Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, third-floor apartment 3B. A four-story concrete building built in 1965. Access via a main entrance with a coded lock (code 1965). There is one elevator and a central stairwell. Street parking is available. The building has a basic fire alarm system. Current conditions: 7°C, overcast, light wind, good visibility. GPS coordinates: 65.6823° N, 18.0921° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Respiratory Failure

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

68-year-old male, found unresponsive by his son. Primary symptoms: Unresponsive, agonal breathing, cyanosis. Secondary symptoms: None reported. Patient lying on the floor in the living room. Medical history: COPD diagnosed 5 years ago, type 2 diabetes, hypertension. Medications: Salmeterol/Fluticasone inhaler 50/500 mcg twice daily, Metformin 1000mg twice daily, Lisinopril 20mg daily. Known allergy to penicillin. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1600 hours: Patient last seen by son, appeared well
1645 hours: Son returned home, found patient unresponsive on the floor
1646 hours: Son called emergency services
1648 hours: Current time, patient still unresponsive, agonal breathing

Prior Events: Patient has had several COPD exacerbations in the past year, requiring hospital admission. Last COPD exacerbation was 2 months ago. Complained of mild shortness of breath yesterday but refused medical attention. Last medical check-up 1 month ago, routine follow-up. Patient lives alone but son lives nearby.

Diagnostics

Initial Assessment

Initial Impression: Respiratory Failure secondary to COPD exacerbation, likely with cardiac involvement.
Justification for F1 Classification:
- Unresponsive patient with agonal breathing and cyanosis is a life-threatening emergency
- High probability of respiratory and/or cardiac arrest
- Time-critical condition requiring immediate intervention

Differential Diagnoses:
1. Acute COPD Exacerbation (high probability)
2. Cardiac Arrest (possible, given unresponsiveness)
3. Pulmonary Embolism (less likely but possible)
4. Severe Hypoglycemia (less likely, given history)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Early notification of hospital for potential cardiac arrest
- Initiation of BLS/ALS protocols on arrival
- Oxygen administration and airway management
- Preparation for rapid transport to the nearest hospital with ICU capabilities

Final Diagnosis

Final Diagnosis: Acute Respiratory Failure secondary to severe COPD exacerbation, complicated by pneumonia.
Key Findings:
- EMS found patient in respiratory arrest, required intubation
- Chest x-ray at hospital showed extensive pneumonia in addition to COPD exacerbation
- Blood gas analysis confirmed severe respiratory acidosis
- Initial cardiac rhythm was sinus bradycardia, but progressed to asystole during resuscitation
- Patient required prolonged ventilation and ICU admission

Outcome validated F1 priority assignment. Rapid dispatch and aggressive resuscitation were critical. Patient had a very poor prognosis due to the severity of the underlying conditions.

Learning Points:
1. F1 classification was absolutely necessary due to the severity of presentation
2. Initial assessment accurately identified the respiratory failure, but the pneumonia was a complicating factor
3. Early recognition of respiratory arrest and aggressive airway management were life-saving

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father... I think he's not breathing! He's on the floor and not responding!

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

Caller It's Hafnarstræti 18, apartment 3B, third floor in Akureyri.

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

Caller I found him on the floor... he's not moving. He's making weird noises when he tries to breathe, like gasping... He's blue.

Dispatcher Is he awake and talking to you?

Caller No, he's completely unresponsive. He has COPD... he's had trouble breathing before.

Dispatcher Does he have any other medical conditions or allergies?

Caller He has diabetes and high blood pressure. He's allergic to penicillin. Please hurry!

Dispatcher Okay, the ambulance is on its way. Don't move him. I need you to stay calm. Can you check if he's breathing at all?

Caller He's barely breathing... It's like he's gasping for air. Oh god, please hurry!