her breath’.
SYSTEMATIC APPROACH
Danger
None at this time.
Response
Alert.
Airway
Clear.
Breathing
RR: 30.
Circulation
HR: 128. Weak radial.
Disability
Moving all four limbs.
Exposure
Normal temperature in the ambulance.
Vital signs
RR: 30 bpm
HR: 128 bpm
BP: 88/60 mmHg
SpO2: unable to obtain
Blood glucose: not repeated
Temperature: not repeated
GCS: 15/15
12 lead ECG: sinus tachycardia with right bundle branch block (RBBB)
1 What is the most common ECG finding in PE? What other ECG changes are associated with PE? The most common ECG finding in PE is sinus tachycardia. PE can cause any of the following ECG changes:T‐wave inversion.New‐onset atrial fibrillation.Right bundle branch block.Right axis deviation.S1Q3T3 (this is a specific pattern that is seen rarely in PE):S waves in lead I.Q waves in lead III.T‐wave inversion in lead III.
2 Explain why females taking the oral contraceptive pill are at greater risk of developing a PE. Virchow’s triad explains the three broad categories that play a part in thrombus formation:Hypercoagulability.Hemodynamic changes (stasis, turbulence).Endothelial injury/dysfunction.Taking contraceptive drugs that contain oestrogen can actually change the constitution of the blood, increasing plasma and other clotting factors. This causes the woman to be in a hypercoagulative state, increasing the risk of developing DVT/PE.
LEVEL 2 CASE STUDY
Life‐threatening asthma
| Information type | Data |
| Time of origin | 07:13 |
| Time of dispatch | 07:15 |
| On‐scene time | 07:26 |
| Day of the week | Monday |
| Nearest hospital | 20 minutes |
| Nearest backup | 10 minutes |
| Patient details | Name: Billy Bob DOB: 01/06/1995 |
CASE
You have been called to a residential address for a 25‐year‐old male with difficulty in breathing. Caller states he has been breathless all night and has had a cough recently.
Pre‐arrival information
The patient is conscious and breathing and is located in a third‐floor flat/unit – there is no lift.
Windscreen report
The location appears safe and you are greeted at the communal entrance by the patient’s partner.
Entering the location
The partner appears agitated and hurries you up the stairs, stating that the patient was having his breakfast and his breathlessness got a lot worse.
On arrival with the patient
The patient is sat leaning forward and appears panicked. He does not say hello when you introduce yourself and states repeatedly that he cannot breathe, in short sharp breaths.
Patient assessment triangle
General appearance
Alert, but does not acknowledge your presence. Acutely distressed. Unable to speak in full sentences, leaning forward with clear dyspnoea.
Circulation to the skin
Pale and peripherally cyanosed.
Work of breathing
He has increased breathing effort and only giving 1 word answers.
SYSTEMATIC APPROACH
Danger
None at this time.
Response
Alert.
Airway
Clear.
Breathing
RR: 32. Rapid and shallow. No accessory muscle use. Minimal air movement bilaterally on auscultation.
Circulation
HR: 130. Radial weak and barely palpable, regular. Capillary refill time 3 seconds. Nail beds appear bluish.
Disability
Pupils equal and reactive to light (PEARL) – 5 mm.
