Preamble

In this written assessment, you will be presented with a simulated case and asked to write an essay exploring the diagnostic information provided and linking this information back to the pathophysiology, patient presentation and possible treatment, with clinical reasoning.

Task Description

You are working in a rural community and are dispatched at 0230hrs to a high-speed single vehicle motor collision vs. tree. You find a 38yo male ejected from the vehicle with the current information:

• Unknown history or medications, estimated weight 110kg
• Unresponsive, GCS 7
• Airway open, RR at 6/min, HR 138/min, BP 84/44mmHg, Temp 35°C
• Physical exam findings include:
• severe facial trauma with multiple lacerations & abrasions across exposed tissue, with dirt embedded & gurgling in the airway with blood
• early ecchymosis developing
• compound fractures to the left radius/ulna
• shortening of the left leg consistent with a femur fracture and no pedal pulse with some pooling of blood in the dirt (estimated 750 mL)

Diagnostics gained from i-STAT (arterial):

• Sodium - 133 mmol/L
• Potassium - 5.6 mmol/L
• Chloride - 93 mmol/L
• Glucose - 8 mmol/L
• Lactate - 2.9 mmol/L
• Creatinine - 130 umol/L
• pH - 7.3
• PCO2 - 56 mmHg
• PO2 - 64 mmHg
• Haemoglobin - 95 g/L
• Haematocrit - 42%

You are to write an essay (word limit 1500 words) addressing the following components:

1. Integrate and discuss why each of these diagnostics may be at their current values relative to the patient's presentation, injuries and case (either why within normal range or not)
2. Explain how the pathophysiology of the injuries caused the changes (either why they are still in normal range or not)
3. Discuss how each the following treatments changes the diagnostics (only if relative to the diagnostic):

· Fluid boluses totalling 4 litres of 0.9% Sodium Chloride

· Fluid boluses totalling 4 litres of Hartmann's or Compound Sodium Lactate

· Fluid bolus of 2 litres of 0.9% Sodium Chloride and 2 units of packed red blood cells

· Restoration of the pedal pulse through traction of the left leg

· Warming of the patient

· Rapid sequence intubation of the patient, then placing them on a ventilator with the following settings: RR of 16, FiO2 100%, Vt of 500 mL, PEEP 5cm, Pmax 40cm

This assessment is worth 30% of your overall mark for this unit. The written assessment will be assessed using the rubric provided on the unit Moodle page, covering the following areas:

· Presentation & layout – presentation of material, word count etc

· Content – based upon the set questions & use of supportive evidence-based material

· Referencing – use of Harvard referencing, reference list

During the compulsory residential school, you will undertake an assessment task designed to explore your practical and declarative knowledge with regard to prehospital diagnostics learned throughout this unit, including (but not limited to) ultrasound and iStat.

A marking rubric for this assessment task will be provided on the unit Moodle page. Students will have a maximum of two (2) attempts for each component assessed. The assessment will be based on marking criteria covering the following key points:

· Successful completion of each component of the assessment

· Demonstration of each component in a timely manner

· Ability to minimise missed steps or minor errors

To achieve a pass mark in this unit you must achieve a pass mark for each component of this assessment (achieve a minimum of 50% for each assessment component). This assessment is worth 50% of the overall mark for this unit.

You will be required to complete two (2) online quizzes; the first will close at the end of Week 5; the second at the end of Week 12. The quizzes will open on the Friday of the preceding week to when the quiz is due, and each will have a specific time limit imposed.

The quizzes will be made up of multiple choice questions exploring content based upon the previous weeks of content (including lecture materials, online modules, links & required readings). Quizzes are cumulative and content will aggregate across the term. The quiz will assess your ability to integrate clinical history and assessment with physiological systems and distinguish between pathologies and pathophysiology within a clinical context.

You will be required to answer each question to receive the marks allocated to that question. Non-attempts will score a zero mark. Quizzes may not be reattempted. This is an individual assessment with no collaboration allowed.

Each quiz is worth 10% of your overall mark for this unit. The first quiz must be completed by 2345hrs on the Friday of Week 5; the second quiz must be completed by 2345hrs on the Friday of Week 12. In the absence of an approved extension, there will be no opportunity to complete the task after this date, and there will be no opportunity to apply a late penalty of five percent per day.