Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, third floor apartment 3B. A five-story concrete building constructed in 1985. Main entrance requires an intercom. One elevator and a central stairwell. Street parking available. Building has a fire alarm system. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6835° N, 18.0898° 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: crushing chest pain radiating to left arm and jaw, shortness of breath, diaphoresis. Patient reports feeling lightheaded and nauseous. Secondary symptoms: anxiety, pale skin. Patient is conscious but distressed. Medical history: Hypertension, hyperlipidemia, type 2 diabetes. Medications: Metformin 500mg twice daily, Atorvastatin 20mg daily, Lisinopril 10mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
14:30 hours: Patient started experiencing mild chest discomfort while watching TV.
14:45 hours: Chest pain increased in intensity, radiating to left arm and jaw. Patient developed shortness of breath and started sweating.
14:50 hours: Patient called his son for help.
14:55 hours: Son arrived, found patient pale and distressed, called emergency services.
14:58 hours: Current time, patient is still experiencing severe chest pain and shortness of breath.

Prior Events: Patient had a similar episode of chest pain 2 years ago, which was diagnosed as stable angina. Patient has been compliant with his medications. Last medical check-up 6 months ago, routine follow-up. Patient lives alone, but son lives nearby.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Myocardial Infarction (AMI)
Justification for F2 Classification:
- High probability of a life-threatening cardiac event based on classic symptoms (chest pain, radiation, shortness of breath, diaphoresis)
- Time-sensitive condition requiring immediate medical intervention
- Potential for rapid deterioration and cardiac arrest

Differential Diagnoses:
1. Acute Myocardial Infarction (high probability)
2. Unstable Angina (likely, but AMI cannot be ruled out)
3. Aortic Dissection (less likely, no reported tearing pain)
4. Pulmonary Embolism (less likely, no history of recent surgery or immobilization)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Immediate initiation of cardiac protocols
- ECG monitoring and interpretation
- Oxygen administration
- Preparation for transport to nearest hospital with cardiac catheterization lab

Final Diagnosis

Final Diagnosis: ST-Elevation Myocardial Infarction (STEMI)
Key Findings:
- 12-lead ECG showed ST-segment elevation in anterior leads, confirming STEMI
- Cardiac biomarkers were elevated, indicating myocardial necrosis
- Patient's pain score remained high despite initial analgesia
- Patient required emergent percutaneous coronary intervention (PCI)

Outcome validated F2 priority assignment. Rapid dispatch, ECG interpretation, and early hospital notification were critical. Patient underwent successful PCI within 90 minutes of symptom onset.

Learning Points:
1. F2 classification appropriate due to the need for timely intervention in suspected cardiac events
2. Initial assessment accurately identified the high likelihood of AMI
3. Prompt ECG acquisition and transmission to the hospital facilitated rapid intervention

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is having terrible chest pain! He can't breathe well.

Dispatcher Okay, I'm sending help. 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 happened?

Caller He was watching TV and then suddenly started complaining about chest pain. He said it's going down his arm and jaw. He's sweating a lot.

Dispatcher Is he awake and talking to you?

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

Dispatcher Does he have any medical conditions?

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

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

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