((If trainees do not ask about how the pain started — specifically whether it was sudden vs gradual, and whether it occurred during or after running — prompt: 'Can you describe exactly when the pain came on?'))

((If trainees raise concern about DVT before completing assessment — patient asks 'Could it be a blood clot?' Prompt: complete the full history and assessment, including timing and response to treatment, before deciding on escalation.))

((If trainees do not attempt passive dorsiflexion (calf stretch) — prompt: 'Is there a simple intervention that often relieves a muscle cramp?'))

((If trainees do not offer oral hydration — prompt: 'She mentions she hasn't eaten or drunk much today. Is there anything you can offer?'))

((If trainees correctly identify exercise cramp and it resolves rapidly — note for debrief: the dramatic and rapid resolution with stretching is the key diagnostic differentiator from vascular pathology. Completing management before escalating avoided unnecessary intervention.))

Exercise-induced gastrocnemius (calf) muscle cramp secondary to dehydration and electrolyte depletion during prolonged exertion. This is NOT a deep vein thrombosis (DVT). Key differentiating features: sudden onset during intense exercise (not gradual onset at rest), palpable muscle in full spasm, rapid and complete resolution with passive stretching, no calf swelling prior to the run, intact bilateral pedal pulses, and absence of significant DVT risk factors (note: OCP is a risk factor but cramp mechanism and rapid resolution make DVT very unlikely). The rapid resolution with stretching is the clinching differentiator — a DVT does not resolve with passive stretch.

• Ensure scene safety — assess roadside environment; ask course marshals to maintain distance and block traffic if required.
• Don appropriate PPE.
• Perform Primary Survey — confirm airway, breathing, and circulation intact; no life-threatening emergency.
• Obtain history — establish onset character (sudden during running, not gradual), prior DVT or clotting history (nil), dehydration status, last oral intake (nil food, minimal fluid).
• Inspect and palpate right calf — note firm, tense, contracted muscle belly (muscle in spasm); no bruising, no skin discolouration, intact skin.
• Assess pedal pulses bilaterally — confirm normal distal circulation in both feet.
• Assess sensation and movement of the right foot and toes — confirm intact.
• Document pain score — 9/10 at initial assessment.
• Attempt passive stretch — gently dorsiflex the foot (pull toes toward shin) to stretch the gastrocnemius; this should provide significant relief of exercise-induced cramp within 1–2 minutes.
• Offer oral hydration — water and/or electrolyte solution if available; patient is dehydrated from exertion without adequate intake.
• Observe the response — cramp pain reduces significantly and rapidly with stretching and hydration; pain score 2/10 at 10 minutes.
• Reassess after resolution — confirm normal neurovascular status, normal vital signs, pain has resolved.
• Reassure patient — explain this is consistent with exercise-induced muscle cramping from dehydration; no emergency escalation is required given rapid and complete resolution.
• Advise patient — she should not continue the run today; she should rehydrate with water and electrolytes and eat; she should seek GP review if the calf becomes swollen, discoloured, or painful at rest in the coming days.
• If pain does NOT resolve with stretching within 5–10 minutes, or if swelling, skin discolouration, or neurological deficit develops — consider escalation to CSP for further assessment.
• Scenario ends when cramp has resolved and appropriate advice has been given.
• Attention to hand hygiene will be given throughout the scenario.

Clinical references: Primary Survey · Secondary & CNS Survey · Pulse & Respirations · Blood Pressure