Emergency Scenario 640_f3_2

Location Information

Garðarsbraut 17, 640 Húsavík, apartment 3B. Three-story wooden residential building constructed in 1955. Main entrance has a key code. Stairwell access only, no elevator. Street parking available. Building has a basic fire alarm system. Current conditions: 8°C, overcast, moderate visibility. GPS coordinates: 66.0432° N, 17.3356° W. Nearest landmark: Húsavík Church.

Emergency Details

45-year-old male, experiencing acute agitation and paranoia. Primary symptoms: Increased agitation, pacing, expressing delusional thoughts about being followed and monitored, verbal aggression. Secondary symptoms: Elevated heart rate, sweating, rapid speech. Patient appears disheveled and is refusing to engage in conversation. Patient has a known history of bipolar disorder, currently not compliant with medication. Patient is at home in his apartment, alone. No known medical conditions other than bipolar disorder. Last meal was a light lunch at 12:00.

History of Events

Timeline:
1400 hours: Patient started exhibiting signs of increased agitation, pacing, and talking to himself.
1415 hours: Patient began expressing paranoid delusions about being watched and followed.
1430 hours: Patient became verbally aggressive, shouting and refusing to engage in conversation.
1445 hours: Neighbor, Jónas Einarsson, heard the commotion and called emergency services.
1450 hours: Current time, patient still agitated, pacing, and expressing delusional thoughts.

Prior Events: Patient has a history of bipolar disorder diagnosed 10 years ago, with multiple previous episodes of mania and psychosis. Patient has a history of medication non-compliance. Last psychiatric appointment was 6 months ago. Patient has a history of substance abuse, last use unknown. Patient lives alone and has limited social support.

Diagnostics

Initial Assessment

Initial Impression: Acute Manic Episode with Psychotic Features
Justification for F3 Classification:
- Patient is experiencing a psychiatric emergency with significant behavioral disturbance
- Patient is not an immediate threat to self or others, but requires medical evaluation and intervention
- Time-sensitive condition, but not life-threatening

Differential Diagnoses:
1. Acute Manic Episode with Psychotic Features (most likely)
2. Acute Psychotic Episode (less likely, no known history of schizophrenia)
3. Substance-Induced Psychosis (possible, but unknown substance use)
4. Agitation secondary to medical condition (less likely, no known medical history)

Required Actions:
- Dispatch of ground EMS with appropriate training for psychiatric emergencies
- Assessment of patient safety and risk of violence
- De-escalation techniques
- Safe transport to the nearest psychiatric facility for evaluation and treatment

Final Diagnosis

Final Diagnosis: Bipolar I Disorder, Current Episode Manic, Severe with Psychotic Features
Key Findings:
- Psychiatric assessment confirmed severe manic symptoms with paranoid delusions
- Patient’s history of bipolar disorder and non-compliance with medication confirmed
- Urine toxicology screen was negative for recent substance use
- No other underlying medical conditions identified

Outcome validated F3 priority assignment. Patient required psychiatric hospitalization and medication management. Patient was stabilized within 72 hours.

Learning Points:
1. F3 classification was appropriate, as the patient required urgent psychiatric care but was not an immediate life threat.
2. Initial assessment accurately identified the manic episode with psychotic features.
3. Early recognition of the psychiatric emergency and proper de-escalation techniques were crucial.

Emergency Call Transcript