The Macstrak Project 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 ENC is a 49-year-old (DOB: 27/04/56) working mom with no significant past medical history.

The Macstrak Project CCU Case Study On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance. The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08:25. She is seen by the triage RN on arrival and her vital signs are as follows: BP 130/70, HR 74 and chest is clear. ENC continues to have chest pain which she rates at 8/10. The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK.

The Macstrak Project CCU Case Study 35 mg of TNK over 5 seconds is given at 08:50. ENC also receives UF heparin IV and metoprolol IV while in the ER. The pain resolves shortly after starting the TNK and the ST segments are normalising.

The Macstrak Project CCU Case Study 35 mg of TNK over 5 seconds is given at 08:50. ENC also receives UF heparin IV and metoprolol IV while in the ER. The pain resolves shortly after starting the TNK and the ST segments are normalising. ENC is admitted to your CCU that same morning with a diagnosis of Acute Myocardial Infarction. She has UF heparin infusing intravenously on arrival. Clopidogrel is started that evening. ENC has no further chest pain or complications while in CCU but her CK and troponin levels remain positive.

The Macstrak Project CCU Case Study ENC is transferred to a tertiary centre for a cath on 04/03/06 at 09:00. Her discharge diagnosis is Acute Myocardial Infarction and her peak CK is 1086, her peak troponin is 24. She is discharged on the following medications: ASA metoprolol clopidogrel UF heparin pravastatin

The Macstrak Project Centre: CCU ICU Date: 20 Day Month Year Patient Initials: F M L Birth Date: 19 Day Month Year Gender: Male Female CCU Case Study ENC is a 49-year-old (DOB: 27/04/56) working mom with no significant past medical history. E N C CCU MACSTRAK X

The Macstrak Project Centre: CCU ICU Date: 20 Day Month Year Patient Initials: F M L Birth Date: 19 Day Month Year Gender: Male Female CCU Case Study ENC is a 49-year-old (DOB: 27/04/56) working mom with no significant past medical history CCU MACSTRAK X On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance E N C

The Macstrak Project Past Medical History : 30 days MI ……………………………. Angina ……………………….. CABG ……………………….. PCI …………………………… CHF ………………………….. TIA/CVA …………………….. Diabetes (oral agents/insulin)... None of the Above……………. CCU Case Study ENC is a 49-year-old (DOB: 27/04/56) working mom with no significant past medical history. X

The Macstrak Project Patient Origin: ER EMS Walk In Dr.’s Office/Clinic (Direct) Other Hospital Inpatient Medical Ward Surgical Ward Other ICU Other: ……………… CCU Case Study On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance. The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08:25. X X

The Macstrak Project VS at Presentation: (complete for all patients) Dyspnea/Rales: None Mild Mod/Severe Systolic BP: < >190 Heart Rate: < >100 CCU Case Study She arrives at the ER at 08:25. She is seen by the triage RN on arrival and her vital signs are as follows: BP 130/70, HR 74 and chest is clear. ENC continues to have chest pain which she rates at 8/10. The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. X X X

The Macstrak Project CCU Case Study ENC is admitted to your CCU that same morning with a diagnosis of Acute Myocardial Infarction. She has UF heparin infusing intravenously on arrival. Clopidogrel is started that evening. ENC has no further chest pain or complications while in CCU but her CK and troponin levels remain positive. Admitting Diagnosis: (Check one only) Acute AMI (48 hrs) UA R/O MI UA RSCP NYD CHF Arrhythmia Aortic Dissection Non ACS Pericardial Disease Other: ………………… ACS X

The Macstrak Project CCU Case Study Symptom Onset : EMS at Scene: Timeline: (AMI pts only - 24 hr clock or > 24 hrs) Hospital Arrival: First ECG: EMS Diagnostic ECG: 0500 On the morning of 02/03/06 ENC awakens at 05:00 with chest pain. She gets up and gets her children ready for daycare and drops them off. Rather than going to work she returns home and her husband calls an ambulance. The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08: X 0805

