Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, first floor of a two-story wooden building. Built in 1950, main entrance is on street level. One main entrance and a back exit. No specific security features. Current conditions: 7°C, overcast, moderate visibility. GPS coordinates: 65.6822° N, 18.0911° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - Suspected Acute Coronary Syndrome

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, sweating. Secondary symptoms: Nausea, lightheadedness. Patient is conscious but distressed. Skin is pale and clammy. Patient is sitting on a chair in his office. Medical history: Hypertension, hypercholesterolemia. Medications: Lisinopril 10mg daily, Atorvastatin 20mg daily, Aspirin 75mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
14:15 hours: Patient started experiencing mild chest discomfort
14:20 hours: Chest pain increased in intensity and started radiating to left arm
14:25 hours: Patient became short of breath and started sweating
14:27 hours: Patient called emergency services
14:30 hours: Current time, patient still experiencing severe chest pain

Prior Events: Patient reports a family history of heart disease. Has experienced mild chest discomfort on exertion in the past, but never this severe. Last medical check-up was 6 months ago, routine follow-up. Patient is a non-smoker, reports moderate alcohol consumption.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Coronary Syndrome (ACS), likely Myocardial Infarction
Justification for F2 Classification:
- High probability of a life-threatening cardiac event based on classic ACS symptoms
- Severe chest pain, radiation, shortness of breath, diaphoresis
- Time-sensitive condition requiring prompt medical evaluation and intervention

Differential Diagnoses:
1. Acute Myocardial Infarction (high probability)
2. Unstable Angina (likely, needs immediate evaluation)
3. Aortic Dissection (less likely, no reported tearing pain)
4. Pulmonary Embolism (less likely, no recent travel or immobility)
5. Musculoskeletal Chest Pain (less likely, given severity and radiation)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Initiate cardiac monitoring and oxygen therapy
- Preparation for transport to nearest hospital with cardiac catheterization lab
- Pre-notification of hospital of potential STEMI

Final Diagnosis

Final Diagnosis: ST-Elevation Myocardial Infarction (STEMI)
Key Findings:
- 12-lead ECG confirmed ST-segment elevation in anterior leads
- Patient's pain score remained high despite initial analgesia
- Troponin levels were significantly elevated on blood tests

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

Learning Points:
1. F2 classification was appropriate due to the need for immediate intervention
2. Initial assessment accurately identified the high probability of STEMI
3. Early ECG interpretation was crucial for diagnosis and treatment pathway
4. Patient education on recognizing symptoms of ACS is important

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I'm having terrible chest pain! It's like a crushing feeling, and it's going down my left arm.

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

Caller It's Hafnarstræti 18 in Akureyri, first floor.

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

Caller It started as a discomfort, but now it's really bad. I'm also feeling short of breath and sweaty.

Dispatcher Are you awake and talking to me?

Caller Yes, but I feel awful. I feel a bit lightheaded.

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

Caller Yes, I have high blood pressure and cholesterol. I take Lisinopril, Atorvastatin, and Aspirin.

Dispatcher Okay, the ambulance is on its way. Try to stay calm and do not exert yourself.

Caller Okay, thank you. I'll wait here.