Actor Script — Bed Space 4

History of presenting complaint: You have had some chest pain. It has been there all morning. It is in the centre of your chest. It feels tight. It does not radiate anywhere. It came on this morning when you when you were at your desk at work. You do not feel short of breath however you feel like you are breathing quickly. You are very worried you are having a heart attack. You have had pain like this before when you have been worried about something. It however has never lasted this long. You have no other chest or respiratory symptoms.

You are currently undergoing a very painful divorce. You recently turned up at your soon-to-be ex-partners house very drunk and were shouting because you are so upset and since then they have threatened to not allow you to have any custody of your children. You work in a coffee shop and do not have the financial resources you think may be necessary to fight them on this. This is causing you a lot of stress. You are not sleeping, often falling to sleep late and waking up early. You have lost weight as you are not eating much. You seem to be on edge all the time. You are unable to enjoy things like you used to. You have thought about killing yourself. You have however not done anything for this. Your children are your protective factor.

You have no other symptoms.

Past medical history: History of depression 2 years ago. This followed the death of your father. You took medication for this for about a year and had some counselling which seemed to help.

Drug history: No regular medication. No drug allergies

Family history: Your father died of a heart attack two years ago. He died suddenly and you did not expect it. You did not get to say goodbye.

Social history: As above. You live in a rented house since moving out of the family home 2 months ago. You do not smoke and have stopped drinking since the episode above. You have two children who are 3 and 8. You do not take recreational drugs.

Systems review: No other symptoms

History of presenting complaint: You feel on your way to work today. You tripped over a loose paving slab and banged your head. You have been feeling a bit dizzy and lighted headed since. You cannot remember much of what happened this morning before setting off for work. You feel a bit sick and vomitted in the ambulance before you got here. You have a sore head. It is throbbing all over. 7/10. No other symptoms associated with this.

Past medical history: AF diagnosed last year on a routine health check. You also have hypertension and type 2 diabetes.

Drug history: Apixaban, candesartan and metformin but you cannot remember the doses at present.

You are allergic to ramipril – it causes you have a cough

Family history: nil of note

Social history: You live with your partner. You work as a librarian. You do not drink or smoke. You do not use any recreational drugs

Systems review: No other symptoms

The simulation is split into two halves, and you will be a different character in each. 2 students will be looking after you for each part of the simulation. These will be observed by student observers. The observers are there to provide feedback for the student and should not be involved in the simulation itself. Following each half of the simulation you will be asked to provide feedback from the patient’s perspective.

You have anxiety related chest pain but are concerned you are having a heart attack. Please be anxious throughout students taking a history from you and performing an A to E assessment of you. Students will need to take an ECG. This will involve them applying stickers to your chest. Please wear clothing which enable this. They also will need to take a set of observations. All investigation will be normal, and the students should offer you reassurance related to this and the plan should be for you to be discharged home with follow up by the GP due to your low mood.

Students will need to take a history from you and do an A to E assessment. They will need to identify that you have a head injury and that it is making you confused. You have some amnesia about events prior to the fall, and you are struggling to remember things such as your medication doses. The students should request a CT head. This will show evidence of a bleed which will require referral to neurosurgeons. Once the students have requested a CT head, please can you become drowsy. You respond if they say you name or apply pressure to a part of your body such as your shoulder, but you should then become drowsy and sleepy again. Students now should be repeating a A to E assessment again.