Emergency Scenario 700_f1

Location Information

Full Location:

Miðgarður 11, 700 Egilsstaðir, single-story residential house. Built in 1985, wooden construction. Main entrance on the north side. No stairs. Street parking available. No security features. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.2667° N, 14.3933° 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:

78-year-old male, sudden onset of right-sided weakness and slurred speech. Patient found by wife. Primary symptoms: Right facial droop, right arm and leg weakness, slurred speech, difficulty understanding. Secondary symptoms: Mild headache, dizziness. Patient is conscious but confused. No known allergies. Medical history: Hypertension, type 2 diabetes. Medications: Metformin 1000mg twice daily, Lisinopril 20mg daily, Atorvastatin 20mg daily. Last meal was a light lunch at 13:00. Patient was watching TV when symptoms began.

History of Events

Timeline:
14:15 hours: Patient was watching TV, wife noticed sudden change in his speech.
14:16 hours: Wife tried to ask him what was wrong, he responded with slurred speech and right sided weakness.
14:17 hours: Wife helped him to the sofa, noticed right facial droop.
14:18 hours: Wife called emergency services.
14:20 hours: Current time, patient is on the sofa, weak and confused. 

Prior Events: Patient had a minor fall 3 months ago, no injuries. Last medical check-up 6 months ago, routine follow-up. No recent illnesses or infections. Patient lives with his wife.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke
Justification for F1 Classification:
- Sudden onset of neurological deficits (facial droop, limb weakness, slurred speech)
- High probability of acute ischemic stroke requiring immediate intervention
- Time-critical condition, 'time is brain', needs immediate transport to stroke center

Differential Diagnoses:
1. Acute Ischemic Stroke (high probability)
2. Transient Ischemic Attack (TIA) (less likely due to persistent symptoms)
3. Intracranial Hemorrhage (less likely without severe headache/vomiting)
4. Hypoglycemia (less likely given history of diabetes, but needs to be ruled out)
5. Seizure (less likely due to no convulsive activity)

Required Actions:
- Dispatch of ground EMS with ALS capabilities immediately
- Early notification of receiving hospital (FSA Egilsstaðir) with stroke center capabilities
- Pre-hospital stroke assessment (FAST score)
- Rapid transport to hospital

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Left Middle Cerebral Artery)
Key Findings:
- CT scan confirmed an acute ischemic stroke in the left middle cerebral artery territory
- NIH Stroke Scale score of 12 upon arrival at the hospital
- Patient received IV thrombolysis (tPA) within 60 minutes of symptom onset
- No evidence of intracranial hemorrhage

Outcome validated F1 priority assignment. Rapid dispatch and transport were crucial for the patient's outcome. Patient was transferred to Landspitali for further care and rehabilitation.

Learning Points:
1. F1 classification was crucial for timely intervention.
2. Pre-hospital stroke assessment was accurate and helped expedite hospital treatment.
3. Rapid dispatch and hospital notification were essential for optimal 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 talk right and his right side is weak!

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

Caller It's Miðgarður 11 in Egilsstaðir.

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

Caller He was watching TV and suddenly started talking funny. Then he couldn't move his right arm and leg well. His face is drooping on one side.

Dispatcher Is he awake and talking to you?

Caller Yes, but he's confused. He can't say things clearly. I think he's scared.

Dispatcher Does he have any medical conditions?

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

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

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