Chest pain assessment and management in the Emergency Department

Written Assessment 1 – Case Study Assignment

Length 2000 words

Participants are required to adhere to the following points:

• An introduction and conclusion is not required
• Keep to the recommended word limit for each question
• Support your assignment with a minimum of twenty contemporary (<5 years old) medical and nursing articles
• Reference all work using American Psychological Association (APA) for academic writing
• A pass in all questions is required to gain an overall pass mark
• Refer to the marking criteria for allocation of marks

Case Study

A 52 year old man named Alan presents to a metropolitan emergency department with central, crushing chest pain radiating to his jaw and left arm. His wife noticed that he was looking pale and felt clammy. The pain came on over 5-10 minutes after eating his dinner. Alan says the pain is 9/10 in severity and is associated with nausea and some shortness of breath. His medical history included hypertension and type 2 diabetes mellitus. Alan has smoked 20 cigarettes daily for the past 27 years. His regular medications include Aspirin, Rampipril and Metformin. His Brother has a heart attack at the age of 60 years.

On arrival at the emergency department you observe that Lan is overweight and looks visibly uncomfortable. His observations are as follows:

• Temperature: 36.6 degrees Celsius
• Heart rate: 70bpm, regular
• Blood pressure: 159/88mmHg
• Respiratory rate: 28rpm
• Oxygen saturation: 95% on room air
• GCS: 15, Pupils equal and reactive to light

You perform an ECG:

Question 1:

Assess the ECG and, using a systematic approach, describe and interpret the ECG. Discuss the aetiology and pathogenesis of coronary atherosclerosis and myocardial ischemia in your answer. (600 words)

Question 2:

Alan was administered Aspirin, Glycerine Trinitrate (GTN) and morphine in the emergency department. Discuss the combined physiologic effects of these medicines on the patient with chest pain and the anticipated therapeutic benefits.

Question 3:

Critically appraise and evaluate the care of patients with chest pain in your emergency department with reference to current Australian guidelines.

Answer the following questions: