| Course | PA 531 Emergency Medicine |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 530 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 531 Week 1
Week 1 Discussion: Initial Post
One Rule for Sudden Headache, Applied by the Night Nurse to a 52-Year-Old Who Was Shoveling Snow: What the Ottawa Rule Permits, What It Stops and the Patient It Mishandles
The Rule, in One Sentence
For an alert adult with a new, severe headache that peaked within an hour and no new neurological deficit, investigate for subarachnoid hemorrhage if any of these is present: age 40 or older, neck pain or stiffness, a witnessed loss of consciousness, onset during exertion, a headache that peaked instantly, or limited neck flexion on examination. This is the Ottawa subarachnoid hemorrhage rule, which in its validation study identified every patient with a hemorrhage among the more than 2,000 enrolled (Perry et al., 2013).
Applied by Somebody Else
The rule only works if somebody other than its author can apply it at 2 a.m. Our triage nurse used it on A.N., a 52-year-old roofer who arrived at our 40-bed hospital with a headache that started "like a bat hit me" while shoveling heavy snow an hour earlier. A.N. was alert, had vomited once and had no weakness or speech change. The nurse ticked age over 40 and onset during exertion, without needing my judgment. The rule permitted nothing else: A.N. had to be investigated.
One Complaint, Walked Out
For A.N. the rule's output was "investigate," which in our hospital means a noncontrast CT of the head; done within six hours of onset and read by a qualified radiologist, that scan alone is very sensitive for a bleed (Perry et al., 2011). The rule stops two things. It stops discharge after an analgesic and a normal neurological examination, which is the classic way a sentinel bleed is missed. And it stops the reverse error, scanning every headache: a 30-year-old with a gradual headache over a day, typical of that person's migraines, does not enter the rule at all, because the rule applies only to headaches that peaked within an hour.
The Case It Mishandles
The rule mishandles patients it was never built for: anyone with a new focal deficit, a known aneurysm, a prior hemorrhage, a brain tumor or recurrent headaches of the same kind. It also has low specificity; in the validation study most patients the rule flagged did not have a hemorrhage. A rule that sends many patients to CT is acceptable in a hospital with a scanner, but at a clinic two hours away, its many positives would mean many transfers. The rule's authors note that it is meant to be applied by clinicians, not in place of their judgment.
Reply to Hannah
Hannah, your rule for chest pain says "get a troponin." Could the unit clerk apply it without asking you? If not, which part needs judgment? And which patient would your rule send home who should stay?
Reply to Luis
Luis, your rule for dizziness is "MRI if neurological signs." What counts as a sign, and would a patient with isolated vertigo from a small cerebellar stroke, with no limb findings, slip through? That is the case I would like your rule to tell us how to handle.
References
Perry, J. J., Stiell, I. G., Sivilotti, M. L. A., Bullard, M. J., Emond, M., Symington, C., Sutherland, J., Worster, A., Hohl, C., Lee, J. S., Eisenhauer, M. A., Mortensen, M., Mackey, D., Pauls, M., Lesiuk, H., & Wells, G. A. (2011). Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: Prospective cohort study. BMJ, 343, Article d4277. https://doi.org/10.1136/bmj.d4277
Perry, J. J., Stiell, I. G., Sivilotti, M. L. A., Bullard, M. J., Hohl, C. M., Sutherland, J., Emond, M., Worster, A., Lee, J. S., Mackey, D., Pauls, M., Lesiuk, H., Symington, C., & Wells, G. A. (2013). Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA, 310(12), 1248-1255. https://doi.org/10.1001/jama.2013.278018
The Chamberlain PA 531 Week 1 instructions
The opening post in the emergency course asks you to propose a single rule for one complaint and test it. Write the rule as one sentence that someone else, such as a triage nurse or a unit clerk, could apply without you. Show that person applying it to one patient, step by step. Walk the complaint out: what the rule permits for this patient and what it forbids, in both directions, preventing missed diagnoses and preventing over-testing. Then name the case your rule mishandles, the patient it was never built for or the setting where its errors become costly. Keep the post short enough to read on a phone and under your section's word ceiling. Reply to two classmates by supplying a patient their rule would fail.
