Emergency Scenario 700_f2

Location Information

Full Location:

Miðvangur 11, 700 Egilsstaðir, Single-story detached house, built in 1985. Main entrance facing the street, no security features. Gravel driveway, ample parking space. Current conditions: 8°C, overcast, good visibility, dry roads. GPS coordinates: 65.2657° N, 14.3946° 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:

62-year-old male, experiencing chest pain and shortness of breath. Primary symptoms: Central chest pain described as a pressure, radiating to left arm, onset 30 minutes ago. Secondary symptoms: Diaphoresis, nausea, mild dizziness. Patient is alert and anxious. Medical history: Hypertension, hyperlipidemia, type 2 diabetes. Medications: Metformin 500mg twice daily, Atorvastatin 20mg daily, Lisinopril 10mg daily. Allergies: None known. Last meal was a light lunch at 13:00. Smoker, 20 pack years.

History of Events

Timeline:
1330 hours: Patient began experiencing mild chest discomfort while resting at home.
1345 hours: Chest pain intensified, radiating to left arm, patient became diaphoretic.
1350 hours: Patient took one aspirin (300mg) and called his son for help.
1355 hours: Son arrived, called emergency services.
1400 hours: Current time, patient sitting on sofa, distressed.

Prior Events: Patient has a history of stable angina, but reports this episode is more severe and prolonged. Last medical check-up 6 months ago, routine follow-up. No recent hospitalizations. Patient lives with his wife, son lives nearby.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Coronary Syndrome (ACS), Non-STEMI
Justification for F2 Classification:
- High probability of cardiac event based on chest pain characteristics, radiation, and associated symptoms
- Time-sensitive condition requiring prompt medical evaluation and treatment
- Patient has risk factors for ACS (hypertension, hyperlipidemia, diabetes, smoking)

Differential Diagnoses:
1. Non-ST-Elevation Myocardial Infarction (NSTEMI) (high probability)
2. Unstable Angina (likely)
3. Aortic Dissection (less likely, no tearing pain)
4. Pericarditis (less likely, no pleuritic pain)
5. Musculoskeletal Chest Pain (less likely given severity and radiation)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- ECG acquisition and interpretation
- Oxygen administration
- Aspirin and antiplatelet therapy if not already taken
- Preparation for transport to nearest hospital with cardiac services

Final Diagnosis

Final Diagnosis: Non-ST-Elevation Myocardial Infarction (NSTEMI)
Key Findings:
- ECG showed ST-segment depression and T-wave inversion in multiple leads
- Serial troponin levels were elevated, confirming myocardial necrosis
- Patient's pain score decreased with analgesia
- Coronary angiography revealed a partially occluded left anterior descending artery.

Outcome validated F2 priority assignment. Rapid dispatch and initial treatment were essential. Patient underwent percutaneous coronary intervention (PCI) with stent placement within 24 hours.

Learning Points:
1. F2 classification was appropriate due to the need for timely intervention
2. Initial assessment accurately identified the high likelihood of an acute cardiac event
3. Early ECG and troponin testing were critical for accurate diagnosis and management

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is having chest pain, it's really bad! I think he's having a heart attack.

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

Caller It's Miðvangur 11, in Egilsstaðir.

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

Caller He was just sitting at home and suddenly started complaining about chest pain. He says it feels like pressure, and 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 worried. He says it's the worst pain he's ever felt.

Dispatcher Does he have any medical conditions?

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

Dispatcher Okay, the ambulance is on its way. Has he taken any medication?

Caller Yes, he took one aspirin a few minutes ago. I’m really worried.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm.

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