Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 98, 600 Akureyri, third floor apartment 3B. A five-story concrete building built in 1985. Main entrance uses a key code system. There is one elevator and a central stairwell. Street parking available. Building has a fire alarm system. Current conditions: 7°C, overcast, light wind. GPS coordinates: 65.6821° N, 18.0915° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

68-year-old male, exhibiting signs of a stroke. Primary symptoms: Sudden onset of right-sided facial droop, slurred speech, and weakness in right arm. Secondary symptoms: Patient is confused and agitated. No reported loss of consciousness. Patient is sitting in a chair in his living room. Medical history: Hypertension, type 2 diabetes, and previous TIA 2 years ago. Medications: Metformin 1000mg twice daily, Lisinopril 20mg daily, Atorvastatin 40mg daily. No known allergies. Last meal was a light lunch at 12:30.

History of Events

Timeline:
1345 hours: Patient was watching TV and suddenly started to slur his speech and his face drooped.
1346 hours: Patient tried to stand but his right arm felt weak and he stumbled.
1347 hours: Wife noticed the symptoms and called for help.
1348 hours: Current time, patient is confused and agitated. Wife is present and providing support.

Prior Events: Patient had a TIA two years ago. No other significant recent illnesses or injuries. Last medical check-up 6 months ago, routine follow-up. Patient lives with his wife.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Ischemic Stroke
Justification for F1 Classification:
- Sudden onset of focal neurological deficits (facial droop, slurred speech, unilateral weakness)
- High probability of stroke based on symptoms and medical history
- Time-sensitive condition requiring immediate medical intervention
- Risk of permanent neurological damage if treatment delayed

Differential Diagnoses:
1. Acute Ischemic Stroke (high probability)
2. Hemorrhagic Stroke (less likely without severe headache or LOC)
3. Transient Ischemic Attack (TIA) (possible but requires immediate evaluation)
4. Hypoglycemia (less likely with known diabetes, but needs to be ruled out)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pre-arrival notification to hospital stroke team
- Preparation for rapid transport to nearest stroke center
- Initiation of stroke protocol on arrival

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke, Right Middle Cerebral Artery (MCA) Occlusion
Key Findings:
- CT scan confirmed a large ischemic stroke in the right MCA territory
- Patient's NIHSS score was 12 on arrival at hospital
- No evidence of hemorrhage on CT scan
- Patient received IV thrombolysis within 90 minutes of symptom onset

Outcome validated F1 priority assignment. Rapid dispatch, pre-hospital notification, and prompt hospital treatment were crucial for the patient's outcome. Patient had significant improvement after thrombolysis.

Learning Points:
1. F1 classification was appropriate due to the time-sensitive nature of the stroke
2. Initial assessment accurately identified the high likelihood of a stroke
3. Rapid response and early hospital notification improved patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

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

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

Caller It's Hafnarstræti 98, apartment 3B, third floor in Akureyri.

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

Caller He was watching TV and suddenly started slurring his words. Then his face started to droop on one side, and his arm feels weak.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he's very confused and agitated. He keeps trying to get up but he's stumbling.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and diabetes, and he had a small stroke a couple of years ago.

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

Caller Okay, thank you, I will wait here with him.