Emergency Scenario 400_f2

Location Information

Full Location:

Hafnarstræti 1, 400 Ísafjörður, ground floor apartment 1B. Two-story wooden residential building constructed in 1950. Main entrance requires a key. No elevator, access via a short flight of stairs. Street parking available. Building is equipped with smoke detectors. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 66.0748° N, 23.1272° W. Nearest landmark: Ísafjörður harbor.

Municipality: Ísafjörður

Postal Code: 400

Emergency Details

Type: Acute Pain Management

Priority Level: F2

Response Time Goal: Urgent (15-30 minutes)

Description:

55-year-old female, reports sudden onset of severe lower back pain. Primary symptoms: Intense, radiating pain from lower back to left leg, unable to stand or walk, muscle spasms. Secondary symptoms: Numbness and tingling in left foot, nausea. Patient alert but distressed. Patient is lying on the floor in her living room. Medical history: History of chronic lower back pain, previous episodes of sciatica, no known allergies. Medications: Ibuprofen 400mg PRN, Diazepam 5mg PRN. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1410 hours: Patient was bending over to pick up an object when she experienced a sudden, sharp pain in her lower back.
1411 hours: Patient attempted to stand but was unable to due to severe pain, fell to the floor.
1412 hours: Patient reports radiating pain to left leg, numbness in foot.
1415 hours: Patient called emergency services.
1418 hours: Current time, patient still on floor, unable to move.

Prior Events: Patient reports frequent episodes of lower back pain for the past 5 years, with occasional sciatica flare-ups. Previous physical therapy. No recent injuries or illnesses. Last medical check-up 6 months ago for routine follow-up.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Sciatica/Lumbar Radiculopathy
Justification for F2 Classification:
- Severe pain with neurological symptoms (numbness, tingling)
- Patient unable to ambulate, suggesting significant functional impairment
- Potential for nerve compression, requiring prompt medical evaluation and pain management

Differential Diagnoses:
1. Acute Sciatica (high probability)
2. Lumbar Disc Herniation (high probability)
3. Muscular Spasm (less likely given severity of pain and neurological symptoms)
4. Spinal Fracture (lower probability, no history of trauma)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pain management protocols initiation
- Assessment for neurological deficits
- Preparation for transport to nearest hospital with neurological services

Final Diagnosis

Final Diagnosis: Acute Lumbar Disc Herniation with Nerve Root Compression
Key Findings:
- MRI confirmed a herniated disc at L4-L5 level, compressing the left S1 nerve root
- Patient's pain score remained high despite initial analgesia
- Neurological exam revealed decreased sensation and weakness in the left foot

Outcome validated F2 priority assignment. Rapid dispatch and pain management were essential. Patient underwent surgical decompression within 48 hours.

Learning Points:
1. F2 classification appropriate due to the need for timely intervention
2. Initial assessment accurately identified the high likelihood of nerve compression
3. Prompt pain management and neurological assessment were crucial for optimal patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I need help! I've hurt my back, it's really bad.

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

Caller It's Hafnarstræti 1, apartment 1B, ground floor in Ísafjörður.

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

Caller I was bending over, and suddenly I got this terrible pain in my back. I can't stand up!

Dispatcher Is the pain anywhere else?

Caller Yes, it's going down my left leg and my foot feels numb.

Dispatcher Are you able to move your leg or foot?

Caller It's hard, it feels weak. I'm also feeling sick to my stomach.

Dispatcher Okay, the ambulance is on its way. Don't try to move. Stay calm, help is coming.

Caller Okay, thank you. I'm in so much pain.