Task: You are responding to a 68-year-old male patient with chest pain and shortness of breath. For each of the differential diagnoses below:
? Outline the specific findings you would expect for this patient based on each differential. Include epidemiological factors, risk factors and history, clinical manifestations and trends. Explain these in terms of the pathophysiology of the condition.
? Outline and justify a pre-hospital management plan based on current best practice.
? Anterior STEMI
? Acute pericarditis
? Pulmonary embolus
(You must address each potential presentation).
Referencing: APA (6th Edition) referencing is to be used.
Your management plan needs to address each differential, as while there will be some similarities, the justifications may be different. This would be best done as 3 management plans. There is no need to replicate information – if you have discussed information in one management plan that is also applicable to another, you can refer back to it as opposed to writing it all again.
The term “trends” in this context is referring to changes in the patient’s clinical presentation over time. For example, this would include the expected clinical course of the disease if no intervention took place (e.g. for external bleeding you would see a trend of increasing tachycardia accompanied by decreasing blood pressure, decreasing conscious state and changes to skin colour and capillary refill). This is a simple example, but gives you an idea of what is required.
The task asks you to “outline the specific findings you would expect for this patient based on each differential. Include epidemiological factors, risk factors and history, clinical manifestations and trends. Explain these in terms of the pathophysiology of the condition.”
This involves researching the factors that are specific to that condition. Some conditions, such as the anterior STEMI, will have risk factors and patient history that are common to myocardial infarction or acute coronary syndrome generally, but others that are specific to that type of ACS. It is important to highlight those elements that are particularly indicative of that condition and to explain why they are relevant (in terms of the pathophysiology). Essentially this section for each condition should provide a snapshot of how that patient would present and thus allow you to differentiate between the three conditions.
In establishing your management plan, this should include clinical interventions and the rationale and evidence supporting them. This should include:
o all relevant details for the intervention (e.g. doses, timing and end-points for drugs for example),
o what is the aim or what are you trying to achieve via the intervention (i.e. the justification), and
o references indicating the source of your evidence. These should be high quality sources indicative of current best practice.