Emergency Scenario 780_f1

Location Information

Full Location:

Hafnarbraut 14, 780 Höfn, ground floor apartment. Two-story wooden residential building constructed in 1955. Main entrance faces the harbor. No elevator, central stairwell. Street parking available. Building has basic smoke detectors. Current conditions: 8°C, overcast, moderate visibility, light wind. GPS coordinates: 64.2509° N, 15.2073° W. Nearest landmark: Höfn harbor.

Municipality: Höfn

Postal Code: 780

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

75-year-old male, found unresponsive by his son. Primary symptoms: Sudden onset of right-sided facial droop, right arm weakness, slurred speech, and now unresponsiveness. Secondary symptoms: None reported. Patient was seen normal approximately 30 minutes prior. 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 13:00.

History of Events

Timeline:
1400 hours: Patient was seen by son, appeared normal.
1430 hours: Son returned to find patient slumped in chair, unresponsive, with right-sided weakness and facial droop.
1432 hours: Son immediately called emergency services.
1434 hours: Current time, patient unresponsive, son is beside him.

Prior Events: Patient has a history of hypertension and diabetes, managed with medications. No recent hospitalizations. Last medical check-up was 6 months ago, routine follow-up. Patient lives alone, but son checks on him daily.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Ischemic Stroke
Justification for F1 Classification:
- Sudden onset of focal neurological deficits including facial droop, arm weakness, and speech difficulty
- Rapid progression to unresponsiveness
- Time-critical condition requiring immediate intervention to preserve neurological function

Differential Diagnoses:
1. Acute Ischemic Stroke (most likely given presentation)
2. Hemorrhagic Stroke (possible, requires imaging to differentiate)
3. Hypoglycemia (less likely given no known history of insulin use or altered mental status prior to event)
4. Seizure (less likely given focal deficits and lack of seizure activity)

Required Actions:
- Dispatch of ground EMS with ALS capabilities, including stroke protocol activation
- Immediate hospital notification to activate stroke team
- Pre-hospital assessment for stroke severity using FAST assessment
- Rapid transport to nearest stroke center for CT imaging and possible thrombolysis

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke, Left Middle Cerebral Artery (MCA) Occlusion
Key Findings:
- CT scan confirmed a large left MCA occlusion
- Patient's NIHSS score was 18 on arrival, indicating severe stroke
- Patient received IV thrombolysis within 60 minutes of arrival

Outcome validated F1 priority assignment. Rapid dispatch and transport were critical. Patient showed some improvement after thrombolysis but had residual deficits.

Learning Points:
1. F1 classification was appropriate due to the time-sensitive nature of acute stroke
2. Initial assessment accurately identified stroke symptoms
3. Rapid pre-hospital activation of stroke protocols and transport to a stroke center were essential for optimal outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father... I think he's had a stroke! He's not responding!

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

Caller It's Hafnarbraut 14 in Höfn, ground floor apartment.

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

Caller I just came to check on him and he's slumped in his chair. He’s not talking, and his face looks droopy on one side. His right arm is weak. He was fine just half an hour ago!

Dispatcher Is he awake at all?

Caller No, he's not responding to me at all now. He was mumbling before, but now nothing.

Dispatcher Does he have any medical conditions?

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

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm if possible. I will stay on the line with you.

Caller Okay, I'm here. Please hurry!