Question

You are in the middle of your shift in the coronary care unit (CCU) of a large urban medical center. Your
new admission, C.B., a 47-year-old woman, was just flown to your institution from a small rural community
more than 100 miles away. She had a STEMI (ST segment elevation myocardial infarction) last
evening. Her current vital signs (VS) are 100/60, 86, 14. After you make C.B. comfortable, you receive
this report from the flight nurse: “C.B. is a full-time homemaker with four children. She has had episodes
of 'chest tightness' with exertion for the past year, but this is her first known MI. She has a history of
hyperlipidemia and has smoked one pack of cigarettes daily for 30 years. Surgical history consists of total
abdominal hysterectomy 10 years ago after the birth of her last child. She has no other known medical
problems. Yesterday at 8 pm, she began to have severe substernal chest pain that referred into her neck
and down both arms. She rated the pain as 9 or 10 on a 0-to-10 scale. She thought it was severe indigestion
and began taking Maalox with no relief. Her husband then took her to the local emergency department,
where a 12-lead electrocardiogram (ECG) showed hyperacute ST elevation in the inferior leads II,
III, aVF and V5 to V6. Before tissue plasminogen activator could be given, she went into ventricular fibrillation
(V-fib). CPR was started and when the code team arrived, she was successfully defibrillated after
two shocks. She then was started on nitroglycerin (NTG), heparin, and amiodarone drips. She was given
IV metoprolol and aspirin 325 mg to chew and swallow. This morning her systolic pressure dropped into
the 80s, and she was placed on a low-dose norepinephrine drip and urgently flown to your institution for
coronary angiography and possible percutaneous transluminal coronary angioplasty. Currently, she has
amiodarone infusing at 1 mg/min, heparin at 1200 units/hr, and norepinephrine at 0.5 mcg/kg/min. The
NTG has been stopped because of low blood pressure. Laboratory work that was done yesterday showed
Na 145 mEq/L, K 3.6 mEq/L, HCO3 19 mEq/L, BUN 9 mg/dL, creatinine 0.8 mg/dL, WBC 14,500/mm3, Hct
44.3%, and Hgb 14.5 g/dL.”

Please help me write the SBAR for this case

Answer 1

We have to write the SBAR , situation- background-Assessment- Recommendation, this is the technique that is used to provide a framework of patient's medical condition so that the members of the health care team can communicate eaily though this technique about patient.

SBAB FOR THIS CASE STUDY ;

SITUATION:

I am calling about C.B, 47 year old woman, from a rural community more than  100 miles away from hospital.

The patient's code status is STEM ((ST segment elevation myocardial infarction)).

I have just made an assessment:

Vital signs are: Blood Pressure 100 /60 , Pulse 86 , Respiration 14 .

I am concerned about the ;

systolic Blood pressure is low .

BACKGROUND:

She had chest tightness with exertion and hyperlipidema

Surgical history of abdominal hysterectomy.

She had severe substernal chest pain that referred into her neck and down both arms.

TREATMENT GIVEN -

• she had 12-lead electrocardiogram (ECG) showed hyperacute ST elevation in the inferior leads II II, aVF and V5 to V6.
• given  ventricular fibrillation,
• She was on nitroglycerin (NTG), heparin, and amiodarone drips.
• IV metoprolol and aspirin 325 mg to chew and swallow.

ASSESSMENT:

I thibk the problem is oronary angiography and possible percutaneous transluminal coronary angioplasty.

TREATMENT IN PROGRESS-

• she has amiodarone infusing at 1 mg/min, heparin at 1200 units/hr, and norepinephrine at 0.5 mcg/kg/min.
• NTG has been stopped because of low blood pressure.

- Na 145 mEq/L, K 3.6 mEq/L, HCO3 19 mEq/L, BUN 9 mg/dL,

- creatinine 0.8 mg/dL,

- WBC 14,500/mm3,

- Hct 44.3%, and Hgb 14.5 g/dL.”

RECOMMENDATIONS:

Based on the assesment .I request that

• we continue with medication.
• the patient be transferred out to CCU and moved to gernal unit after three days.
• I ll be in your contact by two weeks about this issue.