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Bahira Ceyhan Case Assignment


  • Mrs Bahira Ceyhan is a 68-year-old female with no known allergies (NKA)


  • Bahira Ceyhan arrived at the Emergency Department at 1030 hrs with central crushing chest pain radiating to her jaw since 1000 hrs.
  • Findings from the 12 lead ECG recorded by paramedics showed ST elevation in leads V2, V3, V4.
  • 300mg Aspirin administered on route to hospital.


  • Hypertension (Captopril 12.5mg bd)
  • Hyperlipidaemia (Simvastatin 40mg nocte)
  • Type 2 Diabetes Mellitus (DM) (diet controlled)
  • Weight: 87kg


  • Airway: Patent
  • Breathing:
    • Respiratory rate 22
    • bilateral air entry
    • breath sounds clear
    • SpO2 on room air 92%
  • Circulation:
    • Sinus Tachycardia 104bpm.
    • BP 152/92.
    • Diaphoretic and peripherally cool.
    • Central crushing chest pain radiating to the jaw.
      • COLDSPA
    • Character: Crushing chest pain
    • Onset: 10am
    • Location: Central, radiating to jaw
    • Duration: Ongoing
    • Severity: 8/10
    • Pattern: At rest, not relieved by SL Anginine Spray
    • Associated symptoms: Diaphoresis
  • Disability:
    • Alert and oriented.
    • Pupils equal and reacting to light (PEARL).
    • Pain score 8/10.
    • Equal strength in all four limbs.
  • Exposure: IVC Left cubital fossa.
  • Fluid:
    • NBM
    • NO IVF


  • Elevated Troponin 35ng/L/troponin
  • 12 lead ECG: ST elevation (>2mm) V2, V3, V4
  • A diagnosis of acute anterior STEMI is made.



  • Supplemental oxygen if SpO2 < 93%
  • Continuous cardiac ECG monitoring
  • 12-lead ECG now, then every 30 minutes
  • Keep in resuscitation bay (Triage category 2)

Blood tests

  • Troponin now, then again in 2 hours


  • Morphine 2.5mg IVI 2/24 (PRN maximum dose 10mg)
  • Nitro-glycerine 600mcg SL (PRN maximum 3 doses); if pain persists, consider IV Glyceryl Trinitrate infusion
  • Clopidogrel 300mg PO STAT
  • Heparin 5000IU IV STAT

As per STEMI reperfusion flowchart

  • Transfer to Cardiac Cath Lab for urgent primary PCI when ready (<90mins)
  • If PCI delayed, give Tenecteplase 45mg IV as per PACSA @ 1130am

Answer the following questions in relation to the case study.

Question 1 two hundred and fifty w

Choose one clinical manifestation from the following list and discuss the related pathogenesis:

  • central crushing chest pain with radiation to the jaw
  • ST elevation
  • elevated Troponin (35ng/L).

Your response should include an accurate and clear explanation of the pathogenesis causing the clinical manifestation of Mrs Ceyhan.

Question 2, five hundred w

Choose one intervention listed in the following table from each of the following categories:

  • non-pharmacological interventions
  • pharmacological interventions
  • reperfusion interventions.

For each intervention provide a rationale for its use as a strategy to manage a patient presenting with STEMI. Support your answer with evidence and/or pathophysiology information.

Non-pharmacological interventions Pharmacological interventions Reperfusion interventions
  • Supplemental oxygen if SpO2 < 92%
  • 12 lead ECG within 10 minutes of arrival and then every 30 minutes
  • Troponin at 0 and 2 hours
  • Morphine 2.5mg IV
  • Nitro-glycerine 600mcg SL
  • Aspirin 300mg
  • Heparin 5000iu IV
  • Clopidogrel 300mg
  • Tenecteplase 45mg IV
  • Primary Percutaneous Coronary Intervention

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