Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, Apartment 3B, third floor. A five-story concrete building constructed in 1968, with a single main entrance accessible via a coded lock (code: 2741). Elevator and central stairwell available. Street parking is available. Building has a basic fire alarm system. Current weather: 7°C, overcast, light breeze. Visibility is good. GPS coordinates: 65.6837° N, 18.0922° 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 at home. Primary symptoms: Unresponsive, agonal breathing, cyanosis. Secondary symptoms: None reported. Patient found lying on the living room floor. Medical history: COPD, congestive heart failure, type 2 diabetes. Medications: Salbutamol inhaler (as needed), Furosemide 40mg daily, Metformin 500mg twice daily, Aspirin 75mg daily. Allergies: None known. Last meal: Light lunch at 12:00, now 15:45.

History of Events

Timeline:
14:00 hours: Patient was seen by neighbor, appeared normal.
15:30 hours: Neighbor found patient unresponsive on the floor after checking in.
15:32 hours: Neighbor called emergency services.
15:45 hours: Current time. Patient remains unresponsive with agonal breathing. 

Prior Events: Patient has had several exacerbations of COPD requiring hospital admission in the past year. Last hospital discharge was 2 weeks ago. Patient lives alone. Neighbor checks in daily.

Diagnostics

Initial Assessment

Initial Impression: Respiratory Arrest secondary to likely COPD exacerbation and/or cardiac event.
Justification for F1 Classification:
- Unresponsive, agonal breathing, cyanosis indicates imminent life threat
- Patient's known history of COPD and CHF increases risk of respiratory and cardiac compromise
- Time-critical situation requiring immediate intervention to prevent irreversible damage or death.

Differential Diagnoses:
1. Acute COPD Exacerbation with Respiratory Failure (high probability)
2. Cardiac Arrest secondary to myocardial infarction or arrhythmia (high probability)
3. Pulmonary Embolism (possible but less likely)
4. Severe Hypoglycemia (less likely given history of diabetes, but must be considered)

Required Actions:
- Immediate dispatch of ALS ambulance
- Pre-arrival instructions for CPR to caller
- Early notification of hospital emergency department
- Preparation for advanced airway management, cardiac monitoring, and medication administration.

Final Diagnosis

Final Diagnosis: Acute Respiratory Failure secondary to COPD exacerbation and pulmonary edema.
Key Findings:
- Upon arrival, patient was in respiratory arrest with no palpable pulse, CPR initiated
- ECG showed sinus tachycardia with ST depression, indicative of ischemia
- Patient intubated and ventilated. Chest x-ray revealed severe pulmonary edema.
- Arterial blood gas showed severe respiratory acidosis.

Outcome validated F1 priority assignment. Rapid dispatch and advanced life support were critical. Patient stabilized after intubation and ventilation. Admitted to ICU for further management.

Learning Points:
1. F1 classification was essential due to the patient's critical condition.
2. Initial assessment accurately identified the primary respiratory and cardiac components.
3. Pre-arrival CPR instructions and rapid ALS intervention were crucial for patient survival.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I need an ambulance! My neighbor, Jónas, is not breathing! He's on the floor!

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

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

Dispatcher Help is on its way. Is he completely unresponsive?

Caller Yes, he's not responding. He's making weird noises like gasping for air. He's turning blue!

Dispatcher Okay, I need you to stay calm. Is he on his back?

Caller Yes, he's on his back on the living room floor.

Dispatcher I'm going to tell you how to do CPR. Have you ever done CPR before?

Caller No, never. I'm so scared. I don't know what to do.

Dispatcher It's okay, I will guide you. Put your hands in the center of his chest, one on top of the other, and push hard and fast.

Caller Okay, I'm doing it. Oh my god, please hurry! He is not moving!

Dispatcher Keep pushing, the ambulance is on its way. Do you know if he has any medical conditions?

Caller Yes, he has COPD and heart problems, and diabetes. He uses inhalers and takes pills, but I don't know what.

Dispatcher Okay, just keep doing CPR. The ambulance will be there soon.