Emergency Scenario 735_f1

Location Information

Full Location:

Hafnargata 15, 735 Norðfjörður. Two-story wooden house built in 1955. Main entrance facing the street, accessible via a short flight of stairs. No elevator. Side entrance to the garden. No security system. Current conditions: 2°C, light snow, low visibility. GPS coordinates: 65.2083° N, 14.2139° W. Nearest landmark: Norðfjörður harbor.

Municipality: Norðfjörður

Postal Code: 735

Emergency Details

Type: Respiratory Failure

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

78-year-old male, severe respiratory distress. Primary symptoms: Gasping for air, cyanosis around lips, altered mental status (confused and agitated). Secondary symptoms: Chest tightness, productive cough with frothy sputum. Patient is a known COPD patient. Patient is sitting upright in bed. Medical history: COPD diagnosed 15 years ago, hypertension, type 2 diabetes. Medications: Salbutamol inhaler PRN, Tiotropium inhaler daily, Metformin 500mg BID, Lisinopril 10mg daily. Allergies: Penicillin. Last meal was a light soup at 18:00.

History of Events

Timeline:
2100 hours: Patient reports feeling increasingly short of breath, used Salbutamol inhaler without relief.
2115 hours: Patient developed a productive cough with frothy sputum, became increasingly agitated.
2120 hours: Patient's breathing became labored, cyanosis noted around lips, mental status deteriorated.
2125 hours: Current time, patient is gasping for air, unable to speak in full sentences. Wife called emergency services.

Prior Events: Patient has had several COPD exacerbations in the past year requiring hospitalization. Last exacerbation was 2 months ago. No recent infections or other medical issues reported. Patient uses oxygen at home occasionally, but it is not currently in use.

Diagnostics

Initial Assessment

Initial Impression: Acute Respiratory Failure secondary to COPD exacerbation
Justification for F1 Classification:
- Severe respiratory distress with signs of hypoxia (cyanosis, altered mental status)
- Rapid onset of symptoms with no improvement from home medication
- High risk of imminent respiratory arrest without immediate intervention

Differential Diagnoses:
1. Acute Exacerbation of COPD (high probability)
2. Pulmonary Embolism (less likely, no history of DVT, but cannot be ruled out)
3. Acute Pulmonary Edema (possible, given the frothy sputum, but less likely with known COPD)
4. Pneumonia (less likely, no fever reported, but possible)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-arrival instructions to caller: assist patient to a comfortable position, do not give anything to eat or drink, ensure clear access for emergency personnel
- Early notification to hospital of potential respiratory failure, preparation for intubation if required

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Acute Respiratory Failure
Key Findings:
- ABG analysis showed severe hypercapnia and hypoxia, consistent with acute respiratory failure
- Chest X-ray revealed hyperinflation of the lungs and no signs of pneumonia or pulmonary edema
- Patient required intubation and mechanical ventilation upon arrival at the hospital

Outcome validated F1 priority assignment. Rapid dispatch and aggressive airway management were crucial for patient survival.

Learning Points:
1. F1 classification was appropriate given the life-threatening nature of the presentation
2. Initial assessment accurately identified the high probability of respiratory failure
3. Prompt intervention at the scene and during transport were essential for patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, he can't breathe! He's gasping for air!

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

Caller It's Hafnargata 15, in Norðfjörður.

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

Caller He has COPD, and he's been getting worse tonight. He's coughing up foam and he's turning blue!

Dispatcher Is he awake and talking to you?

Caller He's awake but very confused, he can barely talk. He's struggling to breathe.

Dispatcher Does he have any other medical conditions?

Caller Yes, he has high blood pressure and diabetes. He takes inhalers and other pills.

Dispatcher Okay, the ambulance is on its way. Please help him sit upright and don't give him anything to eat or drink. Make sure the way is clear for the paramedics.

Caller Okay, I will. Hurry please!