Emergency Scenario 700_f1

Location Information

Full Location:

Miðgarður 1, 700 Egilsstaðir, single-story detached house. Built in 1985, wood construction. Main entrance on the south side, with a secondary entrance on the west side. No security features. Street parking available. Current conditions: 8°C, overcast, light wind, good visibility. GPS coordinates: 65.2656° N, 14.3936° W. Nearest landmark: Egilsstaðir Airport.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Cardiac Arrest

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old male, found unresponsive. Primary symptoms: Unresponsive, not breathing, no pulse. Secondary symptoms: Cyanosis. Patient was found on the living room floor. Medical history: History of coronary artery disease, hypertension, and type 2 diabetes. Medications: Aspirin 100mg daily, Metoprolol 50mg twice daily, Metformin 500mg twice daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1410 hours: Patient was last seen alert and talking by his wife
1430 hours: Wife found him unresponsive on the living room floor
1432 hours: Wife attempted to wake him, no response
1433 hours: Wife called emergency services
1435 hours: Current time, patient still unresponsive, no breathing, no pulse

Prior Events: Patient reported mild chest pain yesterday, attributed it to indigestion. Had a check-up 6 months ago, no significant changes noted. Has been generally active and independent.

Diagnostics

Initial Assessment

Initial Impression: Cardiac Arrest
Justification for F1 Classification:
- Patient is unresponsive, not breathing, and has no pulse, indicating immediate life-threatening condition.
- Time-critical condition requiring immediate CPR and defibrillation.
- Highest priority for dispatch due to high risk of mortality without immediate intervention.

Differential Diagnoses:
1. Cardiac Arrest (most likely)
2. Respiratory Arrest (less likely given no preceding respiratory symptoms)
3. Severe Hypoglycemia (possible, but less likely given history and presentation)
4. Stroke (possible, but less likely given abrupt onset of unresponsiveness)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Immediate CPR instructions to caller
- Early notification of receiving hospital for potential cardiac intervention
- Preparation for defibrillation and advanced airway management

Final Diagnosis

Final Diagnosis: Ventricular Fibrillation leading to Cardiac Arrest
Key Findings:
- Initial rhythm upon arrival was ventricular fibrillation
- Defibrillation was successful in restoring a perfusing rhythm
- Patient regained spontaneous circulation after two shocks and advanced life support measures
- Subsequent ECG confirmed acute myocardial infarction

Outcome validated F1 priority assignment. Immediate CPR and defibrillation were crucial for survival. Patient was transported to the hospital and underwent coronary angiography with stenting.

Learning Points:
1. F1 classification was essential due to the time-sensitive nature of cardiac arrest.
2. Early recognition and immediate CPR instructions by dispatcher were vital.
3. Rapid defibrillation is key to improving survival rates in cases of ventricular fibrillation.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband! He's not breathing! I think he's dead!

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

Caller It's Miðgarður 1 in Egilsstaðir. Please hurry!

Dispatcher Help is on its way. Is he completely unresponsive?

Caller Yes, he's not moving, not breathing! I can't feel anything!

Dispatcher Okay, I need you to stay calm. I'm going to guide you through CPR. Can you get him on his back on the floor?

Caller (Heavy breathing, sounds of movement) Yes, I've got him on the floor.

Dispatcher Okay, place the heel of one hand in the center of his chest, and the other hand on top. Push hard and fast, about two inches deep. We will do 30 compressions and then 2 breaths. Can you do that?

Caller I...I don't know if I can. I'm so scared! (sounds of distress)

Dispatcher You can do this. We need to keep the blood flowing. Start compressions now, push hard and fast. I will count with you. 1, 2, 3...

Caller (Sounds of compressions and labored breathing) I'm doing it...I'm trying...

Dispatcher That's great. Keep going. The ambulance is on its way. What is his medical history?

Caller He has heart problems, high blood pressure, and diabetes. He takes a lot of pills.

Dispatcher Okay, keep doing the compressions. The ambulance will be there soon. We are doing everything we can.