Hafnarstræti 18, 600 Akureyri, third-floor apartment 3B. A five-story mixed-use building with commercial units on the ground floor and residential apartments above. Built in 1965, concrete construction. Main entrance has a secure entry system with intercom. Elevator and stairwell access. Limited street parking. Building has a fire alarm system. Weather: 7°C, overcast, moderate wind. GPS coordinates: 65.6822° N, 18.0928° W. Landmark: Gamli Baukur restaurant.
68-year-old male, found unresponsive at home. Primary symptoms: Unresponsive, agonal breathing, cyanosis. Secondary symptoms: None reported. Patient found in bed. Medical history: COPD, Type 2 Diabetes, diagnosed 5 years ago, history of recent pneumonia 2 months ago, recent hospital discharge 1 week ago. Medications: Salmeterol/Fluticasone inhaler 50/500mcg twice daily, Metformin 1000mg twice daily, Sitagliptin 100mg daily, Prednisone 5mg daily, Atorvastatin 20mg daily. Allergies: Sulfa drugs. Last meal: Small dinner at 19:00 last night.
Timeline: 2200 hours: Patient went to bed, felt unwell but attributed it to COPD 0700 hours: Wife found patient unresponsive, making gasping sounds 0702 hours: Wife called emergency services 0704 hours: Current time, patient remains unresponsive, gasping for air Prior Events: Patient has been managing COPD at home with inhalers and oral medications. He had pneumonia two months ago requiring hospitalization. Discharged one week ago, has been weak and fatigued since then. No recent changes in medications. Last doctor's appointment 2 weeks ago for routine follow up.
Initial Impression: Respiratory Failure secondary to COPD exacerbation Justification for F1 Classification: - Unresponsive patient with agonal breathing indicates immediate life threat - Cyanosis indicates severe hypoxemia - History of COPD and recent pneumonia suggests respiratory system compromise - Time-critical situation requiring immediate advanced airway management and ventilation Differential Diagnoses: 1. Severe COPD Exacerbation (most likely) 2. Pulmonary Embolism (possible, less likely given history) 3. Acute Myocardial Infarction (possible, less likely given presentation) 4. Pneumothorax (possible, less likely given history) 5. Drug Overdose (unlikely given history) Required Actions: - Dispatch of ground EMS with ALS capabilities - Notification of nearest hospital with ICU capabilities - Immediate airway management and ventilatory support - Continuous cardiac monitoring - Rapid transport to hospital