Transcript Document

CCU Case Studies
The following is a series of case studies to review different patient
types and how they are captured on the form. The information is
provided in sequence to reflect the natural progression of a patient’s
care.
As the case is presented, mark off the required information in the
appropriate fields on your Macstrak form.
At the end of each case study, the form will be reviewed with the
correct answers supplied.
If you have any questions, please refer to your Macstrak manual or
contact us at the Macstrak Project Office.
The Macstrak Project
CCU Case Study
The Macstrak Project
CCU Case Study
DWB is a 50 year old (DOB:02/12/55) man with no significant past
medical history.
The Macstrak Project
CCU Case Study
At 08:15 on 20/02/06 while at work, DWB experiences a dull pain
in his chest accompanied by dizziness and shortness of breath.
Fifteen minutes later the pain subsides and he continues with his
day. At 09:15 he experiences another episode of chest pain and
decides to go to the ER down the street on his way home from
work. The chest pain continues throughout the afternoon and he
arrives at the ER at 19:30. He is seen by the triage RN on arrival
and his vital signs are as follows: BP 132/90, HR 98 and his chest is
clear. An ECG at 19:37 reveals 2 mm of ST elevation in leads V1V4 and Q’s in the same leads. DWB’s pain resolves shortly after
arrival in the ER. The ER MD assesses DWB at 19:53 and decides
it is too late to treat DWB with a patency intervention.
The Macstrak Project
CCU Case Study
DWB is admitted to your CCU with a diagnosis of Acute
Myocardial Infarction. He is started on clopidogrel that evening and
is now on 75 mg per day. His CK and troponins are positive that
evening and the next day. DWB has no further chest pain or
complications while in CCU.
The Macstrak Project
CCU Case Study
DWB is discharged to the cardiac ward on 22/02/06 at 09:30. His
discharge diagnosis is Acute Myocardial Infarction and his peak CK
is 2052, his peak troponin is 32. He is discharged on the following
medications:
ASA
clopidogrel
bisoprolol
ramipril
simvastatin
The Macstrak Project
CCU Case Study
MACSTRAK
Patient Initials: D
F
Birth Date:
CCU
Gender:
W
B
M
L
02
12
Day
Month
X Male
Centre:
19 55
Year
CCU
Date:
ICU
20
Day
Month
Year
Female
DWB is a 50 year old (DOB:02/12/55) man with no significant
past medical history.
The Macstrak Project
CCU Case Study
MACSTRAK
Patient Initials: D
F
Birth Date:
CCU
Gender:
W
B
M
L
02
12
Day
Month
X Male
Centre:
19 55
Year
Date:
CCU
20
02
Day
Month
ICU
20 06
Year
Female
At 08:15 on 20/02/06 while at work, DWB experiences a dull pain
in his chest accompanied by dizziness and shortness of breath.
Fifteen minutes later the pain subsides and he continues with his
day. At 09:15 he experiences another episode of chest pain and
decides to go to the ER down the street on his way home from
work.
The Macstrak Project
CCU Case Study
Past Medical History:
<30 days
MI …………………………….
Angina ………………………..
CABG ………………………..
PCI ……………………………
CHF …………………………..
TIA/CVA ……………………..
Diabetes (oral agents/insulin) ...
None of the Above…………….
>30 days
DWB is a 50 year old
(DOB:02/12/55) man with
no significant past medical
history.
X
The Macstrak Project
CCU Case Study
Patient Origin:
X Walk In
EMS
Dr.’s Office/Clinic (Direct)
Other Hospital
Inpatient
Medical Ward
Surgical Ward
Other ICU
Other: ………………
X ER
At 08:15 on 20/02/06 while at work,
DWB experiences a dull pain in his
chest accompanied by dizziness and
shortness of breath. Fifteen minutes
later the pain subsides and he continues
with his day. At 09:15 he experiences
another episode of chest pain and
decides to go to the ER down the
street on his way home from work.
The chest pain continues throughout
the afternoon and he arrives at the ER
at 19:30.
The Macstrak Project
CCU Case Study
VS at Presentation: (complete for all
Dyspnea/Rales:
Systolic BP:
Heart Rate:
patients)
X None
Mild
Mod/Severe
< 100
101-130
X 131-160
161-190
>190
< 80
X 80-100
>100
The chest pain continues throughout
the afternoon and he arrives at the ER
at 19:30. He is seen by the triage RN
on arrival and his vital signs are as
follows: BP 132/90, HR 98 and his
chest is clear. An ECG at 19:37
reveals 2 mm of ST elevation in leads
V1-V4 and Q’s in the same leads.
DWB’s pain resolves shortly after
arrival in the ER.
The Macstrak Project
CCU Case Study
Admitting Diagnosis: (Check one only)
X Acute AMI (48 hrs)
UA R/O MI
ACS
UA
RSCP NYD
CHF
Arrhythmia
Aortic Dissection
Non ACS
Pericardial Disease
Other: …………………
DWB is admitted to your CCU with
a diagnosis of Acute Myocardial
Infarction. He is started on
clopidogrel that evening and is now on
75 mg per day. His CK and troponins
are positive that evening and the next
day. DWB has no further chest pain
or complications while in CCU.
