Prevalence, Clinical Features, Diagnosis and Paramedic Management
(Report requires specific Sources- see References) Clinical Report Use Clinical Case below Description: Headache due to cerebral vascular accident (choose hemorrhagic or ischemic)
• 70 yr old female
• Sudden onset of headache, slurred speech and loss of function on left side.
• PR 120; BP 190/100: SpO2 99%ra; patients appears confused; headache.
Develop a clinical report that demonstrates their understanding of the prevalence, clinical features, diagnosis and paramedic management of a typical presentation that they may encounter during their ambulance career.
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See below for full instructions including a format and required content in formation. Guidelines for the Clinical Report The clinical report is to be a maximum of 2000 words (+/- 10% without penalty), excluding tables, graphics, pictures or references. Formatting guidelines The following format should be adopted:
• The clinical case report is to be written in 12 point, Times Roman or Arial font, 1.5 line spacing, left justified.
• Major headings should be typed in bold, with a line space between the heading and the first line of the text.
• A 2.5 cm margin is required at the left and right borders, and at the top and bottom of the page.
• Ensure that you pay attention to spelling and grammar. Marks will be deducted as per the assessment rubric for excessive typographical and grammatical errors The main components of the clinical report Header or footer Page numbers must be included as well as the authors name and course ID as a header or footer Title A brief title is required to indicate the clinical presentation topic on which your case study is based.
List of Key Words
In a table, provide a list of ‘key words’ that you are introducing within your case study i.e. “laryngotracheobronchitis” or “Croup”, as this provides the reader with a clear link to the terminology or content which they can search for further information and/or clarification of the terminology within the Paramedical / Medical databases or a medical dictionary.
This should be about one to two paragraphs and should introduce your case. Statement of intention, what are you going to discuss and how will you give….. to your discussion. You need to clearly identify the areas that you will be focusing on in the case study. Set the scene by giving some background on the topic and should include the information sources that you have sourced and used to present your case. Tips
• Consider the structure of a good introduction. Keep everything brief. A statement on the topic, an overview of the sections that are included in the essay body and a statement on the type of evidence you are going to use.
The following are some key areas that you will be required to discuss within the body of the case study: Prevalence and/or Incidence of the Patient’s Clinical Presentation and relevance to paramedic practice. From the literature, describe the frequency of the clinical presentation. Where appropriate it is important to describe the Australian and/or world morbidity / mortality data and the financial burden on society.
• Try and keep the statistics as relevant to Australia as possible.
• Make mention of the financial burden of the disease.
• Make mention of the impact of the disease on the role of paramedics and the ambulance service within the health system. The Patient’s Clinical Presentation In this section you will describe and examine the typical clinical presentation of the patient including clinical examination, full vital signs, findings and any relevant comorbidity factors such as family History and how these factors could affect the patient’s health outcome.
• Look in your textbook for a description, aetiology factors and differential diagnosis pattern e.g. cause; onset of pain; characteristics of pain; location of pain; history; pain increased/relieved by; other symptoms normally associated with this presentation.
• Explain why the patient presents with these symptoms or why typical presentations may vary. Aetiology and Pathophysiology of Case Presentation Identify the causal effects and the relevant underpinning disease processes involved in the patient’s clinical condition.
• In most cases, try to begin the aetiology sentence with ‘this disease is caused by…”
• Try and make the description of pathophysiology flow as much as possible. ‘This occurs which causes this which leads to this etc…’
• Although it occurs to some degree in all areas of medicine, treatments are the areas where more research is needed. It is not enough to find one text book or article that describes the pathophysiology this may cause many students to misinterpret the information which will present out of context, or may transcribe information without truly understanding it.
• Source at least three different texts or articles that describe a pathophysiology or pharmacology and that way you have a greater chance of really understanding it in depth. If it is still vague, ask a lecturer or mentor.
• Explain what you know to friends and family. Even if they are not clinicians, teach them about what you know. It helps to consolidate the information. Then start to write. The whole point of these essays is to understand, not to write.
• When you do use 3 sources for one point, cite all of them. It shows the marker that you have researched well and therefore, hopefully, understood. Pre-hospital Management Provide an overview of the prehospital patient management required for this patient.
• It is ok to use the CPM to say how you would treat the patient as a large percentage of you will end up Queensland Ambulance Service, however always use something else to justify why. Find the evidence the CPM uses to make its decisions.
The best approach to the treatment section (in my opinion) is to list all the treatment options that are available for this condition/patient. Then explain, at a cellular level if possible, how each of them work and also provide as much evidence as possible to support their use. If there is conflicting evidence then include that also.
