In this case study assessment, you will be presented with a simulated case and asked to write an essay exploring the information provided and link this information to the patient presentation, pathophysiology, and possible treatment from a critical care perspective, with clinical reasoning.

Case Description

You are presented with a 40-year-old male patient post-motorcycle accident. The incident has occurred in a semi-rural setting and you are approximately 25 minutes away from a regional trauma centre. Upon arrival, it appears the patient has veered off the road striking a metal guard rail and is located 20 metres from the road down a moderately slanted gully.

You are a newly qualified Critical Care Paramedic working with a qualified Paramedic. No other ambulance resources are available, although police and fire personnel are adequate. A rotary wing asset with a medical officer is available; however, it will be approximately 45 minutes to your location (from the time of your first observations and situational report).

Observations are:

• GCS- 13 (E3, V4, M6) pupils equal and reactive at six
• Respiratory rate- 26 breaths per minute
• Pulse rate- Weak radial at 120 beats per minute
• Blood pressure- 90/50 mmHg
• ECG- Sinus Rhythm @ 120
• Skin- Pale and cool
• Oxygen saturation- 97% in atmospheric air
• Temperature- 35.4 degrees Celsius
• Blood glucose level- 7.1 mmol/L

Past medical history: Nil stated
Medications: Nil stated
The patient’s estimated weight is 80 kg.
 Physical examination reveals:

• No obvious external trauma to the head. Helmet intact with considerable scuffing
• Minor blood loss from the oral cavity, teeth intact
• Thorax intact with minor abrasions
• Diminished air entry to (L) side
• Abdomen soft upper with left upper quadrant tenderness (significant distress on palpation)
• The right lower limb is at greater than 90-degree angulation laterally with gross tissue destruction to the upper and lower muscle masses. There is no pedal pulse located on the limb
• Highly suspected long bone features to the left upper arm 

You are to write an essay (word limit 2500 words) addressing the following components:

• Articulate your initial impression and provisional diagnosis based on the information provided.
• Discuss the pathophysiology and identify your treatment priorities.
• Discuss your planned treatment and how you anticipate your management will impact the patient’s overall clinical picture.

The case study will be assessed using the rubric provided on the unit Moodle page, covering the following areas:

• Presentation and layout – presentation of material, word count etc.
• Content-based on the set questions provided and the use of supportive evidence-based material
• Referencing – use of Harvard referencing, reference list
• Please save/upload your file in a Word format (.doc or .docx).
   

You must achieve a minimum mark of 50% to pass this assessment.

During the compulsory residential school, you will be required to present a ‘Grand Rounds’ presentation regarding one trauma or environmental patient whom you have attended. This is an in-depth look at the patient from initial presentation through to delivery into tertiary care.

Your Grand Rounds presentation requires you to present a unique trauma or environmental case you have attended, exploring the experience from start to finish. Your PowerPoint and presentation itself will need to address the following key points:

1. Your PowerPoint presentation will detail:

• The initial case details (case type, scene information, mechanism of injury etc.)
• Chief complaint and history of presenting illness or injury
• Allergies, medications, past medical history, including social history
• Assessment (initial/general/focused), any diagnostic values obtained, and findings
• Impression, differential diagnoses and main diagnosis
• Overview of main diagnosis (i.e. pathophysiology, manifestations and how your patient fits the diagnosis)
• Epidemiology of the main diagnosis
• Management & treatment
• Your planned and actual treatment
• Note whether a critical care paramedic was involved in the case
• Reflect on whether you would now choose to do things differently as a process of continuous improvement (this is a crucial area that must be addressed)
• Further care needed in the hospital system (if known)
• Prognosis & outcome (if known)
• Your final thoughts on the case
• References

** a hard copy of your PowerPoint will need to be submitted at the time of presentation**

2. Your ability to do a Questions and Answers (Q&A) session. Both students and assessors will ask you questions following your presentation.

You will be allocated 30 minutes to complete both your presentation and the Q&A session.

Your ‘Grand Rounds’ presentation, PowerPoint and Q&A performance will be marked according to the criteria outlined in the rubric provided on the unit Moodle page, covering areas such as:

PowerPoint – structure, theme & layout, wording style & referencing, imagery & visual aspects
Presentation – case details, chief complaint, previous history, assessment of presenting condition, integration of diagnostics and main diagnosis; management and treatment; reflection; relevance and timing
Q&A – ability to appropriately answer questions in a timely manner
You must achieve a minimum mark of 50% to pass this assessment.

During the compulsory residential school, you will individually complete a practical simulation assessment involving an authentic case of a traumatic or an environmental emergency.

The practical assessment will assess your ability to:

• Apply evidence-based knowledge in the management of trauma & environmental emergencies
• Demonstrate advanced critical care paramedic skills & interventions in the management of traumatic & environmental emergencies
• Communicate effectively & demonstrate leadership

Your practical assessment will be marked according to the criteria outlined in the rubric provided on the unit Moodle page. You will be offered a maximum of two (2) attempts at this assessment.

This is a PASS/FAIL assessment task.

If a critical error occurs during your assessment the assessment will immediately cease, no marks will be awarded and it will result in a failed attempt.

Critical errors in this assessment will be classed as:

• An action that causes immediate harm to yourself, partner, patient or bystanders
• Unsafe use of the defibrillator/not recognising cardiac arrest (>1 minute delay in recognition)
• No or incomplete drug check
• Incorrect sharps disposal
• Performing a skill and/or procedure outside the scope of practice of a critical care paramedic (CCP).