Emergency Scenario 700_f1

Location Information

Full Location:

Miðvangur 2, 700 Egilsstaðir, Ground floor apartment 1B. Two-story wooden residential building constructed in 1965. Main entrance is unlocked. No elevator, interior stairwell. Street parking available. Building equipped with smoke detectors. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.2667° N, 14.3950° W. Nearest landmark: Egilsstaðir swimming pool.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old male, exhibiting sudden onset of stroke symptoms. Primary symptoms: Right-sided facial droop, weakness in right arm and leg, slurred speech. Patient is conscious but confused. Secondary symptoms: Headache, mild dizziness. Patient is sitting in a chair in the living room. Medical history: Hypertension, type 2 diabetes, atrial fibrillation. Medications: Metoprolol 50mg twice daily, Metformin 500mg twice daily, Warfarin 5mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
14:15 hours: Patient was watching television, began to feel unwell.
14:18 hours: Patient noted right-sided weakness and difficulty speaking.
14:20 hours: Patient attempted to stand, experienced significant weakness and dizziness.
14:22 hours: Patient's son (caller) found him, immediately called emergency services.
14:24 hours: Current time, patient is still seated, confused and weak.

Prior Events: Patient has a history of transient ischemic attacks (TIAs) in the past year, last TIA was 6 months ago. Patient has not had any recent changes in medication. Last medical check-up was 2 months ago, routine follow-up. Patient lives with his son.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke (Cerebrovascular Accident)
Justification for F1 Classification:
- Sudden onset of focal neurological deficits (facial droop, unilateral weakness, speech disturbance)
- High probability of acute ischemic stroke based on symptoms and risk factors (hypertension, atrial fibrillation)
- Time-critical condition requiring immediate intervention (thrombolysis eligibility within a short therapeutic window)

Differential Diagnoses:
1. Ischemic Stroke (high probability)
2. Hemorrhagic Stroke (less likely, but must be ruled out)
3. Transient Ischemic Attack (TIA) (possible, but current symptoms are more severe and persistent)
4. Hypoglycemia (less likely, but must be considered)
5. Seizure (less likely given presentation)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pre-notification of hospital stroke team
- Rapid transport to the nearest hospital with stroke unit
- Assessment of last known well time for thrombolysis eligibility
- Continuous monitoring of vital signs and neurological status

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Right Middle Cerebral Artery)
Key Findings:
- CT scan of the brain confirmed an acute ischemic stroke in the territory of the right middle cerebral artery
- Patient's symptoms aligned with the imaging findings
- No evidence of hemorrhage or other intracranial pathology

Outcome validated F1 priority assignment. Rapid dispatch, pre-hospital assessment, and transport were critical for timely intervention. Patient received thrombolytic therapy within the therapeutic window and was admitted to the stroke unit for ongoing management.

Learning Points:
1. F1 classification was essential due to the time-critical nature of stroke
2. Initial assessment accurately identified the high probability of stroke
3. Prompt pre-hospital notification allowed for efficient hospital preparation

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is not well! I think he is having a stroke.

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

Caller It's Miðvangur 2, apartment 1B, ground floor in Egilsstaðir.

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

Caller He was watching TV and suddenly his face drooped on one side. He can't move his right arm and leg properly, and he is slurring his words.

Dispatcher Is he awake and talking to you?

Caller Yes, he is awake but he seems confused. He has a headache as well.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure, diabetes, and atrial fibrillation. He takes medications for these.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm. What time did the symptoms start?

Caller I think it was about 10 minutes ago. Thank you, I'll stay with him.