Case: Problem based learning •
You have been dispatched priority 2 to a residential address at 01.33 for a 21 year old male medical student (Andy) who has woken up with increasing shortness of breath, increased rate and work of breathing, increased heart rate and chest pain. • Andy has not been able to sleep for the last 3 to 4 days, felt faint and nauseous when he tried to get out of bed to go to the bathroom. • The call to the ambulance service was made by the Andy’s house mate and friend (Tim). 
Key headings Case
What do you know? (key information) 
What do you think is happening? (hypothesis) 
What are going to do? (actions) 
What further do you want to know? (further information / history gathering)
THINK ABOUT:
• How would you approach this case?
• What would you say want to know?
• What resources might be needed?
Case • On Arrival •
The house mate (Tim) meets you at door and mentions that Andy seems to be getting worse. The breathing seems to be getting shallower, faster and Andy indicates a feeling of “not being able to catch their breath” • The Tim mentions that Andy does have a history of asthma but as fair as he is aware it is well controlled and he has never seen Andy like this before.
Case •
Tim takes you to Andy who is sitting up in bed, leaning forward and trying breath.
• Appears pale and sweaty
• Facial expression is wide eyed and looks very distressed.
• Vital signs
• GCS: 14
• SaO2: 92% Respiratory rate: 30
• Heart: 110 strong / regular / pounding
• Blood pressure: 140/ 85 ECG: Sinus Tachycardia
• BGL: 3.6mmol
• Pain: 7 / 10

Case •
 What do you know? (key information)
 What do you think is happening? (hypothesis)
 What are going to do? (actions)
 What further do you want to know? (further information / history gathering)
• What do you notice regarding: B – Andy’s behaviour? (his movement, eye contact, mannerisms) A – his appearance; posture; facial expression and demeanour?

Case •
Andy speaks in short, hesitant sentences
• He attempts to take deep breaths but finds its difficult to slow down his breathing
• He is shaking and continually scanning the room
• He conveys that he feels that this is the “end” and he feels as though he is going to lose consciousness and die
• He feels as though the walls are coming in on him
Case •
 What do you know? (key information)
 What do you think is happening? (hypothesis)
 What are going to do? (actions)
 What further do you want to know? (further information / history gathering)
• What can you add to the description of Andy’s
• Behaviour and
• Appearance
• How would you describe the following:
• C – Andy’s speech and conversation
• P – his perception, his view of the world and what is happening at the present moment?
• A – Andy’s description of his mood (how he is feeling) and his outward emotions (affect)
Case •
You find out from Tim (the house mate) Andy has recently broken-up with his long term partner of 3 years • They have 2nd year pathophysiology exams coming up in a month and they both have been studying hard recently. • Andy has told Tim he feels “as though he is falling behind and will not make it “ • Tim mentions he hears Andy up and moving around the house at all hours of the night and when asked says he is trying to sleep but feels he can study more at night to try and catch up (this has been occurring over the last 3 months)

Case •
 What do you know? (key information)
 What do you think is happening? (hypothesis)
 What are going to do? (actions)
 What further do you want to know? (further information / history gathering)
• What can you add to the understanding of Andy’s situation?
• Behaviour and Appearance
• C – speech and conversation • P – his perception, • A – Andy’s description of his mood (how he is feeling) and his outward emotions (affect)
• C- Cognition
• Social and psychological factors
Case Signs and Symptoms