Medical

Chest burning after festival food — bystanders alarmed, suspected indigestion

Foundation

Adult · 42yr · male

Patient Information

Dispatch	You are called to a 42-year-old male (James Cho) at the Taste of the Town Food Festival who is sitting on a bench clutching his chest and upper abdomen. Bystanders have called for help saying they think he is having a heart attack.
Patient	James Cho — 42yr (88kg)
Incident History	Patient was sampling food stalls when he developed a burning sensation in his chest and upper abdomen approximately 10 minutes after eating. Bystanders noticed he looked uncomfortable and sat him down. He is pressing his hand to his sternum and grimacing. No loss of consciousness. No vomiting.
Emergency Contact	Anna Cho (Wife) — 0412 449 281

Initial Rapid Assessment

Response	Alert
Airway	Patent. Speaking in full sentences without effort.
Breathing	Comfortable. RR 14. No increased work of breathing. No accessory muscle use. SpO2 99% on room air.
Circulation	Radial pulse strong and regular. Skin warm, pink, and dry. No pallor or diaphoresis. CRT <2s.
Disability	GCS 15 (E4V5M6). Alert, orientated, mildly distressed by discomfort. Cooperative.
Exposure	No rash. Abdomen soft — mild epigastric tenderness on palpation. No guarding, rigidity, or rebound tenderness. No abdominal distension.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	99% (RA)	Nil	14	78	134/84	<2s	15	4 4 ++	36.9	–	5
10 mins	99% (RA)	Nil	14	74	128/80	<2s	15	4 4 ++	36.9	–	3

History Taking

Treatment Response

Diagnosis

Dyspepsia (indigestion/heartburn) triggered by dairy ingestion in a patient with known lactose intolerance. This is NOT a cardiac emergency. Key differentiating features: burning (not crushing) quality, no radiation to arm or jaw, no diaphoresis, no shortness of breath, normal vital signs throughout, symptoms onset temporally linked to dairy food intake, known lactose intolerance, and spontaneous improvement in upright position.

Facilitator Triggers — if trainees miss a critical step

! (If trainees immediately assume cardiac origin and escalate without taking a full history — the patient says: 'Honestly, I think it was the gelato — I'm lactose intolerant. I should know better.' Prompt trainees to complete a full history before escalating.)
! (If trainees do not specifically ask about pain character — prompt: 'What does the pain feel like exactly — is it crushing, pressing, burning, or sharp?')
! (If trainees do not ask about last food intake or dietary history — prompt: 'Is there anything relevant you've eaten recently?')
! (If trainees escalate to calling CSP without completing history and assessment — prompt: 'Before calling for support, what cardiac features are present? What features make a cardiac cause less likely?')
! (If trainees correctly identify indigestion — note for debrief: this is a common scenario at food festivals. The history — particularly last oral intake, timing relative to food, pain character, and known trigger — is the key differentiator. History quality here prevents unnecessary cardiac escalation.)

Treatment Objectives

1. Ensure scene safety — assess environment; move patient to FAP if not already there.
2. Don appropriate PPE — gloves minimum.
3. Perform Primary Survey — confirm patent airway, adequate breathing, and normal circulation; note patient is speaking in full sentences without distress.
4. Obtain vital signs — document normal BP, HR, SpO2, RR, GCS; note absence of pallor, diaphoresis, or cold peripheries — features absent in cardiac emergency.
5. Conduct thorough history using IMISTAMBO — specifically establish: pain character (burning vs crushing/pressure), onset in relation to food intake, radiation (nil), associated symptoms (nil SOB, nil diaphoresis), pertinent history (known lactose intolerance, consumed dairy), last oral intake (gelato/dairy 15 minutes ago), prior cardiac history (nil).
6. Perform Secondary Survey — palpate abdomen; note mild epigastric tenderness only, with no guarding, rigidity, or rebound; no cardiac risk factors identified.
7. Recognise distinguishing features from cardiac presentation: burning (not crushing) quality, no radiation to arm or jaw, no shortness of breath, no diaphoresis, normal vital signs, onset immediately after dairy in known lactose-intolerant patient, and symptoms improving in upright position.
8. Position patient upright or semi-recumbent — this commonly provides relief for indigestion/reflux.
9. Provide clear, calm reassurance — explain that the symptoms are consistent with indigestion related to dairy intake, not a cardiac emergency.
10. Monitor vital signs at 5-minute intervals — confirm ongoing improvement.
11. Advise patient to seek GP review if episodes recur and to avoid dairy products given known lactose intolerance.
12. If symptoms do not improve within 15–20 minutes, new features emerge (radiation, diaphoresis, crushing quality, deteriorating vital signs), or clinical uncertainty remains — contact CSP for advice.
13. Document all findings and advice given.
14. Scenario ends when patient's symptoms have improved and he is cleared to return to the festival.
15. Attention to hand hygiene will be given throughout the scenario.

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

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Signs/Symptoms	Burning sensation in the chest (retrosternal) and upper abdomen. Mild nausea. No vomiting, no radiation, no shortness of breath, no sweating.
Allergies	Nil known drug allergies.
Medications	Nil regular medications.
Pertinent History	Known lactose intolerance — patient acknowledges he usually avoids dairy but 'got carried away' at the food festival. No history of cardiac disease, hypertension, or diabetes. Non-smoker. No family history of early cardiac disease. No prior chest pain episodes.
Last Oral Intake	Gelato (dairy), brie cheese, crackers, grilled meats, and water sampled over approximately 2 hours. Gelato consumed approximately 15 minutes ago.
Events Leading	Patient was enjoying the food festival and consumed multiple dairy-containing products despite knowing he has lactose intolerance. Symptoms began within 10 minutes of eating a large gelato.
Treatment Prior	Nil. Sat down when symptoms developed.

Onset	Approximately 10 minutes after eating dairy-containing food. Gradual onset over 5 minutes, began approximately 15 minutes ago.
Pain	Burning discomfort located behind the sternum and upper abdomen. Not crushing or pressure-like.
Quality	Burning and constant. Slightly worse on leaning forward. Eases marginally when sitting upright.
Radiates	Nil — no radiation to the arm, jaw, neck, or back.
Severity	5/10.