The Macstrak Project
CCU Case Study
Timeline: (AMI pts only - 24 hr clock or > 24 hrs)
Symptom Onset:
0915
EMS at Scene:
Hospital Arrival:
1930
First ECG:
1937
EMS
Diagnostic ECG:
1937
At 09:15 he experiences another
episode of chest pain and decides to
go to the ER down the street on his
way home from work. The chest pain
continues throughout the afternoon
and he arrives at the ER at 19:30.
He is seen by the triage RN on arrival
and his vital signs are as follows BP
132/90, HR 98 and his chest is clear.
An ECG at 19:37 reveals 2 mm of
ST elevation in leads V1-V4 and
Q’s in the same leads.
The Macstrak Project
CCU Case Study
Diagnostic ECG: (ACS pts. only)
No ACS ST-T
LBBB
Paced
X Other
ST ST
V1-4 ………….. X …
V5-6 ……….…
…
IaVL ………... …
II/IIIaVF ….. …
V4R..done ...
V7-9 ..done ...
T
Q
..…
…...
…..
…...
.….
……
…..
…....
X
He is seen by the triage RN
on arrival and his vital signs
are as follows BP 132/90, HR
98 and his chest is clear. An
ECG at 19:37 reveals 2 mm
of ST elevation in leads V1V4 and Q’s in the same
leads. DWB’s pain resolves
shortly after arrival in the ER.
The Macstrak Project
CCU Case Study
Reperfusion Therapy:
X No X Not Indicated:
Risk:

Yes
Thrombolysis 
ECG Not Diag.
Risk of ICB
Here
EMS
ST Up Transient X Too Late
Given (Other Hosp)
Risk Other Bleed
Other: ……………......
Other Hosp
Dose: (mg/units)
TNK/rtPA
SK
Duration: (min)
r-PA (reteplase) Pt.Weight: (kg)
Other
Adjuvant:
ASA
Heparin
GP2b/3a Inhibitor
 blocker IV
Clopidogrel
Other ...............................
Primary/Rescue PCI 
Here
Transfer
Drug:
and/or
Reperfusion Therapy Decided by:
X EP
Consultant
An ECG at 19:37 reveals 2 mm of ST elevation in leads V1-V4 and
Q’s in the same leads. DWB’s pain resolves shortly after arrival in
the ER. The ER MD assesses DWB at 19:53 and decides it is
too late to treat DWB with a patency intervention.
The Macstrak Project
CCU Case Study
Date:
Acuity:
Shift:
Diuretics………………………
Inotropes IV…………………..
ETT/Vent……………………..
PA Line……………………….
TTVP…………………………
IABP………………………….
ACS:
RSCP - Ischemia – Definite….
– Probable…
CK (+ve)………………...……
Troponin (+ve)………………..
NTG IV……………………….
Heparin – UFH…………….....
– LMWH…………….
Other Antithrombin………...…
GP 2b/3a Inhibitor IV……...…
Clopidogrel (or ticlopidine)..…
Cardiac Cath………………....
PCI…………………………...
Outcomes:
VF/Sustained VT………….…
Infarction (new/repeat)*(1) …...
Thrombolysis (new/repeat)*(2)..
Stroke*(3) …………………….
Major Bleed*(4) ………………
Transfusion…………………..
Crs1: ………………………....
Crs2: ……………………..…..
None of the Above……….…..
RN Initials ………………..….
20
D
22
21
N
D
N
D
X
X
X
X
X
X
X
X
X
X
X
N
DWB is admitted to your CCU with a
diagnosis of Acute Myocardial
Infarction. He is started on
clopidogrel that evening and is now
on 75 mg per day. His CK and
troponins are positive that evening
and the next day. DWB has no
further chest pain or complications
while in CCU.
AW KD AW KD
The Macstrak Project
CCU Case Study
02
Date: 22
Day
Month
06 Time: 0930
20 Year
Discharge Diagnosis:
X Acute MI
Peak CK: 2052
Unstable Angina
Trop: 32
Chest Pain NYD
CHF
Arrhythmia
Other Cardiac Problem: …………..................
Non Cardiac Problem: …..….............……….....
DWB is discharged to the cardiac
ward on 22/02/06 at 09:30. His
discharge diagnosis is Acute
Myocardial Infarction and his
peak CK is 2052, his peak
troponin is 32. He is discharged
on the following medications:
ASA
clopidogrel
bisoprolol
ramipril
simvastatin
The Macstrak Project
CCU Case Study
Discharged To:
Discharge Meds:
X Cardiac Ward
X ASA
X Clopidogrel (or ticlop.)
Med/Surg Ward
Step Down Unit
CV Surgery
Other ICU
Other Hospital
Home
Death
Other:..............
Heparin (UF or LMW)
Nitrates (po/top)
X B Blocker
X ACEI
A2 Blocker
X Statin
None of Above
DWB is discharged to the cardiac
ward on 22/02/06 at 09:30. His
discharge diagnosis is Acute
Myocardial Infarction and his peak
CK is 2052, his peak troponin is 32.
He is discharged on the following
medications:
ASA
clopidogrel
bisoprolol
ramipril
simvastatin
The Macstrak Project