Mr James Holbrook is a 27yr old male who was involved in a Motor Bike Accident. He sustained 4 fractured ribs on the right side.

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Case One

Mr James Holbrook is a 27yr old male who was involved in a Motor Bike Accident. He sustained 4 fractured ribs on the right side.

Observations on presentation-

T 36, PR 98, RR 28, BP 150/80. Oxygen sats are 92% on room air. Patient is complaining of severe pain on right side of chest, 8/10. GCS 15. No other surgical or medical history.

Chest xray showed fractured ribs and right closed pneumothorax, no mediastinal shift.

Case Two

Mr Ronald Jones is a 55 year old male who presents with acute chest pain for the past 2 hours. The pain came on while he was mowing the lawn.

Observations on presentation-

T 35.5, PR 90, RR 20, BP 130/90. Patient is complaining of crushing chest pain, radiating down left arm, pain is 4/10. GCS 15. Nil previous cardiac history, no other medical or surgical history. Patient is 20 kgs overweight and smokes 10 cigarettes per day. Patient is not on any medications.

ECG shows ST elevation in 2 contiguous leads of > 2mm. Mr Jones has been diagnosed with a MI.

Case Three

Mrs Joan Johnson is a 65 year old female who presented with acute abdominal pain. The pain came on yesterday after eating dinner.

Observations on presentation-

T 37.4, PR 96, RR 28, BP 160/80 Patient is complaining of sudden onset upper abdominal pain, that radiates through to the back and is associated with nausea and vomiting. GCS 15. Past history- appendicectomy at age 20. Does not drink alcohol.

Lipase is elevated at 2000. Mrs Johnson has been given a diagnosis of pancreatitis.

Case Four

Mr Robert Holden is an 80 year old male who is on your ward with a fractured right femur that he sustained after a fall at the nursing home. He is awaiting surgery. At 0300 you walk past his bed and find he has laboured breathing.

You do a full set of observations and find T 36.6 and sweating profusely, BP 180/95mmHg, PR 106 and irregular, RR 30 and increased work of breathing. His oxygen sats are 81% on room air. You review his medication chart and see he was charted for 80mgs of Frusemide mane, which was not signed for yesterday. Mr Holden has been diagnosed as having acute pulmonary oedema.

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