CRACKAMC Clinical Simulator
Volar Wrist Lacerations & Nerve Injuries: Advanced Clinical Assessment
Station 1: Michael Ross (28)
Patient Mental Model & Script
Opening: “Doctor, I was just washing up and this glass bowl shattered. It sliced my wrist really deep. I’m worried because I can’t seem to move my index finger properly.”
The Guitarist’s Panic: You are Michael, a professional guitarist. This injury is absolutely terrifying because your livelihood and your identity depend entirely on the precision of your hands. You were washing a heavy glass salad bowl when it slipped and broke in the sink; a jagged shard sliced across your right wrist. You saw immediate, heavy “spurting” blood that looked bright red. You managed to tie a tea towel around it as tightly as you could before rushing here.
The pain is a sharp, 7/10 throb. Your fingers feel incredibly stiff. When the doctor asks you to move, you realize with horror that you cannot bend the very tip of your index finger at all—it just stays straight. Furthermore, your thumb and index finger feel “tingly,” almost like they are falling asleep or vibrating. You are right-handed, which makes this even worse. You haven’t had a tetanus shot since you were a kid, maybe 12 years ago.
Your primary concern, which you keep coming back to, is: “Will I ever be able to play the guitar again? I have a major concert in three weeks. Is this permanent nerve damage?” You are visibly anxious, breathing quickly, and you need the doctor to be honest but also provide some sense of a path forward. You aren’t just a patient; you’re a musician whose career might have ended an hour ago in a kitchen sink.
The Guitarist’s Panic: You are Michael, a professional guitarist. This injury is absolutely terrifying because your livelihood and your identity depend entirely on the precision of your hands. You were washing a heavy glass salad bowl when it slipped and broke in the sink; a jagged shard sliced across your right wrist. You saw immediate, heavy “spurting” blood that looked bright red. You managed to tie a tea towel around it as tightly as you could before rushing here.
The pain is a sharp, 7/10 throb. Your fingers feel incredibly stiff. When the doctor asks you to move, you realize with horror that you cannot bend the very tip of your index finger at all—it just stays straight. Furthermore, your thumb and index finger feel “tingly,” almost like they are falling asleep or vibrating. You are right-handed, which makes this even worse. You haven’t had a tetanus shot since you were a kid, maybe 12 years ago.
Your primary concern, which you keep coming back to, is: “Will I ever be able to play the guitar again? I have a major concert in three weeks. Is this permanent nerve damage?” You are visibly anxious, breathing quickly, and you need the doctor to be honest but also provide some sense of a path forward. You aren’t just a patient; you’re a musician whose career might have ended an hour ago in a kitchen sink.
Critical Errors: Failure to check Radial Pulse/Cap Refill; Failure to isolate FDP vs FDS; Ignoring guitar social context.
Task i: Focused PE (Motor, Sensory, Vascular)
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Task ii: Explain Findings to Examiner
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Task iii: Management & Empathy
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Station 2: David Miller (35)
Patient Mental Model & Script
Opening: “I cut my wrist on a tin can two weeks ago. The doctor at the clinic put three stitches in and said I’d be fine, but I keep dropping my keys and my thumb feels weak.”
The Frustrated Carpenter: You are David, a carpenter. Two weeks ago, you were opening a tin of wood stain when the lid sliced your left wrist. It didn’t bleed “that much,” so you didn’t think it was a big deal. A junior doctor at an after-hours clinic looked at it briefly, didn’t do much of an exam, and just stitched the skin.
The skin has healed now, but you feel like a “clumsy oaf.” You can’t pinch small nails or hold your hammer properly. The skin on your palm near the thumb and the first three fingers feels “thick” or “woolly”—not totally numb, but like you’re wearing a thin glove. You find it impossible to bring your thumb across to touch your pinky finger.
If the doctor taps the scar, you feel a sharp “electric shock” sensation that shoots into your fingers. You are incredibly worried about your job; if you can’t use your hand, you can’t work. You are frustrated with the previous doctor: “Did they miss something? Is this going to be permanent? I need to get back to the site, but I can’t even pick up a screwdriver right now.” You are looking for a definitive answer as to why your hand isn’t working despite the “clean” healing of the wound.
The Frustrated Carpenter: You are David, a carpenter. Two weeks ago, you were opening a tin of wood stain when the lid sliced your left wrist. It didn’t bleed “that much,” so you didn’t think it was a big deal. A junior doctor at an after-hours clinic looked at it briefly, didn’t do much of an exam, and just stitched the skin.
The skin has healed now, but you feel like a “clumsy oaf.” You can’t pinch small nails or hold your hammer properly. The skin on your palm near the thumb and the first three fingers feels “thick” or “woolly”—not totally numb, but like you’re wearing a thin glove. You find it impossible to bring your thumb across to touch your pinky finger.
If the doctor taps the scar, you feel a sharp “electric shock” sensation that shoots into your fingers. You are incredibly worried about your job; if you can’t use your hand, you can’t work. You are frustrated with the previous doctor: “Did they miss something? Is this going to be permanent? I need to get back to the site, but I can’t even pick up a screwdriver right now.” You are looking for a definitive answer as to why your hand isn’t working despite the “clean” healing of the wound.
