CVA: Storyboard

Cyril Lambert, now 69, goes to see his family physician, Dr. Martin, about recurrent episodes of palpitations with some dizziness and worsening of his breathing. Based on the clinical exam, Dr. Martin diagnoses atrial fibrillation with mild congestive heart failure. He orders a number of investigations, including blood work, an EKG and a chest x-ray. The EKG confirms atrial fibrillation and Dr. Martin starts Cyril on Coumadin. Unfortunately, Cyril is non-compliant with taking his new medications.

Six months later Cyril suffers a significant stroke and is taken to the local community hospital ER by ambulance. He is transferred to a tertiary care hospital in the nearest city where he is admitted for several weeks.

On discharge home, Cyril’s wife Mabel contacts the local Community Care Access Centre (CCAC) to arrange for home care. The CCAC coordinates the services of a team of health care providers, including nurses, practical nurses, dieticians, physiotherapists, speech therapists, occupational therapists, psychologists and social workers.

One year later Cyril continues to smoke and his lung function has progressively deteriorated. He is on continuous oxygen and, with the deficits from his stroke, is able to do very little for himself. After several discussions with his family and Dr. Martin, Cyril creates a patient directive in his EMR against any resuscitation attempts for him, should the situation arise.

Six months later, Cyril develops a respiratory infection and is admitted to the local community hospital. He is not physically able to return home so is admitted to a long term care facility. He dies there two years later.

Encounters

• 7.1.1 EMT
• 7.1.2 Acute Care Hospital Admission
• 7.1.3 CCAC
• 7.1.4 Home Care
• 7.1.5 LTC Facility

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