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 DWB is a 50 year old (DOB:02/12/55) man with no significant past medical history.

4. The Macstrak Project CCU Case Study At 08:15 on 20/02/06 while at work, DWB experiences a dull pain in his chest accompanied by dizziness and shortness of breath. Fifteen minutes later the pain subsides and he continues with his day. At 09:15 he experiences another episode of chest pain and decides to go to the ER down the street on his way home from work. The chest pain continues throughout the afternoon and he arrives at the ER at 19:30. He is seen by the triage RN on arrival and his vital signs are as follows: BP 132/90, HR 98 and his chest is clear. An ECG at 19:37 reveals 2 mm of ST elevation in leads V 1 - V 4 and Q’s in the same leads. DWB’s pain resolves shortly after arrival in the ER. The ER MD assesses DWB at 19:53 and decides it is too late to treat DWB with a patency intervention.

5. The Macstrak Project CCU Case Study DWB is admitted to your CCU with a diagnosis of Acute Myocardial Infarction. He is started on clopidogrel that evening and is now on 75 mg per day. His CK and troponins are positive that evening and the next day. DWB has no further chest pain or complications while in CCU.

6. The Macstrak Project CCU Case Study DWB is discharged to the cardiac ward on 22/02/06 at 09:30. His discharge diagnosis is Acute Myocardial Infarction and his peak CK is 2052, his peak troponin is 32. He is discharged on the following medications: ASA clopidogrel bisoprolol ramipril simvastatin

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 DWB is a 50 year old (DOB:02/12/55) man with no significant past medical history. D W B 02 12 55 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 CCU MACSTRAK At 08:15 on 20/02/06 while at work, DWB experiences a dull pain in his chest accompanied by dizziness and shortness of breath. Fifteen minutes later the pain subsides and he continues with his day. At 09:15 he experiences another episode of chest pain and decides to go to the ER down the street on his way home from work. 20 02 06 D W B 02 12 55 X

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 DWB is a 50 year old (DOB:02/12/55) man with no significant past medical 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 At 08:15 on 20/02/06 while at work, DWB experiences a dull pain in his chest accompanied by dizziness and shortness of breath. Fifteen minutes later the pain subsides and he continues with his day. At 09:15 he experiences another episode of chest pain and decides to go to the ER down the street on his way home from work. The chest pain continues throughout the afternoon and he arrives at the ER at 19:30. 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 The chest pain continues throughout the afternoon and he arrives at the ER at 19:30. He is seen by the triage RN on arrival and his vital signs are as follows: BP 132/90, HR 98 and his chest is clear. An ECG at 19:37 reveals 2 mm of ST elevation in leads V 1 -V 4 and Q’s in the same leads. DWB’s pain resolves shortly after arrival in the ER. X X X

12. The Macstrak Project CCU Case Study DWB is admitted to your CCU with a diagnosis of Acute Myocardial Infarction. He is started on clopidogrel that evening and is now on 75 mg per day. His CK and troponins are positive that evening and the next day. DWB has no further chest pain or complications while in CCU. 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

13. The Macstrak Project CCU Case Study Symptom Onset : EMS at Scene: Timeline: (AMI pts only - 24 hr clock or > 24 hrs) Hospital Arrival: First ECG: EMS Diagnostic ECG: 0915 At 09:15 he experiences another episode of chest pain and decides to go to the ER down the street on his way home from work. The chest pain continues throughout the afternoon and he arrives at the ER at 19:30. He is seen by the triage RN on arrival and his vital signs are as follows BP 132/90, HR 98 and his chest is clear. An ECG at 19:37 reveals 2 mm of ST elevation in leads V 1 -V 4 and Q’s in the same leads. 1930 1937

14. The Macstrak Project Diagnostic ECG: (ACS pts. only) ST  ST  T  Q No ACS ST-TV 5-6 ……….… … ….. …... PacedII/IIIaVF ….. … ….. ….... OtherV 4 R..done... V 7-9..done... CCU Case Study V 1-4 ………….. …..… …... LBBB IaVL ………... ….…. …… He is seen by the triage RN on arrival and his vital signs are as follows BP 132/90, HR 98 and his chest is clear. An ECG at 19:37 reveals 2 mm of ST elevation in leads V 1 - V 4 and Q’s in the same leads. DWB’s pain resolves shortly after arrival in the ER. X X X

15. The Macstrak Project Reperfusion Therapy: No  Not Indicated:  ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk:  Risk of ICB Risk Other Bleed Other: ……………...... Drug:TNK/rtPA SK r-PA ( reteplase ) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor  blocker IV Clopidogrel Other............................... and/or Primary/Rescue PCI  Here Transfer Reperfusion Therapy Decided by:EP Consultant CCU Case Study Yes  Thrombolysis  Here EMS Other Hosp Dose: (mg/units) Duration: (min) Pt.Weight: (kg) An ECG at 19:37 reveals 2 mm of ST elevation in leads V 1 -V 4 and Q’s in the same leads. DWB’s pain resolves shortly after arrival in the ER. The ER MD assesses DWB at 19:53 and decides it is too late to treat DWB with a patency intervention. X X X X

16. 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 DWB is admitted to your CCU with a diagnosis of Acute Myocardial Infarction. He is started on clopidogrel that evening and is now on 75 mg per day. His CK and troponins are positive that evening and the next day. DWB has no further chest pain or complications while in CCU. 20 21 22 KD AW XX XX XX XXX XX

17. 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 DWB is discharged to the cardiac ward on 22/02/06 at 09:30. His discharge diagnosis is Acute Myocardial Infarction and his peak CK is 2052, his peak troponin is 32. He is discharged on the following medications: ASA clopidogrel bisoprolol ramipril simvastatin Day Month Year Peak CK: Trop: 22 0206 0930 X 2052 32

18. The Macstrak Project CCU Case Study DWB is discharged to the cardiac ward on 22/02/06 at 09:30. His discharge diagnosis is Acute Myocardial Infarction and his peak CK is 2052, his peak troponin is 32. He is discharged on the following medications: ASA clopidogrel bisoprolol ramipril simvastatin 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 X X X X