Critical Errors: Failure to perform Pen Test (APB); Failure to check Index Finger sensation; Missing the missed nerve injury.
Task i: Injury & Symptom History
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Task ii: Neuro & Motor Exam
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Task iii: Diagnosis & Specialist Plan
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Station 3: Sarah Jenkins (21)
Patient Mental Model & Script
Opening: “I… I did it again. I’m sorry. I just needed the feeling to stop.”
The Crisis of Emptiness: You are Sarah, a university student with a history of Borderline Personality Disorder and previous episodes of self-harm. Tonight, after a devastating fight with your partner, you felt an overwhelming sense of emptiness and emotional pain. You used a razor blade to cut your left wrist.
But this time feels “different.” It’s deeper than before. You noticed your pinky finger is hanging straight and won’t curl up like the others into a natural fist. The side of your hand and your entire pinky finger are completely numb. You are currently in a “come-down” phase—withdrawn, deeply ashamed, and exhausted. You aren’t actively trying to end your life right now, but you feel a profound lack of care for your own well-being.
You live with a roommate who has no idea you struggle with this, and your parents are in another state, so you feel very alone. You are terrified of the numbness but too ashamed to bring it up directly unless the doctor asks. You are hyper-sensitive to the doctor’s tone; if you feel judged, you will shut down. You just wanted the emotional noise to stop, but now you’ve caused a physical problem you don’t know how to fix. You need to know if you’ve done permanent damage to the “wires” in your arm.
The Crisis of Emptiness: You are Sarah, a university student with a history of Borderline Personality Disorder and previous episodes of self-harm. Tonight, after a devastating fight with your partner, you felt an overwhelming sense of emptiness and emotional pain. You used a razor blade to cut your left wrist.
But this time feels “different.” It’s deeper than before. You noticed your pinky finger is hanging straight and won’t curl up like the others into a natural fist. The side of your hand and your entire pinky finger are completely numb. You are currently in a “come-down” phase—withdrawn, deeply ashamed, and exhausted. You aren’t actively trying to end your life right now, but you feel a profound lack of care for your own well-being.
You live with a roommate who has no idea you struggle with this, and your parents are in another state, so you feel very alone. You are terrified of the numbness but too ashamed to bring it up directly unless the doctor asks. You are hyper-sensitive to the doctor’s tone; if you feel judged, you will shut down. You just wanted the emotional noise to stop, but now you’ve caused a physical problem you don’t know how to fix. You need to know if you’ve done permanent damage to the “wires” in your arm.
Critical Errors: Focusing ONLY on psych and missing Ulnar nerve/tendon; Failure to check Froment’s Sign; Judgmental tone.
Task i: Physical Extent of Injury
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Task ii: Psychiatric Risk Assessment
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Task iii: Integrated Management Plan
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Station 4: James Thompson (45)
Patient Mental Model & Script
Opening: “A sheet of zinc-alum caught me right across the pulse. It was a clean cut, but man, it bled a lot. I’ve got a bandage on it now.”
The Foreman’s Burden: You are James, a construction foreman. You pride yourself on site safety, so you feel embarrassed that you’re the one in the clinic. A sudden gust of wind caught a sharp metal sheet you were holding, and it sliced right into your wrist. It was a 4cm horizontal cut on the thumb-side (radial) of your wrist.
The bleeding was terrifying—it was spurting like a fountain (pulsatile). You reacted quickly and applied a makeshift tourniquet-style bandage yourself. Now, your heart is racing (110 bpm) because you’re anxious. You can’t bend your thumb at the tip (FPL) no matter how hard you try. You can bend your other fingers, but they feel weak and “off.”
Your thumb and index finger feel like they’ve been hit by a hammer—painful and tingling. You are the main breadwinner for your family. You spend your days manual handling and pointing at complex site plans. If you are out of work for months, your family is in serious financial trouble. You need to know: “How long is the recovery? Can I be back on site on Monday just to supervise?” You are desperate for a quick fix but deep down you know this is serious.
The Foreman’s Burden: You are James, a construction foreman. You pride yourself on site safety, so you feel embarrassed that you’re the one in the clinic. A sudden gust of wind caught a sharp metal sheet you were holding, and it sliced right into your wrist. It was a 4cm horizontal cut on the thumb-side (radial) of your wrist.
The bleeding was terrifying—it was spurting like a fountain (pulsatile). You reacted quickly and applied a makeshift tourniquet-style bandage yourself. Now, your heart is racing (110 bpm) because you’re anxious. You can’t bend your thumb at the tip (FPL) no matter how hard you try. You can bend your other fingers, but they feel weak and “off.”
Your thumb and index finger feel like they’ve been hit by a hammer—painful and tingling. You are the main breadwinner for your family. You spend your days manual handling and pointing at complex site plans. If you are out of work for months, your family is in serious financial trouble. You need to know: “How long is the recovery? Can I be back on site on Monday just to supervise?” You are desperate for a quick fix but deep down you know this is serious.
Critical Errors: Failure to check Radial Pulse; Failure to check FPL (Flexor Pollicis Longus).
Task i: Vascular & Motor Exam
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Task ii: Explain Flexor Isolation (FDS/FDP)
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Task iii: Specialist Referral & Work Impact
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