Emergency Scenario 640_f1

Location Information

Full Location:

Garðarsbraut 17, 640 Húsavík, ground floor apartment 1B. A two-story wooden residential building built in 1965. Main entrance has a small step. No elevator. Street parking available. Building has smoke detectors. Current conditions: 3°C, overcast, light snow, low visibility. GPS coordinates: 66.0469° N, 17.3406° W. Nearest landmark: Húsavík Swimming Pool.

Municipality: Húsavík

Postal Code: 640

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old male, sudden onset of stroke symptoms. Primary symptoms: Right-sided facial droop, right arm weakness, slurred speech, confusion. Secondary symptoms: Mild headache, nausea. Patient is conscious but disoriented. Patient is sitting in a chair in his living room. Medical history: Hypertension, type 2 diabetes, previous TIA 2 years ago. Medications: Metformin 500mg twice daily, Lisinopril 10mg daily, Aspirin 75mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
1330 hours: Patient was watching TV, suddenly developed right-sided weakness and slurred speech
1332 hours: Patient attempted to stand, unable to move right arm and leg, became confused
1335 hours: Wife called emergency services
1337 hours: Current time, patient still sitting in chair, confused, right-sided weakness

Prior Events: Patient had a TIA two years ago, recovered fully. Compliant with medications. No recent illnesses or injuries. Last medical check-up 6 months ago, routine follow-up. Patient lives with his wife, who is the caller.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Ischemic Stroke
Justification for F1 Classification:
- Sudden onset of focal neurological deficits (facial droop, arm weakness, slurred speech)
- High probability of stroke based on symptoms and medical history
- Time-sensitive condition requiring immediate medical intervention (thrombolysis or thrombectomy)
- Rapid transport to stroke center is crucial for optimal outcome

Differential Diagnoses:
1. Acute Ischemic Stroke (high probability)
2. Hemorrhagic Stroke (less likely, but must be ruled out)
3. Transient Ischemic Attack (less likely given persistent symptoms)
4. Hypoglycemia (possible, but less likely given patient's diabetes management)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-notification of stroke center at Akureyri Hospital
- Rapid transport to hospital with stroke protocol
- Continuous monitoring of vital signs and neurological status

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke, Left Middle Cerebral Artery (MCA) Occlusion
Key Findings:
- CT scan confirmed an acute ischemic stroke in the left MCA territory
- NIH Stroke Scale score was 12 on arrival, indicating moderate to severe stroke
- Patient received IV thrombolysis within 60 minutes of arrival
- Subsequent angiography revealed a large vessel occlusion, and mechanical thrombectomy was performed

Outcome validated F1 priority assignment. Rapid dispatch and transport were essential for timely intervention. Patient had significant improvement in neurological deficits post-thrombectomy.

Learning Points:
1. F1 classification was crucial due to the time-sensitive nature of stroke
2. Initial assessment accurately identified the high probability of stroke
3. Pre-hospital notification and rapid transport enabled timely thrombolysis and thrombectomy, improving patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, he's not well! I think he's having a stroke!

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

Caller It's Garðarsbraut 17, apartment 1B in Húsavík.

Dispatcher Help is on its way. Can you tell me what is happening with your husband?

Caller He was watching TV, and suddenly his face drooped on one side. His arm and leg on that side are weak and he's talking funny. He seems confused.

Dispatcher Is he awake and able to talk to you?

Caller Yes, he is awake but he is not making much sense. He is trying to talk, but it's slurred.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and diabetes. He had a small stroke a couple of years ago. He takes medicine for all of that.

Dispatcher Okay, the ambulance is on its way. Do not give him anything to eat or drink. Stay with him and keep him calm.

Caller Okay, thank you. I'm so scared. I will stay with him.