The Macstrak Project Diagnostic ECG: (ACS pts. only) ST  ST  T  Q No ACS ST-TV 5-6 ……….… … ….. …... PacedII/IIIaVF ….. … ….. ….... OtherV 4 R..done... V 7-9..done... CCU Case Study V 1-4 ………….. …..… …... LBBB IaVL ………... ….…. …… The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. She arrives at the ER at 08:25. X X

The Macstrak Project Reperfusion Therapy: No  Not Indicated:  ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: …………… Drug:TNK/rtPA SK r-PA ( reteplase ) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other and/or Primary/Rescue PCI  Here Transfer Reperfusion Therapy Decided by:EP Consultant CCU Case Study Yes  Thrombolysis  Here EMS Other Hosp Dose: (mg/units) Duration: (min) Pt.Weight: (kg) The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. X X X X X 62

The Macstrak Project Reperfusion Therapy: No  Not Indicated:  ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: …………… Drug:TNK/rtPA SK r-PA ( reteplase ) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other and/or Primary/Rescue PCI  Here Transfer Reperfusion Therapy Decided by:EP Consultant CCU Case Study Yes  Thrombolysis  Here EMS Other Hosp Dose: (mg/units) Duration: (min) Pt.Weight: (kg) The ambulance arrives at 07:50. At 08:05, en-route to the hospital, ENC has an ECG which shows ST elevation in II/IIIaVF. ASA is given to chew. X X X X X 62 X

The Macstrak Project Reperfusion Therapy: No  Not Indicated:  ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: …………… Drug:TNK/rtPA SK r-PA ( reteplase ) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other and/or Primary/Rescue PCI  Here Transfer Reperfusion Therapy Decided by:EP Consultant CCU Case Study Yes  Thrombolysis  Here EMS Other Hosp Dose: (mg/units) Duration: (min) Pt.Weight: (kg) 35 mg of TNK over 5 seconds is given at 08:50. ENC also receives UF heparin IV and metoprolol IV while in the ER. The pain resolves shortly after starting the TNK and the ST segments are normalising. X X X X X X X X

The Macstrak Project CCU Case Study The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. TLysis Started: Arrive Lab: First Inflation: TLysis Ordered: GP 2b/3a Started: Transfer: 0840

The Macstrak Project CCU Case Study 35 mg of TNK over 5 seconds is given at 08:50. The ER MD assesses ENC and finds she has no contraindications to thrombolytic therapy. At 08:40 the decision is made to treat ENC (weight 62 kg) with TNK. TLysis Started: Arrive Lab: First Inflation: TLysis Ordered: GP 2b/3a Started: Transfer:

The Macstrak Project 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 ………………..…. Date: CCU Case Study DNDNN D ENC is admitted to your CCU that same morning with a diagnosis of Acute Myocardial Infarction. She has UF heparin infusing intravenously on arrival. Clopidogrel is started that evening. ENC has no further chest pain or complications while in CCU but her CK and troponin levels remain positive XXXXX KD AW XXX XX XX XXX XXX

The Macstrak Project Discharge Diagnosis: Acute MI Unstable Angina Chest Pain NYD CHF Arrhythmia Other Cardiac Problem: ………… Non Cardiac Problem: …..… ………..... Date: 20 Time: CCU Case Study ENC is transferred to a tertiary centre for a cath on 04/03/06 at 09:00. Her discharge diagnosis is Acute Myocardial Infarction and her peak CK is 1086, her peak troponin is 24. She is discharged on the following medications: ASA metoprolol clopidogrel UF heparin pravastatin Day Month Year Peak CK: Trop: X

The Macstrak Project CCU Case Study ENC is transferred to a tertiary centre for a cath on 04/03/06 at 09:00. Her discharge diagnosis is Acute Myocardial Infarction and her peak CK is 1086, her peak troponin is 24. She is discharged on the following medications: ASA metoprolol clopidogrel UF heparin pravastatin Discharged To: Cardiac Ward Med/Surg Ward Step Down Unit CV Surgery Other ICU Other Hospital Home Death Other: Discharge Meds: ASA Clopidogrel (or ticlop.) Heparin (UF or LMW) Nitrates (po/top) B Blocker ACEI A2 Blocker Statin None of Above X X X X X X