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Case Outline

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Submitted By Hannahjayne16
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CASE STUDY 1
Acute coronary syndrome
Patrick Gallagher

Case outline
Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Accident and Emergency Department. On admission, Peter is sweaty, clammy, nauseated and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter’s first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20–30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Peter is immediately triaged and taken to the resuscitation room. You are the receiving nurse.
Observations on admission include:
Respiratory rate: 18 breaths per minute
Oxygen saturations: 95%
Blood pressure: 150/90 mmHg
Pulse: 94 beats per minute
Temperature: 37ºC.
On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior
STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full blood picture (FBP) and highly sensitive troponin T.

1

Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology. A

On admission to Accident and Emergency (A&E), Peter will be assessed using the Manchester
Triage system (Cooke and Jinks 1999) incorporating the ABCDE approach as per the
Resuscitation Council (UK) (2011). The ABCDE assessment and management tool can be applied to all deteriorating or critically ill patients. It is recognized that approximately
30 per cent of people developing a myocardial infarction die before reaching hospital

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