Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 96, 600 Akureyri, third floor apartment 3B. Five-story concrete building, built in 1995. Main entrance has a coded lock (code: 2468). Elevator and stairwell access. Street parking available. Building has a fire sprinkler system. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 65.6823° N, 18.0912° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - STEMI

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

65-year-old male, experiencing severe chest pain. Primary symptoms: Crushing chest pain radiating to left arm and jaw, shortness of breath, diaphoresis. Secondary symptoms: Nausea, dizziness. Patient is pale and anxious. Patient is sitting on a chair in his living room. Medical history: Hypertension, hyperlipidemia, type 2 diabetes. Medications: Metformin 1000mg BID, Atorvastatin 20mg daily, Lisinopril 10mg daily, Aspirin 81mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1415 hours: Patient began experiencing mild chest discomfort
1430 hours: Chest pain intensified, radiating to left arm and jaw, accompanied by shortness of breath and sweating
1435 hours: Patient took one aspirin 81mg
1440 hours: Patient called emergency services
1442 hours: Current time, patient still experiencing severe chest pain

Prior Events: Patient has a history of stable angina, but this pain is significantly more severe and prolonged. No recent hospitalizations. Last medical check-up 6 months ago, routine follow-up. Patient lives with his wife, who is also present.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute ST-Elevation Myocardial Infarction (STEMI)
Justification for F1 Classification:
- Classic presentation of STEMI with severe, crushing chest pain radiating to left arm and jaw, associated with diaphoresis and shortness of breath
- Time-critical condition requiring immediate intervention to prevent myocardial damage and potential cardiac arrest
- High probability of life-threatening event

Differential Diagnoses:
1. STEMI (high probability)
2. Unstable Angina (less likely given severity and duration of pain)
3. Aortic Dissection (less likely given lack of tearing pain and unequal pulses)
4. Pulmonary Embolism (less likely given lack of pleuritic chest pain)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pre-hospital ECG acquisition and transmission to hospital
- Early notification of hospital to activate cardiac catheterization lab
- Oxygen administration and IV access

Final Diagnosis

Final Diagnosis: Acute Anterior STEMI
Key Findings:
- 12-lead ECG on arrival showed significant ST-segment elevation in leads V1-V4
- Cardiac troponin levels were significantly elevated upon arrival at the hospital
- Coronary angiography revealed a complete occlusion of the left anterior descending (LAD) artery
- Successful percutaneous coronary intervention (PCI) with stent placement was performed

Outcome validated F1 priority assignment. Rapid dispatch and ECG transmission were critical. Patient received timely reperfusion therapy, preventing further myocardial damage.

Learning Points:
1. F1 classification was essential due to the severity and time-critical nature of STEMI
2. Initial assessment accurately identified the high probability of a STEMI
3. Pre-hospital ECG was crucial for early diagnosis and activation of the cardiac catheterization lab

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I need an ambulance! My chest hurts so bad, I can't breathe!

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

Caller It's Hafnarstræti 96, apartment 3B, third floor in Akureyri.

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

Caller It started as a discomfort, but now it's like a crushing pain. It's going down my left arm and into my jaw. I'm sweating and feel sick.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake, but he looks very pale and is struggling to breathe.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure, high cholesterol, and diabetes. He takes medication for all of them.

Dispatcher Okay, the ambulance is on its way. Has he taken any aspirin today?

Caller He took one aspirin about 10 minutes ago.

Dispatcher Okay, the ambulance is on its way. Stay with him and keep him calm. Don't let him move around.

Caller Okay, thank you. We will wait here.