Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 23, 600 Akureyri, ground floor of a commercial building, former pharmacy. Single-story building with glass storefront and main entrance on Hafnarstræti. No elevators. Street parking available. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6822° N, 18.0888° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Chest Pain - Suspected Cardiac Event

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

65-year-old male, experiencing severe chest pain. Primary symptoms: Crushing chest pain radiating to the left arm, shortness of breath, diaphoresis. Secondary symptoms: Nausea, dizziness. Patient alert but anxious. Patient is sitting on a chair in the waiting area of the former pharmacy. Medical history: Hypertension, hypercholesterolemia, family history of heart disease. Medications: Lisinopril 10mg daily, Atorvastatin 20mg daily, Aspirin 75mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1430 hours: Patient experienced sudden onset of chest pain while walking on the street
1432 hours: Patient entered the former pharmacy seeking help, sat down on chair
1434 hours: Patient reports increasing pain and shortness of breath
1435 hours: Caller called emergency services
1436 hours: Current time, patient still sitting, pale and diaphoretic

Prior Events: Patient reports intermittent chest discomfort in the past week, but no previous severe episodes. Last medical check-up 6 months ago, routine follow-up. No recent illnesses or injuries. Patient was previously a smoker, quit 5 years ago.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Coronary Syndrome (ACS), likely Myocardial Infarction (MI)
Justification for F2 Classification:
- High probability of a life-threatening cardiac event based on classic symptoms
- Chest pain radiating to the left arm, shortness of breath, diaphoresis
- Time-sensitive condition requiring rapid medical intervention

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

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Immediate ECG monitoring
- Oxygen administration
- Aspirin administration
- Pain management protocols initiation
- 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 acute MI
- Troponin levels were elevated, further supporting the diagnosis
- Patient's pain score remained high despite initial analgesia
- No other significant medical conditions detected

Outcome validated F2 priority assignment. Rapid dispatch and ECG were critical for early diagnosis and intervention. 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 ECG and cardiac intervention
2. Initial assessment accurately identified the high likelihood of a STEMI
3. Early recognition of symptoms and prompt action contributed to a better patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I need an ambulance! A man here is having terrible chest pain.

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

Caller It's Hafnarstræti 23 in Akureyri, the old pharmacy building.

Dispatcher Help is on its way. Can you tell me what's happening?

Caller He's clutching his chest, he looks pale and sweaty. He says it's really bad.

Dispatcher Is he awake and talking to you?

Caller Yes, but he's breathing heavily and seems very scared.

Dispatcher Does he have any medical conditions?

Caller I don't know him, but he said something about high blood pressure.

Dispatcher Okay, the ambulance is on its way. Try to keep him calm and still. Don't give him anything to eat or drink.

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