1. 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.

2. The Macstrak Project CCU Case Study

3. The Macstrak Project CCU Case Study SJ is a 60-year-old man (14/4/45) with no previous cardiac history but had a mild CVA in 1986 (no sequelae). He is on ASA po OD.

4. The Macstrak Project CCU Case Study SJ is a 60-year-old man (14/4/45) with no previous cardiac history but had a mild CVA in 1986 (no sequelae). He is on ASA po OD. On the morning of 11/02/06 his wife finds him unresponsive in the living room just after 09:00 and calls 911. The ambulance arrives at 09:29 as SJ is beginning to awaken. The paramedics find that his BP is 96/50 and his HR is 40. He is placed on a monitor which shows sinus bradycardia at a rate of 35-40. He is placed on O2 at 2 liters via nasal prongs and an IV of D5W TKVO.

5. The Macstrak Project CCU Case Study SJ arrives in the ER at 09:52. His BP is 86/48, HR 32 and chest is clear. He becomes asystolic with a loss of consciousness. CPR is commenced and epinephrine and atropine are given. After 2 minutes the monitor shows non-conducted P waves with a ventricular response of 25. A transcutaneous pacemaker is placed with a rate set at 70. He is transferred to CCU with a diagnosis of high grade AV block.

6. The Macstrak Project CCU Case Study In CCU he receives a temporary transvenous pacemaker (TTVP) with the rate set at 70. He is alert and responsive and BP is 110/70. He remains stable over the next 12 hours but his underlying rhythm remains sinus bradycardia with AV dissociation and a ventricular response of 45. He has had no chest pain and his CK is negative. The internist feels that SJ needs a permanent pacemaker and the decision is made to transfer him to a regional centre when a bed becomes available.

7. The Macstrak Project CCU Case Study In CCU he receives a temporary transvenous pacemaker (TTVP) with the rate set at 70. He is alert and responsive and BP is 110/70. He remains stable over the next 12 hours but his underlying rhythm remains sinus bradycardia with AV dissociation and a ventricular response of 45. He has had no chest pain and his CK is negative. The internist feels that SJ needs a permanent pacemaker and the decision is made to transfer him to a regional centre when a bed becomes available. On the 13/02/06 at 10:00 SJ is transferred to the regional centre via ambulance for a pacemaker insertion. His discharge diagnosis is high grade AV block.

8. 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 SJ is a 60-year-old man (14/4/45) with no previous cardiac history but had a mild CVA in 1986 (no sequelae). He is on ASA po OD. S J 14 04 45 CCU MACSTRAK X

9. 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 On the morning of 11/02/06 his wife finds him unresponsive in the living room just after 9:00 a.m and calls 911. The ambulance arrives at 09:29 as SJ is beginning to awaken. The paramedics find that his BP is 96/50 and his HR is 40. He is placed on a monitor which shows sinus bradycardia at a rate of 35-40. He is placed on O2 at 2 liters via nasal prongs and an IV of D5W TKVO. S J 14 04 45 CCU MACSTRAK 11 02 06 X

10. 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 SJ is a 60-year-old man (14/4/45) with no previous cardiac history but had a mild CVA in 1986 (no sequelae). He is on ASA po OD. X

11. 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 SJ arrives in the ER at 09:52. His BP is 86/48, HR 32 and chest is clear. He becomes asystolic with a loss of consciousness. CPR is commenced and epinephrine and atropine are started. After 2 minutes the monitor shows non-conducted P waves with a ventricular response of 25. A transcutaneous pacemaker is placed with a rate set at 70. He is transferred to CCU with a diagnosis of high grade AV block. X X

12. The Macstrak Project VS at Presentation: (complete for all patients) Dyspnea/Rales: None Mild Mod/Severe Systolic BP: < 100 101-130 131-160 161-190 >190 Heart Rate: < 80 80-100 >100 CCU Case Study SJ arrives in the ER at 09:52. His BP is 86/48, HR 32 and chest is clear. He becomes asystolic with a loss of consciousness. CPR is commenced and epinephrine and atropine are started. After 2 minutes the monitor shows non conducted P waves with a ventricular response of 25. A transcutaneous pacemaker is placed with a rate set at 70. He is transferred to CCU with a diagnosis of high grade AV block. X X X

13. The Macstrak Project CCU Case Study SJ arrives in the ER at 09:52. His BP is 86/48, HR 32 and chest is clear. He becomes asystolic with a loss of consciousness. CPR is commenced and epinephrine and atropine are started. After 2 minutes the monitor shows non-conducted P waves with a ventricular response of 25. A transcutaneous pacemaker is placed with a rate set at 70. He is transferred to CCU with a diagnosis of high grade AV block. 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

14. 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 In CCU he receives a temporary transvenous pacemaker (TTVP) with the rate set at 70. He is alert and responsive and BP is 110/70. He remains stable over the next 12 hours but his underlying rhythm remains sinus bradycardia with AV dissociation and a ventricular response of 45. He has had no chest pain and his CK is negative. 11 12 13 XXXXX KD AW

15. 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 On the 13/02/06 at 10:00 SJ is transferred to the regional centre via ambulance for a pacemaker insertion. His discharge diagnosis is high grade AV block. Day Month Year Peak CK: Trop: 13 0206 1000 X

16. The Macstrak Project CCU Case Study On the 13/02/06 at 10:00 SJ is transferred to the regional centre via ambulance for a pacemaker insertion. His discharge diagnosis is high grade AV block. 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

17. The Macstrak Project CCU Case Study SJ is a 60-year-old man (14/4/45) with no previous cardiac history but had a mild CVA in 1986 (no sequelae). He is on ASA po OD. 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