1. The Macstrak Project ER 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 ER Case Study

3. The Macstrak Project ER Case Study DRB is a 76 year old male (13/02/30) who had a large anterior infarction 3 years ago.

4. The Macstrak Project ER Case Study DRB is a 76 year old male (13/02/30) who had a large anterior infarction 3 years ago. On 15/3/06: 17:30DRM experiences a new onset of shortness of breath (SOB) with minimal exertion while at home. The dyspnea was increasing and he decides to present to the ER.

5. The Macstrak Project ER Case Study 18:30Arrives in the ER (non EMS) with persistent SOB. 18:40Triaged level III. 18:45Nursing assessment reveals that DRB has gained 3 kg with peripheral edema over the past week and has had increasing dyspnea on exertion. Tonight, his dyspnea worsened and progressed to dyspnea at rest. He denies chest pain. On examination, his BP is 140/90 and his HR is 110. On ausculation, he has mod/severe rales bilaterally.

6. The Macstrak Project ER Case Study 18:55ECG shows Left Bundle Branch Block (LBBB). 19:00Seen by the ER MD who orders diuretics IV, NTG S/L, routine bloodwork and a chest X-ray. 19:15Chest X-ray confirms pulmonary edema. 20:15DRB’s dyspnea improves following diuresis.

7. The Macstrak Project ER Case Study 20:20ER MD decides DRB should be admitted to the ward. 22:00Admitted to the ward service in stable condition with CHF.

8. The Macstrak Project Centre: Date: 20 Day Month Year Patient Initials: F M L Birth Date: 19 Day Month Year Gender: Male Female ER Case Study DRB is a 76 year old male (13/02/30) who had a large anterior infarction 3 years ago. D R B 13 02 30 ER MACSTRAK X

9. The Macstrak Project Centre: Date: 15 03 20 06 Day Month Year Patient Initials: F M L Birth Date: 19 Day Month Year Gender: Male Female ER Case Study DRB is a 76 year old male (13/02/30) who had a large anterior infarction 3 years ago. On 15/3/06: DRM experiences a new onset of shortness of breath (SOB) with minimal exertion while at home. The dyspnea was increasing and he decides to present to the ER. D R B 13 02 30 ER MACSTRAK X

10. The Macstrak Project ER Case Study Arrives in the ER (non EMS) with persistent SOB. X

11. The Macstrak Project ER Case Study Arrives in the ER (non EMS) with persistent SOB. X

12. The Macstrak Project ER Case Study Triaged level III. X

13. The Macstrak Project VS at Presentation: VS Absent Systolic BP: Dyspnea/Rales: < 100 None 101-130 Mild 131-160 Mod/Severe 161-190 >190 Heart Rate: < 60 61-80 81-100 >100 ER Case Study Nursing assessment reveals that DRB has gained 3 kg with peripheral edema over the past week and has had increasing dyspnea on exertion. Tonight, his dyspnea worsened and progressed to dyspnea at rest. He denies chest pain. On examination, his BP is 140/90 and his HR is 110. On ausculation, he has mod/severe rales bilaterally. X X X

14. The Macstrak Project ER Case Study Nursing assessment reveals that DRB has gained 3 kg with peripheral edema over the past week and has had increasing dyspnea on exertion. Tonight, his dyspnea worsened and progressed to dyspnea at rest. He denies chest pain. On examination, his BP is 140/90 and his HR is 110. On ausculation, he has mod/severe rales. X X X X

15. The Macstrak Project ER Case Study 17:30DRM experiences a new onset of shortness of breath (SOB) with minimal exertion while at home. 18:30Arrives in the ER (non EMS) with persistent SOB. 18:40Triaged level III. 18:45Nursing assessment reveals that DRB has gained 3 kg with peripheral edema over the past week and has had increasing dyspnea on exertion. 19:00Seen by the ER MD who orders diuretics IV, NTG S/L, routine blood work and a chest X-ray. 17:30 18:30 18:40 18:45 19:00

16. The Macstrak Project ER Case Study ECG shows Left Bundle Branch Block (LBBB). X

17. The Macstrak Project ER Case Study 18:55ECG shows Left Bundle Branch Block (LBBB). 18:55

18. The Macstrak Project ER Case Study Seen by the ER MD who orders diuretics IV, NTG S/L, routine bloodwork and a chest X-ray. X

19. The Macstrak Project ER Case Study Seen by the ER MD who orders diuretics IV, NTG S/L, routine bloodwork and a chest X-ray. X

20. The Macstrak Project ER Case Study Admitted to the ward service in stable condition with CHF. X X

21. The Macstrak Project ER Case Study Admitted to the ward service in stable condition with CHF. X

22. The Macstrak Project ER Case Study 20:20ER MD decides DRB should be admitted to the ward. 22:00Admitted to the ward service in stable condition with CHF. X 20:20 22:00