Emergency Scenario 465_f1

Location Information

Full Location:

Hafnargata 12, 465 Bíldudalur, single-story wooden house built in 1965. Main entrance on the south side. No elevator. Street parking available. No security features. Current conditions: 8°C, overcast, light wind, good visibility. GPS coordinates: 65.6814° N, 23.5327° W. Nearest landmark: Bíldudalur harbor.

Municipality: Bíldudalur

Postal Code: 465

Emergency Details

Type: Chest Pain - STEMI

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

62-year-old male, experiencing severe chest pain. Primary symptoms: crushing chest pain, radiating to left arm and jaw, shortness of breath, sweating. Secondary symptoms: nausea, dizziness. Patient alert but anxious. Skin pale and clammy. Patient sitting on a chair in his living room. Medical history: Hypertension, hyperlipidemia. Medications: Amlodipine 10mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1415 hours: Patient experienced sudden onset of severe chest pain while resting
1416 hours: Pain radiated to left arm and jaw, associated with shortness of breath and sweating
1417 hours: Patient felt nauseous and dizzy
1418 hours: Patient's wife called emergency services
1420 hours: Current time, patient still experiencing severe chest pain

Prior Events: Patient reports no recent illnesses or injuries. Last medical check-up 6 months ago, routine follow-up. Patient has a history of smoking (20 pack-years), quit 5 years ago. Family history of heart disease.

Diagnostics

Initial Assessment

Initial Impression: Suspected ST-Elevation Myocardial Infarction (STEMI)
Justification for F1 Classification:
- High probability of acute coronary syndrome based on classic symptoms: severe crushing chest pain, radiation to left arm and jaw, diaphoresis, dyspnea, nausea.
- Time-critical condition requiring immediate intervention to minimize myocardial damage and mortality.
- Presentation consistent with STEMI, requiring immediate ECG and potential thrombolytic therapy or PCI.

Differential Diagnoses:
1. STEMI (highest probability)
2. Unstable Angina (less likely given severity of pain and diaphoresis)
3. Aortic Dissection (less likely given no reported tearing pain or pulse deficit)
4. Pulmonary Embolism (less likely given no risk factors and gradual onset)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-arrival instructions to patient/caller: chewable aspirin if available, remain calm
- Immediate ECG acquisition and transmission to hospital
- Pre-hospital notification of nearest hospital with PCI capabilities

Final Diagnosis

Final Diagnosis: Acute ST-Elevation Myocardial Infarction (STEMI) of the anterior wall
Key Findings:
- 12-lead ECG confirmed ST-segment elevation in anterior leads (V1-V4), indicative of anterior wall STEMI
- Troponin levels elevated, confirming myocardial necrosis
- Coronary angiography revealed complete occlusion of the proximal left anterior descending artery (LAD)

Outcome validated F1 priority assignment. Rapid dispatch, pre-hospital ECG, and early hospital notification were crucial for timely intervention. Patient underwent successful percutaneous coronary intervention (PCI) with stent placement.

Learning Points:
1. F1 classification was appropriate given the time-sensitive nature of STEMI
2. Initial assessment accurately identified the high likelihood of STEMI
3. Pre-hospital ECG and rapid transfer to a PCI-capable hospital are essential for improving patient outcomes

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband has terrible chest pain! He's very sick, I think he's having a heart attack!

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

Caller It's Hafnargata 12 in Bíldudalur.

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

Caller He was just sitting and then he grabbed his chest and started saying it was a very bad pain. He's sweating and can't breathe well.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake, but he's very pale and he says his arm and jaw hurt too. He's very scared.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and high cholesterol. He takes medication for both.

Dispatcher Okay, the ambulance is on its way. Does he have any aspirin at home?

Caller Yes, I think so. I'll check.

Dispatcher If you find it, have him chew one aspirin tablet if he is able to swallow. Keep him calm and wait for the ambulance. Don't let him walk around.

Caller Okay, I found it. He's chewing it now. Thank you, we'll wait.