Case study
Patient: 22yo, ~ 50 kg female feeling unwell and vomiting 10 times over the last day. Time is 0630.
On arrival: She is sitting upright in bed. She looks lethargic and confused.
On examination: Central abdominal pain, nausea, lethargy. She is unable to keep any food down. She describes the vomit as mostly liquid with no blood. Intermittent diarrhoea. Increased thirst, increased urination. Very hungry
Medical History: hypothyroidism.
Medications: oral contraceptive pill and thyroxine. Always compliant with medications.
Allergies: n/a
Primary survey:
Dangers – none
Response/conscious state – AVPU (response to verbal commands, not fully alert)
Circulation – Radial pulse fast and weak
Airway – Clear of obstructions
Breathing – Fast and irregular (possible kussmals)
Vital Sign Survey:
- GCS – 13 (E3, V4, M6) -eyes opening to sound and verbally confused
- Speech – Normal
- Pupils – PEARL (normal)
- Respiratory rate – 24/ minute. Irregular rhythm with a sweet odour.
- SpO2 – 98% on room air
- Lung sounds – Air entry: clear, right = left
- Pulse 106/ minute, regular and weak
- Blood pressure – 85/60mmHg
- Temperature – 37°c (tympanic)
- Blood glucose level – 28 mmol/L
- Skin – dry, warm, poor skin turgor and dry mucous membranes
- Last eaten: Small dinner 12 hours ago
- Pain: Pain in abdomen 6/10. No other abnormalities detected
- ECG
- Give a succinct summary of the patient’s condition, including pathophysiology. Outline the diagnosis and what is happening to the patient.
- Show your understanding of the patient presentation relating to their signs and symptoms. State each sign and symptom and explain how the condition is causing them, explain this in detail.
- Provide the paramedicine treatment plan based on the Queensland ambulance service clinical practice guidelines and justified by current literature (e.g. peer reviewed articles). This must be in detail and include doses, drug routes of administration, repeat doses, maximum doses for all medicines.
Queensland ambulance service clinical practice guidelines: https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Diabetic%20emergency_Hyperglycaemia.pdf
Queensland ambulance service drug therapy protocols: https://www.ambulance.qld.gov.au/dtprotocols.html
Queensland ambulance service clinical practice procedures/equipment:
https://www.ambulance.qld.gov.au/CPPtable.html
- This treatment plan should be compared to other Australasian ambulance guidelines. Are they in line with best evidence? Do they vary or contradict? If they’re not, examples need to be given and the impact that other treatment recommendations may have needs to be discussed.
Ambulance Victoria clinical practice guidelines: https://cpg.ambulance.vic.gov.au/#/tabs/tab-0/info
Ambulance Tasmania clinical practice guidelines: https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0018/107334/A00_-_Ambulance_Tasmania_Clinical_Practice_Guidelines_for_Paramedics_and….pdf
St John New Zealand Clinical procedures and guidelines: https://www.stjohn.org.nz/globalassets/documents/health-practitioners/cpg_comprehensive_web170525.pdf
To receive a high mark:
-Condition overview demonstrates excellent understanding of pathophysiology of the patient’s condition.
– The student links and demonstrates an understanding of their patient’s condition in relation to their signs and symptoms.
-Management plan; Comprehensive, correct, and is well supported with appropriate primary resources (strong, reliable, recent, and peer reviewed – not state CPGs). Some discussion of how this care compares with that recommended by Australasian state-based CPGs.
-All sources accurately referenced as per APA referencing style. APA reference list has no errors
Misc.
-1200 words +/-120 words.
-References should be peer reviewed journals from no earlier than 2015. APA 6th edition.
-I will be editing the assignment heavily after receiving it.
-I will find a way to give a large tip if it is done well and receives a high mark.
-If there are any confusing or difficult parts let me know and I’ll try to clear it up.
