Emergency Scenario 900_f1

Location Information

Full Location:

Hamarstígur 7, 900 Vestmannaeyjar, single-story residential house built in 1965. Main entrance at street level, no stairs. No security features. Gravel driveway. Current conditions: 8°C, overcast, light winds, good visibility. GPS coordinates: 63.4407° N, 20.2695° 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, difficulty speaking (slurred speech). Secondary symptoms: Mild confusion, headache. Patient is conscious but agitated. No reported trauma. Patient is sitting in a chair in the living room. Medical history: Hypertension, type 2 diabetes. Medications: Metformin 500mg twice daily, Lisinopril 10mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1410 hours: Patient was watching television, suddenly developed right-sided weakness and slurred speech.
1412 hours: Patient tried to stand but was unable to lift right arm. He felt confused and had a headache.
1414 hours: Patient's wife called emergency services.
1415 hours: Current time, patient is conscious but agitated, sitting in a chair.

Prior Events: Patient has a history of hypertension and type 2 diabetes, well-controlled with medication. No previous strokes or TIAs. Last medical check-up 6 months ago, routine follow-up. Patient lives with his wife. No recent illnesses or injuries.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke (Cerebrovascular Accident)
Justification for F1 Classification:
- Acute onset of focal neurological deficits (facial droop, arm weakness, slurred speech)
- High probability of a stroke based on presentation and risk factors
- Time-critical condition requiring immediate medical intervention to minimize brain damage

Differential Diagnoses:
1. Ischemic Stroke (most likely)
2. Hemorrhagic Stroke (possible)
3. Transient Ischemic Attack (TIA) (less likely given symptom duration)
4. Hypoglycemia (less likely given history of diabetes)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pre-hospital stroke assessment (FAST score)
- Early notification of stroke center at Landspítali
- Preparation for rapid transport to nearest hospital with stroke services

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke, Left Middle Cerebral Artery (MCA) Territory
Key Findings:
- CT scan of the brain confirmed an acute ischemic stroke in the left MCA territory
- Patient's symptoms were consistent with left-sided cerebral involvement
- NIH Stroke Scale score was 12 upon arrival at the hospital

Outcome validated F1 priority assignment. Rapid dispatch and transport were critical for potential thrombolytic therapy. Patient received tPA within the therapeutic window, with partial recovery of function.

Learning Points:
1. F1 classification was essential due to the time-sensitive nature of stroke treatment
2. Initial assessment accurately identified the high probability of stroke
3. Early notification of the stroke center was crucial for timely intervention

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, he's... I think he's having a stroke! He can't move his right arm, and his face is drooping!

Dispatcher Okay, I'm sending help right away. 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 watching TV, and suddenly he couldn't lift his arm. He's talking funny, like his words are slurred. Oh, he looks so scared!

Dispatcher Is he awake and can he understand you?

Caller Yes, he's awake, but he seems confused. He keeps trying to move his arm, but he can't. He has a headache too, he says.

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 try to move him. Stay with him and keep him calm. I will stay on the line with you until they arrive.

Caller Okay, thank you so much! I am so worried!