CAM101CBL2013 Week8ChrisHillary CaseOutline:

Tenyear11and12studentsfromDerwentCollege,alongwithtwoteachers,have beenwalkingandcampinginCradleMountainReserveaspartoftheirOutdoor Educationcourse(seehttp://www.parks.tas.gov.au/index.aspx?base=236and http://www.parks.tas.gov.au/file.aspx?id=6464forinformationaboutthearea). Theywakeonday3tofindthatoneofthestudents,ChrisHillary,isnotinhisbed andnotrespondingtocallsaroundthecampsite.Inaddition,thereisamarked deteriorationintheweather,withthetemperaturearound2degreesC,astrong southwesterlywindandlowcloudcoverwithsomemistonthepeaks. TheteachersarrangethegroupintotwosearchpartiestotrytofindChris.They agreetosettimesforthesearchandsignalstoeachother.Afteraboutanhourone ofthegroupsfindsChrislyinghurt,consciousbutdistressed,atthebottomofa smallcliff.Hehasinjuredhisbackinthefall,havinggotupintheearlymorningwith diarrhoea,andwanderedawayfromthecampsiteinthedark.Hesayshecouldnt findhiswayupthecliff.Heiscoldandshivering,withblueextremities.Heis complainingofthirst,nauseaanddizziness,andseemsalittleconfused. Theteachersprovidefirstaidtreatmentandasmobilephonereceptionispoor,they setoffanEPIRBtoalertauthoritiestotheirposition.Rescueissomewhathampered bytheweather,butafteraboutanotherhourparamedicsarriveviahelicoptertoassessand treatChrisandevacuatehimtohospital.Heisassessedandmanagedforpossibleheadand spinalinjuries,moderatehypothermia(tympanictemperature34.7degreesC),moderate dehydration(BP100/60,PR90regular,respiratoryrate20,mildlyreducedtissueturgor)and normalbloodglucose(4.5mmol/l).Wetclothesareremovedandheiswrappedinaspace blanket.Aspinalboardisappliedbeforeheismovedtothehelicopter.

Rationaleforthecase
Thecaseprovidesanintroductiontotemperaturehomeostasisandanotherexample offluidlossanditseffectonthebody.Studentswillconsidertheroleofhealth professionalsinemergencysituations.Riskmanagementandpreventativestrategies forheatandcoldstressarepresented. Therewillbefurtherdevelopmentofcommunicationskillsinvolvingeffective interviewingskills. Studentswillreflectontheirownrisktakingbehaviouraspartofpersonaland professionaldevelopment.Theethicsconceptsofautonomy,paternalismand informedconsentarerelatedtothecase.

CBLObjectives:
Duringthisweekstudentswill: Translatethepatientnarrativeintoasummarisedformatwithalogical progressionofinformation Explaintheimportanceoftemperaturehomeostasisinthebody Listthepathwaysofheatlossfromthebody,andthephysiologicalresponses toheatloss Describetheeffectofhypothermiaonbasicbodilyfunctions Relatetheconceptsofautonomy,paternalismandinformedconsentbetween thecircumstancesofthecaseandamoregeneralcontext Outlinetheriskfactors,clinicalfeaturesandfirstaidmanagementofhyperthermia

CBLActivitiesandQuestionsMondayTutorial:
1)CaseReviewandCaseQuestions: ReadthecaseandprepareaSUMMARYofthecasefromthepointofviewofamedical studenttravellingwiththeparamedics. Twostudentsfromthegroupwillbeaskedbythetutortoreadouttheirsummariesandthe groupwilldiscussandcometoagreementonwhatneedstobeincludedandwhy. Studentswillbeaskedtohandintheirsummariesforthetutorstomarkandgivewritten feedbackonanindividualbasis.Thisisaformativeassessmentonly. Temperatureregulation/homeostasis Thebodyusuallymaintainsaconstanttemperaturebybalancingheatproductionand heatloss. Whydoesthebodystemperatureneedtobetightlyregulatedwithinafewdegrees? Whataretheinternalandexternalsourcesofheatlossinourbushwalker? OutlineChrisspossiblephysiologicalresponsestocoldexposure. Chrisreportedhavinghaddiarrhoeainthenight.Howmightthishavecontributedtohis physicalstate? HowmighthypothermiaanddehydrationaffectChrisdecisionmakingcapacity? EthicalPractice Duetohypothermiaandmilddelirium,Chrissabilitytoseek,understandandconsentto medicaltreatmentmaybeimpairedhemaybeconsideredtohavereducedcompetence. Inthefollowingsectionconsiderthemorecommonsituationwherethereisno impairmentofthepatientsabilitiesbyeitherphysiological,developmentalorillness processes. Definethetermsautonomyandpaternalism. Whyisautonomyconsideredanimportantethicalprinciple? Howcanwepromoteapersonsabilitytobeselfdeterminingandselfgoverning? Howdoyoufeelwhensomeoneyoucareforisengaginginbehaviourthatislikelyto causeseriousadversehealthconsequences? Howcouldweashealthprofessionalsproducebetteroutcomesforourpatients whentheyareengaginginactivities/behaviourswhichendangertheirhealth? Whataresomereasonsdoctorsmaywishtomakedecisionsfortheirpatients? Isthereeveraroleforpaternalisminmedicalpracticeoraretherealwaysother options?

2)PreparationforCasePresentationsFridaymorning StudentshavebeenallocatedtooneofthetaskslistedAandBonMyLO. PrepareaBRIEF(5minute)summarytopresenttotherestofyourCBLgroup.Therewillbe noelectronicaudiovisualaids,butyouareencouragedtousethewhiteboardorbring alongaidse.g.handoutstoillustrateyourpresentation.Therestofthegroupincludingthe tutorwillaskquestionsandprovideinputandfeedbackattheendofthepresentation. Timelimitsforpresentationswillbestrictlyadheredtosothatallstudentshaveanequal opportunitytopresent. Thefirsttwo(2)presentationsyoudowillbeofaformativenature,allowingyoutoreceive feedbackonyourperformance.Thesecondtwo(2)presentations(inweeks812)willbe summativeandmustbepassedinordertopassCAM101(seeUnitOutline). TheCBLtutorwillmarkthepresentationpass/fail(seeassessmentcriteriasheet)and providefeedback.Eachstudentwillreceiveanindividualassessment.Ifasummative presentationisdeemednottobeapass,thestudent(s)willbeaskedtodoanother (different)presentationinasubsequentweek. YourGroup OnFriday,afterthepresentations,thetutorwillleadadiscussionaboutyourCBLgroup. Howisyourgroupfunctioning?Whatisworkingwell,andwherearethedifficulties? Howcouldthefunctioningofyourgroupbeimproved?