Emergency Scenario 700_f1

Location Information

Full Location:

Miðgarður 17, 700 Egilsstaðir. Single-story detached house, built in 1995, concrete foundation, wood frame. Main entrance via front door, no security system, gravel driveway. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.2667° N, 14.3975° 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 male, altered mental status, fever, and rapid breathing. Primary symptoms: Confusion, lethargy, fever of 39.5°C (103.1°F), rapid and shallow breathing, heart rate of 120 bpm. Secondary symptoms: Shivering, sweating, pale skin. Patient is in bed, appears very ill. Medical history: Type 2 diabetes, recent urinary tract infection (UTI) treated with antibiotics 2 weeks ago, hypertension. Medications: Metformin 1000mg twice daily, Lisinopril 20mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
1500 hours: Patient complained of feeling unwell, reported chills and fatigue.
1600 hours: Patient's wife noted he was increasingly confused and lethargic.
1700 hours: Patient's wife measured a fever of 39.5°C, patient started breathing rapidly.
1710 hours: Patient's wife called emergency services.
1712 hours: Current time, patient is in bed, unresponsive to simple questions.

Prior Events: Patient had a UTI diagnosed and treated with antibiotics 2 weeks ago. Patient has been managing his diabetes well, with regular monitoring. No recent travel or exposure to infectious diseases. Last medical check-up 3 months ago, routine follow-up.

Diagnostics

Initial Assessment

Initial Impression: Suspected Sepsis secondary to possible unresolved UTI
Justification for F1 Classification:
- Altered mental status, fever, and rapid breathing indicate a severe systemic infection.
- High risk of rapid deterioration and multi-organ failure without immediate intervention.
- Time-critical condition requiring immediate transport to hospital and initiation of sepsis protocol.

Differential Diagnoses:
1. Sepsis (high probability)
2. Severe infection (e.g., pneumonia) (moderate probability)
3. Diabetic ketoacidosis (DKA) (moderate probability)
4. Stroke (lower probability, no focal neurological deficits reported)
5. Heatstroke (low probability, weather is cool)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Immediate transport to hospital
- Early notification of hospital for sepsis alert
- Oxygen therapy and IV access if possible

Final Diagnosis

Final Diagnosis: Septic Shock secondary to urosepsis
Key Findings:
- Blood cultures positive for E. coli, confirming urosepsis.
- Patient's lactate levels were elevated, indicating severe tissue hypoperfusion.
- Patient required vasopressors and mechanical ventilation upon arrival at the hospital.
- Initial assessment accurately identified the high risk of sepsis and need for rapid intervention.

Outcome validated F1 priority assignment. Rapid dispatch and early notification were crucial for timely treatment. Patient admitted to ICU, stabilized after initial interventions, and recovered after a prolonged course of antibiotics and supportive care.

Learning Points:
1. F1 classification was critical for this case due to rapid deterioration.
2. Initial assessment correctly identified the high likelihood of sepsis based on vital signs and altered mental status.
3. Early notification and rapid transport contributed to improved patient outcome.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband is very sick! I think he needs an ambulance right away.

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

Caller It's Miðgarður 17, in Egilsstaðir.

Dispatcher Help is on its way. Can you tell me what's wrong with him?

Caller He's very confused, he has a high fever, and he's breathing very fast. He's very weak.

Dispatcher How high is his fever?

Caller I measured 39.5 degrees Celsius. He was shivering earlier but now he's sweating and his skin is pale.

Dispatcher Is he awake and talking to you?

Caller He's awake, but he's not really responding properly. He just looks very sick and tired. He had a UTI a couple of weeks ago, and he is diabetic.

Dispatcher Okay, the ambulance is on its way. Don't try to move him. Stay with him and keep him as comfortable as possible.

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