Emergency Scenario 700_f1

Location Information

Full Location:

Miðvangur 12, 700 Egilsstaðir, Single-story detached house built in 1985. Main entrance faces the street. No security features. Street parking available. Current conditions: 8°C, overcast, light wind, good visibility. GPS coordinates: 65.2654° N, 14.3938° W. Nearest landmark: Egilsstaðir Swimming Pool.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Sepsis

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

68-year-old male, showing signs of severe infection. Primary symptoms: High fever (39.5°C), rapid heart rate (120 bpm), rapid breathing (28 breaths/min), confusion, and lethargy. Secondary symptoms: Shivering, pale skin, and decreased urine output. Patient is currently at home, initially reported feeling unwell yesterday, with symptoms worsening rapidly today. Medical history: Type 2 diabetes, recent UTI treated with antibiotics 2 weeks ago. Medications: Metformin 1000mg twice daily, Lisinopril 10mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
Yesterday 16:00 hours: Patient reported feeling unwell, with mild fatigue and chills.
Yesterday 20:00 hours: Fever developed (38.0°C), patient took paracetamol.
Today 08:00 hours: Patient woke up with high fever (39.0°C), increased fatigue, and confusion.
Today 10:00 hours: Symptoms worsened, patient became increasingly lethargic, and wife called emergency services.
Today 10:05 hours: Current time, patient barely responsive, wife is very distressed.

Prior Events: Patient had a UTI 2 weeks ago, treated with a 7-day course of antibiotics. No recent hospitalizations or surgeries. Patient usually active and independent.

Diagnostics

Initial Assessment

Initial Impression: Suspected Sepsis
Justification for F1 Classification:
- Presence of multiple SIRS criteria (fever, tachycardia, tachypnea, altered mental status)
- High risk of rapid deterioration and organ dysfunction
- Time-critical condition requiring immediate medical intervention

Differential Diagnoses:
1. Sepsis (high probability given infection history and presentation)
2. Severe Infection (e.g., pneumonia, pyelonephritis, less likely without specific symptoms)
3. Diabetic Ketoacidosis (less likely, no history of uncontrolled diabetes or recent insulin omission)
4. Heat Stroke (less likely given weather conditions)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Immediate notification of hospital with sepsis protocol
- Early IV access and fluid resuscitation
- Oxygen administration if needed
- Continuous monitoring of vital signs

Final Diagnosis

Final Diagnosis: Sepsis secondary to unresolved UTI
Key Findings:
- Blood cultures positive for E. coli, confirming bacterial sepsis
- Patient's lactate level was elevated, indicating tissue hypoperfusion
- Initial antibiotic treatment was not effective against the specific bacteria
- Patient required ICU admission for hemodynamic support and organ support

Outcome validated F1 priority assignment. Rapid transport and aggressive treatment were critical. Patient required mechanical ventilation and vasopressors.

Learning Points:
1. F1 classification was appropriate given the severity and time-critical nature of sepsis
2. Initial assessment accurately identified the high probability of sepsis
3. Prompt hospital notification and initiation of sepsis protocol were essential for patient survival

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband is very sick! I think he's terribly ill, please send help!

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

Caller It's Miðvangur 12, in Egilsstaðir.

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

Caller He's been sick since yesterday, but now he's really bad. He has a very high fever, he's confused and very weak. I'm very worried!

Dispatcher Is he awake and talking to you?

Caller He is barely awake, he's very lethargic. He doesn't seem to understand me very well.

Dispatcher Does he have any medical conditions?

Caller He has diabetes, and he had a urine infection recently. He finished his antibiotics about two weeks ago.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him calm. I'm going to ask you a few more questions

Caller Okay, thank you. I will wait here with him. Please hurry!