• Don’t forget ICP’s as a consideration in treatment and state what benefit they may bring to the case. Conclusion The conclusion is developed to recap on the significant learning outcomes of the case study and should be only a paragraph in length.
• Show your readers what you have learnt and why this report was important. Show the reader that your clinical report was meaningful and how it will be useful to your future paramedic practice.
• Synthesize, don\’t summarize: Don\’t simply repeat things that were in your report. They have read it, show the reader how the points you made and the supporting examples you used fit together.
• Give your reader something to think about, perhaps a way to use your knowledge in the \”real paramedic\” world. General Tips
• Have somebody proof read the report, preferably someone with a clinical background and skills in academic writing. Give them the question and the marking criteria. Even if they have no background of relevance, have someone read it anyway. Grammar errors are a common problem and another reader can help to identify such error in your writing.
• Consider the depth. If you don’t understand what you’ve read, don’t write it down. Read from multiple sources, discuss it if you wish and understand it fully. Then go about writing in your words (still cite it though).
• Consider how you set it out. There are guidelines given regarding font, spacing and size and it makes it much easier for the assessor to read if it is set out correctly. References Please use a Harvard referencing style, the main key is that you are consistent in your referencing style throughout the Clinical Case Report. Tips
• Every fact needs referencing in text. Leave no fact uncited. Do not cite the end of a paragraph. If you got the information from somewhere then reference it.
• Study intensely the style in which you are referencing. There is no excuse for inaccurate uses of citation, please use the USC Referencing: a student’s guide to Harvard style, 4th edition, available at MAPS.
• Aim for one reference for approximately every 100 words of an assignment, which means approximately 20 references in your reference list for a 2000 word fast essay writing service. Include the intext citations wherever necessary.(this is a guide not set in stone)
• Keep the references up to date (<5-10yrs old) where possible and from peer reviewed journals. Not the CPM, except in the section on pre-hospital management
• Include an intext citation for any pictures below.
• If using a website in the reference list, then put in the full and exact web address of the page where the information is displayed, not the home page. Important Note It is preferred that you cite references obtained mainly from primary publications in peer reviewed journals or credible peer reviewed medical practice websites.
It is acceptable to obtain information from relevant review articles and from clinical text books for definitions of pure anatomy and physiology information, but do not rely too heavily on these sources. All reference material including web sites that are reported, cited or utilised to formulate your ideas should be referenced carefully. Please see below a detailed list of resources.
Some of these are directly relevant to your report; others will help you gain a better understanding of your chosen topic prior to writing your clinical report. Note that the sources below are NOT recorded in Harvard style, you will need to convert to Harvard style any that you use in your clinical report. HEADACHE DUE TO CEREBRAL VASCULAR ACCIDENT
• National Stroke Foundation, 2012. National Stroke Week 10-16 September 2012.Australia. <http://strokefoundation.com.au/national-stroke-week/>
• Hunter New England: Strategic and Clinical Services Planning Unit, 2008. HNE Health Stroke Services Plan 2008 – 2012. Hunter New England, New Lambton, NSW. • American Stroke Association, 2012. Dallas, Texas. •
• Australian Institute of Health and Welfare, 2011. Cardiovascular Disease: Australian Facts 2011. Cardiovascular disease series. Cat no. CVD 53. Canberra: AIHW.
• Australian Institute of Health and Welfare (AIHW): O’Brien K, 2005. Living dangerously. Australians with multiple risk factors for cardiovascular disease. AIHW cat. no. AUS 57.Canberra: AIHW.
