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For all learners, the case should begin with obtaining a complete history, and performing a thorough physical exam. The nurse can help the learners to set the patient up on the monitor.

The learners should order laboratories, imaging studies, and appropriate medications (such as IV fluids, antiemetics, and pain control).

Throughout the scenario, the patient will be very disagreeable to the plan of care. He will be difficult to obtain history from and will be angry during the examination, “because that hurts me!” He will also initially refuse IV access and will require discussion about why this is necessary. He will then become hostile about the possibility of needing a CT scan because, “Aren't you a doctor? Can't you just figure it out based on what I've told you?” Ultimately he will require multiple efforts at verbal de‐escalation before agreeing.

After the learner discusses the diagnosis of volvulus and the need for surgical evaluation with the patient, he will become upset and frustrated. He will calm down if the learner takes the time to listen to him and acknowledge his frustrations.

The trigger for the end of the case will be consultation with surgery for intervention and admission.