Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 99, 600 Akureyri, ground floor apartment 1B. A two-story wooden building constructed in 1955. Main entrance is on the street level, no stairs. Street parking available. No specific security features. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6825° N, 18.0935° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Sepsis

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old male, altered mental status, suspected sepsis. Primary symptoms: confusion, lethargy, rapid breathing, fever. Secondary symptoms: chills, nausea, decreased urine output. Patient is pale and diaphoretic. History of urinary tract infection (UTI) treated 3 days ago. Patient found by his son in bed. Medical history: Type 2 diabetes, hypertension, benign prostatic hyperplasia (BPH). Medications: Metformin 1000mg BID, Lisinopril 10mg daily, Tamsulosin 0.4mg daily. Allergies: Penicillin. Last meal was a light lunch at 13:00.

History of Events

Timeline:
10:00 hours: Patient reports feeling unwell, mild chills
12:00 hours: Patient takes lunch, reports increased fatigue
14:00 hours: Patient complains of feeling feverish, takes paracetamol
16:00 hours: Patient becomes increasingly lethargic and confused
17:00 hours: Son arrives, finds patient unresponsive, calls emergency services
17:05 hours: Current time, patient is confused and breathing rapidly

Prior Events: Patient had UTI symptoms 5 days ago, treated with oral antibiotics for 3 days. No recent hospitalizations or surgeries. Last check-up 6 months ago, routine follow-up. Patient lives alone, son checks on him daily.

Diagnostics

Initial Assessment

Initial Impression: Suspected Sepsis Secondary to UTI
Justification for F1 Classification:
- Altered mental status, rapid breathing, fever, and history of recent UTI are highly suggestive of sepsis, a life-threatening condition.
- Time-critical condition requiring immediate intervention to prevent organ dysfunction and death.
- High probability of septic shock given the rapid progression of symptoms.

Differential Diagnoses:
1. Sepsis (high probability)
2. Severe Dehydration (less likely given fever)
3. Diabetic Ketoacidosis (possible, but less likely given the rapid onset of symptoms and history of recent infection)
4. Stroke (less likely given the gradual onset and fever)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Early notification of the receiving hospital of a potential sepsis case
- Initiation of sepsis protocols (oxygen, IV access, fluid resuscitation) upon arrival
- Continuous monitoring of vital signs and level of consciousness

Final Diagnosis

Final Diagnosis: Severe Sepsis Secondary to Urosepsis
Key Findings:
- Blood cultures positive for E. coli, confirming a bacterial infection.
- Patient's lactate level was elevated, indicating significant tissue hypoperfusion.
- Initial blood pressure was low, responding to fluid resuscitation.
- Patient required ICU admission and aggressive antibiotic therapy.

Outcome validated F1 priority assignment. Rapid dispatch and aggressive treatment were essential for patient survival.

Learning Points:
1. F1 classification appropriate given the severity and rapid progression of symptoms
2. Initial assessment accurately identified sepsis as the most likely diagnosis
3. Prompt recognition and treatment of sepsis are critical to improving patient outcomes
4. History of recent UTI should raise suspicion for sepsis in elderly patients with altered mental status

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is very sick! I think he needs an ambulance.

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

Caller It's Hafnarstræti 99, apartment 1B in Akureyri.

Dispatcher Help is on its way. Can you tell me what's wrong with your father?

Caller He's very confused and weak. He's breathing fast and feels very hot. He had a UTI a few days ago.

Dispatcher Is he awake and talking to you?

Caller Yes, but he's not making much sense. He's very tired and pale.

Dispatcher Does he have any medical conditions?

Caller Yes, he has diabetes and high blood pressure. He also has prostate problems. He takes medication for all of them.

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

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