Emergency Scenario 600_f1

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, second floor apartment 2B. Three-story brick building constructed in 1965. Main entrance has a coded lock (code: 1965). No elevator, only a central stairwell. Street parking available. Building equipped with smoke detectors. 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 by son. Primary symptoms: Unresponsive, gasping respirations, cyanosis around lips. Secondary symptoms: None reported by caller. Medical history: COPD, congestive heart failure, type 2 diabetes. Medications: Salbutamol inhaler PRN, Furosemide 40mg daily, Metformin 500mg twice daily, Ramipril 5mg daily. Allergies: Penicillin. Last meal was a light lunch at 13:00. Found on living room floor.

History of Events

Timeline:
1500 hours: Patient last seen conscious by son, reported feeling 'a bit tired'.
1545 hours: Son found patient unresponsive on living room floor.
1546 hours: Son called emergency services.
1548 hours: Current time, patient still unresponsive with gasping respirations.

Prior Events: Patient has a history of exacerbations of COPD requiring hospitalization. Last exacerbation was 2 months ago. Reports increasing shortness of breath over the last 3 days. No recent change in medications reported. Patient lives alone but son visits daily.

Diagnostics

Initial Assessment

Initial Impression: Acute Respiratory Failure secondary to COPD exacerbation with possible cardiac involvement.
Justification for F1 Classification:
- Unresponsive patient with gasping respirations and cyanosis, indicating immediate life threat
- History of COPD and CHF increases risk of rapid deterioration
- Time-critical condition requiring immediate airway management and advanced life support

Differential Diagnoses:
1. COPD Exacerbation (high probability)
2. Acute Pulmonary Edema (possible, given history of CHF)
3. Myocardial Infarction (possible, given age and history)
4. Stroke (less likely given primary respiratory symptoms)
5. Severe Hypoglycemia (possible, given history of diabetes)

Required Actions:
- Dispatch of ground EMS with ALS capabilities, immediate response
- Early notification of hospital with respiratory and cardiac support capabilities
- Preparation for intubation and mechanical ventilation
- Immediate oxygen administration and cardiac monitoring

Final Diagnosis

Final Diagnosis: Acute Respiratory Failure secondary to severe COPD exacerbation with superimposed pneumonia.
Key Findings:
- Initial assessment confirmed severe respiratory distress, unresponsive, gasping respirations, cyanosis, and reduced air entry bilaterally.
- Patient required immediate intubation and mechanical ventilation.
- Chest x-ray revealed bilateral infiltrates consistent with pneumonia, and hyperinflated lungs consistent with COPD.
- ABG showed severe hypercapnia and hypoxemia.
- Troponin levels were negative, ruling out acute myocardial infarction.

Outcome validated F1 priority assignment. Rapid intervention was critical for patient survival. Patient required ICU admission and treatment for pneumonia.

Learning Points:
1. F1 classification was essential for immediate response.
2. Initial assessment correctly identified the primary life-threatening respiratory issue.
3. The presence of pneumonia was not initially obvious but contributed to the severity of the presentation.
4. Early airway management and mechanical ventilation were crucial for stabilizing the patient.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

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

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

Caller It's Hafnarstræti 18, apartment 2B, second 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 responding. He's making these weird gasping noises. His lips look blue.

Dispatcher Is he breathing at all?

Caller Barely, just these gasping breaths. He has COPD and heart problems.

Dispatcher Does he take any medications?

Caller Yes, he has inhalers, water pills, and pills for his diabetes and blood pressure. He's allergic to penicillin.

Dispatcher Okay, the ambulance is on its way. Do not try to move him. Stay with him and keep him calm if possible.

Caller Okay, thank you. I'll stay here with him.