Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, third floor apartment 3B. Five-story concrete building constructed in 1995. Main entrance has a key code and intercom. Elevator and central stairwell access. Street parking available. Building has a fire suppression system. Current conditions: 7°C, overcast, light wind, moderate visibility. GPS coordinates: 65.6823° N, 18.0935° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - Suspected Acute Myocardial Infarction

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

68-year-old male, experiencing severe chest pain. Primary symptoms: Sudden onset of crushing chest pain, radiating to the left arm and jaw, shortness of breath, diaphoresis. Patient reports feeling lightheaded and nauseous. Secondary symptoms: Pale skin, anxiety. Patient is sitting on a chair in his living room. Medical history: Hypertension, hyperlipidemia, type 2 diabetes. Medications: Metformin 1000mg twice daily, Atorvastatin 20mg daily, Lisinopril 10mg daily, Aspirin 75mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1445 hours: Patient began experiencing mild chest discomfort while watching TV.
1450 hours: Chest pain intensified, radiating to left arm and jaw.
1452 hours: Patient became diaphoretic and short of breath.
1455 hours: Patient called his son for help.
1457 hours: Son arrived and called emergency services.
1500 hours: Current time, patient is still experiencing severe chest pain and related symptoms.

Prior Events: Patient has a history of stable angina, no prior heart attacks. Last medical check-up was 6 months ago, routine follow-up. Patient reports no recent changes in medications or lifestyle. No recent illnesses or injuries.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Myocardial Infarction (AMI)
Justification for F2 Classification:
- High probability of AMI based on classic symptoms: crushing chest pain, radiation, diaphoresis, shortness of breath.
- Time-sensitive condition requiring rapid intervention to prevent myocardial damage.
- Potential for rapid deterioration to life-threatening arrhythmias.

Differential Diagnoses:
1. Acute Myocardial Infarction (high probability)
2. Unstable Angina (less likely given severity and new onset of symptoms)
3. Aortic Dissection (less likely, no reported tearing pain)
4. Pulmonary Embolism (less likely, no risk factors reported)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- ECG acquisition and interpretation
- Oxygen administration
- Aspirin administration
- Preparation for transport to nearest hospital with cardiac catheterization capabilities

Final Diagnosis

Final Diagnosis: ST-Elevation Myocardial Infarction (STEMI)
Key Findings:
- 12-lead ECG confirmed ST-segment elevation in anterior leads.
- Troponin levels were significantly elevated on blood work.
- Patient's pain score remained high despite initial analgesia.

Outcome validated F2 priority assignment. Rapid dispatch and ECG acquisition were crucial. Patient underwent emergent percutaneous coronary intervention (PCI) with stent placement within 90 minutes.

Learning Points:
1. F2 classification was appropriate due to the time-sensitive nature of STEMI.
2. Initial assessment accurately identified the high likelihood of AMI.
3. Early ECG acquisition and interpretation are vital in the diagnosis and treatment of STEMI.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

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

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

Caller It's Hafnarstræti 18, apartment 3B, third floor in Akureyri.

Dispatcher Help is on its way. Can you tell me what is happening with your father?

Caller He suddenly got a very bad pain in his chest. It's going down his left arm and his jaw. He's sweating a lot and can't breathe well.

Dispatcher Is he awake and talking to you?

Caller Yes, he is awake but very pale and he says he feels like he's going to throw up.

Dispatcher Does he have any medical conditions or take any medications?

Caller Yes, he has high blood pressure, high cholesterol and diabetes. He takes pills for those and also a small aspirin every day.

Dispatcher Okay, the ambulance is on its way. Don't let him move. Stay with him and try to keep him calm. Do you have any of his medications available?

Caller Yes, I do. I will stay with him. Thank you.