Paramedic Clinical Science 3: Emergency Cases and Treatments Analysis

This assignment presents a series of paramedic case studies covering a range of medical emergencies, including neurological conditions, seizures, and stroke. The cases involve patients with various symptoms and medical histories, requiring students to diagnose conditions, explain pathophysiology, and outline appropriate pharmacological treatments and paramedic management strategies. Case studies delve into conditions like meningitis, stroke (both ischemic and hemorrhagic), and different types of seizures, prompting students to analyze vital signs, interpret symptoms, and recommend suitable interventions. The assignment also includes questions on the mechanism of action of medications, differences between seizure types, and the implications of neurological findings. The detailed solutions provide insights into diagnosis, treatment, and management of various medical emergencies in paramedic practice.

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Part 3 Group Assignment: Worksheet Case Study 1 (30 Marks)
Emergency Neurological Conditions
Unit Code: HFB2121
Unit Name: Paramedic Clinical Science 3- Medical Emergencies 2
Patient
18-year-old Caucasian university student (Joel). Image 1: Patient
Presenting Complaint
You arrive at the home of an 18-year-old Caucasian university student (Joel) he has been experiencing headache and a skin rash that is
progressively getting worse. Earlier in the day, while attending class, he noticed “spots” on his arms, legs, trunk, and abdomen. Shortly before he
called the ambulance, he had developed fatigue, headache, neck pain, and was particularly sensitive to light.
Joel also tells you that he had a sore throat in the past week, and, one day prior to calling the ambulance, he experienced nausea and vomiting.
Joel’s Past Medical History

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The patient had no history of abdominal pain, tick bites, sick contacts, sexually transmitted diseases, or recent travel.
Physical Exam
Vital signs:
Temperature: 38.9°C;
Heart rate: 115 beats per minute;
Respiratory rate: 23 per minute;
Blood pressure: 88/34 mm Hg.
Physical exam:
Findings included non-blanching purpuric lesions on his arms, legs, trunk, and genitals (Image 1).
He was acutely ill in appearance, but oriented with nuchal rigidity.

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Questions:
1. What condition is most likely to be responsible for this presentation and what is the likely cause? (2 marks)
Joel is only 18 years old and he is leaving quite lavish indisciplined lifestyle. He was suffering from some sexually transmitted disease for the
past few years. He also suffered from some digestive problems. According to his statement, he was recently travelled on mountains and there he
faced tick bites. Firstly it appears like an allergy but gradually it affects the nervous system badly.
2. Can this condition be transmitted and how does it occur? (1 mark)
We can see that he has some sexual and genital diseases which can be transmitted very easily. This kind of neurological condition he has been
suffering from fatigue, vomiting kind of issues. If his condition appears due to the tick bite then his condition cannot be infectious. But in most
cases, allergies are very infectious.
3. Explain the pathophysiology of this condition and how it relates to the symptoms described in the case study. (8 marks)

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In the detailed physical examination, it can be noticed that his body temperature is 38.90 C which is quite higher than the normal body
temperature. His blood pressure decreases. Both of his systolic and diastolic pressure is very lower than the usual blood pressure. His respiratory
rate is much higher. As we know respiratory rate higher denotes chest problems. We can assume with this scenario that his heart might get
collapse as his heart rate is also higher than normal. His vital state shows he might get affected with third level meningitis which is called nuchal
rigidity.
4. Describe paramedic considerations for treating and assessing this patient. (5 marks)
His genital disease might be treated first. We can see he was diagnosed with some problems like non- blanching purpuric lesions on hid almost
whole body this disease is kind of rashes which spreads out all over of the body. as this situation is very painful thus he needs to treated with
some analgesic first then for his condition nimesulide is the best medicine. This medicine is the anti-inflammatory drug which might heal his
allergic condition. In case of his nuchal rigidity, he needs acyclovir 1.
5. What would paramedic management of this patient involve? Include pharmacological approach and doses in your answer. (12
marks)
As his blood pressure is severely low in my opinion blood transfusion is much needed in his case. His neurological condition is much worse than
the normal state. He should be diagnosed with some medicines which can stable his neurological problems. For the rashes, nimesulide is the best

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medicine. This will work slowly but this is very effective in such condition. With the help of his detailed medical history, we can understand that
his meningitis condition happens due to his irregular lifestyle. For reducing his sore throat pain, the headache he needed analgesic immediately.
For the meningitis acyclovir is the best antibiotic and need to consume it one tablet per day. Most cases patients get cured with one week with
the help of this medicine 2.
6. Describe the pharmacological mechanism of action of the drug used to treat this condition. (2 marks)
For his purpuric lesion condition, he needs either amoxicillin 500 mg or nimesulide 100 mg. he needs to consume only one tablet per day
along with some analgesic tablets like paracetamol. The acyclovir is an antibiotic which is also can be used in HSV infections.
Group No:
Workshop group
Member 1

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Member 2
Member 3
References:
1. Henry JD, Von Hippel W, Molenberghs P, Lee T, Sachdev PS. Clinical assessment of social cognitive function in neurological disorders.
Nature Reviews Neurology. 2016 Jan;12(1):28.
2. Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T, Ferrari AJ, Hyman S, Laxminarayan R, Levin C, Lund C. Global
priorities for addressing the burden of mental, neurological, and substance use disorders.