• Australian Institute of Health and Welfare (AIHW) & Senes S, 2006. How we manage stroke in Australia. AIHW cat. no. CVD 31. Canberra: Australian Institute of Health and Welfare
• Brain Foundation, 2012. Subarachnoid Haemorrhage. Headache Australia. <http://brainfoundation.org.au/a-z-of-disorders/53-subarachnoid-haemorrhage >
• Carroll, P, 1997. Pulse Oximetry – At Your Fingertips. RN, vol. 60, no.2,
• David B. Matchar, Douglas C. McCrory, Henry J. M. Barnett, John R. Feussner 1994. Medical Treatment for Stroke Prevention. Annals of Internal Medicine. vol. 121, no. 1,
• Dewey, H, Thrift, A, Mihalopoulos, C, Carter, R, Macdonell, R A L, McNeil, J J & Donnan, G A, 2001. Cost of stroke in Australia from a societal perspective. Results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke: Journal of American Heart Association. vol. 32,
• Dewey, H, Thrift, A, Mihalopoulos, C, Carter, R, Macdonell, R A L, McNeil, J J & Donnan, G A 2003. Lifetime cost of stroke subtypes in Australia. Findings from the North
• East Melbourne Stroke Incidence Study (NEMESIS). Stroke: Journal of American Heart Association. vol. 34,
• Di Carlo, A, Lamassa, M, Baldereschi, M, Pracucci, G, Basile, A, Wolfe, C, Giroud, M, Rudd, A, Ghetti, A & Inzitari, D, 2003. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke, vol. 34, no. 5,
• Easton, D J, Saver, J L, Albers, G W, Alberts, M J, Chaturvedi, S, Feldmann, E, Hatsukami, T S, Higashida, R T, Johnston, S C, Kidwell, C S, Lutsep, H L, Miller, E & Sacco, R L. 2009. Definition and Evaluation of a Transient Ischemic Attack. vol. 40,Available online:http://stroke.ahajournals.org/content/40/6/2276.full.pdf+html
• Fuster, V., Stein, B., & Amboose, J. A. 1990. Atherosclerotic plaque rupture and thrombosis evolving concepts. Circulation, 82,
• Hankey G J, Jamrozik, K, Broadhurst, R J, Forbes, S, Burvill, P, Anderson, C & Stewart-Wynne, E G, 1998. Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke: Journal of American Heart Association. vol. 29, no. 12,
• Hunter New England: Strategic and Clinical Services Planning Unit, 2008. HNE Health Stroke Services Plan 2008 – 2012. Hunter New England, New Lambton, NSW.
• Ingall, T, 2004. Stroke—Incidence, Mortality, Morbidity and Risk. Journal of Insurance Medicine, Vol 36,
• Jamrozik K, Broadhurst, R J, Hankey, G J, Burvill, P W, Anderson, C S, 1999. Trends in incidence, severity and short-term outcome of stroke in Perth, Western Australia. Stroke: Journal of American Heart Association. vol. 30,
• Maggiore, A W 2012. ‘Time is Brain’ in prehospital stroke treatment. June 4.
• Millin, G, Gullett, T & Daya M, 2007. EMS Management of Acute Stroke – Out-of-Hospital Treatment and Stroke System Development. Prehospital Emergency Care, vol 11, no 3,
• National Stroke Foundation, 2012. National Stroke Week 10-16 September 2012.Australia. <http://strokefoundation.com.au/national-stroke-week/>
• Perry, M H, Davis, B R, Price, T R, Applegate, W B, Fields, W S, Guralnik, J M, Kuller, L, Pressel, S, Stamler, J & Probstfield, J L, 2000. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke. Journal of the American Medical Association. vol. 284, no. 4
• Porth, C. M. & Matfin, G. 2009. Pathophysiology: concepts of altered health states (8th ed.). New York: Lippincott Williams & Wilkins.
• Ropper, A H & Samuels, M A, 2009. Adams and Victor’s principles of neurology 9th ed. McGraw-Hill, New York, • Sandercock, P, Collins, R, Counsell, C & Farrell, B, 1997. The International Stroke Trial (IST): A randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke. The Lancet, vol. 349, no. 9065,
• Streat, S & Silvester, W, 2001. Organ donation in Australia and New Zealand – ICU Perspectives. Journal of Critical Care and Resuscitations. vol.3, no. 1,
• Tan, Y & Christensen, M, 2012. The pathophysiology of ischemic stroke: Considerations for Emergency Department Advanced Practice Nursing. Singapore Nursing Journal. vol.39, no 2,
• Thompson, J F, Hibberd, A D, Mohasci, P J, 1995. Can cadaveric organ donation rates be improved? Anaesthesia Intensive Care. vol. 23, no. 1,
• Thrift A G, Dewey H M & Macdonell R A L, 2000. Stroke incidence on the east coast of Australia: the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke, vol. 31,
• Thrift A G, Dewey, H M, Madconell, R A, McNeil J J, Donnan, G A, 2000. Stroke incidence on the east coast of Australia. Stroke: Journal of American Heart Association. vol. 31,
• Toole, J F, 1999. Brain infarction: Pathophysiology, clinical feature and management cerebrovascular disorders (5th ed.). Philadelphia: Lippincott William & Wilkins.
• US Department of Health and Human Services: National Heart, Lung and Blood Institute, <http://www.nhlbi.nih.gov/about/org.htm >
• Wainman, P, 2011. Transient ischaemic attacks. InnovAiT, Vol. 4, No. 7, Wechsler, L, 2011. Intravenous Thrombolytic Therapy for Acute Ischemic Stroke. The New England journal of medicine, vol. 364, no. 22,
• Wolf, P A, 1998. Prevention of stroke. Lancet vol. 352, sup. 3,
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