Emergency Scenario 780_f2

Location Information

Full Location:

Hafnarbraut 12, 780 Höfn, second floor apartment 203. Three-story concrete residential building constructed in 1995. Main entrance requires key or intercom. One elevator and central stairwell. Street parking available. Building equipped with fire alarm system. Current conditions: 7°C, overcast, moderate visibility. GPS coordinates: 64.2534° N, 15.2088° W. Nearest landmark: Höfn Harbour.

Municipality: Höfn

Postal Code: 780

Emergency Details

Type: Neurological Symptoms

Priority Level: F2

Response Time Goal: Urgent (15-30 minutes)

Description:

65-year-old male, experiencing sudden onset of right-sided weakness and slurred speech. Patient reports severe headache. Symptoms began approximately 30 minutes prior to call. Patient is conscious but confused. No known history of seizures. Patient is sitting on a chair in his living room. Medical history: Hypertension, type 2 diabetes, hyperlipidemia. Medications: Metformin 1000mg twice daily, Lisinopril 20mg daily, Atorvastatin 40mg daily. No known allergies. Last meal was lunch at 13:00.

History of Events

Timeline:
1400 hours: Patient reports sudden onset of severe headache.
1410 hours: Patient developed right-sided weakness and slurred speech.
1415 hours: Patient's wife called emergency services.
1420 hours: Current time, patient is conscious but confused, sitting in a chair.

Prior Events: Patient reports occasional headaches, no previous stroke or TIA. Last medical check-up was 6 months ago, routine follow-up. Patient lives with his wife. No recent illnesses or injuries.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke
Justification for F2 Classification:
- Sudden onset of neurological deficits (right-sided weakness, slurred speech)
- High suspicion of stroke due to risk factors (hypertension, diabetes, hyperlipidemia)
- Time-sensitive condition requiring immediate medical intervention

Differential Diagnoses:
1. Ischemic Stroke (most likely given sudden onset)
2. Hemorrhagic Stroke (possible, requires imaging to differentiate)
3. Transient Ischemic Attack (TIA) (possible, but current symptoms more severe)
4. Hypoglycemia (less likely given no history of insulin use, but must rule out)
5. Seizure (less likely given no reported history)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Pre-notification of receiving hospital (stroke alert)
- Immediate assessment and initiation of stroke protocols
- Rapid transport to hospital with CT scan capabilities

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke (Middle Cerebral Artery)
Key Findings:
- CT scan of the head confirmed a left middle cerebral artery (MCA) ischemic stroke
- Patient's NIH Stroke Scale score was 12, indicating moderate severity
- No evidence of intracranial hemorrhage
- Blood glucose was within normal range

Outcome validated F2 priority assignment. Rapid dispatch and pre-hospital notification were crucial for timely thrombolysis. Patient received tPA within 4 hours of symptom onset.

Learning Points:
1. F2 classification appropriate due to time-critical nature of stroke
2. Initial assessment accurately identified the high likelihood of stroke
3. Rapid transport and pre-hospital notification facilitated timely intervention

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, he's not well. He suddenly got a bad headache and now he can't move his right side properly and his speech is slurred.

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

Caller It's Hafnarbraut 12, apartment 203, second floor in Höfn.

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

Caller He was fine, then he complained of a terrible headache. After a few minutes he started slurring his words and his right arm and leg are weak. He's confused.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but not making much sense, he's not himself at all. He’s sitting on a chair, I helped him to sit down.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure, diabetes, and high cholesterol. He takes pills for them.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm. Has he had any food recently?

Caller He had lunch at about 1 pm. I will wait here with him.