Scenario 5. Cardiac
Description of incident and response
A middle-aged man (54 years) is experiencing severe chest pain in his rural
home. His wife calls 999 at 10:23 as she thinks her husband is having a heart
attack – he has experienced angina periodically for around five years. The
EMDC dispatches a paramedic/trainee crewed ambulance at the same time as
alerting the local Community First Responder (CFR) team. The ambulance is
estimated to arrive in 20 minutes owing to the patient’s rural location – the
First Responders will look after the patient until the ambulance clinicians
arrive. Two local Community First Responders, both with First Person OnScene BASIC training, arrive at 10:30.
dot.rural MIME project (Managing Information in Medical Emergencies) www.dotrural.ac.uk/mime
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Here is a timeline of events and of the patient’s status:
Time
Events and patient status
(after 999 call)
7 minutes
(10:30)
9 minutes
(10:32)
Events: CFRs arrive on-scene, check that it is safe to approach
and carry out an initial global assessment of the patient’s
condition. One CFR applies a lightweight sensor that records
the patient’s ECG (3 lead), heart rate, breathing rate, blood
pressure and blood oxygen saturation.
Primary survey: alert, airway clear (talking), breathing rate 18
breaths per minute, pulse 100 beats per minute, blood pressure
100/65, oxygen saturation is 92 % on air. Capillary refill –
SLOW (around 4 seconds). Facial appearance – PALE. Patient
has had significant central chest pain and tightness for the past
30 minutes, which is radiating down his left arm.
Events: CFRs apply a non-rebreathing mask and O2 is applied at
15 ltrs/min. The patient has experienced angina periodically for
the last five years – he has no other known medical problems.
He has been prescribed a GTN spray, which he uses only when
his angina flares up. He has no known allergies.
On advice from a paramedic advisor the CFRs encourage the
patient to take his GTN spray, which he has with him.
12 minutes
(10:35)
15 minutes
(10:38)
20 minutes
(10:43)
Events: Patient feels faint – the CFRs move the patient from a
chair to lying down.
Events: Patient’s chest pain suddenly worsens – he vomits.
Events: Ambulance crew arrives – CFRs give a verbal and
written handover. Monitor remains attached until more
advanced monitoring (i.e. 12 lead ECG) is ready.
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Physiologic data from the sensor
Time from
start of
monitoring
(real time)
1 minute
(10:31)
2 minutes
(10:32)
3 minutes
(10:33)
4 minutes
(10:34)
5 minutes
(10:35)
6 minutes
(10:36)
SYSTEM
ALERTS
Breathing
rate (breaths
per minute)
Heart rate
(beats per
minute)
Blood
oxygen
saturation
(%)
Blood
pressure
(mmHg)
18
100
92 %
(on air)
100/65
-
16
104
91 %
(on air)
98/70
-
15
108
96 %
(on O2)
98/65
-
15
112
95 %
(on O2)
92/60
-
-
DATA
UNRELIABLE
-
-
-
Motion?
16
96 %
(on O2)
105
96/65
-
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3
7 minutes
(10:37)
8 minutes
(10:38)
9 minutes
(10:39)
10 minutes
(10:40)
11 minutes
(10:41)
12 minutes
(10:42)
13 minutes
(10:43)
15
-
97 %
(on O2)
107
-
-
109/67
-
-
DATA
UNRELIABLE
Motion?
-
-
-
-
DATA
UNRELIABLE
Motion?
22
108
94 %
(on O2)
100/66
-
20
110
95 %
(on O2)
101/67
-
22
109
94 %
(on O2)
103/70
-
23
111
95 %
(on O2)
97/70
-
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Here are some graphs of the data from the sensor:
30
BREATHING RATE
24
24
25
23
Breathing rate (breaths per minute)
22
20
20
18
17
18
17
17
15
DATA
UNRELIABLE!
DATA
UNRELIABLE!
10
5
0
1
2
3
4
5
6
7
8
9
10
11
12
13
110
109
111
11
12
13
Monitoring time (min)
220
HEART RATE
200
180
Heart rate (beats per minute)
160
140
120
100
104
108
112
105
108
107
100
80
DATA
UNRELIABLE!
60
DATA
UNRELIABLE!
40
20
0
1
2
3
4
5
6
7
8
9
10
Monitoring time (min)
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5
100
97
96
96
On O2
92
Blood oxygen saturation (%)
91
90
On
Air
On O2
On
Air
95
95
95
95
94
On O2
On O2
On O2
DATA
UNRELIABLE!
94
On O2
On O2
On O2
DATA
UNRELIABLE!
85
BLOOD OXYGEN SATURATION
80
75
70
1
2
3
4
5
6
7
8
9
10
11
12
100
101
103
99
67
66
67
10
11
13
Monitoring time (min)
150
BLOOD PRESSURE
140
130
120
110
100
98
98
Blood pressure (mmHg)
100
96
97
92
90
80
70
70
65
65
65
70
70
12
13
60
60
DATA
UNRELIABLE!
50
40
DATA
UNRELIABLE!
30
20
Blood pressure (systolic)
Blood pressure (diastolic)
10
0
1
2
3
4
5
6
7
8
9
Monitoring time (min)
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