Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, first floor, retail space, former pharmacy. Single-story building with large storefront windows. Main entrance on Hafnarstræti. No security features. Street parking available. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6810° N, 18.0900° 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:

65-year-old male, experiencing severe chest pain. Primary symptoms: Crushing chest pain radiating to left arm, shortness of breath, diaphoresis. Patient reports feeling very anxious and lightheaded. Secondary symptoms: Nausea, pale skin. Patient is conscious and oriented. Medical history: Hypertension, hyperlipidemia, type 2 diabetes. Medications: Metformin 500mg twice daily, Atorvastatin 20mg daily, Lisinopril 10mg daily, Aspirin 75mg daily. No known allergies. Last meal was a sandwich at 12:00.

History of Events

Timeline:
1330 hours: Patient started experiencing mild chest discomfort.
1345 hours: Chest pain intensified, radiating to left arm, shortness of breath began.
1350 hours: Patient became diaphoretic, felt lightheaded, and called emergency services.
1352 hours: Current time, patient is sitting in a chair, reporting severe chest pain.

Prior Events: Patient has a family history of heart disease. No prior cardiac events. Last medical check-up 6 months ago, routine follow-up. Patient was at work when symptoms started.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Myocardial Infarction (AMI)
Justification for F2 Classification:
- High probability of acute coronary syndrome based on classic presentation
- Severe chest pain, radiation, shortness of breath, diaphoresis
- Time-sensitive condition requiring rapid intervention to minimize cardiac damage

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

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- ECG monitoring and interpretation
- Administration of oxygen, aspirin, and pain management protocols
- Preparation for transport to nearest hospital with cardiac catheterization lab

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 tests
- Patient's pain score remained high despite initial analgesia

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

Learning Points:
1. F2 classification appropriate due to the need for immediate cardiac intervention
2. Initial assessment accurately identified the high likelihood of an AMI
3. Prompt recognition of STEMI on ECG led to timely reperfusion therapy, improving patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I... I think I'm having a heart attack! My chest hurts so bad.

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

Caller It's Hafnarstræti 18, in Akureyri, it's a former pharmacy. I'm on the first floor.

Dispatcher Help is on its way. Can you describe the pain?

Caller It's like a crushing pain in my chest, and it's going down my left arm. I can't breathe properly.

Dispatcher Are you feeling dizzy or sweaty?

Caller Yes, very dizzy and I'm sweating a lot. I feel awful.

Dispatcher Do you have any medical conditions or take any medications?

Caller I have high blood pressure, high cholesterol and diabetes. I take metformin, atorvastatin, lisinopril, and aspirin.

Dispatcher Okay, the ambulance is on its way. Try to stay calm and don't move too much.

Caller Okay, thank you. I'll try to stay still.