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 an electronic lock and intercom. One elevator and a central stairwell. Street parking available, often congested. Building is equipped with a sprinkler system and fire alarm. Current conditions: 7°C, overcast, moderate visibility. GPS coordinates: 65.6837° N, 18.0936° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Neurological Symptoms

Priority Level: F2

Response Time Goal: Urgent (15-30 minutes)

Description:

68-year-old male, sudden onset of right-sided weakness and slurred speech. Patient is conscious but confused. Primary symptoms: Right arm and leg weakness, facial droop on right side, difficulty speaking. Secondary symptoms: Mild headache, dizziness. Patient was watching TV when symptoms started. Medical history: Hypertension, type 2 diabetes, previous transient ischemic attack (TIA) 2 years ago. Medications: Metformin 500mg twice daily, Lisinopril 10mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was lunch at 13:00.

History of Events

Timeline:
15:45 hours: Patient was watching TV, suddenly developed right-sided weakness.
15:46 hours: Patient attempted to stand, experienced difficulty and slurred speech.
15:47 hours: Patient's wife, the caller, noticed symptoms and called emergency services.
15:50 hours: Current time, patient is sitting on the sofa, conscious but confused.

Prior Events: Patient had a TIA 2 years ago, fully recovered. No recent illnesses or injuries. Regular medical check-ups, last one 6 months ago. Patient lives with his wife, who is present and assisting.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke (Cerebrovascular Accident)
Justification for F2 Classification:
- Sudden onset of focal neurological deficits (right-sided weakness, slurred speech, facial droop)
- History of TIA increases suspicion of stroke
- Time-sensitive condition requiring rapid medical intervention to minimize neurological damage

Differential Diagnoses:
1. Ischemic Stroke (most likely)
2. Hemorrhagic Stroke (less likely but possible)
3. Transient Ischemic Attack (TIA) (possible, but symptoms are more severe and prolonged)
4. Hypoglycemia (less likely, but should be ruled out)
5. Seizure (less likely given the lack of reported convulsions)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Rapid transport to nearest hospital with stroke center
- Pre-hospital stroke assessment and notification to hospital
- Monitor vital signs and level of consciousness closely

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Right Middle Cerebral Artery)
Key Findings:
- CT scan of the brain revealed an acute ischemic stroke in the right middle cerebral artery territory.
- Patient's NIH Stroke Scale score was 12, indicating moderate to severe stroke.
- Patient was eligible for thrombolytic therapy, which was administered within 4 hours of symptom onset.
- No other acute conditions identified during medical assessment.

Outcome validated F2 priority assignment. Rapid dispatch and transport were crucial for timely treatment.

Learning Points:
1. F2 classification was appropriate due to the need for rapid assessment and intervention.
2. Initial assessment accurately identified the high likelihood of stroke.
3. Prompt recognition and transport to a stroke center were critical for improving patient outcome.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, I think he's having a stroke! He can't move his right side properly and he's talking funny.

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 exactly what happened?

Caller He was watching TV and suddenly his right arm and leg went weak. He can't speak properly, it's all slurred.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he seems confused. He's got a bit of a headache too, he says.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure and diabetes. He had a mini-stroke a couple of years ago too.

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

Caller Yes, he takes metformin, lisinopril, and atorvastatin. I'll stay here with him.

Dispatcher Excellent, the ambulance will be there as soon as possible.