Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, third floor, office 302. Four-story commercial building constructed in 1990. Main entrance has a coded lock, code is 1234. Elevator and stair access. Street parking available. Building has fire alarm and sprinkler system. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 65.6821° N, 18.0894° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - Suspected Acute Coronary Syndrome

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

55-year-old male, experiencing severe chest pain. Primary symptoms: Crushing chest pain radiating to the left arm and jaw, shortness of breath, diaphoresis. Patient reports feeling lightheaded. Secondary symptoms: Nausea. Patient is conscious but anxious. Skin is pale and clammy. Patient is sitting in his office chair. Medical history: Hypertension, hypercholesterolemia, family history of heart disease. Medications: Lisinopril 20mg daily, Atorvastatin 40mg daily. No known allergies. Last meal was a sandwich at 12:00.

History of Events

Timeline:
13:15 hours: Patient started experiencing mild chest discomfort.
13:20 hours: Chest pain increased in intensity, radiating to the left arm and jaw.
13:22 hours: Patient started feeling short of breath and sweaty.
13:25 hours: Patient called his colleague for help, who then called emergency services.
13:28 hours: Current time, patient still experiencing severe chest pain and shortness of breath.

Prior Events: Patient reports occasional mild chest discomfort in the past, attributed to indigestion. No prior heart attack or cardiac interventions. Last medical check-up 6 months ago, routine follow-up. Patient has a stressful job. Non-smoker.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Coronary Syndrome (ACS), likely Myocardial Infarction (MI)
Justification for F2 Classification:
- High probability of a cardiac event based on classic symptoms (chest pain, radiation, diaphoresis)
- Potential for rapid deterioration and life-threatening arrhythmias
- Time-sensitive condition requiring prompt medical intervention and ECG evaluation

Differential Diagnoses:
1. Myocardial Infarction (high probability)
2. Unstable Angina (likely, requires ECG to differentiate)
3. Aortic Dissection (less likely, no reported tearing pain)
4. Pulmonary Embolism (less likely, no reported pleuritic pain or hemoptysis)
5. Esophageal Spasm (less likely, pain is more severe and radiating)

Required Actions:
- Dispatch of ground EMS with ALS capabilities and ECG monitoring
- Oxygen administration and monitoring
- Pain management protocols initiation (nitroglycerin if indicated, morphine)
- Preparation for transport to nearest hospital with cardiac catheterization lab

Final Diagnosis

Final Diagnosis: Acute ST-Elevation Myocardial Infarction (STEMI)
Key Findings:
- 12-lead ECG confirmed ST-segment elevation in anterior leads
- Elevated cardiac biomarkers (troponin) confirmed myocardial necrosis
- Patient's pain score remained high despite initial analgesia

Outcome validated F2 priority assignment. Rapid dispatch, ECG acquisition, and early notification of the hospital were essential. Patient underwent successful percutaneous coronary intervention (PCI) within 90 minutes of symptom onset.

Learning Points:
1. F2 classification appropriate due to time-critical nature of STEMI
2. Initial assessment accurately identified the high likelihood of ACS
3. Prompt ECG acquisition and early hospital notification are critical in reducing morbidity and mortality

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My colleague is having severe chest pain! I think he's having a heart attack.

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

Caller It's Hafnarstræti 18, office 302, third floor in Akureyri.

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

Caller He was working at his desk, then he started complaining about chest pain. It's really bad, he's sweating and can't breathe well.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he's pale and looks really scared. He's saying his left arm hurts too.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and cholesterol, I think. He takes some pills for that.

Dispatcher Okay, the ambulance is on its way. Don't let him move too much. Stay with him and try to keep him calm.

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