Emergency Scenario 780_f1

Location Information

Full Location:

Hafnarbraut 10, 780 Höfn, Apartment 3B on the third floor. A four-story concrete building constructed in 1995. Main entrance has a key code, 1234#. Elevator and central stairwell available. Street parking. Building has a fire alarm system. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 64.2509° N, 15.2084° W. Nearest landmark: Höfn Harbour.

Municipality: Höfn

Postal Code: 780

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

76-year-old male, exhibiting sudden onset of stroke symptoms. Primary symptoms: Right-sided facial droop, right arm weakness, slurred speech. Secondary symptoms: Confusion, difficulty understanding simple questions. Patient is conscious but agitated. Medical history: Hypertension, Type 2 Diabetes. Medications: Metformin 1000mg twice daily, Lisinopril 20mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was lunch at 13:00. Patient was watching television when symptoms started.

History of Events

Timeline:
1500 hours: Patient was watching TV, felt sudden weakness in right arm.
1502 hours: Patient attempted to speak, noticed slurred speech and facial droop.
1503 hours: Patient became confused and agitated.
1504 hours: Wife called emergency services.
1506 hours: Current time, patient is conscious but symptoms are worsening. 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: Acute Stroke
Justification for F1 Classification:
- Rapid onset of focal neurological deficits (facial droop, arm weakness, slurred speech)
- High probability of acute ischemic stroke based on presentation
- Time-sensitive condition requiring immediate intervention (thrombolysis or thrombectomy)

Differential Diagnoses:
1. Ischemic Stroke (most likely)
2. Hemorrhagic Stroke (less likely, but possible)
3. Transient Ischemic Attack (TIA) (less likely due to persistent symptoms)
4. Hypoglycemia (unlikely given diabetic history and no reported insulin use)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-notification of the receiving hospital stroke team
- Assessment of patient's last known well time
- Monitoring of vital signs and neurological status
- Preparation for rapid transport to nearest stroke center

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke due to Left Middle Cerebral Artery (MCA) Occlusion
Key Findings:
- CT scan confirmed a large left MCA occlusion
- Patient's NIH Stroke Scale score was 18 upon arrival to hospital
- Thrombolysis was initiated within 45 minutes of arrival
- Subsequent thrombectomy was performed with successful recanalization

Outcome validated F1 priority assignment. Rapid dispatch, pre-hospital notification, and prompt treatment were essential. Patient made a significant recovery with minimal residual deficits.

Learning Points:
1. F1 classification was crucial for timely intervention and optimal outcome
2. Initial assessment accurately identified the high probability of acute stroke
3. Pre-notification and early hospital activation of stroke protocols improved patient outcomes

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, he's... something is wrong. He can't move his right arm and his face is drooping.

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

Caller It's Hafnarbraut 10, apartment 3B, third floor in Höfn.

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

Caller He was watching TV and suddenly his arm went weak. He's talking funny too, like slurred.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake, but he seems confused. He doesn't understand me well. His face is drooping on one side.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and diabetes. He takes pills for both. He had a small stroke before, maybe six months ago.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm. What time did you first notice the symptoms?

Caller Maybe five minutes ago. It happened very quickly. I'm so worried.