Emergency Scenario 700_f2

Location Information

Full Location:

Miðvangur 10, 700 Egilsstaðir, ground floor apartment. Two-story wooden residential building built in 1985. Main entrance is at street level, no steps. No elevator. Street parking available. Building has basic smoke detectors. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.2647° N, 14.3956° W. Nearest landmark: Egilsstaðir swimming pool.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Acute Coronary Syndrome - Non STEMI

Priority Level: F2

Response Time Goal: Urgent (15-30 minutes)

Description:

65-year-old male, experiencing chest pain. Primary symptoms: Chest pain described as pressure, radiating to the left arm and jaw, started 30 minutes ago. Secondary symptoms: Mild shortness of breath, nausea, sweating. Patient is conscious and anxious. Medical history: Hypertension, hyperlipidemia, type 2 diabetes. Medications: Metformin 500mg twice daily, Atorvastatin 20mg daily, Lisinopril 10mg daily. No known allergies. Last meal was a sandwich at 12:00.

History of Events

Timeline:
1300 hours: Patient reports onset of chest pain, described as a heavy pressure.
1310 hours: Pain radiates to left arm and jaw, patient becomes diaphoretic and nauseous.
1320 hours: Patient calls his son, Jónas, for assistance.
1325 hours: Jónas arrives and calls emergency services.
1330 hours: Current time, patient is sitting on the sofa, still experiencing chest pain.

Prior Events: Patient had a routine check-up 6 months ago, no recent changes in medication. No prior history of cardiac events. Patient reports mild exertion prior to the onset of symptoms, was working in the garden.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Coronary Syndrome - Non-STEMI
Justification for F2 Classification:
- Patient presenting with classic symptoms of ACS including chest pain, radiation, diaphoresis, and nausea.
- High probability of cardiac event requiring prompt medical evaluation and treatment.
- Symptoms onset within the last 30 minutes, indicating an acute event.
- Patient has multiple risk factors for ACS (hypertension, hyperlipidemia, diabetes).

Differential Diagnoses:
1. Acute Myocardial Infarction (Non-STEMI) (high probability)
2. Unstable Angina (likely)
3. Aortic Dissection (less likely, no tearing pain)
4. Pulmonary Embolism (less likely, no significant respiratory distress)
5. Esophageal Spasm (less likely, pain is more severe and radiating)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- ECG monitoring and interpretation
- Pain management protocols initiation
- Oxygen administration if indicated
- Preparation for transport to nearest hospital with cardiac care facilities

Final Diagnosis

Final Diagnosis: Acute Non-ST Elevation Myocardial Infarction (NSTEMI)
Key Findings:
- ECG showed ST depression and T-wave inversion in multiple leads
- Initial Troponin I was elevated, confirming myocardial damage
- Patient's pain was relieved with nitrates and morphine
- No other significant findings during physical examination

Outcome validated F2 priority assignment. Rapid dispatch, ECG acquisition, and pain management were crucial. Patient was admitted for cardiac monitoring and further treatment including possible PCI.

Learning Points:
1. F2 classification appropriate due to time-sensitive nature of ACS.
2. Initial assessment accurately identified the high likelihood of a cardiac event.
3. Importance of early ECG for diagnosis and treatment planning.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

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

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

Caller It's Miðvangur 10 in Egilsstaðir. Ground floor apartment.

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

Caller He started having chest pain about 30 minutes ago. It's like a heavy pressure. It's going down his left arm and into his jaw now. He's sweating and feels sick to his stomach.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he looks really pale and is in a lot of pain.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure, high cholesterol, and diabetes. He takes medication for all of those.

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

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