Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, ground floor of a two-story wooden building constructed in 1935. Main entrance at street level, no steps. Secondary entrance through back alley with one step. Building is a commercial space with one office. No security features. Weather: 8°C, overcast, light breeze. GPS coordinates: 65.6817° N, 18.0898° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - Suspected Myocardial Infarction

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

68-year-old male, experiencing sudden onset of severe chest pain. Primary symptoms: crushing chest pain radiating to left arm and jaw, shortness of breath, diaphoresis, nausea. Patient is pale and anxious. Secondary symptoms: dizziness. Patient is sitting in a chair in his office. Medical history: Hypertension, hypercholesterolemia, type 2 diabetes. Medications: Metformin 1000mg twice daily, Atorvastatin 20mg daily, Lisinopril 10mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
13:45 hours: Patient began experiencing mild chest discomfort.
13:50 hours: Chest pain intensified, radiating to left arm and jaw, associated with shortness of breath and sweating.
13:52 hours: Patient called his son for assistance.
13:55 hours: Son arrived, called emergency services.
13:57 hours: Current time, patient still experiencing severe chest pain, sitting in chair, appears distressed.

Prior Events: Patient had a routine check-up 6 months ago, no significant changes noted. Patient reports experiencing mild chest discomfort occasionally over the past few weeks but attributed it to indigestion. 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 (chest pain, radiation, diaphoresis, dyspnea)
- Time-sensitive condition requiring prompt medical intervention to minimize myocardial damage
- Patient's medical history (hypertension, hypercholesterolemia, diabetes) increases risk

Differential Diagnoses:
1. Acute Myocardial Infarction (high probability)
2. Unstable Angina (possible, but symptoms suggest AMI)
3. Aortic Dissection (less likely, no reported tearing pain)
4. Pulmonary Embolism (less likely, no sudden onset of dyspnea without chest pain)
5. Pericarditis (less likely, pain not pleuritic or positional)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Immediate ECG monitoring and interpretation
- Oxygen administration and pain management protocols
- Rapid transport to nearest hospital with cardiac catheterization capabilities

Final Diagnosis

Final Diagnosis: ST-Elevation Myocardial Infarction (STEMI)
Key Findings:
- 12-lead ECG showed ST-segment elevation in multiple leads, confirming STEMI
- Troponin levels were elevated, indicating myocardial damage
- Patient's pain score remained high despite initial analgesia
- Coronary angiography revealed a complete occlusion of the left anterior descending artery

Outcome validated F2 priority assignment. Rapid dispatch and ECG interpretation were critical. Patient underwent successful percutaneous coronary intervention (PCI) within 90 minutes of symptom onset.

Learning Points:
1. F2 classification appropriate due to the need for timely intervention
2. Initial assessment accurately identified the high likelihood of AMI
3. Prompt ECG and transport contributed to a better patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

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

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

Caller It's Hafnarstræti 18 in Akureyri, it's his office on the ground floor.

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

Caller He was fine a few minutes ago and then suddenly he started complaining about chest pain. He says it's really bad, like crushing, and it's going down his arm.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he's very pale and sweaty. He is having trouble breathing.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure, high cholesterol, and diabetes. He takes pills for all of them.

Dispatcher Okay, the ambulance is on its way. Keep him calm and don't let him move too much. I'll stay on the line with you.

Caller Okay, thank you. I will stay with him.