Cardiac
Presents: Sitting, clutching chest, breathing heavy, anxious
Chief Complaint: Chest pain: “There is a vice around my chest”
VS: A&Ox4, HR 88, strong & reg, RR 22, reg, labored. Skin: pale, cool, sweaty/clammy
Symptoms: mid-sternal, crushing chest pain, short of breath, nausea, weakness,
feeling of impending doom
Onset: about 30 min ago while hiking
Provokes/Palliates: worse with exertion, slight relief with rest
Quality: tightness, crushing, steady
Radiation: left shoulder & arm, into left jaw
Severity: 8/10
Trending: “It’s getting a little better as I am resting – still pretty bad”
Allergies: none
Medication: high blood pressure medication, "I have Nitro, Should I use it? (Don't know
how to take it)
Past Medical History: high blood pressure, father died of heart attack, "pre-diabetic"
Last Intake & Output: sandwich and soda at lunch, 1 liter water so far today, peeing &
pooping fine
Events: “I was hiking, the trail got steep. I was almost to the top, my chest started to
feel heavy part way up, now it is so bad I can’t continue.”
Stroke
Presents: Sitting, left side doesn't move, moaning, holding head (with right arm only),
looking confused
Chief Complaint: “my head hurts, my head really hurts”
VS: A&Ox2 (person, place), HR/RR/Skin: as is.
Signs: slurred speech, confused, slow to answer as can't find right words. DO NOT
move left arm or look to the left
Symptoms: head ache, left arm is flaccid
Onset: not sure
Provokes/Palliates: nothing, head just hurts
Quality: unable to describe
Radiation: no
Severity : 8/10
Trending: think it is getting worse
Allergies: almonds
Medication: high blood pressure medication, hay fever
Past Medical History: high blood pressure, “Don’t always take my medication.” Lasik
surgery last year.
Last Intake & Output: think ate lunch, can’t get the rest of the words out
Events: Don't know. Know I am here and you are here.
Appendicitis
Presents: side lying, knees drawn up, holding very still & reluctant to move
Chief Complaint: “my belly hurts”
VS: A&Ox4, HR 118 strong & reg, RR 18 easy & not labored, Skin flushed, hot, dry.
Signs: very uncomfortable.
Symptom: right lower quadrant pain, nausea
Onset: started last night, a little better this morning, now much worse
Provokes/Palliates: movement makes it worse, holding still is better, hurts to
push on it.
Quality: steady pain
Radiation: no
Severity: 7-8/10
Trending: started last night, a little better this morning, now much worse
Allergies: dairy products
Medication: Ibuprofen, helped a little. Zantac
Past Medical History: indigestion, Gastric Reflux
Last Intake & Output: dinner last night, nothing since. Peed this am, none since. little
diarrhea today
Events: nauseated after dinner, I woke up in the night with abdominal pain, took some
Ibuprofen, felt a little better this morning. Pain returned and now worse. Now right
lower abdomen very tender. Think I am going to vomit!
Kidney Stones
Presents: sitting, rocking back & forth, unbearable/excruciating pain, moaning, can't
focus on questions
Chief Complaint: “right side/flank pain” "so much pain!"
VS: A&Ox4, HR 100 strong & reg, RR 20 easy, unlabored, Skin pink, warm, sweaty.
Signs: anxious, obviously pain, can’t focus on questions due to severity of pain
Symptoms: right side/flank pain, nausea
Onset: acute onset this morning
Provokes/Palliates: "Nothing- can't handle this pain!"
Quality: “like a knife in my side”
Radiation: right flank into lower abdomen and into groin
Severity: 10/10, can't get any worse
Trending: some waves of worse pain, but never gone. "Can't take this much
longer!"
Allergies: peanuts and cats
Medication: Albuterol inhaler, sometimes
Past Medical History: "Oh man, does this matter!? I am in so much pain!"
Last Intake & Output: "C'mon- just get me something for my pain!" Nothing since
dinner. “oh yeah, one gulp of water with some ibuprofen” I think I need to pee but
can’t tell due to pain! pooped last night
Events: “Pain woke me up this morning, bad pain, seems to be getting worse! I tried
some ibuprofen but nothing helps. "Can you help me!? I am hurting so bad!"
Gastroenteritis
Presents: awake, lying on side, knees drawn up, holding still. Get SUPER dizzy if they
sit you up.
