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 dispatched at 1930hrs in a critical care capacity to back up a crew at a 19yo male cardiac arrest post submersion. Bystanders report that the patient appeared to be heavily intoxicated and was seen to be wandering along the riverfront. On their return, the bystanders saw the patient floating in the water and rescued him. Bystander CPR was commenced immediately. They report the patient was submerged for approximately 10 minutes in very cold water. The initial crew have initiated management, and can offer the following information upon your arrival 20 minutes after the initial incident:

• Unknown history or medications, estimated weight 80kg
• Unresponsive, GCS 3 (E 1 V 1 M 1); pupils fixed at 5mm
• Supraglottic airway insitu, ventilated via BVM utilising 100% O₂
• CPR in progress; ECG PEA
• There are course crackles throughout both lung fields; O₂ saturations are unrecordable
• Temperature 29°C
• Physical exam findings - nil obvious trauma

The crew continue with their management while you comprehensively reassess the patient and gain IV access. Upon your assessment, including i-STAT (arterial), you find the following:

• ROSC - ECG sinus bradycardia at a rate of 16 beats per minute
• Unrecordable BP
• pH 7.015
• PCO₂ 97 mmHg
• PO₂ 260 mmHg
• HCO₃ 16 mmHg
• BE (base excess) -10
• Lactate 9.6 mmol/L
• Glucose 17 mmol/L

You are to write an essay (word limit 3000 words +/- 10%) addressing the following components:

• Discuss how the pathophysiology of the case relates to the presenting diagnostic values (either why they are still within normal range or not)
• Discuss your planned treatment and how you expect your management will impact each of these diagnostic values
• Discuss how each of the following treatments would have an impact on the patient’s diagnostic values (only if relative to the diagnostic value) and overall patient condition:

                - Intubation of the patient, then placing them on the ventilator (you will need to include justification for the ventilation settings you select)

                - Regardless of recent ROSC, consideration of the relevant reversible causes of cardiac arrest

                - Normothermic fluid boluses totalling 2 litres of 0.9% Sodium Chloride

                - Warmed fluid boluses totalling 2 litres of 0.9% Sodium Chloride

                - Administration of Sodium Bicarbonate 8.4%

**For each of the above, ensure you re-integrate the pathophysiology of the patient’s presentation back into your discussion, and use relevant evidence-based material to support your arguments**.

This assessment is worth 60% 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

You must achieve a pass mark for each component of this assessment. This assessment is a PASS/FAIL task.

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 20% of your overall mark for this unit. The first quiz must be completed by 2345hrs AEST on the Friday of Week 5; the second quiz must be completed by 2345hrs AEST 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.