Systematic Assessment of the Patient and History in Prehospital Treatment - Case Study Example

A patient case where the clinical presentation was cardiovascular Illness/disease (Paramedics Area) Facilitator Systematic Assessment of the patient and history in prehospital treatment The first step in the assessment is checking on the history of the patient for possible underlying illnesses that may have led to the current situation. The patient has a high cholesterol history and has been non-compliant in taking medication to treat the condition. This explains that there is a possible case of heart attack. The paramedics should check the pulse rate of the patient, which can be assessed using first aid tools. The paramedics should also inquire about possible cases of genetic predisposition of the condition through interrogating the patient about his history to find out if it is hereditary. (Wu et al, 2013).The patient is possibly suffering from cardiovascular shock, which prompts an evaluation on his pulse rate and blood pressure in order to classify the extent of his problem. This mainly helps in determining the patient’s hemodynamic status, which is classified into four classes aided by scientific research as shown below. Class Heart Rate (beats per minute) Blood Pressure (mmHg) I 100 bpm decreased pressure III Tachycardia >120 bpm Hypotension IV >140 bpm Hypotension Source: Reese, 2007 In a case of cardiogenic shock, the patient’s cardiac muscle is severely impaired, leading to low cardiovascular activity, which may lower the pulse rate of the patient. An examination of the cholesterol levels in the body of the patient thus follows to determine the level of attention he may need in order to prevent a paralyzing cardiac arrest (Beebe & Myers, 2011). High cholesterol levels observed may have caused dyspnea, which lowers the supply of oxygen to the heart hence causing the cardiogenic shock. When cholesterol levels are not managed through taking the appropriate medication, the patient is likely to suffer myocardial infarction, which eventually leads to cardiogenic shock. Once the cholesterol levels are established, the cardiac problem should be narrowed down further through evaluation of the disease symptoms, such as third heart sound, ST elevation from V2 to V4, and low SpO2 (Tang et al, 2014). These symptoms give clue as to which specific cardiac issue the patient may have suffered from while keenly looking at the symptoms and behavioral features of the patient. In the patient’s case, the presence of these symptoms show that he is suffering from a cardiovascular disease while the cholesterol and fat levels narrow it down to cardiovascular shock. However, the pulse rate and history of treatment shows that he is suffering from a cardiogenic shock, hence the need to begin diagnosis and treatment. In any case the paramedics discover a high pulse rate, they may recommend the patient to seek further treatment, although such a recommendation is not mandatory (Shauly et al, 2011). Physical Signs, Symptoms, and Actions: The patient has a number of symptoms that lead to conclusion that he has a cardiovascular problem. The patient’s pulse is 130. More so, observation shows that his blood pressure is 83/51. In the case of the lung fields for the patient: bilateral crackles, SpO2: 93% ORA. The doctors could hear a third heart sound after a careful analysis revealing elevation of ST segment in leads V2 to V4 (Karmakar et al, 2013).These signs show that he has a cardiovascular issue that is affecting his breathing system. More so, the fact that a third heart sound is audible means that the blood arteries to the heart or tissues around the heart are dead and blocked. This causes strained breathing in the patient. The patient can possibly be diagnosed with cardiogenic shock, which is an advanced form of cardiovascular shock. The patient might have been suffering from cardiogenic shock because of manifestations of shortness of breath (dyspnea), above normal pulse rate (tachycardia) at about 130 bpm, low blood pressure (hypotension) at about 83/51, coolness or having cold, clammy skin, and bilateral crackles as observed in a patient with tension pneumothorax (Karmakar et al, 2013). The paramedics will first undertake a cardiac anatomy to understand the situation of the patient and the diagnosis needed. Actions taken vary in different patients experiencing cardiogenic attacks (Govil et al, 2009). However, for this specific patient, the first step is light medication to reduce chest pains and open up his breathing system. This is a simple cardiac first aid recommended in the paramedics Emergency Medical Services. A normal first aid in cardiovascular attack is sufficient for the patient. However, in order to open up the heart well and facilitate swift circulation of air and blood in the cardiac system, cardiac catheterization is undertaken on the patient (Banerjee & Kumar, 2011). With cardiac catheterization done, the supply of blood and oxygen to the heart is enhanced. For this particular patient, history of cholesterol issues may mean that multiple evaluations have to be undertaken as there may be huge need for escalation of the situation to the hospital treatment. Coronary angiography is the next step undertaken in order to clean up the system and prepare him for the final treatment. This can be done inside or outside the hospital. Cardiogenic specialists carry equipment necessary for this in case an emergency situation calls for it (Barnett et al, 2011). The rationale for the evaluations involves a series of diagnostic actions relevant for patients with cardiogenic attacks (Bai et al, 2011). First aid helps in preventing chances of the patient fainting or losing breath in the process of diagnosis (Aehlert, 2011). Cardiac catheterization is undertaken on the patient as a way of improving his air circulation and lowering the effect of the cholesterol levels in the body, while the chest checks help in establishing the specific tissues affected in order to determine the level of diagnosis required (Hollenberg, 2009). Assessment and decision making Assessment done Assessment for the patient started with viewing his history of treatment and the symptoms .First, the patient had refused medication despite the fact that he was diagnosed with high cholesterol levels (Flesch et al, 2008). The decision made at this point was to take the patient through further evaluation recommended by the paramedics EMS and know whether they had any other underlying illness. However, a preliminary conclusion was made that the patient may have suffered cardiovascular shock from too much cholesterol around the heart. Other symptoms were also assessed, leading to conclusion that the patient suffered cardiogenic attack (Dong-Bao et al, 2011). What was done right? Different guidelines for handling the shock apply in different areas (Curtis & Ramsden, 2011). For example, the Canadian Cardiovascular Society (CCS), together with the American College of Cardiology (ACC) and American Heart Association (AHA), works toward the application of the STEMI Guidelines in a Canadian setting (Ferté et al, 2010). The first aid services were done correctly. The patient was taken through basic first aid to sustain him and enhance breathing and blood circulation to the heart (Gatti, Luciani & Stella, 2012). The symptoms were correctly observed by the medical experts. The patient might have been suffering from cardiogenic shock manifested by the shortness of breath (dyspnea), above normal pulse rate (tachycardia) at about 130 bpm, low blood pressure (hypotension) at about 83/51, coolness or having a cold, clammy skin, and bilateral crackles as observed in a patient with tension pneumothorax (Gheorghiade et al, 2011). However, the conclusion was made prematurely. It was imperative to have more tests before concluding that the patient suffered from the shock. The patient was not taken through x-rays to determine the level of shock that he had suffered. However, this was a result of the process being prehospital hence x-rays will be undertaken in hospital. What could be done better? The process of diagnosis for the patient was also done in an average way instead of an outstanding way considering the problem was critical to the life of the patient (Aelvoet et al, 2010). Cardiac catheterization is undertaken on the patient as a way of improving his air circulation and lowering the effect of the cholesterol levels in her body while the chest x-rays help in establishing the specific tissues affected in order to determine the level of diagnosis required.Cardiac catheterization was not done at all. As much as the patient was helped to regain normal breathing through first aid, Cardiac catheterization was highly important as it would dictate the number of x-rays that the patient required to go through (Millin et al, 2008). Current Best Practice Related to the case The best practices currently undertaken for cardiogenic shock include preventive and curative practices. In terms of preventive practices in the field, patients are advised to avoid food rich in cholesterol (Andrei et al, 2014). Cholesterol blocks the blood arteries, which increases the risk of cardiogenic shock (Millin et al, 2008). The patient was not receiving adequate guidance on the foods that he needed to avoid in order to protect him from the adverse effects of cholesterol intake. I would correct this by offering adequate information on the best policies to manage food to prevent cholesterol surge. Some of the patients with high levels of cholesterol are advised to take medication to reduce its level in the body and facilitate quick recovery of the system. However, when a patient avoids the medication, chances of cardiogenic shock increase immensely (Myers, 2009). The patient clearly avoided medical advice hence I would put him under hospital observation for some time in order for him to take medication (Grace et al, 2013).Another preventive measure in the best practices is quickly treating the cause of the cardiogenic shock. A patient with a valve problem, for example, is advised on a surgery to correct the problem before it can advance to cardiogenic shock (Myers, 2009). The risk factors for cardiogenic shock include other conditions, such as diabetes, high blood pressure, high cholesterol and triglycerides (Myers, 2009). When they are subdued on time, a patient greatly lowers chances of suffering from cardiogenic shock.The patient was not checked for possible risk factors for cardiogenic shock. As much as the patient’s history is evaluated, it is hard to know whether the problem was sufficiently handled (Suwanski, 2011). Conclusion Cardiogenic shock refers to a condition in which there is a severe impairment of cardiac muscle, which leads to decreased cardiac output and inadequate tissue perfusion. The patient has a high cholesterol history and has been non-compliant in taking medication to treat the condition. This explains that there is a possible case of heart attack. Assessment for the patient started with reviewing his history of treatment and the symptoms shown by the patient. The best practices currently undertaken for cardiogenic shock include preventive and curative practices. In terms of preventive practices in the field, patients are advised to avoid foods rich in cholesterol. More so, medication regimen, such as fibrinolysis therapy is viewed by most clinical evidence to be the last step in managing cardiogenic shock due to a number of limitations and contraindications. The patient has a number of diseases that lead to conclusion that he has a cardiovascular problem and procession to diagnosis in the same. References Aelvoet, W., Terryn, N., Molenberghs, G., De Backer, G., Vrints, C., & van Sprundel, M. (2010). Do inter-hospital comparisons of in-hospital, acute myocardial infarction case-fatality rates serve the purpose of fostering quality improvement? an evaluative study. BMC Health Services Research, 10, 334. doi:http://dx.doi.org/10.1186/1472-6963-10-334 Andrei, C. L., Tigu, G., Dragoescu, R. M., & Sinescu, C. J. (2014). 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Protocol for a randomised blocked design study using telephone and text-messaging to support cardiac patients with diabetes: A cross cultural international collaborative project. BMC Health Services Research, 13, 402. doi:http://dx.doi.org/10.1186/1472-6963-13-402 Read More