Chief Complaint: abdominal pain
VS: A&Ox4, HR 118 strong & regular, RR 22 easy, unlabored, Skin: pale, warm, moist.
Signs: obviously uncomfortable
Symptoms: abdominal pain, nausea, vomiting, diarrhea, weakness
Onset: started yesterday after lunch with a little nausea
Provokes/Palliates: lying still is tolerable, I get dizzy if I sit up, nausea worse with
movement
Quality: "just hurts"
Radiation: no
Severity: 5/10
Trending: steady for the last 5 hrs
Allergies: peanuts, penicillin
Medication: epi pen if I need it
Past Medical History: head injury as a kid racing mountain bikes
Last Intake & Output: No food since lunch yesterday, had left over chicken salad
sandwich. Some Gatorade this morning, threw it up. Can’t remember when last
peed. Diarrhea in the night and x 5 today.
Events: Feeling fine yesterday until sometime after lunch. Nauseated so didn't eat
dinner. Nobody else was saying they were sick. Diarrhea in the night and started
vomiting this morning & all day. Too weak to continue.
Carbon Monoxide Poisoning
Presents: sitting on side of trail, holding head
Chief Complaint: headache, nausea
VS A&Ox4, HR/RR/Skin as is. Signs: looks normal but uncomfortable
Symptoms: wicked headache, nausea, weakness
Onset: "I wake up every morning like this, today is the worst"
Provokes/Palliates: "usually just gets better through the day"
Quality: miserable
Radiation: no
Severity: 7/10
Trending: "Worse in the mornings. Today has not really improved much."
Allergies: peanut butter, anything with peanuts
Medication: Ibuprofen, "not helping"
Past Medical History: “Frostbitten toes last winter when I had broken down
snowmobile” “I don’t want to talk about it”
Last Intake & Output: "Eating and drinking less until nausea goes away, peeing and
pooping fine, not throwing up."
Events: Out here camping solo, raining every evening, “pain in the *&#$ because I
have had to cook in my tent” “Last night I fell asleep before dinner was done.
Burned my chili-mac and ran out of fuel."
Hyponatremia
Presents: vomiting at the side of the trail
Chief Complaint: “I must be dehydrated! I have a headache & nausea”
VS: A&Ox4, HR 90 strong/regular, RR 18 easy/unlabored, Skin pink/warm/dry.
Signs: vomiting
Symptoms: nausea & vomiting, peeing frequently
Onset: headache this am “I was so dehydrated from Mexican food last night”
Provokes/Palliates: trying to drink water to get rid of my headache
Quality: feel miserable
Radiation: none
Severity: 4/10
Trending: headache not going away, now vomiting & peeing frequently
Allergies: dogs & brussel sprouts
Medication: over the counter hay fever medication
Past Medical History: fishhook in my ear last week, had to go the ER
Last Intake & Output: “4 liters of water since breakfast. No food since I am feeling
nauseated.” “Peeing
about every 10min. Just now had some diarrhea – mostly water."
Events: It’s a hot day. I am out for a trail run trying to get in shape to climb the Grand
Teton next month. I am working on drinking more water. I had Mexican food last
night & it was super salty. I drank a liter of water before bed, not enough because
I woke up with a headache this morning. Drank a liter before breakfast, ate some
pancakes. Headache worse so I have been trying to re-hydrate. I don’t know how
I got so dehydrated.
Anaphylaxis
Have Epi pen & Benadryl
Presents: Sitting upright struggling to breathe, itching all over, talking in 2-3 word
clusters
Chief Complaint: Can't catch my breath! Feels like lips & tongue are big. Itching all over
VS: A&Ox4, HR 120 regular/strong, RR 30 rapid/shallow, Skin pink, warm, dry.
Signs: face & lips swollen, skin blotchy red, hives
Symptoms: short of breath, itchy, anxious
Onset: 15 min ago stung by hornet
Provokes/Palliates: nothing
Quality: terrified! can't breathe
Radiation: everywhere
Severity: 8/10
Trending: getting worse
Allergies: fire ants “I get a bad reaction”
Medication: epi pen, used it already, may have been frozen last year
Past Medical History: ER visit 2 years ago from a fire ant bite in Gulf of Mexico. Had
to be air lifted off. Now I have this stupid epi pen that apparently does not work. I
thought I used it right. Last Intake & Output: All fine, no issues
Events: 15 min ago stung by a hornet. This all started fast.
