Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, Ground floor retail space. Single-story brick building constructed in 1965, renovated in 2010. Main entrance is at street level, no steps. No secondary exits. No security features. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 65.6832° N, 18.0897° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Syncope - Unwitnessed Fall

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

68-year-old male, found unresponsive in his shop. Primary symptoms: Unresponsive, shallow breathing, pale skin, no apparent injury from fall. Secondary symptoms: Possible incontinence. Patient found on the floor behind the counter. Medical history: Type 2 diabetes, hypertension, previous episode of syncope 2 years ago, no known allergies. Medications: Metformin 1000mg twice daily, Lisinopril 10mg daily, Aspirin 75mg daily. Last meal was a sandwich at 11:00.

History of Events

Timeline:
1230 hours: Patient last seen by a customer, appeared normal
1245 hours: Patient found unresponsive on the floor by a delivery driver
1246 hours: Delivery driver called emergency services
1247 hours: Current time, patient still unresponsive, shallow breathing

Prior Events: Patient has a history of syncope, last episode two years ago during hot weather, attributed to dehydration. No recent changes in medications or health conditions. Last medical check-up was 6 months ago, routine follow-up. Patient lives alone and manages his small retail shop.

Diagnostics

Initial Assessment

Initial Impression: Syncope with Possible Underlying Cause
Justification for F2 Classification:
- Unresponsiveness and shallow breathing indicate a potentially life-threatening condition.
- History of syncope raises concerns for recurrence or more serious underlying pathology.
- Time-sensitive condition requiring prompt medical evaluation and intervention.

Differential Diagnoses:
1. Vasovagal Syncope (possible given history, but unresponsiveness more concerning)
2. Cardiac Arrhythmia (high concern given age and history of hypertension)
3. Hypoglycemia (possible given diabetes)
4. Stroke/TIA (consider given unresponsiveness)
5. Seizure (possible, no witness to onset)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Airway management and oxygen administration
- Cardiac monitoring and assessment
- Blood glucose level check
- Rapid transport to hospital for further evaluation

Final Diagnosis

Final Diagnosis: Cardiac Arrhythmia - Atrial Fibrillation with Rapid Ventricular Response
Key Findings:
- ECG showed atrial fibrillation with a rapid ventricular response (RVR)
- Blood glucose was normal, ruling out hypoglycemia
- Patient regained consciousness briefly during transport, reported feeling palpitations prior to syncope
- No evidence of stroke or seizure on examination

Outcome validated F2 priority assignment. Rapid dispatch and cardiac monitoring were critical. Patient was stabilized with medication and admitted for observation.

Learning Points:
1. F2 classification was appropriate due to the potential for a life-threatening arrhythmia.
2. Initial assessment correctly identified syncope and the need for cardiac evaluation.
3. History of syncope was a critical clue to the underlying cardiac condition.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I found a man on the floor in his shop, he's not responding!

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

Caller It's Hafnarstræti 18, in Akureyri, it's a shop on the ground floor.

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

Caller I'm a delivery driver, I came in to drop off a package, and I found him on the floor behind the counter. He's not moving.

Dispatcher Is he breathing?

Caller Yes, but it's very shallow. His skin is pale. I don't see any injuries.

Dispatcher Okay, do you know if he has any medical conditions?

Caller I don't know, I just deliver packages here. I don't know the man.

Dispatcher Okay, the ambulance is on its way. Stay with him and keep him as still as possible. Don't try to move him.

Caller Okay, I will wait here. I'm a bit nervous, hope he's okay.