Emergency Scenario 400_f1

Location Information

Full Location:

Aðalstræti 14, 400 Ísafjörður. Ground floor apartment, single-story wooden building constructed in 1950. Main entrance has a small step. No elevator. Street parking available. Building equipped with smoke detectors. Current conditions: 3°C, light snow, moderate visibility. GPS coordinates: 66.0734° N, 23.1276° W. Nearest landmark: Ísafjörður Hospital.

Municipality: Ísafjörður

Postal Code: 400

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

75-year-old male, sudden onset of right-sided weakness and difficulty speaking. Primary symptoms: Left facial droop, right arm and leg weakness, slurred speech. Secondary symptoms: Confusion, dizziness. Patient is awake but disoriented. Medical history: Hypertension, type 2 diabetes, atrial fibrillation. Medications: Metoprolol 50mg daily, Metformin 500mg twice daily, Warfarin 5mg daily. No known allergies. Last meal was lunch at 13:00.

History of Events

Timeline:
15:10 hours: Patient was watching television, suddenly slumped in his chair.
15:11 hours: Patient's wife noticed facial droop and slurred speech.
15:12 hours: Patient's wife attempted to communicate, noted right-sided weakness.
15:13 hours: Patient's wife called emergency services.
15:15 hours: Current time, patient is conscious but confused, wife is present.

Prior Events: Patient has a history of mild TIAs in the past year, last TIA episode 6 months ago. Last INR check was one week ago, within therapeutic range. No recent illnesses or injuries. Last medical check-up 2 months ago, routine follow-up. Patient lives with his wife.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke
Justification for F1 Classification:
- Sudden onset of focal neurological deficits (facial droop, right-sided weakness, slurred speech) indicative of stroke.
- Time-sensitive condition requiring immediate medical intervention to minimize neurological damage.
- Presence of stroke risk factors (hypertension, atrial fibrillation, diabetes) increases suspicion.

Differential Diagnoses:
1. Ischemic Stroke (most likely)
2. Hemorrhagic Stroke (possible, requires imaging to differentiate)
3. Transient Ischemic Attack (TIA) (less likely due to persistent symptoms)
4. Hypoglycemia (possible but less likely given history of diabetes management)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities.
- Pre-hospital stroke assessment using FAST scale.
- Early notification of receiving hospital stroke team.
- Preparation for rapid transport to hospital with stroke center.

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke
Key Findings:
- CT scan of the brain confirmed a large ischemic stroke in the left middle cerebral artery territory.
- Patient's NIHSS score was 12, indicating moderate to severe stroke.
- Patient received IV thrombolysis within 60 minutes of arrival at the hospital.

Outcome validated F1 priority assignment. Rapid dispatch and early hospital notification were critical for initiating thrombolytic therapy.

Learning Points:
1. F1 classification was appropriate due to the time-critical nature of stroke.
2. Initial assessment accurately identified the high probability of stroke.
3. Early recognition of stroke symptoms by the caller was crucial for rapid response.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband! I think he's having a stroke. He suddenly can't speak properly and his face is drooping.

Dispatcher Okay, I'm sending help immediately. What is your address?

Caller It's Aðalstræti 14, in Ísafjörður. We are on the ground floor.

Dispatcher Help is on its way. Can you tell me what happened?

Caller He was watching TV and then he just slumped over. His face is drooping on one side, and he's slurring his words. I think his right arm is weak too. He looks confused.

Dispatcher Is he awake and can he understand you?

Caller Yes, he's awake but he's very confused. He can't really talk properly.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure, diabetes, and atrial fibrillation. He takes medication for all of them, and also warfarin.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm. I'm going to ask you some questions. Can you raise both of his arms in front of him?

Caller Okay, I'm here with him, and I'm trying to raise his arms... his right arm is very weak. It's falling down.

Dispatcher Okay, thank you. Help is on its way. Please stay on the line with me until they arrive.

Caller Okay, thank you. I'm so scared.