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 flat/unit.
Windscreen report
The location appears safe. Greeted at the main door by the patient’s wife.
Entering the location
Wife escorts you up in the lift to the patient’s flat.
On arrival with the patient
Patient is sat in the tripod position and appears distressed. He makes eye contact when you arrive, but does not speak as is so short of breath. He has a productive cough that results in a string of green‐looking sputum that he manages to capture in his handkerchief to show you.
Patient assessment triangle
General appearance
Alert, and makes eye contact, but is acutely distressed. Can only speak in single words and is reluctant to talk. In tripod position, coughing.
Circulation to the skin
Pink face, breathing through pursed lips.
Work of breathing
Increased work of breathing – rapid and shallow breaths with accessory muscle use.
SYSTEMATIC APPROACH
Danger
None at this time.
Response
Alert.
Airway
Clear.
Breathing
RR: 36. Rapid and shallow, with accessory muscle use. Widespread bilateral wheeze noted on auscultation.
Circulation
HR:
