Emergency Scenario 900_f1

Location Information

Full Location:

Heimagata 7, 900 Vestmannaeyjar, single-story detached house. Built in 1965, concrete foundation with wooden frame. Main entrance on the south side, small porch with two steps. One secondary exit to the backyard. No security features. Street parking available. Current conditions: 8°C, cloudy, light breeze, good visibility. GPS coordinates: 63.4401° N, 20.2742° W. Nearest landmark: Vestmannaeyjar Golf Club.

Municipality: Vestmannaeyjar

Postal Code: 900

Emergency Details

Type: Sepsis

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

74-year-old male, suspected sepsis. Primary symptoms: High fever (39.5°C), altered mental status (confused, disoriented), rapid breathing (28 breaths/min), rapid heart rate (115 bpm). Secondary symptoms: Shivering, weakness, reduced urine output. Patient is pale and appears unwell. Patient is in bed at home. Medical history: Type 2 diabetes, chronic kidney disease, recent UTI treated with antibiotics (completed 3 days ago). Medications: Metformin 1000mg twice daily, Insulin 10 units at night, Lisinopril 10mg daily, Paracetamol 500mg as needed. Allergies: Penicillin. Last meal was a small soup at 18:00 yesterday.

History of Events

Timeline:
Yesterday 18:00: Patient had a light soup, felt okay.
Yesterday 22:00: Patient started feeling feverish and shivery.
Today 02:00: Patient woke up with high fever, confusion, and rapid breathing.
Today 07:00: Patient’s condition worsened, weakness and reduced urine output.
Today 08:15: Caller found patient in this state and called emergency services.

Prior Events: Patient had a UTI last week, treated with antibiotics. Completed the course three days ago. Patient has been generally stable, though with known kidney issues. Last medical check-up was one month ago for routine diabetes and kidney function check.

Diagnostics

Initial Assessment

Initial Impression: Suspected Sepsis secondary to recent UTI
Justification for F1 Classification:
- Multiple signs of systemic inflammatory response syndrome (SIRS) including fever, tachycardia, tachypnea, and altered mental status.
- High risk for rapid deterioration due to underlying conditions (diabetes, CKD).
- Time-critical condition requiring immediate intervention and advanced life support.

Differential Diagnoses:
1. Sepsis (high probability)
2. Severe infection (UTI recurrence, pneumonia) (high probability)
3. Diabetic Ketoacidosis (DKA) (less likely, no history of DKA)
4. Acute Kidney Injury (AKI) (possible contributing factor)

Required Actions:
- Immediate dispatch of ALS ambulance
- Pre-alert hospital of potential sepsis case
- Initiate sepsis protocol: oxygen, IV access, fluid bolus if indicated
- Rapid transport to nearest hospital with ICU capabilities

Final Diagnosis

Final Diagnosis: Severe Sepsis secondary to recurrent UTI, complicated by acute kidney injury.
Key Findings:
- Blood cultures positive for E. coli, confirming UTI source
- Lactate level elevated, indicating tissue hypoperfusion
- Acute kidney injury confirmed by elevated creatinine levels
- Patient required vasopressors to maintain blood pressure

Outcome validated F1 priority assignment. Rapid intervention was crucial for survival. Patient required ICU admission and aggressive treatment. The patient had a positive outcome after several days of intensive care.

Learning Points:
1. F1 classification appropriate due to the high risk of rapid deterioration in sepsis cases
2. Initial assessment accurately identified the high likelihood of sepsis
3. Timely pre-hospital initiation of sepsis protocols is critical for patient outcome

Emergency Call Transcript

Dispatcher Emergency services, what is your emergency?

Caller My father is very sick! He's burning up with fever and is confused, I think.

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

Caller It's Heimagata 7 in Vestmannaeyjar.

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

Caller He was fine yesterday, but he got a fever last night and now he's very confused and breathing fast. He's very weak.

Dispatcher Is he awake and talking to you?

Caller Yes, but he doesn't make much sense. He's very out of it. He's also shaking a lot.

Dispatcher Does he have any medical conditions?

Caller Yes, he has diabetes and kidney problems. He also had a urine infection last week.

Dispatcher Okay, the ambulance is on its way. Do not give him anything to eat or drink. Stay with him and keep him calm.

Caller Okay, thank you. I will wait here with him, I am so scared!