Scenario — Renal colic at an AFL game

foundation Medical · Elderly · 75yr · male

Patient Information

Dispatch	You are called to a 75-year-old male (Graeme Holloway) at the FAP at Optus Stadium who is complaining of severe left-sided flank pain and nausea that started approximately 40 minutes ago.
Patient	Graeme Holloway — 75yr (75kg)
Incident History	Pt was watching the AFL game from his seat when he developed sudden onset severe left flank pain radiating to the groin. He felt nauseated and made his way to the FAP with assistance from stadium staff.
Emergency Contact	Margaret Holloway (Wife) — 0412 448 731

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor.
Breathing	Self-ventilating. RR 18, no increased work of breathing. No accessory muscle use.
Circulation	Radial pulse present, regular, adequate strength. Skin pale and diaphoretic. Nil external haemorrhage.
Disability	GCS 15 (E4V5M6). Orientated to time, place and person. Distressed secondary to pain.
Exposure	Patient guarding left flank. No visible rash, bruising or swelling. Abdomen soft on inspection.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	18	98	148/88	<2s	15	4 4 ++	36.9	6.4 mmol/L	8
10 mins	98% (RA)	Nil	16	90	144/86	<2s	15	4 4 ++	36.9	6.4 mmol/L	4

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from renal colic (ureteric calculus), presenting with classic sudden-onset severe left flank pain radiating to the groin in a 75-year-old male with a prior history of kidney stones.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not ask about a history of abdominal aortic aneurysm or does not palpate the abdomen — remind the facilitator to ask: 'What else could cause severe flank pain in a 75-year-old male?' Prompt the trainee to consider AAA as a differential and reassess the abdomen for pulsatile mass or tenderness.)
! (If the trainee does not ask about allergies before administering Methoxyflurane — patient states 'I'm not sure, does it matter?' Facilitator pauses scenario and probes the trainee: 'What do you need to confirm before administering any medication?')
! (If the trainee does not offer Ondansetron for the nausea — patient begins to retch and states 'I feel like I'm going to be sick.' Facilitator asks: 'Is there anything else you can offer this patient?')
! (If the trainee does not monitor vitals at the 10-minute mark — facilitator prompts: 'How often should you be recording observations for this patient?')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — confirm airway patent, breathing adequate, circulation intact, GCS 15.
3. Position patient in a position of comfort — seated or semi-recumbent as preferred by the patient.
4. Complete Vital Sign Survey including BP, HR, RR, SpO2, BGL, pain score, and temperature.
5. Take IMISTAMBO history including SAMPLE — specifically ask about prior kidney stones, medications (Ramipril, Atorvastatin), allergies, and history of AAA.
6. Gently palpate all four quadrants of the abdomen to assess for rigidity, guarding, or pulsatile mass to assist in differentiating renal colic from AAA.
7. Administer Methoxyflurane (Penthrox) 3 mL via Penthrox Inhaler device, self-administered by patient, for analgesia — pain score 8/10.
8. Reassess pain score at 5 minutes following Methoxyflurane commencement — expected improvement to approximately 4/10.
9. Administer Ondansetron 4 mg oral wafer for nausea — confirm no contraindications (no apomorphine use, GCS 15, patient not under 2 years).
10. Do NOT administer Aspirin — patient has no chest pain of cardiac origin and suspected AAA must be considered and excluded as a differential in this age group (Aspirin is listed as a precaution in suspected AAA).
11. Apply oxygen only if SpO2 drops below 94% — current SpO2 98% on room air does not require supplemental oxygen.
12. Record full observations at 10 minutes — confirm improvement in pain score and haemodynamic stability.
13. Arrange transport via ambulance to nearest emergency department for imaging and definitive management.
14. Scenario ends on arrival of ambulance and IMISTAMBO handover.
15. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Methoxyflurane · Ondansetron · Pain Assessment · Primary Survey · Secondary & CNS Survey · Blood Pressure · Pulse & Respirations · Pulse Oximetry · Blood Glucose Monitor · Oxygen

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Signs/Symptoms	Severe left-sided flank pain radiating to the left groin. Nausea. Restlessness and inability to find a comfortable position.
Allergies	Nil known drug allergies.
Medications	Ramipril 5mg daily (for hypertension). Atorvastatin 40mg nocte.
Pertinent History	Known hypertension. No prior history of kidney stones. No history of abdominal aortic aneurysm. No recent trauma. Has had similar but milder episodes in the past which were investigated and found to be kidney stones.
Last Oral Intake	Pie and beer approximately 2 hours ago.
Events Leading	Pt was seated in the stands watching the AFL game when the pain came on suddenly. No prior warning. Denied any urinary symptoms at time of onset but now reports the urge to urinate.
Treatment Prior	Nil. Did not take any analgesia before presenting to the FAP.

Onset	Sudden onset approximately 40 minutes ago while seated watching the game.
Pain	Severe, cramping, left flank pain radiating to the left groin and inner thigh.
Quality	Cramping, colicky — comes in waves, very intense at peak.
Radiates	Radiates from left flank to left groin and inner thigh.
Severity	8/10 at rest, 10/10 at peak of each wave.