Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 22, 600 Akureyri. Second floor office in a three-story commercial building constructed in 1995. Main entrance on street level with a coded access after business hours. Building has a central staircase and elevator. Street parking available. Current conditions: 7°C, overcast, light wind. GPS coordinates: 65.6810° N, 18.0889° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - Suspected Cardiac

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

56-year-old male, experiencing sudden onset of severe chest pain. Primary symptoms: Crushing chest pain radiating to left arm, shortness of breath, diaphoresis. Secondary symptoms: Nausea, dizziness. Patient is conscious and alert but anxious. Skin is pale and clammy. Patient is sitting in his office chair. Medical history: Hypertension, hypercholesterolemia. Medications: Lisinopril 10mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was a sandwich at 12:00.

History of Events

Timeline:
14:15 hours: Patient experienced sudden onset of chest pain while working at his desk.
14:16 hours: Pain intensified, radiating to his left arm. Patient became short of breath and diaphoretic.
14:17 hours: Patient called his colleague for help.
14:18 hours: Colleague arrived and called emergency services.
14:20 hours: Current time, patient still in office chair, experiencing chest pain.

Prior Events: Patient has had intermittent episodes of mild chest discomfort over the past month, attributed to indigestion. Last medical check-up 6 months ago, routine follow-up. No recent illnesses or injuries. Patient is a smoker (1 pack per day).

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Coronary Syndrome (ACS), most likely Myocardial Infarction (MI)
Justification for F2 Classification:
- High probability of a cardiac event based on chest pain characteristics, radiation, and associated symptoms.
- Patient has risk factors for coronary artery disease (hypertension, hypercholesterolemia, smoking).
- Time-sensitive condition requiring prompt medical intervention to minimize myocardial damage.

Differential Diagnoses:
1. Acute Myocardial Infarction (high probability)
2. Unstable Angina (likely)
3. Aortic Dissection (less likely, no reported tearing pain)
4. Pulmonary Embolism (less likely, no sudden onset of severe dyspnea)
5. Musculoskeletal Chest Pain (less likely given the severity and associated symptoms)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Initiation of cardiac protocols (ECG, oxygen, aspirin)
- Preparation for 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, consistent with STEMI
- Troponin levels were elevated, confirming myocardial damage
- Patient's pain score remained high despite initial analgesia
- Coronary angiography revealed a complete occlusion of the left anterior descending (LAD) artery

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

Learning Points:
1. F2 classification was appropriate due to the time-sensitive nature of STEMI
2. Initial assessment accurately identified the high probability of a cardiac event
3. Prompt ECG acquisition and interpretation were crucial for rapid diagnosis and intervention

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My colleague is having severe chest pain! He's at Hafnarstræti 22.

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

Caller Hafnarstræti 22, second floor office in Akureyri.

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

Caller He was working at his desk and suddenly grabbed his chest. He says it's very painful and he can't breathe well.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but looks pale and is sweating. He's very anxious.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and high cholesterol. He takes pills for it.

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.