Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 98, 600 Akureyri, third-floor office, Suite 305. A modern, four-story commercial building with glass facade, built in 2015. Main entrance is accessible via a ramp and steps. Elevator and stairwell access to all floors. Keypad access to the third floor. Street parking available. Current conditions: 7°C, overcast, light wind. GPS coordinates: 65.6827° N, 18.0923° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Neurological Symptoms

Priority Level: F2

Response Time Goal: Urgent (15-30 minutes)

Description:

45-year-old male, experiencing sudden onset of left-sided weakness and slurred speech at work. Primary symptoms: Left arm and leg weakness, difficulty speaking, facial droop on the left side. Secondary symptoms: Mild headache, confusion. Patient is conscious but appears distressed. Medical history: Reports occasional migraines, no other significant medical history. Medications: None. No known allergies. Last meal was a sandwich at 12:00.

History of Events

Timeline:
13:10 hours: Patient was at his desk working, felt a sudden onset of weakness in his left arm and leg.
13:12 hours: Patient attempted to stand and experienced difficulty with balance and coordination. Noticed slurred speech.
13:14 hours: Patient's coworker, Jónas Einarsson, noticed the symptoms and called emergency services.
13:16 hours: Current time, patient is sitting in his office chair, appears confused and is struggling to speak clearly.

Prior Events: Patient reports no recent illnesses or injuries. No history of similar episodes. Last medical check-up was 6 months ago, routine check-up. Patient has been working long hours this week due to a project deadline.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke (Cerebrovascular Accident)
Justification for F2 Classification:
- Sudden onset of focal neurological deficits (left-sided weakness, slurred speech, facial droop)
- Time-sensitive condition requiring rapid medical intervention to minimize neurological damage
- High risk of permanent disability if not treated promptly

Differential Diagnoses:
1. Ischemic Stroke (high probability)
2. Hemorrhagic Stroke (possible)
3. Transient Ischemic Attack (TIA) (less likely given persistence of symptoms)
4. Hypoglycemia (less likely, no history of diabetes, patient is conscious)
5. Migraine with Aura (possible, but focal weakness is atypical)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Rapid transport to nearest hospital with stroke center capabilities
- Pre-notification of hospital to prepare for stroke assessment and treatment
- Monitoring of vital signs and neurological status during transport

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke in the Right Middle Cerebral Artery (MCA) Territory
Key Findings:
- CT scan of the brain confirmed a right MCA territory ischemic stroke
- Patient's symptoms persisted despite initial supportive care
- NIH Stroke Scale (NIHSS) score of 8 upon arrival at the hospital
- Patient received thrombolytic therapy (tPA) within the appropriate time window

Outcome validated F2 priority assignment. Rapid transport and thrombolysis were crucial to minimize neurological damage. Patient was admitted to the stroke unit for further care and rehabilitation.

Learning Points:
1. F2 classification appropriate due to the time-sensitive nature of stroke
2. Initial assessment accurately identified the likelihood of a stroke
3. Prompt recognition of symptoms and rapid transport to a stroke center are critical for improved outcomes

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My coworker is having some kind of medical issue. He can't move his left arm and leg properly, and he's talking funny.

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

Caller We are at Hafnarstræti 98, third floor, suite 305, in Akureyri.

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

Caller He was just working at his desk and suddenly he started to act strange. He said his arm and leg felt weak. Then he started talking funny. His face looks a bit droopy on one side too.

Dispatcher Is he awake and talking to you?

Caller Yes, he is awake but he seems confused and is having trouble speaking. He’s still sitting in his chair.

Dispatcher Does he have any medical conditions?

Caller He gets migraines sometimes, but I don’t think he takes any medication regularly. He hasn't mentioned anything else.

Dispatcher Okay, the ambulance is on its way. Stay with him and keep him calm. Do not give him anything to eat or drink.

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