Emergency Scenario 700_f1

Location Information

Full Location:

Miðvangur 10, 700 Egilsstaðir. Two-story residential building, built in 1985. Main entrance has a coded lock (code: 1985). One stairwell, no elevator. Street parking available. Current conditions: 8°C, overcast, moderate wind, good visibility. GPS coordinates: 65.2667° N, 14.3947° W. Nearest landmark: Egilsstaðir Airport.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Sepsis

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old female, altered mental status, suspected sepsis. Primary symptoms: Confusion, lethargy, rapid breathing, fever, chills. Secondary symptoms: General weakness, decreased urine output. Patient is pale and diaphoretic. Medical history: Type 2 diabetes, chronic kidney disease, recent UTI treated with antibiotics. Medications: Metformin 1000mg twice daily, Insulin 10 units daily, Amlodipine 5mg daily. Allergies: Penicillin. Last meal was a small lunch at 13:00.

History of Events

Timeline:
1600 hours: Patient reports feeling unwell, mild chills, fatigue.
1700 hours: Patient developed fever, increased confusion.
1800 hours: Patient became increasingly lethargic, difficult to rouse.
1815 hours: Caller (patient's daughter) arrived, found patient unresponsive, called emergency services.
1820 hours: Current time, patient barely responsive, rapid breathing.

Prior Events: Patient had a urinary tract infection 1 week ago, treated with antibiotics. No recent hospitalizations. Baseline mental status is alert and oriented. No recent travel. No known recent exposure to contagious diseases. Patient lives alone, but daughter visits daily.

Diagnostics

Initial Assessment

Initial Impression: Suspected Sepsis
Justification for F1 Classification:
- Altered mental status, fever, rapid breathing are indicative of severe infection.
- High risk of rapid deterioration, requiring immediate medical intervention.
- Time-critical condition with potential for multi-organ failure.

Differential Diagnoses:
1. Sepsis (high probability)
2. Severe Dehydration (possible, less likely given fever)
3. Diabetic Ketoacidosis (possible, but altered mental status is more severe than typical DKA)
4. Stroke (less likely, no focal neurological deficits reported)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Early hospital notification with sepsis alert
- Rapid transport to nearest hospital with ICU services
- Initiate sepsis protocol en route

Final Diagnosis

Final Diagnosis: Septic Shock secondary to Urosepsis
Key Findings:
- Blood cultures positive for E. coli, confirming urosepsis.
- Patient's lactate level was elevated, indicating tissue hypoperfusion.
- Hypotension unresponsive to initial fluid bolus.
- Patient required vasopressors and mechanical ventilation in ICU.

Outcome validated F1 priority assignment. Rapid dispatch and early treatment were crucial. Patient was admitted to ICU for further management.

Learning Points:
1. F1 classification was appropriate due to high risk of mortality.
2. Initial assessment accurately identified the high likelihood of sepsis.
3. Early recognition and rapid treatment of sepsis are critical for improved outcomes.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My mother is very sick! I think she needs an ambulance right away!

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

Caller It's Miðvangur 10, in Egilsstaðir.

Dispatcher Help is on its way. What's wrong with your mother?

Caller She's very confused and weak. She has a fever and she's breathing fast. She's not really talking to me.

Dispatcher How old is your mother?

Caller She's 72 years old.

Dispatcher Does she have any medical conditions?

Caller Yes, she has diabetes and kidney problems. She was treated for a UTI last week.

Dispatcher Okay, the ambulance is on its way. Can you try to keep her awake? Do not give her anything to eat or drink.

Caller Okay, I will try. She's barely responding.