How the PA 531 Week 1 example is put together
The post states the Ottawa rule in a single sentence and cites the validation study in more than 2,000 patients. The night nurse applies it to A.N., a 52-year-old roofer whose headache hit like a bat while throwing snow, ticking age over 40 and exertional onset. The walk-out ends in a noncontrast CT and cites Perry's six-hour CT sensitivity. Two things the rule stops are named: discharge after analgesia and scanning a gradual migraine-like headache that never enters the rule. A section names patients outside the rule, from focal deficits to known aneurysms, and discusses low specificity in a clinic far from a scanner. Replies ask Hannah whether a clerk could apply her troponin rule and ask Luis how his dizziness rule handles a small cerebellar stroke.
PA 531 Week 1 rubric: what full points look like
Points this week go first to the rule itself. A post without a single-sentence rule, or with a rule that needs the author's judgment to apply, scores lowest. Graders also want to see the rule applied to one complaint by somebody else, step by step. Credit rises when the post shows what the rule permits and what it stops, in both directions. Naming the case the rule mishandles is weighted heavily, since a rule presented without limits cannot be trusted. Citations should support the rule's performance. Length matters: posts over the ceiling are marked down. Replies earn credit when they supply a concrete failure case for a classmate's rule rather than general praise.
PA 531 Week 1 help from the desk
The usual problem with this post is a rule so loose that only its author could apply it. Send the complaint and the scenario your section posted, and a model post would write the rule as one sentence, hand it to another clinician in the scenario and walk the complaint through it. What the rule allows and stops is shown in both directions, and the case it mishandles is named with the reason. Each reply supplies a classmate with a patient their rule would fail. If your complaint is chest pain, syncope or dizziness, the same structure applies with a rule from that field. The length stays within your section's limit, and the scenario details in your post should be your own.
Get a PA-531 Week 1 example written to your instructions
Send the assignment as your classroom posts it, with the word ceiling and the reply count, and a custom PA-531 Week 1 post is written to it and returned inside 24 to 48 hours. There is no charge for the first. The scenarios are made up for the page, and no record from a real department is used to build one.
More PA 531 papers and MPAS samples
- PA 531 Week 2: Chief Complaint Brief
- PA 531 Week 3: Triage Sorting Exercise
- PA 531 Week 4: Worst-first Differential
- PA 531 Week 5: Stabilization Sequence Write-up
- PA 531 Week 6: Time-bounded Workup Plan
- PA 531 Week 7: Disposition Decision Write-up
- PA 531 Week 8: Return Precautions Sheet
- PA 530 Week 1: Ankle Mechanism Discussion Post
- PA 528 Week 1: Lesion Localization Post
- PA 526 Week 1: Abdominal Region Discussion Post
- PA 524 Week 1: Filtration Stand-In Discussion Post
PA 531 Week 1 questions, answered
Does the post need a case attached to it?
In most classrooms yes, though it can be very brief. A rule with no patient beside it cannot be shown doing anything, and sections tend to carry a row for application rather than for the statement alone. Two or three lines of complaint, vital signs where the assignment supplies them, and the rule running against that is enough. Send the assignment and the sample matches whatever detail your section allows.
Can the rule come straight out of the reading?
It can start there, and citing where it came from helps. What loses marks is a definition copied across with nothing said about the complaint on the page, because the row being scored is what the rule does, not where it was found. A borrowed sentence that is then narrowed, or shown failing on one case, reads as work. An unmodified quotation reads as filler.
How many replies does Week 1 usually want?
Sections differ, and the number is published in the classroom rather than assumed. Two is common, spread across separate days, with a stated minimum length. The count matters less than what each reply carries: a case the original rule handles badly. A reply agreeing at length scores below a short one that breaks something. Send the reply requirement with the assignment.
Where can I find a free PA 531 Week 1 sample paper?
This page holds a full PA 531 Week 1 post applying the Ottawa subarachnoid hemorrhage rule through a triage nurse, with replies to two classmates.
Which patients does the PA 531 Week 1 rule mishandle?
Patients with new focal deficits, known aneurysms, prior bleeds, brain tumors or recurrent similar headaches, plus many low-risk patients it sends to CT.