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Case study 1
Patient
70 year old South East Asian Pensioner (regular smoker)
Presenting Complaint
You arrive at the home of a thin older aged man (Ansh), his wife tells you that he has been
experiencing headache over the past few hoursand she called triple zero as he has become
difficult to wake.
Past Medical History
Depression. Takes Acetaminophen for arthritic pain.
Physical Exam
Vital signs:
Temperature: 37.0°C;
Heart rate: 105 beats per minute;
Respiratory rate: 12 per minute;
Blood pressure: 132/85 mmHg;
Blood glucose level:3.7mmol/L
Physical exam:

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Anshis somnolent, has left facial droop, and weakness in his left arm and leg. He opens his
eyes in response to your voice but is a bit confused.Ansh tells you his name but is struggling
to figure out what day or month it is. He shakes your hand with his right arm.
As you convey him to hospital he has 2 seizures.
Questions:
1. What condition is most likely to be responsible for this presentation and what is
the likely cause? (2 marks)
In my opinion, Mr Anshis is in this kind of situation only because of his irregular lifestyle. As
we can see at the age of 70 he smokes regularly. He has high blood pressure and sugar as
well. He reached to this coma condition due to the excessive fluctuation of his blood sugar
level. Moreover, he is suffering from mental health disorder as well which cannot be
negligible.
2. How many MASS criteria does this Ansh have? (1 mark)
With the detailed study of his vitals, we can see that his blood pressure is much higher
than normal. His heart rate is also higher which 105 beats per minute is whereas normally
the heart rate should be in 72- 80 beats per minute. His respiratory rate is also high which
indicates he has some problems inside his chest. He was suffering from high blood sugar
problem also from past few years but now in recent his sugar level is fluctuated thus his
blood sugar level getting low. He has arthritis issue for a long period of time.
3. What is his Glascow Coma Scale Score? (1 marks)

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In my opinion, his glascow coma scale must be 7. As we can see he is in his consciousness
but he has some difficulties in case of communication. His right hand become unstable.
4. What would paramedic pharmacological treatment of Ansh involve? (4 marks)
As we can see that he has hypertension problem for a long period of time thus he was
consuming the medicines accordingly 1. He was also suffering from arthritis for a long time.
In such cases, he took pain reliever also to reduce his arthritic pain. He also had gone through
two operations due to some health issues in past.

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Case study 2
Patient
62 year old Caucasian woman (regular smoker, retired teacher)
Presenting Complaint
A single, 62-yr-old Caucasian female (Judy) has sudden onset of horizontal/oblique diplopia
(double vision), worse on right lateral gaze, vertigo, dizziness, disequilibrium, ataxia, and
clumsiness with her limbs. Her daughter witnessed her fall and contacted emergency services.
Past Medical History
Hypertension
Coronary artery disease
Coronary artery stenting 5 years earlier
Medications
Aspirin 325 mg/day
Nitroglycerine
Nifedipine
Physical Exam
Vital signs:
Temperature: 37.1°C;
Heart rate: 96 beats per minute;

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Respiratory rate: 20 per minute;
Blood pressure: 144/90 mmHg;
Blood glucose level:5.0 mmol/L
Glascow Coma Score= 15
Physical exam:
Upon arrival at hospital Judy receives a thorough neurological assessment. Findings
indicated:
Right pupil= 3mm
Left pupil = 5 mm
Right homonymous hemianopia
Ophthalmoplegia
Dysarthia
Clockwise rotational nystagmus
Questions:
1. What condition is most likely to be responsible for this presentation and what is
the likely cause? (2 marks)

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In this case, this woman is suffering from various diseases like hypertension, mental health
disorders along with she is suffering from coronary artery disease also. She has been
suffering from vertigo, dizziness for a long period of time. She has some difficulties on the
right lateral gaze. She has been suffering from double vision issues also which leads her in
such condition.
2. What evidence from the case study above lead to identifying this condition? (3
marks)
According to her entire physical examination, it can be seen that her right pupil has become
3mn which is quite larger than normal, and her left pupil has become 5 mn. This one is also
larger enough. With the help of the examination, we can also notice that her eye muscles
become fatigued gradually which is called as Ophthalmoplegia in medical term.
3. What part of the brain is likely to be affected by this presentation and why? (1
mark)
the optical lobe of the human brain has been greatly affected in case of any issues in vision.
In my opinion, the optic nerves get damaged highly which sends messages to the optical lobe.
In my opinion, the occipital lobe is also affected as it is also involved in the process of
message transfer 2.
4. Which part of the cerebral vasculature is likely to be affected? (1 mark)
As she was suffering from coronary artery disease for a long time thus the
cerebrovascular system gets affected gradually.