Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 96, 600 Akureyri. Third floor apartment, accessed by stairs or elevator. The building is a four-story concrete structure, built in 1985, with a main entrance on Hafnarstræti. The apartment door is on the left at the top of the stairs. Keypad entry to the main building, code is 1234. Current conditions: 8°C, overcast, moderate visibility. GPS coordinates: 65.6823° N, 18.0915° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Neurological Symptoms

Priority Level: F2

Response Time Goal: Within 15-30 minutes

Description:

68-year-old male experiencing sudden onset of left-sided weakness and slurred speech. Patient is conscious but confused. Symptoms began approximately 20 minutes ago. Patient has a history of hypertension and type 2 diabetes. No known allergies. Medications include Metformin 1000mg twice daily, Lisinopril 20mg daily, and Atorvastatin 20mg daily. Last meal was a light lunch at 13:00. Patient found slumped in his armchair in the living room by his son.

History of Events

Timeline:
13:45 hours: Patient was reportedly fine during lunch.
14:10 hours: Son found patient slumped in armchair, noticed slurred speech and weakness.
14:15 hours: Son called emergency services.
14:18 hours: Current time. Patient remains in the same condition. Son is present and able to provide information. Prior Events: Patient has a history of poorly controlled hypertension and type 2 diabetes. Has experienced occasional dizzy spells in the past. No recent hospitalizations. Last medical check-up was 6 months ago, routine follow-up.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke
Justification for F2 Classification:
- Sudden onset of focal neurological deficits (left-sided weakness, slurred speech)
- High probability of stroke, a time-sensitive condition
- Requires urgent medical assessment and potential thrombolytic therapy

Differential Diagnoses:
1. Ischemic Stroke (most likely given presentation)
2. Hemorrhagic Stroke (less likely but possible)
3. Transient Ischemic Attack (TIA) (possible, requires assessment)
4. Hypoglycemia (less likely, but needs to be ruled out)
5. Seizure (less likely, no reported convulsions)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pre-notification to the receiving hospital (stroke center)
- Rapid transport to the nearest hospital with stroke care services
- Monitoring of vital signs and neurological status en route

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke
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 severity
- Blood glucose was within normal limits, ruling out hypoglycemia
- No evidence of hemorrhage on CT scan

Outcome validated F2 priority assignment. Rapid transport and stroke protocol activation were crucial. Patient received thrombolytic therapy within 2 hours of symptom onset and showed some improvement in neurological deficits.

Learning Points:
1. F2 classification was appropriate due to the need for rapid intervention
2. Initial assessment accurately identified the high likelihood of stroke
3. Early recognition of stroke symptoms and timely activation of stroke protocols are essential for optimal patient outcomes

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father... I think he's having a stroke! He can't move his left arm and his speech is slurred.

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

Caller It's Hafnarstræti 96, apartment on the third floor in Akureyri.

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

Caller I just found him slumped in his chair. He was fine at lunch. Now he can't move his left side properly and he's talking funny.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but seems confused. He's trying to talk but it's not clear.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure and diabetes. He takes medication for both.

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

Caller It must have been about 20 minutes ago. I just found him like this. I'm really worried.

Dispatcher Okay, help is on its way. Stay on the line if you can, and keep monitoring him.

Caller Okay, I will. Thank you.