mrs. P is a 63-year-old female who was not feeling well for a couple of weeks. She went to her Primary Care Physician (PCP) complaining of increased dyspnea on exertion, weakness, nausea, headaches, loss of appetite and periods of confusion. Since she has an extensive medical history that included pulmonary hypertension and emphysema, blood work was obtained. She was told that she had leukocytosis, hyponatremia (Sodium 126 mEq/L ), hypokalemia (Potassium 2.5 mEq/L) and an acute kidney injury (AKI). She was told to go to the emergency room and was admitted to the telemetry unit.

Some people in the public, and especially RNs and nursing students, know exactly what a DNR is. They know that this means once a person experiences a cardiac and/or respiratory arrest, they are not to be resuscitated. In a policy from IU Health North Hospital (2016), the following treatments are to be withheld in the case of a respiratory and/or cardiac arrest when the patient has a signed DNR: chest compressions, start of ventilation support, endotracheal intubation, electrical countershock, cardiac pacing externally, and/or bolus administration containing antiarrhythmic, vasopressors, or inotropes. There is an exceptions section to the policy that states that “DNR orders are generally suspended in anesthetizing locations” (IU Health North Hospital, 2016, p. 4). It is noted that any existing directives need to be discussed with the patient when possible. It is important to view all aspects to this ethical issue to be able to see the entire picture of it. This includes looking at what is currently done, the opinions of patients and physicians, along with looking at policies from the American Society of Anesthesiologists along with the American College of Surgeons.

| Lesson Outline: Allocated teacher-NExplaining legal requirements : Duty of care: A duty of care is implied when the person who is requiring your assistance is in your workplace. E.g. patient, co-worker or visitor. Consent of an unresponsive patient is assumed in an emergency situation. (Crouchman, 2009; Milne & Mellman-Jones, 2010).Cultural awareness/sensitivity: We need to mindful of varying cultures when assisting patients, as different cultures prefer to be unexposed which is necessary when defibrillation is required. Eg, Muslims (Hattersley & Keogh, 2009). Confidentiality: Following an emergency situation it is vital to refrain from speaking to others outside the workplace about the patient to ensure the patient’s privacy and dignity. Think about how you would feel if you where in the patient’s situation. (Maeder, Martin-Sanchez, Croll, & Ambrosoli, 2012)?Limitations: Remember that once you start you can’t stop until you’re physically unable to or help arrivesDebriefing: Participating in the debriefing process is vital due to the enormity of the situation, enabling the nurse to express

This paper will specifically focus on a case involving an intellectually disabled adult female who was reported to be experiencing sudden onset shortness of breath. Upon arrival of EMS, the patient’s caretaker escorted the responding personnel to a back room where the patient was sitting upright in bed and appearing cyanotic throughout the face. Upon initial assessment, it was determined that the patient was both pulseless and apneic indicating the need to begin immediate resuscitation efforts. This patient was transported under the strong suspicion that she was suffering from a pulmonary embolism which resulted in cardiac arrest. Care of this patient was transferred at the hospital where resuscitation efforts were continued by emergency room staff with no success. The ultimate goal of this report is to discuss the pulmonary circuit as well as the implications of impaired circulation within the lungs. This case study also aims to identify key clinical findings of pulmonary embolisms and signs of deterioration in an effort to help improve prehospital recognition within the EMS community.

Yearly, the adult population suffers over 350,000 out-of-hospital cardiac arrests (OHCA) in the United States (Go et al., 2012). Prehospital emergency medical services (EMS) is involved with about 60% of these cardiac arrests (CA) (Go et al., 2012). EMS frequently transports these patients to the emergency department (ED) without return of spontaneous circulation (ROSC). Of those transported without ROSC it is not unusual to pronounce the time of death shortly after arrival in the ED. The ED then must allot resources to complete the protocols after a death. Additionally, the patient’s family now has a bill for ED services, even if the patient arrived dead.

In the medical and in the EMS field, research is conducted as information obtained from every day emergencies is gathered and analyzed in an effort to improve patient care. Data obtained from the EMS fields has revealed two essential outcomes for the EMS field: administration of Nitroglycerin on patients with right ventricular involvement cardiac issues, and backboard immobilization of patients. Over the years, the cardiac guidelines has been for paramedics to administer Nitroglycerin (NTG) to cardiac patients except patients whose EKG findings show right ventricular involvement to avoid hypotension and avoid complications; however, new research suggests the opposite. Research has shown a very small percentile difference on hypotension

Wanda is a 89 year old Caucasian women previously taking no medications and lives alone. She was in good health, still driving, and able to take care of herself. She was admitted to the hospital with a hip fracture after a fall. After surgery is completed she is comfortably recovering on the tele floor. Since completion of surgery, her blood pressure has been unstable. She is put on several blood pressure medications, as well as blood thinners to prevent DVT post surgery. Despite all this she is subsequently discharged to a rehab facility on her new list of medications. Within the first 24 hours of care in the rehab facility she becomes increasingly confused, passes out during therapy and is admitted back to the hospital. Upon re admission

While protocols are needed and are currently revised every so often, there are some revisions that should be made that have not been yet. One of the greatest injustices in today’s society is caused by protocols. First responders are taught to maintain a standard of quality care, which means that all patients are supposed to receive the best care possible no matter what. This includes disregarding one’s personal views on gender, race, and other things. Unfortunately, this does not occur to the extent that it should. For example, in PA’s cardiac arrest protocols outline the use of mechanical CPR devices, such as the Lund University Cardiac Arrest System (LUCAS) Device (Pennsylvania Department of Health, 2017, p. 69-72). This device performs compressions for the care provider and has been proven to increase the survivability of patients in