Emergency Scenario 735_f1

Location Information

Full Location:

Hafnargata 14, 735 Norðfjörður, a two-story wooden house built in 1955. Main entrance on the street side. No elevator, access via stairs. Street parking available. No specific security features. Current conditions: 2°C, clear skies, good visibility. GPS coordinates: 65.0432° N, 13.9921° W. Nearest landmark: Norðfjörður harbor.

Municipality: Norðfjörður

Postal Code: 735

Emergency Details

Type: Chest Pain - STEMI

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

62-year-old male, experiencing severe chest pain. Primary symptoms: crushing chest pain radiating to left arm, shortness of breath, diaphoresis. Secondary symptoms: nausea, dizziness. Patient is pale and anxious. Patient is conscious but appears distressed. Medical history: Hypertension, type 2 diabetes. Medications: Metformin 1000mg BID, Lisinopril 20mg daily, Atorvastatin 40mg daily. No known allergies. Last meal was a light lunch at 13:00. Patient is at home.

History of Events

Timeline:
1400 hours: Patient was sitting watching television when he developed sudden onset of severe chest pain.
1402 hours: Pain became progressively worse, radiating to left arm, accompanied by shortness of breath and sweating.
1404 hours: Patient called his wife who then called emergency services.
1406 hours: Current time, patient is still experiencing severe chest pain.

Prior Events: Patient has a history of hypertension and type 2 diabetes, managed with medication. No prior history of heart attack. Last medical check-up 6 months ago, routine follow-up. Patient is a former smoker, quit 5 years ago. No recent illnesses or injuries. Wife is present at the scene.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute ST-Elevation Myocardial Infarction (STEMI)
Justification for F1 Classification:
- Classic presentation of STEMI with severe, crushing chest pain, radiation to left arm, shortness of breath, diaphoresis, and nausea
- Time-sensitive condition requiring immediate intervention to minimize myocardial damage and risk of death
- High probability of life-threatening arrhythmia or cardiac arrest

Differential Diagnoses:
1. STEMI (high probability)
2. Unstable Angina (less likely given severity and radiation of pain)
3. Aortic Dissection (less likely given lack of tearing pain and unequal pulses)
4. Pulmonary Embolism (less likely given lack of pleuritic pain and hemoptysis)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-arrival instructions to the caller, including aspirin administration if not contraindicated
- Early notification of receiving hospital for potential PCI activation
- Rapid transport to nearest hospital with cardiac catheterization lab

Final Diagnosis

Final Diagnosis: Confirmed Acute ST-Elevation Myocardial Infarction (STEMI) in the anterior territory
Key Findings:
- 12-lead ECG showed ST-segment elevation in V1-V4 leads
- Troponin levels were elevated, confirming myocardial injury
- Coronary angiography revealed a 100% occlusion of the proximal left anterior descending (LAD) artery
- Patient underwent successful primary percutaneous coronary intervention (PCI) with stent placement

Outcome validated F1 priority assignment. Rapid dispatch and treatment were critical to salvage myocardial tissue. Patient had a successful outcome with no major complications.

Learning Points:
1. F1 classification appropriate due to the time-critical nature of STEMI
2. Initial assessment accurately identified the high probability of STEMI
3. Prompt activation of the cardiac catheterization lab was essential for a positive outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband is having terrible chest pain! I think he's having a heart attack!

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

Caller It's Hafnargata 14 in Norðfjörður.

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

Caller He was just sitting and suddenly started complaining of crushing chest pain. He's sweating and can barely breathe. It's like he can't get enough air.

Dispatcher Is the pain going anywhere else?

Caller Yes, he says it's going down his left arm. He looks really pale.

Dispatcher Is he awake and talking to you?

Caller Yes, he is awake but he is very distressed and says he feels nauseous.

Dispatcher Does he have any medical conditions or take any medications?

Caller Yes, he has high blood pressure and diabetes. He takes metformin, lisinopril and atorvastatin.

Dispatcher Okay, the ambulance is on its way. Does he have any allergies to medications?

Caller No, he doesn't have any allergies.

Dispatcher Okay, has he taken aspirin today?

Caller No, he hasn't.

Dispatcher If he is able to, have him chew one 300mg aspirin, if you have one. Stay with him and keep him calm. Help is on the way.

Caller Okay, I will. Thank you so much!