Emergency Scenario 900_f1

Location Information

Full Location:

Hamarstígur 7, 900 Vestmannaeyjar. Single-story detached residential house built in 1965. Main entrance on the west side, no stairs. No security features. Street parking available. Current conditions: 8°C, overcast, light wind, good visibility. GPS coordinates: 63.4408° N, 20.2723° 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 stroke symptoms. Primary symptoms: Right-sided facial droop, right arm weakness, slurred speech. Patient reports sudden onset of symptoms approximately 15 minutes ago. Secondary symptoms: Mild headache, slight dizziness. Patient conscious but confused. Medical history: Hypertension, type 2 diabetes. Medications: Metformin 500mg twice daily, Lisinopril 20mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was lunch at 13:00.

History of Events

Timeline:
14:15 hours: Patient was watching TV when his wife noticed sudden onset of facial droop and slurred speech
14:16 hours: Wife attempted to ask questions, noticed right arm weakness
14:18 hours: Wife called emergency services
14:20 hours: Current time, patient is conscious but confused, symptoms persist

Prior Events: Patient reports no recent illnesses or injuries. Last medical check-up 6 months ago, routine follow-up for chronic conditions. No history of stroke or TIA. Patient lives with his wife.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke
Justification for F1 Classification:
- Sudden onset of focal neurological deficits (facial droop, arm weakness, slurred speech)
- Time-critical condition requiring immediate intervention to minimize brain damage
- High probability of acute ischemic stroke based on symptom presentation

Differential Diagnoses:
1. Ischemic Stroke (high probability)
2. Hemorrhagic Stroke (possible, requires imaging to differentiate)
3. Transient Ischemic Attack (TIA) (less likely given persistent symptoms)
4. Hypoglycemia (less likely given diabetes management)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-arrival notification to nearest stroke center (Landspitali National Hospital)
- Initiation of stroke protocols including rapid transport and pre-hospital stroke assessment
- Preparation for possible thrombolytic therapy if indicated

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Left Middle Cerebral Artery)
Key Findings:
- CT scan confirmed a large ischemic stroke in the left middle cerebral artery territory
- NIH Stroke Scale score was 12 upon arrival at the hospital, indicating moderate to severe stroke
- Patient received intravenous thrombolysis (tPA) within 3 hours of symptom onset

Outcome validated F1 priority assignment. Rapid transport and early intervention were crucial in limiting the extent of neurological damage.

Learning Points:
1. F1 classification was essential due to the time-sensitive nature of stroke
2. Initial assessment accurately identified the high likelihood of an acute stroke
3. Early hospital notification and rapid transport facilitated prompt thrombolytic therapy

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, I think he's having a stroke! His face is drooping on one side, and he can't move his arm properly.

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

Caller It's Hamarstígur 7 in Vestmannaeyjar.

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

Caller He was just sitting watching TV, and suddenly his face started to droop, and his speech is slurred. He can't lift his right arm.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake, but he's confused. He doesn't seem to understand me well.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and diabetes. He takes medication for both.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm. Do you know what time the symptoms started?

Caller Yes, it was about 15 minutes ago, maybe a bit more. Please hurry!

Dispatcher We are on our way. Please keep him calm and do not give him anything to eat or drink.