Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, ground floor of a commercial building. The building is a two-story structure with a glass facade, built in 1995. The main entrance is on Hafnarstræti. No security codes are needed. Street parking is available. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 65.6825° N, 18.0915° W. Nearest landmark: The Cultural Center Hof.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - Suspected Acute Coronary Syndrome

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

68-year-old male, experiencing sudden onset of severe chest pain. Primary symptoms: Crushing chest pain radiating to left arm, shortness of breath, diaphoresis. Secondary symptoms: Nausea, dizziness. Patient is conscious and anxious. Skin is pale and clammy. Patient is sitting on a chair in his office. Medical history: Hypertension, hypercholesterolemia, type 2 diabetes. Medications: Metformin 500mg twice daily, Atorvastatin 20mg daily, Lisinopril 10mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
13:30 hours: Patient began experiencing chest discomfort while working at his desk.
13:35 hours: Chest pain intensified, radiating to left arm. Patient began to feel short of breath and nauseous.
13:38 hours: Patient called his son for help, who then called emergency services.
13:40 hours: Current time, patient is sitting in his office, experiencing severe chest pain and diaphoresis.

Prior Events: Patient has a history of stable angina, but reports this pain is significantly worse than previous episodes. No recent illnesses or injuries. Last medical check-up 6 months ago, routine follow-up. Patient has a family history of heart disease.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Coronary Syndrome (ACS)
Justification for F2 Classification:
- High probability of cardiac event based on symptom presentation (chest pain, radiation, shortness of breath, diaphoresis)
- Patient has multiple risk factors for ACS (age, hypertension, hypercholesterolemia, diabetes)
- Time-sensitive condition requiring prompt medical evaluation and intervention

Differential Diagnoses:
1. Acute Myocardial Infarction (high probability)
2. Unstable Angina (likely)
3. Aortic Dissection (less likely, no tearing pain)
4. Pulmonary Embolism (less likely, no recent immobilization)
5. Musculoskeletal Chest Pain (less likely, given severity and associated symptoms)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- ECG monitoring and interpretation
- Oxygen administration
- Aspirin administration (if no contraindications)
- Preparation for transport to nearest hospital with cardiac services

Final Diagnosis

Final Diagnosis: ST-Elevation Myocardial Infarction (STEMI)
Key Findings:
- ECG showed ST-segment elevation in multiple leads, confirming a STEMI
- Troponin levels were elevated on blood tests
- Patient's pain score remained high despite initial analgesia
- No other significant findings on full examination

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

Learning Points:
1. F2 classification appropriate due to the need for timely intervention in suspected cardiac events
2. Initial assessment accurately identified the high likelihood of ACS
3. Rapid ECG interpretation and treatment are essential for improving patient outcomes in STEMI

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is having severe chest pain! He can't breathe properly.

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

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

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

Caller He was at work and suddenly got a very bad pain in his chest. He says it's going down his left arm. He's sweating and feels sick.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he's very distressed. He looks very pale.

Dispatcher Does he have any medical conditions?

Caller He has high blood pressure, high cholesterol and diabetes. He takes pills for all of them.

Dispatcher Okay, the ambulance is on its way. Try to keep him calm and have him sit still. Do not let him walk around.

Caller Okay, thank you. I will wait here with him.