Emergency Scenario 700_f1

Location Information

Full Location:

Miðgarður 11, 700 Egilsstaðir, single-story detached house. Constructed in 1985, wooden structure. Main entrance at the front with a small porch. No security features. Paved driveway. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.2678° N, 14.3938° W. Nearest landmark: Egilsstaðir Airport.

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, sudden onset of stroke symptoms. Primary symptoms: Left-sided facial droop, left arm weakness, slurred speech. Patient is conscious but confused. Secondary symptoms: Mild headache, slight dizziness. Patient is sitting in a chair in the living room. Medical history: Hypertension, Type 2 Diabetes. Medications: Metformin 1000mg twice daily, Lisinopril 20mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
13:10 hours: Patient was watching television, appeared normal.
13:15 hours: Wife noticed patient's face drooping, arm weakness, and slurred speech.
13:16 hours: Wife helped patient to a chair.
13:17 hours: Wife called emergency services.
13:20 hours: Current time, patient is conscious but confused, symptoms persistent.

Prior Events: Patient has had well-controlled hypertension and diabetes for several years. No prior strokes or TIAs. Last medical check-up was 6 months ago, routine follow-up. Patient lives with his wife. No recent illnesses or injuries.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke
Justification for F1 Classification:
- Rapid onset of focal neurological deficits (facial droop, arm weakness, slurred speech)
- High probability of acute stroke, requiring immediate intervention to minimize neurological damage
- Time-critical condition, requiring immediate dispatch and hospital pre-notification for potential thrombolysis

Differential Diagnoses:
1. Ischemic Stroke (most likely)
2. Hemorrhagic Stroke (possible)
3. Transient Ischemic Attack (TIA) (less likely due to persistent symptoms)
4. Bell's Palsy (less likely due to associated arm weakness)
5. Hypoglycemia (possible, but unlikely given diabetic history)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pre-notification of hospital stroke team
- Rapid transport to the nearest stroke center
- Assessment of blood glucose level upon arrival

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Left Middle Cerebral Artery)
Key Findings:
- CT scan confirmed a large ischemic stroke in the territory of the left middle cerebral artery.
- Patient's NIHSS score was 12 upon arrival at hospital.
- Patient was eligible for and received intravenous thrombolysis.

Outcome validated F1 priority assignment. Rapid dispatch and pre-hospital notification were essential for prompt treatment. Patient was admitted to the stroke unit for further management and rehabilitation.

Learning Points:
1. F1 classification was appropriate due to the time-critical nature of stroke
2. Initial assessment accurately identified the high likelihood of stroke
3. Rapid transport and early notification facilitated timely thrombolytic therapy

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

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

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

Caller It's Miðgarður 11, 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, and his arm seems weak. He is also having trouble talking.

Dispatcher Is he awake and talking to you?

Caller Yes, he is awake but he seems confused and his speech is slurred.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and diabetes. He takes pills for both.

Dispatcher Okay, the ambulance is on its way. Please stay with him and try to keep him calm. Do you know when the symptoms started?

Caller It was just a few minutes ago, maybe five or ten minutes. Thank you, I'm very worried.