Hafnarstræti 18, 600 Akureyri. Ground floor of a two-story wooden commercial building built in 1950, currently a small bakery. Main entrance at street level, no stairs. No elevator. Rear access through a back alley with a single door. No security features, no codes. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6824° N, 18.0916° W. Nearest landmark: Akureyri Art Museum.
68-year-old male, experiencing severe chest pain. Primary symptoms: Sudden onset of crushing chest pain radiating to left arm, shortness of breath, diaphoresis. Patient reports feeling lightheaded and nauseous. Patient is conscious and responsive, but appears distressed. Secondary symptoms: Palpitations, anxiety. Patient is sitting on a chair in the bakery's customer area. Medical history: Hypertension, hyperlipidemia, previous MI (5 years ago). Medications: Aspirin 75mg daily, Atorvastatin 20mg daily, Lisinopril 10mg daily, Metoprolol 50mg twice daily. Known allergy to penicillin. Last meal was a sandwich at 10:00.
Timeline: 1100 hours: Patient arrived at the bakery to purchase bread. 1105 hours: Patient suddenly experienced severe chest pain, became pale and diaphoretic. 1106 hours: Patient sat down on a chair, reported pain radiating to his left arm. 1107 hours: Patient's breathing became labored, felt nauseous. 1108 hours: Bakery employee (caller) initiated emergency call. 1110 hours: Current time, patient remains seated, conscious but distressed. Prior Events: Patient had a routine check-up 2 months ago, with no significant changes in his condition. He reports no recent changes in his medications. No recent illnesses or injuries. Patient lives alone, but has family nearby.
Initial Impression: Suspected Acute Coronary Syndrome (ACS), likely Myocardial Infarction (MI) Justification for F2 Classification: - High probability of life-threatening cardiac event based on classic ACS symptoms - Severe chest pain, radiation to left arm, shortness of breath, diaphoresis - History of previous MI and other cardiac risk factors - Time-sensitive condition requiring rapid intervention to prevent further myocardial damage Differential Diagnoses: 1. Acute Myocardial Infarction (STEMI/NSTEMI) (high probability) 2. Unstable Angina (likely, but less severe) 3. Aortic Dissection (less likely, but must consider) 4. Pulmonary Embolism (less likely, but must consider) 5. Esophageal Spasm (less likely given presentation) Required Actions: - Dispatch of ground EMS with ALS capabilities, including ECG monitoring - Administration of oxygen and aspirin (if not already taken) - Establishment of IV access - Preparation for immediate transport to the nearest hospital with cardiac services