Emergency Scenario 700_f1

Location Information

Full Location:

Miðgarður 2, 700 Egilsstaðir, ground floor apartment. Two-story residential building constructed in 1995. Main entrance is accessible via a ramp. No elevator. Street parking available. Building has a basic fire alarm system. Current conditions: 7°C, overcast, light wind. GPS coordinates: 65.2667° N, 14.3992° W. Nearest landmark: Egilsstaðir swimming pool.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Respiratory Failure

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old male, severe respiratory distress. Primary symptoms: Extreme shortness of breath, gasping for air, cyanosis around lips, altered mental status. Secondary symptoms: Agitation, confusion, diaphoresis. Patient is conscious but barely responsive. Patient is in his living room. Medical history: COPD, diagnosed 15 years ago, congestive heart failure, diagnosed 5 years ago. Medications: Salmeterol/Fluticasone inhaler 50/500 mcg twice daily, Tiotropium inhaler 18 mcg once daily, Furosemide 40 mg daily, Metoprolol 50mg daily. Allergies: Penicillin. Last meal: Light soup at 18:00. Patient was watching television before onset of symptoms.

History of Events

Timeline:
2000 hours: Patient was watching television, reported feeling slightly unwell.
2015 hours: Patient began to experience increased shortness of breath, attempted to use his inhaler with no relief.
2020 hours: Patient's breathing rapidly deteriorated, became severely distressed and agitated.
2022 hours: Patient's wife called emergency services.
2023 hours: Current time, patient is barely responsive, gasping for air.

Prior Events: Patient has had several exacerbations of COPD in the past year, requiring hospitalization. Last hospital admission was 3 months ago for a COPD flare-up. Patient has a history of poor medication adherence.

Diagnostics

Initial Assessment

Initial Impression: Acute Respiratory Failure secondary to COPD Exacerbation
Justification for F1 Classification:
- Life-threatening condition with severe respiratory distress and altered mental status.
- Cyanosis and rapid deterioration indicate severe hypoxemia requiring immediate intervention.
- Time-critical condition requiring immediate advanced airway management and respiratory support.

Differential Diagnoses:
1. Acute Exacerbation of COPD (most likely)
2. Pulmonary Embolism (less likely, no chest pain reported)
3. Acute Myocardial Infarction (less likely, no chest pain reported)
4. Pneumonia (possible, but acute onset suggests COPD exacerbation)

Required Actions:
- Immediate dispatch of ALS ambulance with advanced airway capabilities.
- Pre-arrival instructions to caller to maintain open airway.
- Early hospital notification and activation of respiratory team.
- Preparation for potential intubation and mechanical ventilation.

Final Diagnosis

Final Diagnosis: Acute Respiratory Failure secondary to Severe COPD Exacerbation with superimposed pneumonia.
Key Findings:
- Initial presentation consistent with COPD exacerbation.
- Chest X-ray confirmed presence of bilateral pneumonia.
- Arterial blood gas analysis showed severe hypoxemia and hypercapnia.
- Patient required intubation and mechanical ventilation upon arrival at the hospital.

Outcome validated F1 priority assignment. Rapid dispatch and advanced life support were critical. Patient received treatment for both COPD exacerbation and pneumonia, and was admitted to ICU.

Learning Points:
1. F1 classification was appropriate given the severity and rapid deterioration.
2. Initial assessment accurately identified the primary respiratory distress but additional underlying conditions required further evaluation.
3. Pre-hospital intubation could have been necessary, underscoring the need for ALS response.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, he can't breathe! He's really bad!

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

Caller It's Miðgarður 2, in Egilsstaðir. Ground floor apartment.

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

Caller He was watching TV and then he started struggling to breathe. He has COPD. He's gasping for air now and he's turning blue!

Dispatcher Is he awake?

Caller Yes, but barely. He's confused. He's sweating a lot.

Dispatcher Does he have any other medical conditions or allergies?

Caller He has heart failure too. And he is allergic to penicillin. He takes inhalers and some heart pills.

Dispatcher Okay, the ambulance is on its way. Try to keep him calm and keep his airway clear. Don't give him anything to eat or drink.

Caller Okay, thank you. I will try. He looks so bad.