Case study – Cheap Research Essays

Written Assignment
You may choose one of the following cases to write a 3000 word case study. In this case
study you must cover the following points:

a Diagnosis; this discussion must look at the given history, signs and symptoms to
make a clear diagnosis. You should include possible differentials diagnoses and
rationale for exclusion (or rationale why you cannot exclude any particular diagnosis).
All your discussion should be referenced.

a Select the most likely diagnosis and discuss the following:

o The epidemiology of the condition and possible contributing factors for its
incidence.
o The pathophysiology of the condition, including likely complications
o The prehospital management of the condition, including evidence to support this
management.
Marks will be deducted for word counts greater than 10% over the limit.
You may use tables to present data, but these should be captioned and explained. The
bibliography/references are not counted in the word count.
Referencing should use either Harvard or APA style.
The marking rubric associated with this assignment should be used as a guide to your
writing.
Case 1: Ryan

You are called at 0125 hrs to a home address to a 3 year old male patient; Ryan,
who is short of breath. When you arrive you find some very anxious parents who tell
you that Ryan is having an asthma attack, and they want you to rush Ryan to hospital
without delay.

Your professional manner and confident demeanour allows you to calm the situation
and allow for some time to ascertain a history and conduct a physical examination.
History: Pre-term birth at 29 weeks; had spent 5 weeks in the neonate intensive care
unit.

Has had several episodes of shortness of breath over the last 3 years, but this
episode is the worst. He had been unwell for two days with a runny nose, earache
and general irritability. He has not been eating and drinking as much as normal and
had vomited earlier in the evening. GP visited yesterday suggested an URTl and
prescribed paracetamol and Demazin Cold Relief Infant Drops 5oml
(Pseudoephedrine and Chlorpheniramine)

Tonight Ryan has progressively become worse with continual irritability, increasing
shortness of breath and fever. Paracetamol and Demazin were last administered at
2330 hrs but do not appear to have relieved Ryan.

Physical examination:

General appearance: pale with slight cyanosis of lips; sitting upright and appears
lethargic; clearly short of breath with sternal and intercostal retraction. Ryan has a
weak cough and is drooling.

Observations:

Go8: 14 – does not clearly answer questions, but obeys requests

HR: 120

BP: 90/45 – but struggles as you inflate the cuff.

Skin: hot, sweaty and pale

Cap refill: >2 sec

ECG: sinus tachycardia

RR: 36;

Spo2: 96%

Chest sounds: some inspiratory stridor and expiratory crackles; shallow breathing
with poor air entry to bases.
Case 2: Sarah

You are called at 0505 hrs to a home address to a 25 year old woman; Sarah, who is
pregnant and has a severe frontal headache. When you arrive the woman’s husband
directs you to the bedroom where you find the woman in bed in a darkened room.
History: First pregnancy; 28 weeks gestation. Has been attending antenatal checks
and has been told that her blood pressure is a little high. Her urine test last week has
shown +ve protein. Her blood group is 0 -ve and she has been screened for
infectious diseases (none present).

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Today her headache began at about midnight, and has gradually become worse. She
also has some niggling pain in her flanks and some lower back pain. Sarah feels
dizzy and unsteady if she sits up. She complains that strong light worsens her pain.
Physical examination:

GCS: 15

HR: 102

BP: 170/100

Skin: pale cold and dry

Cap refill: >2 sec

ECG: sinus tachycardia

RR: 28

SpO2: 97%

Chest: Clear

Abdomen: mostly non-tender, but painful on both flanks

Nil vaginal loss reported

Pain score (frontal headache): 10/10
Case 3: Sylvia

You are called at 2215 hrs to a unit in an aged care facility to Sylvia, an 88 year old
lady who is short of breath. You are met at the door by Sylvia’s husband George,
who directs you to the bedroom where Sylvia is sitting up in bed with some pillows
behind her. You can immediately see that Sylvia is quite distressed and is struggling
to breathe.

History: IHD with L) ventricular failure, type 2 diabetes mellitus, asthma, chronic
obstructive pulmonary disease, OA and OP. She had seen her doctor last Friday and
he was concerned that her breathing was becoming worse. He had referred her to a
cardiologist, but the appointment had not yet happened. George, tells you that she
has been bad at night for the last 2 weeks and gets worse lying down. Sylvia had
been a smoker for much of her life, having ceased smoking only 2 years ago.
Tonight Sylvia has seemed a little worse and has become a little disorientated and
agitated. George became worried because she normally was quite with it. Her
breathing seemed to be worse tonight with more coughing and sputum production.
Physical examination: