Professional Documents
Culture Documents
02 Acute Asthma Case
02 Acute Asthma Case
$/LWWOH,QIOXHQ]DD%LJ$VWKPD$WWDFN/HYHO,
5HEHFFD63HWWLW3KDUP'0%$%&36%&336
/($51,1*2%-(&7,9(6
$IWHUFRPSOHWLQJWKLVFDVHVWXG\WKHUHDGHUVKRXOGEHDEOHWR
ߧ5HFRJQL]HWKHVLJQVDQGV\PSWRPVRIDQDFXWHDVWKPDH[DFHUEDWLRQ
ߧ)RUPXODWHWKHUDSHXWLFHQGSRLQWVEDVHGRQWKHLQLWLDWLRQRIDSKDUPDFRWKHUDS\SODQXVHGWRWUHDWWKH
DFXWHDVWKPDV\PSWRPV
ߧ,GHQWLI\DSSURSULDWHGRVDJHIRUPVHOHFWLRQEDVHGRQWKHSDWLHQWߞVDJHDELOLW\WRWDNHPHGLFDWLRQRU
DGKHUHQFHWRWHFKQLTXH
ߧ'HWHUPLQHDQDSSURSULDWHKRPHSKDUPDFRWKHUDS\SODQLQFOXGLQJGLVFKDUJHFRXQVHOLQJDVWKHSDWLHQW
QHDUVGLVFKDUJHIURPDKRVSLWDOVHWWLQJ
3$7,(1735(6(17$7,21
&KLHI&RPSODLQW
ߡ0\GDXJKWHUKDVKDGDEDGIHYHUDQGQRZVKHLVKDYLQJWURXEOHEUHDWKLQJDQGDOEXWHUROGRHVQߞWKHOSߢ
+3,
7HUUL&ROOLQVLVDQ\HDUROG$IULFDQ$PHULFDQJLUOZKRSUHVHQWVWRWKH('ZLWKDGD\KLVWRU\RI
IHYHUVPDODLVHDQGQRQSURGXFWLYHFRXJK7KHPRWKHUJDYHDFHWDPLQRSKHQDQGLEXSURIHQWRKHOSFRQWURO
WKHIHYHU0RWKHUVWDWHGWKDWߡDORWRIRWKHUNLGVLQKHUFODVVKDYHEHHQVLFNWKLVIDOOWRRߢ7HUULVWDUWHG
KDYLQJWURXEOHEUHDWKLQJWKHPRUQLQJRIDGPLVVLRQDQGWKHPRWKHUJDYHKHUDOEXWHUROPJYLD
QHEXOL]DWLRQWZLFHZLWKLQDQKRXU7HUULVWLOOVRXQGHGZKHH]\WRWKHPRWKHUDIWHUWKHDOEXWHURODQG7HUUL
VWDWHGLWZDVߡKDUGWREUHDWKߢ7HUULZDVSUHYLRXVO\ZHOOFRQWUROOHGUHJDUGLQJDVWKPDV\PSWRPV3UHYLRXV
FOLQLFQRWHVUHSRUWHGV\PSWRPVGXULQJWKHGD\RQO\ZLWKDFWLYHSOD\DWVFKRRORUDWKRPHDQGUDUH
QLJKWWLPHV\PSWRPV6KHXVHV351DOEXWHUROWRKHOSZLWKV\PSWRPVDIWHUSOD\LQJ+HUDVVHVVPHQWLQWKH
HPHUJHQF\GHSDUWPHQWUHYHDOHG7HUULWRKDYHODERUHGEUHDWKLQJVXFKWKDWVKHFRXOGRQO\FRPSOHWHIRXU
WRILYHZRUGVHQWHQFHV6KHKDGVXEFRVWDOUHWUDFWLRQVWUDFKHDOWXJJLQJZLWKWDFK\SQHDDWEUHDWKVPLQ
+HURWKHUYLWDOVLJQVZHUHDKHDUWUDWHRIESPEORRGSUHVVXUHRIWHPSHUDWXUHRIp&DQG
DZHLJKWRINJ7KHLQLWLDOR[\JHQVDWXUDWLRQZDVDQGVKHZDVVWDUWHGRQR[\JHQDW/PLQYLD
QDVDOFDQQXOD%LODWHUDOH[SLUDWRU\DQGLQVSLUDWRU\ZKHH]HVZHUHQRWHGRQH[DPLQDWLRQ$FKHVW[UD\
UHYHDOHGDULJKWORZHUOREHFRQVROLGDWLRQFRQVLVWHQWZLWKSQHXPRQLDDQGSRVVLEOHHIIXVLRQ$IWHU
UHFHLYLQJWKUHHDOEXWHUROLSUDWURSLXPQHEXOL]DWLRQVKHUEUHDWKVRXQGVDQGR[\JHQDWLRQGLGQRWLPSURYH
VRVKHZDVVWDUWHGRQDOEXWHUROYLDFRQWLQXRXVQHEXOL]DWLRQDWPJKRXUDQGKHUR[\JHQZDVWLWUDWHGWR
/PLQ6KHZDVDOVRJLYHQDGRVHRIPJ,9PHWK\OSUHGQLVRORQHDQGDGRVHRIPJ,9PDJQHVLXP
VXOIDWH7HUULZDVWKHQWUDQVIHUUHGWRWKH3,&8IRUIXUWKHUWUHDWPHQWDQGPRQLWRULQJ
30+
$VWKPDODVWKRVSLWDOL]DWLRQ\HDUVDJRDQGKDVKDGWZRFRXUVHVRIRUDOFRUWLFRVWHURLGVLQWKHSDVW\HDU
)+
$VWKPDRQIDWKHUߞVVLGHRIWKHIDPLO\
6+
/LYHVZLWKPRWKHUIDWKHUDQGWZRVLEOLQJVERWKRIZKRPKDYHDVWKPD7KHUHDUHWZRFDWVDQGDGRJLQ
WKHKRPH)DWKHULVDVPRNHUEXWVWDWHVWKDWKHWULHVWRVPRNHRXWVLGHDQGQRWDURXQGWKHNLGV6KHLVLQWKH
VHFRQGJUDGHDQGLVYHU\DFWLYHRQWKHSOD\JURXQG
0HGV
$OEXWHUROPJQHEXOL]HG4ߙ+351ZKHH]LQJ
)OXWLFDVRQHSURSLRQDWHPFJ0',WZRSXIIV%,'
$FHWDPLQRSKHQPJP/ߚP/4+351IHYHU
,EXSURIHQPJP/ߚP/4+351IHYHU
$OO
1.$
526
)HYHUFRXJKLQFUHDVHGZRUNRIEUHDWKLQJ
3K\VLFDO([DPLQDWLRQ
*HQ
$OHUWDQGRULHQWHGEXWLQPLOGGLVWUHVVZLWKGLIILFXOW\EUHDWKLQJ
96
%337p&552VDWRQ/PLQQDVDOFDQQXOD
6NLQ
1RUDVKHVQREUXLVHV
+((17
1&$73(55/$
1HFN/1
6RIWVXSSOHQRFHUYLFDOO\PSKDGHQRSDWK\
&KHVW
:KHH]HVWKURXJKRXWDOOOXQJILHOGVVWLOOZLWKVXEFRVWDOUHWUDFWLRQV
&9
555QRPUJ
$EG
6RIW171'
([W
1RFOXEELQJRUF\DQRVLV
1HXUR
$ 2QRIRFDOGHILFLWV
/DEV
5HVSLUDWRU\YLUDOSDQHOQDVDOVZDESRVLWLYHIRULQIOXHQ]D$SUREDEO\+1VWUDLQ
&KHVW;5D\
5//FRQVROLGDWLRQ
$VVHVVPHQW
$VWKPDH[DFHUEDWLRQZLWKYLUDOSQHXPRQLD
48(67,216
3UREOHP,GHQWLILFDWLRQ
D&UHDWHDOLVWRIWKHSDWLHQWߞVGUXJUHODWHGSUREOHPV
E:KDWLQIRUPDWLRQVLJQVV\PSWRPVODERUDWRU\YDOXHVLQGLFDWHVWKHVHYHULW\RIWKHDFXWHDVWKPD
DWWDFN"
'HVLUHG2XWFRPH
:KDWDUHWKHDFXWHJRDOVRISKDUPDFRWKHUDS\LQWKLVFDVH"
7KHUDSHXWLF$OWHUQDWLYHV
D:KDWQRQGUXJWKHUDSLHVPLJKWEHXVHIXOIRUWKLVSDWLHQW"
E:KDWIHDVLEOHSKDUPDFRWKHUDSHXWLFDOWHUQDWLYHVDUHDYDLODEOHIRUWKHWUHDWPHQWRIDFXWHDVWKPD"
2SWLPDO3ODQ
D:KDWGUXJGRVDJHIRUPGRVHVFKHGXOHDQGGXUDWLRQRIWKHUDS\DUHEHVWIRUWKLVSDWLHQWߞVDFXWH
DVWKPDH[DFHUEDWLRQ"
E:KDWRWKHUSKDUPDFRWKHUDS\ZRXOG\RXUHFRPPHQGLQWKHDFXWHWUHDWPHQWRIWKLVSDWLHQW"
&/,1,&$/&2856(
:LWKLQKRXUVRILQLWLDWLRQRIWKHWUHDWPHQWSODQIRUPDQDJHPHQWRIWKHDFXWHH[DFHUEDWLRQ7HUULZDV
VWDEOHHQRXJKWRWUDQVIHUWRWKHJHQHUDOSHGLDWULFIORRU+HUYLWDOVLJQVZHUH%33557
p&DQG2VDWRQ/PLQQDVDOFDQQXOD0RWKHUVWDWHVWKDWVKHLVDEOHWRVSHDNLQIXOOVHQWHQFHV
QRZDQGQRORQJHUVHHPVWRKDYHWURXEOHEUHDWKLQJ
F:KDWGUXJGRVDJHIRUPGRVHVFKHGXOHDQGGXUDWLRQRIWKHUDS\DUHEHVWIRUWKLVSDWLHQWߞVGLVFKDUJH
SODQ"
2XWFRPH(YDOXDWLRQ
D2QFHWKHSDWLHQWKDVWUDQVIHUUHGWRWKHJHQHUDOPHGLFDOIORRUDQGKHUYLWDOVKDYHLPSURYHGVHHWKH
VHFWLRQߡ&OLQLFDO&RXUVHߢZKDWFOLQLFDODQGODERUDWRU\SDUDPHWHUVDUHQHFHVVDU\WRHYDOXDWHWKH
WKHUDS\IRUDFKLHYHPHQWRIWKHGHVLUHGWKHUDSHXWLFRXWFRPHDQGWRGHWHFWRUSUHYHQWDGYHUVHHIIHFWV
DWWKDWSRLQWLQWKHSDWLHQWߞVFDUH"
E:KDWFOLQLFDOSDUDPHWHUVDUHQHFHVVDU\WRHYDOXDWHWKHHIILFDF\RIWKHSDWLHQWߞVDVWKPDWKHUDS\DIWHU
KRVSLWDOGLVFKDUJH"
3DWLHQW(GXFDWLRQ
D:KDWVKRXOGWKHIDPLO\PRQLWRUIRUUHJDUGLQJWKHSRWHQWLDODGYHUVHHIIHFWVIURPWKHGUXJWKHUDS\DQG
KRZVKRXOGWKH\EHFRXQVHOHGRQWKHXVHRIWKHDVWKPDPHGLFDWLRQVHVSHFLDOO\UHJDUGLQJWKH
GLIIHUHQFHVEHWZHHQTXLFNUHOLHIDQGFRQWUROOHUPHGLFDWLRQV"
E'HVFULEHWKHLQIRUPDWLRQWKDWVKRXOGEHSURYLGHGWRWKHIDPLO\UHJDUGLQJPHGLFDWLRQGHOLYHU\
WHFKQLTXHDQGSRVVLEOHDVWKPDWULJJHUV
)2//2:8348(67,216
6KRXOGDQ\FRXJKDQGFROGSURGXFWVEHXVHGIRUDVWKPDV\PSWRPV":K\RUZK\QRW"
:KDWLQIRUPDWLRQVKRXOGEHJLYHQWRSDWLHQWVIDPLOLHVUHJDUGLQJLQIOXHQ]D"
:KDWLQIRUPDWLRQFDQEHJLYHQWRIDPLOLHVZKRDUHFRQFHUQHGDERXWJLYLQJWKHLUFKLOGߡVWHURLGVߢIRU
DVWKPDWUHDWPHQWHLWKHULQDQDFXWHDVWKPDH[DFHUEDWLRQRUIRUFRQWUROOHUWKHUDS\"
6(/)678'<$66,*10(176
5HVHDUFKWKHHIILFDF\RIV\VWHPLFFRUWLFRVWHURLGVIRUWUHDWPHQWRIDFXWHDVWKPDH[DFHUEDWLRQZKHQ
JLYHQLQWUDYHQRXVO\YHUVXVRUDOO\HQWHUDOO\
'LVFXVVWKHGLIIHUHQFHVLQDFXWHDVWKPDH[DFHUEDWLRQV\PSWRPVLQDQDGXOWSDWLHQWYHUVXVDSHGLDWULF
