Chest Pain After Shoveling

TRAINING SCENARIO

Study the structure, quotes, times, negatives, and response — then write your own from the call sheet. Do not paste this as your scored draft.

TRAINING SCENARIO — S: 58 y/o male, estimated 92 kg, English-speaking, GCS 15 / AOx4. Historian: Patient (primary) and spouse (onset and activity). Patient/historian stated "It feels like an elephant sitting on my chest." Chief complaint: Crushing substernal chest pain after shoveling. Onset: Sudden at 09:10 while shoveling the front walk. Provocation/palliation: Began with exertion; sitting still did not relieve; no change with position or breathing. Quality: Crushing pressure; patient says "elephant on my chest". Radiation/location: Left arm to the elbow; denied jaw, back, or right-arm radiation. Severity: 8/10 at first contact; 5/10 after nitroglycerin. Time/duration: Continuous since 09:10; still present at handoff. Signs/symptoms: Pale, cool, diaphoretic, clutching chest, mild nausea, no vomiting. Allergies: no known drug allergies. Medications: Lisinopril 20 mg daily; atorvastatin 40 mg nightly; aspirin 81 mg daily (not taken this morning). Past medical history: Hypertension; CAD with stent 3 years ago; no prior MI by patient report; no diabetes. Last oral: Coffee and toast about 07:30. Events: Shoveled about 15 minutes, sudden pain, walked inside with spouse, 911 at 09:11. Pertinent negatives: denied shortness of breath at onset; no syncope. This TRAINING SCENARIO includes chest pain, shovel, aspirin, nitro. Care included aspirin, nitroglycerin.

O: Location: Private residence, living room (front walk just shoveled). Scene: Cold overcast morning, packed snow on the walk. Patient sitting in a living-room chair, pale, diaphoretic, clutching his chest. Spouse at the door, cooperative. No scene hazards. BLS first-in; ALS on scene one minute later.. Exam: Airway patent; speaking full sentences; Lungs clear bilaterally; no crackles or wheeze; Skin pale, cool, diaphoretic; No JVD, no peripheral edema; Abdomen soft and nontender; No focal neuro deficits; GCS 15. Serial vitals: 09:16 BP 148/92 HR 98 RR 20 SpO2 96% RA; GCS 15, pain 8/10, skin pale, diaphoretic. 09:28 BP 132/84 HR 88 RR 18 SpO2 97% RA; GCS 15, pain 5/10, skin less diaphoretic.

A: Working impression for this TRAINING SCENARIO: Chest Pain After Shoveling — Crushing substernal chest pain after shoveling.

P: Treatments: Position of comfort, seated. Aspirin 324 mg PO chewed at 09:22 — tolerated. Nitroglycerin 0.4 mg SL at 09:25 — pain 8/10 → 5/10; no syncope or hypotension. Oxygen not applied (SpO2 96% on room air). Cardiac monitor en route; ALS transport to PCI center. Response: Pain decreased 8/10 to 5/10 after nitroglycerin. Skin less diaphoretic. Remained AOx4. No hypotension after NTG.. Ambulance transport and monitoring were required; private vehicle was not appropriate. ALS transport lights/siren to PCI-capable ED. Bedside report to charge RN. Spouse followed by POV.