1. The Macstrak Project ER 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.

2. The Macstrak Project ER Case Study

3. The Macstrak Project ER Case Study MBG is a 55 year old male (17/9/50) with no known past medical history. On 10/2/06: 14:10MBG experiences gradual onset of chest pain accompanied by a burning sensation and nausea.

4. The Macstrak Project ER Case Study 15:15Arrives at the ER from work (non EMS) and triaged at level II to the cardiac room. 15:20Nursing assessment reveals persistent midsternal chest pain with a burning sensation and nausea. MBG has had no episodes in the last 24 hours other than his symptoms on presentation. He has, however, experienced the same symptoms 4 or 5 times in the past week but never lasting longer that 10 minutes. He is a nonsmoker and has no history of hypertension. His cholesterol was normal 6 months ago. MBG has 4 older brothers, each free of heart disease. On examination, his BP is 138/70 and his HR is 84. His chest is clear. He is given ASA po.

5. The Macstrak Project ER Case Study 15:271st ECG is normal (No ACS ST-T). 15:30Seen by an ER MD who finds that MBG’s chest pain has resolved. The ER MD orders and IV at TKVO, cardiac bloodwork (including troponin and CK) and and a chest X- ray. 15:40The ER MD decided to keep MBG in the ER for observation. 20:15Repeat ECG and cardiac enzymes are normal, troponin is negative and CK is normal.

6. The Macstrak Project ER Case Study 21:30MBG is discharged home in stable condition with a diagnosis of retrosternal chest pain not yet diagnosed (RSCP NYD) to be followed up by family physician. (Follow up booked.)

7. The Macstrak Project Centre: Date: 20 Day Month Year Patient Initials: F M L Birth Date: 19 Day Month Year Gender: Male Female ER Case Study MBG is a 55 year old male (17/9/50) with no known past medical history. M B G 17 09 50 ER MACSTRAK X

8. The Macstrak Project Centre: Date: 10 02 20 06 Day Month Year Patient Initials: F M L Birth Date: 19 Day Month Year Gender: Male Female ER Case Study MBG is a 55 year old male (17/9/50) with no known past medical history. On 10/2/06: MBG experiences gradual onset of chest pain accompanied by a burning sensation and nausea. M B G 17 09 50 ER MACSTRAK X

9. The Macstrak Project ER Case Study Nursing assessment reveals persistent midsternal chest pain with a burning sensation and nausea. X Nausea X

10. The Macstrak Project ER Case Study Arrives at the ER from work (non EMS) and triaged at level II to the cardiac room. X

11. The Macstrak Project ER Case Study Arrives at the ER from work (non EMS) and triaged at level II to the cardiac room. X

12. The Macstrak Project VS at Presentation: VS Absent Systolic BP: Dyspnea/Rales: < 100 None 101-130 Mild 131-160 Mod/Severe 161-190 >190 Heart Rate: < 60 61-80 81-100 >100 ER Case Study Nursing assessment reveals persistent midsternal chest pain with a burning sensation and nausea. MBG has had no episodes in the last 24 hours other than his symptoms on presentation. He has, however, experienced the same symptoms 4 or 5 times in the past week but never lasting longer that 10 minutes. He is a nonsmoker and has no history of hypertension. His cholesterol was normal 6 months ago. MBG has 4 older brothers, each free of heart disease. On examination, his BP is 138/70 and his HR is 84. His chest is clear. He is given ASA po. X X X

13. The Macstrak Project ER Case Study Nursing assessment reveals persistent midsternal chest pain with a burning sensation and nausea. MBG has had no episodes in the last 24 hours other than his symptoms on presentation. He has, however, experienced the same symptoms 4 or 5 times in the past week but never lasting longer that 10 minutes. He is a nonsmoker and has no history of hypertension. His cholesterol was normal 6 months ago. X X X X X X

14. The Macstrak Project ER Case Study 14:10MBG experiences gradual onset of chest pain accompanied by a burning sensation and nausea. 15:15Arrives at the ER from work (non EMS) and triaged at level II to the cardiac room. 15:20Nursing assessment reveals persistent midsternal chest pain with a burning sensation and nausea. 15:30Seen by an ER MD who finds that MBG’s chest pain has resolved. 14:10 15:15 15:20 15:30

15. The Macstrak Project ER Case Study 1st ECG is normal (No ACS ST-T). X

16. The Macstrak Project ER Case Study 15:271st ECG is normal (No ACS ST-T). 15:27

17. The Macstrak Project ER Case Study Repeat ECG and cardiac enzymes are normal, troponin is negative and CK is normal. X

18. The Macstrak Project ER Case Study Nursing assessment reveals persistent midsternal chest pain with a burning sensation and nausea. He is a nonsmoker and has no history of hypertension. His cholesterol was normal 6 months ago. MBG has 4 older brothers, each free of heart disease. On examination, his BP is 138/70 and his HR is 84. His chest is clear. He is given ASA po. X

19. The Macstrak Project ER Case Study MBG is discharged home in stable condition with a diagnosis of retrosternal chest pain not yet diagnosed (RSCP NYD) to be followed up by family physician. (Follow up booked.) X

20. The Macstrak Project ER Case Study MBG is discharged home in stable condition with a diagnosis of retrosternal chest pain not yet diagnosed (RSCP NYD) to be followed up by family physician. (Follow up booked.) X

21. The Macstrak Project ER Case Study 21:30MBG is discharged home in stable condition with a diagnosis of retrosternal chest pain not yet diagnosed (RSCP NYD) to be followed up by family physician. (Follow up booked.) X 21:30