1. The caregiver will be practicing diagnosing and treating a patient for an illness. You are presenting with the signs and symptoms of appendicitis. Don’t tell your caregiver this.
2. Straight-line winds knocked down several trees in the neighborhood and you are assisting in the clean-up
3. You and your friend (the caregiver) have been working since 8 am. 
4. Your friend was hungry at 11 am and ate their lunch.
5. You did not feel hungry – you felt a little nauseous and refused to eat. 
6. You have been drinking water all day. The water came from your home.
7. The last time you ate was this morning at 6 am.  You had oatmeal at home.
8. It is now 2 PM and you have been cutting and clearing trees since 8 AM.
9. You used the bathroom when you stopped at 2 PM and your poop was runny.
10. You are still feeling nauseous and you are not hungry, but you attempted to eat lunch and you don’t feel like eating.

PT SAMPLE History.  Give these answers when your caregiver asks SAMPLE History questions.

1. Signs and Symptoms: You feel nauseous and even though you have not eaten anything since 8 am this morning, you are not hungry.
2. Allergies: Penicillin
3. Medications: Allegra for seasonal allergies.  You took one Allegra this morning like you do every morning
4. Past Medical HX: None. 
5. Last In – Last Out
   1. Drink – You have been drinking water from your camelback all day. Water is from your home tap.
   2. Food – You tried to eat a sandwich that you brought with you from home.  Even though it is in the afternoon, you are not hungry, but you force yourself to eat half the sandwich.  You really are not hungry.
   3. Pee – You peed right before lunch and it was clear
   4. Poop – You poop before lunch and it was runny
6. Events Leading Up to the Crisis: You’ve been working since 8 am and you started feeling nauseous a few hours ago

PT Exam

Your caregiver should perform a Primary and Secondary Assessment. During the Secondary Assessment Physical Exam when the caregiver divides your abdominal area into four quadrants – when the caregiver pushes into your Right Lower Quadrant, you report no pain, but when the caregiver releases pressure, you cry out in pain.  

PT Vital Signs:  When the caregiver takes your vital signs, come out of character and read off the vital signs they would measure

Time:	2:05 PM	2:20 PM	2:35 PM	2:50
LOC:	A+Ox3	A+Ox3	A+Ox3	A+Ox3
HR	70	74	76	78
RR	12	14	14	16
Skin	Pale –  Cool	Pale –  Cool	Pale –  Cool	Pale –  Cool

PT Outcome

You are presenting with the signs and symptoms of appendicitis and your caregiver must convince you to go to the hospital emergency room immediately.

If your caregiver says, “Let’s wait for 30-minutes and see if you feel better,” come out of character and tell your caregiver, “It’s been 30-minutes, and I do not feel any better. Now, what do you do?” Go back into character.

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Post Scenario Debrief

1. You are presenting with the signs and symptoms of Appendicitis.
2. Did the caregiver have the you lay down during the Secondary Assessment?
   1. It may feel weird to do, but this is the only way to push on the stomach.  You may need to tell your patient that this is what you were taught to do in your training. It is the same thing a doctor would do.
   2. Anytime you have a patient complain of nausea, have them lay down, divide the stomach into four quadrants and gently push in and rapidly release pressure.
   3. Any pain – pushing in or on release – is a sign of “organitis” and is not normal. This is a sign of something wrong.
3. How does your SOAP Note look?  Compare it to the example SOAP Note provided earlier in the course.
4. What is your rescue plan?  How are you going to get the patient to the hospital?