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Scenario: A case of angina


Please note: The users who submit scenarios have declared that all patient details are fiction. We cannot guarentee the accuracy of any suggested treatment or the realism of suggested observations. You should judge these for yourself.



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Scenario Overview:
The first aiders are covering an event in a small town and are approached by a someone who says that they have chest pain. The patient has known angina and the situation will get better after they have taken their GTN spray. This is a relatively easy scenario that gives first aiders a chance to investigate a chest pain and to distinguish the difference between angina and a heart attack.
Difficulty:
First Aider Easy
How the scenario should progress:
The pain will begin to reduce and the patient will become comfortable again after they have been encourage to take their GTN spray.
Patient 1:
Name: Gertrude Henry    Age: 72    Sex: Female
Medication: GTN spray and 'some other heart meds'
Allergies: Some plasters
Past medical/family/social history: Lives with husband and is generally independent. Other than 'a few heart issues' generally fit and well although is able to do less these days.
Findings on examination: Patient has central chest pain that 'is quite severe' at about 7/10. It seems to be staying in the chest area and came on when she was rushing to try and catch a train home. This has happened before and the patient knows that she has angina and does have her GTN spray on her (but don't tell the first aiders that she has angina until they ask). Patient is a bit out of breath and is sweating quite a bit. The pain doesn't get worse and seems to be pretty constant. The pain will get better with rest and after the GTN spray is used.
Possible treatment from first aiders: Good history to find out about angina. Get patient to rest and to take their GTN.
Time after start: 0 mins After GTN + rest
Response: Alert Alert
Airway: Yes Yes
Breathing? Yes Yes
Respirations: 24 short 19 normal
Pulse: 110 90
Oxygen Sats: 90 95
Pain Score: 7/10 2/10 and getting better



Tips for the patient actors:
Don't just tell the first aiders about your angina - get them to start asking questions first.

Scenario submitted by: Anonymous