Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 22, 600 Akureyri, third-floor apartment 3B. A five-story concrete building built in 1985. Main entrance has a coded lock (code: 1985). One elevator and a central stairwell. Street parking available. Building has a fire alarm system. Current conditions: 7°C, overcast, light breeze, good visibility. GPS coordinates: 65.6828° N, 18.0925° 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:

72-year-old male, found unresponsive. Primary symptoms: Unresponsive, gasping respirations, cyanosis. Secondary symptoms: None reported. Patient is lying on the floor in the living room. Medical history: COPD, hypertension, Type 2 diabetes. Medications: Salbutamol inhaler (as needed), Seretide inhaler (250/50 mcg twice daily), Metformin 1000mg twice daily, Amlodipine 10mg daily. Allergies: Penicillin. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1400 hours: Patient was last seen sitting on the sofa, watching TV, appeared well.
1415 hours: Caller, the patient's son, arrived at the apartment, found the patient unresponsive on the floor.
1416 hours: Caller called emergency services.
1418 hours: Current time, patient remains unresponsive with gasping respirations.

Prior Events: Patient has a history of COPD exacerbations, has been hospitalized twice in the past year for respiratory issues. Last medical check-up was 2 months ago. No recent changes in medication. Patient lives alone, son visits daily.

Diagnostics

Initial Assessment

Initial Impression: Acute Respiratory Failure, likely secondary to COPD exacerbation
Justification for F1 Classification:
- Unresponsive patient with gasping respirations and cyanosis indicates a life-threatening condition.
- Immediate intervention is required to prevent cardiac arrest.
- High risk of rapid deterioration.

Differential Diagnoses:
1. COPD Exacerbation (high probability)
2. Pulmonary Embolism (less likely, no reported chest pain)
3. Myocardial Infarction (less likely, no reported chest pain, but cannot be ruled out)
4. Severe Pneumonia (less likely, no reported fever or cough)
5. Overdose (less likely, no known history)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities.
- Early notification to hospital emergency department.
- Initiation of airway management and ventilatory support protocols.
- Preparation for immediate transport to the nearest hospital.

Final Diagnosis

Final Diagnosis: Acute Respiratory Failure secondary to Severe COPD Exacerbation with Hypercapnia
Key Findings:
- Arterial blood gas analysis revealed severe hypercapnia and hypoxia.
- Chest X-ray showed signs of COPD with no evidence of pneumonia or other acute pathology.
- Patient's unresponsiveness and gasping respirations were consistent with severe respiratory failure.
- Response to initial interventions (oxygen and assisted ventilation) was slow but positive.

Outcome validated F1 priority assignment. Rapid dispatch and aggressive airway management were essential. Patient required intubation and mechanical ventilation upon arrival at the hospital. Patient stabilized in ICU.

Learning Points:
1. F1 classification was appropriate due to the patient's critical condition.
2. Initial assessment accurately identified the life-threatening nature of the situation.
3. Early recognition of respiratory failure and rapid intervention were crucial for survival.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father! He's not breathing right! I think he's dying!

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

Caller It's Hafnarstræti 22, apartment 3B, third floor in Akureyri.

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

Caller I just got here, and he's on the floor. He's not responding. He's making weird noises like gasping for air. He looks blue!

Dispatcher Is he awake? Can he talk to you?

Caller No! He's completely out of it! He's not responding to me at all!

Dispatcher Does he have any medical conditions that you know of?

Caller Yes, he has COPD and diabetes and high blood pressure. He uses inhalers.

Dispatcher Okay, the ambulance is on its way. Don't move him. Stay with him and I will guide you through some steps. Can you check if he is breathing?

Caller Okay, I am here with him. Yes, he is breathing, but it's like... gasping. I don't know what to do!

Dispatcher Okay, just stay calm. Help is on the way. I need you to stay with him and keep him as still as possible. Do not move him unless you need to for his safety. Do you understand?

Caller Yes, I understand. I'm so scared. Thank you.