Emergency Scenario 900_f1

Location Information

Full Location:

Heiðarvegur 2, 900 Vestmannaeyjar, Single-story detached house built in 1965. Main entrance faces the street. No steps at entrance. Gravel driveway. House has a small garden. Current conditions: 8°C, overcast, moderate visibility. GPS coordinates: 63.4427° N, 20.2734° W. Nearest landmark: Vestmannaeyjar Golf Club.

Municipality: Vestmannaeyjar

Postal Code: 900

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 difficulty speaking. Primary symptoms: Right facial droop, right arm and leg weakness, slurred speech. Patient is conscious but confused. Secondary symptoms: Headache, dizziness. Patient was found by his wife in the living room. Medical history: Hypertension, type 2 diabetes, atrial fibrillation. Medications: Metoprolol 50mg twice daily, Metformin 500mg twice daily, Warfarin 5mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1410 hours: Patient was watching TV, appeared normal.
1415 hours: Wife noticed patient was slurring his words and had right-sided weakness.
1416 hours: Wife called emergency services.
1418 hours: Current time, patient is still in the living room, conscious but confused. Wife is providing support.

Prior Events: Patient had a transient ischemic attack (TIA) 2 years ago. No recent changes in medication. Last check-up 6 months ago, routine follow-up. Patient lives with his wife.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke (Cerebrovascular Accident)
Justification for F1 Classification:
- Sudden onset of focal neurological deficits (facial droop, hemiparesis, dysarthria)
- High probability of acute stroke requiring immediate intervention
- Time-critical condition, with potential for significant morbidity and mortality
- Need for rapid transport to a stroke center for thrombolytic therapy if indicated

Differential Diagnoses:
1. Ischemic Stroke (most likely)
2. Hemorrhagic Stroke (possible, requires imaging)
3. Transient Ischemic Attack (less likely given symptom duration and severity)
4. Hypoglycemia (less likely, patient is not known to be hypoglycemic)
5. Seizure (less likely given no report of convulsions)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Activation of stroke protocol, early hospital notification
- Rapid transport to the nearest hospital with stroke capabilities
- Continuous neurological assessment and vital sign monitoring

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Left Middle Cerebral Artery)
Key Findings:
- CT scan of the brain confirmed a large ischemic infarct in the left middle cerebral artery territory
- Patient's symptoms persisted despite initial supportive care
- NIH Stroke Scale (NIHSS) score was 18 upon arrival at hospital
- Patient received intravenous thrombolytic therapy (tPA) within the appropriate window

Outcome validated F1 priority assignment. Rapid dispatch and transport were crucial for potential thrombolytic therapy. Patient was admitted to the 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. Early notification to the hospital and activation of stroke protocols improved patient outcomes

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 immediately. What is your address?

Caller It's Heiðarvegur 2, in Vestmannaeyjar.

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

Caller He was watching TV and then I noticed he started slurring his words and his right arm and leg were weak. He looks confused.

Dispatcher Is he awake and talking to you, even if it's difficult?

Caller Yes, he's awake but he seems confused. He's trying to talk but it doesn't make sense.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure, diabetes and atrial fibrillation. He takes medications for those.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him as calm as you can.

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