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 MLA is a 56-year-old man (19/02/50) with no previous cardiac history.

4. The Macstrak Project CCU Case Study MLA is a 56-year-old man (19/02/50) with no previous cardiac history. On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast, irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25. While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He receives metoprolol 5 mg IV with a reduction in HR to 104. He is transferred to your CCU.

5. The Macstrak Project CCU Case Study In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2.

6. The Macstrak Project CCU Case Study In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2. On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin

7. 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 MLA is a 56-year-old man (19/02/50) with no previous cardiac history. M L A 19 02 50 CCU MACSTRAK X

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 On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast, irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25. M L A 19 02 50 CCU MACSTRAK X 15 03 06

9. 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 MLA is a 56-year-old man (19/02/50) with no previous cardiac history. X

10. 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 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25. X X

11. 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 While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He is transferred to your CCU. X X X

12. The Macstrak Project CCU Case Study 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 While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He is transferred to your CCU.

13. 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 is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2. 15 X X X X X KD 1617 X X KD SMSM SMSM

14. 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 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin Day Month Year Peak CK: Trop: 17 0306 0930 X

15. The Macstrak Project CCU Case Study On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin 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