Emergency Scenario 735_f1

Location Information

Full Location:

Hafnargata 18, 735 Norðfjörður, ground floor apartment. Two-story wooden residential building, constructed in 1960. Main entrance is unlocked. No elevator, only stairs. Street parking available. Building equipped with smoke detectors. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.1983° N, 14.0132° W. Nearest landmark: Norðfjörður harbor.

Municipality: Norðfjörður

Postal Code: 735

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old male, sudden onset of right-sided weakness and slurred speech. Patient is conscious but confused. Facial droop on the right side. Patient is sitting in a chair. No reported head trauma. Medical history: Hypertension, Type 2 diabetes. Medications: Metformin 500mg twice daily, Lisinopril 10mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1410 hours: Patient was watching television, began slurring speech.
1412 hours: Patient developed right-sided weakness, difficulty raising right arm.
1413 hours: Wife noticed facial droop, patient became confused.
1414 hours: Wife called emergency services.
1415 hours: Current time, patient is conscious but confused, sitting in a chair.

Prior Events: Patient had a transient ischemic attack (TIA) 6 months ago. No recent illnesses or injuries. Last medical check-up 2 months ago, routine follow-up. Patient lives with his wife.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke
Justification for F1 Classification:
- Sudden onset of neurological deficits (right-sided weakness, slurred speech, facial droop)
- High suspicion of acute stroke, a time-critical emergency
- Requires immediate medical intervention to minimize brain damage

Differential Diagnoses:
1. Ischemic Stroke (most likely)
2. Hemorrhagic Stroke (possible)
3. Transient Ischemic Attack (less likely given persistent symptoms)
4. Hypoglycemia (less likely, no history of insulin use)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-notification of nearest stroke center
- Rapid transport to hospital with CT scan capabilities
- Documentation of time of symptom onset for thrombolysis eligibility

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Left Middle Cerebral Artery)
Key Findings:
- CT scan confirmed a large left middle cerebral artery (MCA) ischemic stroke
- Patient's NIH Stroke Scale (NIHSS) score was 18 upon arrival
- Patient received intravenous thrombolysis within the treatment window
- Patient demonstrated partial recovery of motor function after thrombolysis

Outcome validated F1 priority assignment. Rapid dispatch and treatment were crucial for improving patient outcome. Patient admitted to stroke unit for ongoing care.

Learning Points:
1. F1 classification was essential due to the time-sensitive nature of stroke
2. Initial assessment accurately identified the high likelihood of a stroke
3. Rapid recognition of stroke symptoms by the caller facilitated timely intervention

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, he's not right! He can't talk properly, and his arm is weak!

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

Caller It's Hafnargata 18 in Norðfjörður. We're on the ground floor.

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

Caller He was just sitting watching TV, and then he started slurring his words. Now his right arm is weak, and his face looks droopy on one side.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake, but he's confused. He doesn't understand me properly.

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. Don't let him get up. Stay with him and try to keep him calm.

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