Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, ground floor of a two-story wooden building. Built in 1950, renovated in 2010. Main entrance faces the street, accessible via a small step. No elevator. Street parking available. Building has a simple lock system. Current conditions: 7°C, cloudy, good visibility. GPS coordinates: 65.6828° N, 18.0885° 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 sudden onset chest pain. Primary symptoms: severe, crushing chest pain radiating to the left arm, shortness of breath, diaphoresis. Patient reports feeling 'very unwell'. Secondary symptoms: nausea, dizziness. Patient is conscious but anxious. Medical history: Hypertension, hyperlipidemia, family history of heart disease. Medications: Amlodipine 10mg daily, Atorvastatin 20mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
1310 hours: Patient was sitting at his desk when he experienced sudden onset of chest pain.
1312 hours: Pain became more intense, patient started sweating and felt short of breath.
1315 hours: Patient called his son for help.
1317 hours: Son arrived, immediately called emergency services.
1320 hours: Current time, patient is still experiencing chest pain and is anxious.

Prior Events: Patient has a history of high blood pressure and cholesterol. Father died of a heart attack at age 60. No recent illnesses or injuries. Last medical check-up 6 months ago, routine follow-up. Patient lives with his wife, son lives nearby.

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, radiating to the arm, shortness of breath, diaphoresis
- Time-sensitive condition requiring rapid intervention to minimize myocardial damage

Differential Diagnoses:
1. Acute Myocardial Infarction (high probability)
2. Unstable Angina (likely given symptoms)
3. Aortic Dissection (less likely given no tearing pain)
4. Pulmonary Embolism (less likely given no sudden pleuritic pain)
5. Pericarditis (less likely given radiation of pain)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Initiate cardiac monitoring and oxygen therapy
- Consider aspirin administration (if not contraindicated)
- Early notification of nearest cardiac capable hospital

Final Diagnosis

Final Diagnosis: ST-Elevation Myocardial Infarction (STEMI)
Key Findings:
- 12-lead ECG showed ST-segment elevation in multiple leads, confirming STEMI
- Troponin levels were elevated, indicating myocardial damage
- Patient's pain score remained high despite initial analgesia
- No other significant findings on physical exam

Outcome validated F2 priority assignment. Rapid dispatch and early ECG were critical for timely intervention. Patient underwent successful percutaneous coronary intervention (PCI) within 90 minutes of arrival at the hospital.

Learning Points:
1. F2 classification was appropriate given the time-sensitive nature of the condition
2. Initial assessment accurately identified the high likelihood of ACS
3. Early ECG and prompt transport facilitated rapid treatment and improved patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what is your emergency?

Caller My father is having severe chest pain! I think he's having a heart attack!

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

Caller It's Hafnarstræti 18, in Akureyri. It's a ground floor office.

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

Caller He was sitting at his desk, and suddenly he said he had a terrible pain in his chest. It's spreading to his arm, and he's sweating a lot.

Dispatcher Is he awake and talking to you?

Caller Yes, he is awake but he's very pale and says he feels awful. He's also having trouble breathing.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure and high cholesterol. He takes medication for it. He has a family history of heart problems as well.

Dispatcher Okay, the ambulance is on its way. Don't let him move around too much. Stay with him and try to keep him calm.

Caller Okay, I will. Thank you. Please hurry!