Scenario — Chest pain at a fun run — suspected ACS in a young adult female

intermediate Cardiac · Adult · 35yr · female

Patient Information

Dispatch	A 35YO female has self-presented to the FAP at the Riverside Fun Run complaining of chest tightness and shortness of breath after completing the 10km course. (Mia Cartwright)
Patient	Mia Cartwright — 35yr (65kg)
Incident History	Pt completed the 10km run approximately 15 minutes ago. Shortly after finishing she developed central chest tightness and shortness of breath. She initially attributed it to exertion but symptoms have not settled with rest and she became concerned.
Emergency Contact	Daniel Cartwright (Husband) — 0412 883 047

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor or swelling.
Breathing	Shortness of breath present. Respiratory effort slightly increased. Nil audible wheeze or crackles. RR 20.
Circulation	Radial pulse present — regular, moderate strength. Skin pale and diaphoretic. Nil external bleeding.
Disability	GCS 15 (E4V5M6). Alert and orientated to time, place and person. Anxious.
Exposure	No rashes, swelling or visible injury. Wearing running attire. Skin pale and sweaty.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	96% (RA)	Mild	20	104	118/76	<2s	15	4 4 ++	37.1	6.2 mmol/L	6
10 mins	98% (O2 NRB 10L/min)	Nil	16	96	110/72	<2s	15	4 4 ++	37.1	6.2 mmol/L	3

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a suspected Acute Coronary Syndrome (ACS) presenting atypically in a young adult female following exertion, with chest tightness, diaphoresis, nausea and shortness of breath that has not resolved with rest.

Facilitator Triggers — if trainees miss a critical step

! (If Aspirin is not considered within the first 5 minutes of assessment, prompt the trainee: the patient asks 'Is there anything you can give me for this?' — guide trainees to recognise the ACS protocol.)
! (If GTN is administered without first assessing BP, patient's BP drops to 78/50 — challenge the trainee to identify hypotension before further GTN doses.)
! (If oxygen is not applied within 4 minutes, SpO2 drops to 92% on RA and patient reports increasing breathlessness — prompt reassessment.)
! (If BGL is not checked, facilitator prompts: 'The patient mentions she hasn't eaten much today and feels a bit light-headed' — reinforce full vital sign survey.)
! (If GTN is given without asking about PDE5 inhibitor use, the facilitator should pause and prompt: 'Do you have any other questions before administering that medication?' — reinforce contraindication screening.)

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — Airway patent, breathing with mild increased work, circulation intact, GCS 15.
3. Limit patient exertion — seat patient comfortably at the FAP, do not allow further walking or standing.
4. Perform Vital Sign Survey — BP, HR, RR, SpO2, BGL, pain score, GCS, temperature.
5. Apply oxygen via non-rebreather mask at 10–15 L/min — titrate to maintain SpO2 94–98%.
6. Obtain IMISTAMBO history — confirm onset, character of chest pain, radiation, allergies, medications (OCP noted), prior cardiac history.
7. Screen GTN contraindications — ask about PDE5 inhibitor use (sildenafil/tadalafil etc.) in previous 24–72 hours; confirm BP systolic >90 mmHg and HR between 50–150 bpm.
8. Administer Aspirin 300mg oral — chewed or dissolved in a small amount of water — for suspected ACS.
9. Administer GTN 400 microg (1 spray) sublingually — administer in seated/semi-recumbent position; DO NOT shake bottle; prime if first use.
10. Reassess pain score 5 minutes post-GTN. If pain >3/10, administer Methoxyflurane (Penthrox) 3 mL via inhaler device — patient self-administers.
11. Reassess BP before each subsequent GTN spray; administer further GTN at 5-minute intervals if pain persists and BP maintained above 90 mmHg systolic.
12. Administer Ondansetron 4mg oral wafer if patient reports nausea or vomiting — confirm no contraindications.
13. Perform Secondary Survey as clinically indicated.
14. Record full observations every 10 minutes (or 5 minutes if patient deteriorates).
15. Arrange Priority 1 ambulance transport — pre-notify receiving facility. Do not leave patient unattended.
16. Reassure patient continuously throughout assessment and treatment.
17. Scenario ends on arrival of ambulance and IMISTAMBO handover.
18. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Chest Pain / Acute Coronary Syndrome · Aspirin · Glyceryl Trinitrate (GTN, Nitroglycerin) · Methoxyflurane (Penthrox) · Ondansetron · Oxygen

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Signs/Symptoms	Central chest tightness, shortness of breath, nausea, diaphoresis. No radiation. No palpitations reported.
Allergies	NKDA.
Medications	Oral contraceptive pill (Levlen). No other regular medications.
Pertinent History	No prior cardiac history. Non-smoker. Occasional runner — this is her first fun run of this distance. No family history of cardiac disease that she is aware of.
Last Oral Intake	Water and a banana approximately 1 hour prior to race start. No food since.
Events Leading	Pt was completing the 10km Riverside Fun Run. She finished the course and crossed the line, then walked to the recovery area where symptoms developed at rest.
Treatment Prior	Sat down and rested after finishing — no improvement in symptoms. No medications taken.

Onset	Approximately 15–20 minutes ago, shortly after finishing the 10km run.
Pain	Central chest tightness — 'like someone is squeezing my chest'.
Quality	Constant, tight, squeezing sensation in the centre of the chest.
Radiates	Nil radiation.
Severity	6/10 at rest.