Asthma/allergies
Have INHALER
Presents: coughing, sneezing wheezing
Chief Complaint: shortness of breath
VS: A&Ox4, HR 110 strong/regular, RR 32 labored/wheezing, Skin flushed, warm, dry.
Signs: very anxious, coughing, wheezing, runny nose, watery eyes, sneezing,
obviously short of breath
Symptoms: feeling miserable, short of breath "all clogged up & can't breathe"
Onset: “started after I took a breather in the grass back there”
Provokes/Palliates: “I can’t seem to catch my breath”
Quality: miserable
Radiation: “my chest feels tight”
Severity: about 6/10, I have had worse (was admitted to the hospital once a long
time ago)
Trending: started with just sneezing, now worse, getting all plugged up
Allergies: yes to lots of plants, dust, cats & birds, especially chickens
Medication: Claritin, Allegra, sometimes Benadryl. Have this inhaler- should I use it?
How?
Past Medical History: I had asthma when I was really young. Doing allergy testing such a pain in my rear!
Last Intake & Output: Hamburger & fries, milk shake & some water. Peeing and
pooping fine.
Events: Doing fine this morning. Started when I was sitting in the sage brush. Too short
of breath to continue.
Altitude
Presents: sitting, obviously uncomfortable, holding head
Chief Complaint: “My head hurts and I can’t breathe!”
VS: A&Ox4, HR/RR/Skin: as is.
Signs: looks uncomfortable
Symptoms: headache, weakness, short of breath
Onset: this afternoon
Provokes/Palliates: trying to walk! Can't believe how winded I am!
Quality: I feel weak as a kitten
Radiation: no
Severity: 4/10
Trending: started with just a headache, now weak and short of breath
Allergies: clams, iodine
Medication: none
Past Medical History: “I got shot with an arrow in the arm last year hunting”
Last Intake & Output: taco & a beer for lunch, drank 2 liters water today, peeing clear
and pooping ok
Events: On Vacation! Flew from Homer, Alaska on the red eye, got in to Idaho Falls
this morning, and drove up to ski on Galena. Just ate lunch and went for a hike.
Too short of breath to continue.
Diabetic – High Blood Sugar
Have insulin, syringe, & glucose
Presents: lying on side knees drawn up, vomit x1 during scenario, so very thirsty, get
up to pee once
Chief Complaint: feeling horrible, weak, nausea
VS: A&Ox4, HR 115 strong/regular, RR 26 easy/rapid, Skin: pale, warm, very dry.
Signs: vomiting, anxious
Symptoms: nausea, weakness, thirsty
Onset: day before yesterday had some food poisoning with vomiting & diarrhea
Provokes/Palliates: nothing
Quality: miserable
Radiation: abdominal discomfort
Severity: 5/10
Trending: really worried as it is getting worse
Allergies: codeine & some antibiotics
Medication: high blood pressure pill & insulin
Past Medical History: I have been on insulin since I was 17. Usually no problem. Left
my glucometer on a rock at the last campsite. It’s too far to go back now.
Last Intake & Output: bad burrito for breakfast a couple of days ago. Only some
crackers and gummy bears since then. Drinking Gatorade, seems to make me
want to puke! Peeing is too good, think diarrhea getting better
Events: Sick to my stomach with some diarrhea for a couple days. Nausea during the
night, and today super thirsty and weak. Don’t know my blood sugar but test strip
shows ketones in my urine.” Too weak to continue.
Anxiety (panic attack)
Have Epi pen & Benadryl
Presents: Sitting upright struggling to breathe, rubbing chest, very anxious, fingers
don't straighten
Chief Complaint: feels like my airway is closing off
VS: A&Ox4, HR 100 strong/regular, RR 30 rapid, shallow. Skin: pink, warm, dry.
