Facilitator notes

Facilitator, please role-play this patient and allow the student/team to collect a focused history. The key elements are reported here, provide generic information when there is no applicable answer below.
After the role-play, provide the History handout to the player.

Payne Stark, 35 years old, non-Aboriginal or Torres Strait Islander.

Opening line: “I feel like I can’t breathe!”

You have been short of breath for the last 3 hours. It came on suddenly, just as you were finishing a long day at work. You have central, dull chest pain that is worse when you take a deep breath. The pain does not radiate, and it does not change when you move. You have not noticed anything making it better. You thought it might go away on its own, but after about one hour you decided to come to the Emergency Department.

You have had episodes of shortness of breath and dull chest pain over the past month, but this is much worse. If asked about any other symptoms, you remember you have had some cramping pain in your legs, particularly in the left calf. You have had no recent trauma, travel, or infections.

Past medical history

You have been told you have gastroesophageal reflux disease . You take pantoprazole and the combined oral contraceptive pill daily. You have no past surgical history.

Both your father and your mother died from heart attacks in the last few years. Your mother passed away at 65 and your father at 72 years of age. Your older brother (44yo) and sister (39yo) are in good health as far as you know.

Lifestyle and social history

You work as a bus driver for the public transport system, sedentary occupation and lifestyle. You live alone in Maitland. You drink a bottle of wine most evenings and have smoked 20 cigarettes a day for the past 15 years.