SDWLHQWDQGGHVFULEHZKHQ\RXZRXOGUHIHUDSDWLHQWRUIDPLO\WRWKHSK\VLFLDQRUHPHUJHQF\
GHSDUWPHQWEDVHGRQDQLQGLYLGXDOL]HGDVWKPDDFWLRQSODQ
'LVFXVVWKHDSSURSULDWHXVHRI,9PDJQHVLXPLQDQDFXWHDVWKPDH[DFHUEDWLRQ
&/,1,&$/3($5/
)RUSURSHUWUHDWPHQWRIDQDFXWHDVWKPDH[DFHUEDWLRQWKHSDWLHQWRUIDPLO\QHHGVWREHDZDUHRIWKHILUVW
V\PSWRPVRIDQH[DFHUEDWLRQDQGSRVVLEOHWULJJHUV$WWKLVSRLQWWKHSDWLHQWIDPLO\VKRXOGLQLWLDWHKHU
DVWKPDDFWLRQSODQWRPLQLPL]HWKHV\PSWRPVGXUDWLRQRIGUXJWKHUDS\DQGVHYHULW\RIWKHH[DFHUEDWLRQ
7KLVLQWXUQVKRXOGGHFUHDVHWKHQXPEHURIVHYHUHH[DFHUEDWLRQVDQGKRVSLWDODGPLVVLRQV
$&.12:/('*0(17
6SHFLDOWKDQNVWR-HQQLIHU'RQDOGVRQ3KDUP'IRUKHUFRQWULEXWLRQLQWKHLQLWLDOGHYHORSPHQWRIWKLVFDVH
5()(5(1&(6
%DVQHW60DQGHU*$QGRK-HWDO6DIHW\HIILFDF\DQGWROHUDELOLW\RIHDUO\LQLWLDWLRQRIQRQLQYDVLYH
SRVLWLYHSUHVVXUHYHQWLODWLRQLQSHGLDWULFSDWLHQWVDGPLWWHGZLWKVWDWXVDVWKPDWLFXVDSLORWVWXG\
3HGLDWU&ULW&DUH0HGߙ
1DWLRQDO$VWKPD(GXFDWLRQDQG3UHYHQWLRQ3URJUDP([SHUW3DQHOUHSRUWJXLGHOLQHVIRUWKH
GLDJQRVLVDQGPDQDJHPHQWRIDVWKPD%HWKHVGD0'1DWLRQDO,QVWLWXWHVRI+HDOWK$YDLODEOHDW
KWWSZZZQKOELQLKJRYJXLGHOLQHVDVWKPDDVWKJGOQKWP$FFHVVHG0DUFK
$OGLQJWRQ6%HDVOH\5$VWKPDH[DFHUEDWLRQVDVVHVVPHQWDQGPDQDJHPHQWRIVHYHUHDVWKPDLQ
DGXOWVLQKRVSLWDO7KRUD[ߙ
$QGUHZ70F*LQWHH(0LWWDO0.HWDO+LJKGRVHFRQWLQXRXVQHEXOL]HGOHYDOEXWHUROIRUSHGLDWULF
VWDWXVDVWKPDWLFXVDUDQGRPL]HGWULDO-3HGLDWUߙ
9H]LQD.&KDXKDQ%)'XFKDUPH)0,QKDOHGDQWLFKROLQHUJLFVDQGVKRUWDFWLQJEHWDDJRQLVWV
YHUVXVVKRUWDFWLQJEHWDDJRQLVWVDORQHIRUFKLOGUHQZLWKDFXWHDVWKPDLQKRVSLWDO&RFKUDQH
'DWDEDVH6\VW5HYߙ
5RZH%+&DPDUJR&$7KHUROHRIPDJQHVLXPVXOIDWHLQWKHDFXWHDQGFKURQLFPDQDJHPHQWRI
DVWKPD&XUU2SLQ3XOP0HGߙ
.RNRWDMOR6'HJQDQ/0H\HUV5HWDO8VHRILQWUDYHQRXVPDJQHVLXPVXOIDWHIRUWKHWUHDWPHQWRIDQ
DFXWHDVWKPDH[DFHUEDWLRQLQSHGLDWULFSDWLHQWV-3HGLDWU3KDUPDFRO7KHUߙ
/LQN+:3HGLDWULFDVWKPDLQDQXWVKHOO3HGLDWU5HYߙ
5DQN0$/L-7&OLQLFDOSHDUOVIRUSUHYHQWLQJGLDJQRVLQJDQGWUHDWLQJVHDVRQDODQG+1
LQIOXHQ]DLQIHFWLRQVLQSDWLHQWVZLWKDVWKPD-$OOHUJ\&OLQ,PPXQROߙ