Screening Adolescent for Heart Risk

Screening Adolescent for Heart Risk

 
paper instructions



Case study #1 – Screening Adolescent for Heart Risk



Patient Name: Chris Brooker, Age 15, male



Height 5’ 11” Weight 178 BP: 115/78 P: 78 RR: 15/min



Chief complaint/reason for office visit: Pre-participation sports examination for basketball season



PMH: (Bulleted format)




·  Mild, intermittent asthma since age 8; uses Albuterol as needed for wheezing and before playing sports. 2 puffs before start of exercise
·  sometimes get short of breath with exercise, but not more than his teammates
·  once felt like he was going to pass out when exercising, but thinks it was due to




dehydration and fatigue because it was during the Hot summer



He wants to play on the city league team. Has been playing on the team since grade school. He has mild, intermittent asthma and uses his Albuterol as needed for wheezing and before playing sports. On history he reports that he sometimes get short of breath with exercise, but not more than his teammates. He also says he once felt like he was going to pass out when exercising, but because it was during the hot summer, he thinks it was due to dehydration and fatigue. He is otherwise well



Family History




·  negative for unexplained sudden deaths in anyone under 50 years
·  Family Hx: DM – MGM; Pat GF: HTN; Pat GM: Breast CA




ROS




·  Not documented - no pertinent positives or negatives
·  HEENT – normal – wears glasses for distance vision since age 5; wears contacts




since age 12




·  Card/Resp – no complaints
·  GI – nausea occasional after
·  GU – deny dysuria, frequency
·  Surgeries: Tonsillectomy age 7
·  NKDA
·  Meds: None




Physical examination – PAY ATTENTION TO HIGHLIGHTED



· normal findings for all systems, except:




·  Cardiac: new soft systolic ejection murmur [never heard before and it is not been documented elsewhere by others in the electronic medical record.
·  What is the best way to screen adolescents to exclude those at risk of sudden cardiac death from athletic participation?
·  In the U.S., the American Heart Association has not recommended the use of the 12- lead EKGs as a screening tool for athletic pre-participation. This is in contrast to other countries, such as Italy and Japan, which have been screening with EKGs for more than 20 years and report data that suggest a decrease in mortality rates from SCD in athletes as a result. Recently, the International Olympic Committee and European Society of Cardiology have recommended the use of the 12-lead EKG as a screen for athletic participation. The AHA has expressed concern about the high false-positive rate of mass EKG screening , as well as the practical implementation and cost-effectiveness of a mass EKG screening program.




In practice, what should the clinician do?



Certain locales, whether as part of a research protocol or through advocacy work, have been able to implement mass-participation EKG screening and place AEDs in high- school athletic venues.



Pay attention to the AHA 12-point screening recommendations and any concerns that arise should prompt further cardiac evaluation.



RUBRIC



Case Study Outline and Rubric



A case study will be presented for the student to resolve.  The case will require the student to reflect and solve a complex acute health issue that incorporates a cultural or ethical dilemma requiring cultural competence, ethical decision making, legal awareness, and patient-centered evidence-based practice. Students will be given a population and clinical course appropriate case study to complete in a minimum of 5 pages and a maximum of 7 pages not including reference and title pages.







Criteria
Possible points
Points awarded


Provide a comprehensive review of the chief complaint, history of presenting illness, review of systems and physical assessment for the health issue
10
 


Provide a list of differential diagnosis and your diagnosis. Discuss the pathophysiology of the most likely health issue presented. 
20
 


Present the social issue(s) including parent al anxiety and how it may conflict with the patient care/health promotion
15
 


Provide patient-centered pharmacological and/or non-pharm solutions to the health issue
20
 


Review and synthesize a comprehensive list of AHA14-point evaluation guidelines for sports participation
15
 


Reflect on recent AHA 14-point pre-participation evaluation. Will you clear this patient to play sport? Yes/No? Support your diagnosis with the guideline
10
 


Spelling, grammar, complete and correctly APA formatted references (include a cover page)
10
 


Total Possible Points
100
 







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