Signs: talking in short sentences, very anxious
Symptoms: Short of breath, chest pain, cramping in hands
Onset: 30 min ago
Provokes/Palliates: nothing
Quality: terrifying
Radiation: everywhere
Severity: 8/10
Trending: getting worse, feel like I am going to die
Allergies: shell fish and other things that swim. I get a rash and my tongue swells up
Medication: I have an Epi pen and am about to use it
Past Medical History: many visits to doctor with allergies. Last time in the ER doctor
said it was not an allergic reaction
Last Intake & Output: Not concerned about that right now! My fingers won't straighten
and I can't breathe! Events: 30 min ago in a shop down town. A guy was smoking
and eating some kind of tuna fish dip. I think I was exposed to the fish
Gastro-intestinal Bleeding
Presents: laying down, get very dizzy when they sit you up
Chief Complaint: Feeling really weak
VS: A&Ox4, HR 120 rapid, weak, RR 20 easy, quiet, Skin: pale, cool, clammy.
Signs: dizzy if sit up
Symptoms: weakness, a little abdominal pain & cramping
Onset: past couple of days, worse today
Provokes/Palliates: laying down I feel a bit better
Quality: just feel weak
Radiation: not really
Severity: 5/10
Trending: worse today, getting anxious as feel worsening
Allergies: antibiotics, I forgot which ones
Medication: Ibuprofen 800mg 3x’s a day
Past Medical History: tendonitis in my elbows. Taking Ibuprofen to clear it up just
starting to get better
Last Intake & Output: peeing fine. Pooping often, smells bad & looks like tar- eating too
many wild berries I think
Events: Just out for a walk trying to get some fresh air but super weak and dizzy like I
might pass out so I laid down
Exertional Syncope (Heat Exhaustion)
Presents: laying down
Chief Complaint: I feel super weak and nauseated
VS: A&Ox4, HR 110 strong, regular, RR 20 easy/quiet, Skin pale, hot, sweaty.
Signs: anxious
Symptoms: nausea, weakness, light headed, seeing stars when I sit up
Onset: 10 min ago.
Provokes/Palliates: feeling better laying in the shade
Quality: whole body is weak
Radiation: no
Severity: 6/10
Trending: getting slightly better
Allergies: wood glue
Medication: none
Past Medical History: had a heart issue a few years ago but doing fine now
Last Intake & Output: 2 cups of coffee, 1 bottle of PowerAde, 2 bottles of water. Peed
1 time this morning. Pooped yesterday.
Events: cutting firewood all day. Super-hot, been sweating like a horse. I feel terrible,
like I might pass out, just have to lay down
Seizure (unwitnessed)
Presents: sitting upright, looking around, confused
Chief Complaint: I don’t feel very well
VS: A&Ox1, person only. HR/RR/Skin as is.
Signs: talking slowly, blank look. Dirty face, peed your pants
Symptoms: I don’t know, nothing hurts, just very confused
Onset: Unknown “what time is it?”
Provokes/Palliates: nothing
Quality: not sure
Radiation: no
Severity: “what? I don’t know.”
Trending: “Nothing is wrong. I guess it’s getting better”
Allergies: none
Medication: none
Past Medical History: Fell off a horse when I was 14, head injury. Used to have
seizures. Had a seizure 2 yrs ago when I dislocated my knee cap playing rugby
Last Intake & Output: all fine, no issues
Events: I don’t know. I was just taking pictures and then you were here talking to me
Flu-like symptoms/ Pneumonia
Presents: sitting, coughing frequently, anxious as feel short of breath
Chief Complaint: short of breath
VS: A&O x4, HR 90 strong/regular, RR 22, easy/unlabored, Skin pink, hot, dry.
Signs: obviously uncomfortable, coughing, looks like having some breathing issue
Symptoms: Headache, sore throat, cough, chills. Short of breath when trying to walk
Onset: past few days with cough and sore throat
Provokes/Palliates: resting is better, breathing cool air better, coughing makes
my head hurt
Quality: miserable
Radiation: hurt all over
Severity: 6/10
Trending: no good sleep for days, coughing all night, definitely getting worse
Allergies: Latex, all “caine” drugs (Novocaine, lidocaine, Marcaine….)” "Dentists don’t
like me”
Medication: Ibuprofen & Tylenol, Can't imagine how bad I'd be without it!
Past Medical History: “normally healthy, stupid cold for about a week, worse now like
my head about to explode”
Last Intake & Output: drinking water and soda, ate some soup this morning.
Swallowing makes my throat hurt. Peeing and pooping fine.
Events: Out for a walk today, wanted some fresh air, now too short of breath to
continue