Emergency Scenario 700_f1

Location Information

Full Location:

Miðgarður 14, 700 Egilsstaðir, single-story detached house. Constructed in 1985, wooden frame with corrugated iron roof. Main entrance faces south, with a small porch. No security features, accessible via a short driveway. Current conditions: 8°C, overcast, light breeze. GPS coordinates: 65.2665° N, 14.3938° 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:

78-year-old male, patient is exhibiting signs of severe infection. Primary symptoms: High fever (39.5°C), altered mental status (confused, disoriented), rapid breathing (30 breaths/min), rapid heart rate (120 bpm), skin is mottled and clammy. Secondary symptoms: Patient reports chills and body aches for 2 days. Patient is weak and barely responsive. Patient is at home in his living room. Medical history: Type 2 diabetes, recent urinary tract infection (treated 1 week ago), hypertension. Medications: Metformin 500mg twice daily, Lisinopril 10mg daily, Paracetamol 500mg PRN. No known allergies. Last meal was a small portion of soup at 18:00 yesterday.

History of Events

Timeline:
Day 1, 1000 hours: Patient began experiencing mild chills and body aches. Assumed it was a cold.
Day 1, 2000 hours: Symptoms worsened, patient took paracetamol.
Day 2, 0800 hours: Patient reported feeling very weak and feverish.
Day 2, 1200 hours: Patient became increasingly confused and disoriented.
Day 2, 1400 hours: Patient's son (caller) found him unresponsive and called emergency services.
1405 hours: Current time, patient is barely responsive.

Prior Events: Patient was treated for a UTI with antibiotics 1 week ago. Completed the course of antibiotics. No recent travel or other known exposures. Patient lives alone, but son checks on him daily.

Diagnostics

Initial Assessment

Initial Impression: Suspected Sepsis due to severe infection
Justification for F1 Classification:
- Patient exhibits multiple SIRS criteria (fever, tachycardia, tachypnea, altered mental status)
- High probability of life-threatening condition requiring immediate intervention
- Time-critical condition requiring rapid transport and treatment

Differential Diagnoses:
1. Sepsis (most likely)
2. Severe Dehydration (less likely due to fever and other systemic signs)
3. Severe Infection (likely cause of sepsis)
4. Diabetic Ketoacidosis (less likely given lack of specific symptoms)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Early notification of hospital (Egilsstaðir Hospital) of potential sepsis case
- Pre-hospital sepsis protocols initiation (IV access, fluids, oxygen)
- Continuous monitoring of vital signs and level of consciousness

Final Diagnosis

Final Diagnosis: Severe Sepsis secondary to Urinary Tract Infection
Key Findings:
- Blood cultures positive for E. coli (consistent with UTI)
- Lactate level elevated (3.5 mmol/L)
- Hypotension (80/50 mmHg) despite fluid bolus
- Patient required vasopressors and advanced respiratory support in the hospital

Outcome validated F1 priority assignment. Rapid dispatch and early hospital notification were crucial. Patient required ICU admission and prolonged treatment.

Learning Points:
1. F1 classification was appropriate due to the time-critical nature of sepsis
2. Initial assessment accurately identified the high likelihood of sepsis
3. Early recognition of sepsis signs and prompt interventions significantly improved patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father 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 14 in Egilsstaðir.

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

Caller He's got a high fever, he's very confused, and he's breathing really fast. He's very weak and barely talking.

Dispatcher How long has he been sick?

Caller He's been feeling unwell for two days, but he got much worse today. He was treated for a UTI last week.

Dispatcher Is he taking any medications?

Caller Yes, he takes metformin for diabetes and lisinopril for blood pressure.

Dispatcher Okay, the ambulance is on its way. Don't move him. Stay with him and keep him as comfortable as possible. Is he still conscious?

Caller He's barely responsive, but he's still breathing. I'm very worried.

Dispatcher The ambulance is on its way. We're sending paramedics to help him. Please stay on the line until they arrive, and I will provide further instructions.