Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri. Ground floor apartment in a two-story wooden building built in 1955. Main entrance faces the street, no security features. Parking available on street. Current conditions: 8°C, overcast, light wind. GPS coordinates: 65.6813° N, 18.0934° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Respiratory Distress

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

65-year-old male, experiencing severe shortness of breath. Primary symptoms: Labored breathing, wheezing, unable to speak in full sentences, cyanosis around lips. Secondary symptoms: Agitation, diaphoresis, chest tightness. Patient is sitting upright, clutching chest. Medical history: COPD diagnosed 5 years ago, history of smoking. Medications: Salbutamol inhaler (2 puffs as needed), Tiotropium inhaler (1 puff daily), Prednisolone 5mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1430 hours: Patient reports feeling slightly short of breath, used his salbutamol inhaler
1445 hours: Symptoms worsened rapidly, severe shortness of breath, wheezing
1450 hours: Patient called his son for help
1452 hours: Son arrived, called emergency services
1455 hours: Current time, patient is struggling to breathe, cyanotic

Prior Events: Patient has had several COPD exacerbations in the past, usually managed at home with increased inhaler use. No recent hospitalizations. Last medical check-up 6 months ago, routine follow-up. Patient lives alone, but son lives nearby.

Diagnostics

Initial Assessment

Initial Impression: Severe COPD Exacerbation
Justification for F2 Classification:
- Significant respiratory distress, cyanosis, inability to speak in full sentences
- Potential for rapid deterioration and respiratory failure
- Time-sensitive condition requiring prompt medical intervention

Differential Diagnoses:
1. COPD Exacerbation (high probability)
2. Acute Pulmonary Embolism (less likely, no sudden onset of chest pain)
3. Pneumothorax (less likely, no reported chest trauma)
4. Acute Heart Failure (less likely, no history of heart failure)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen administration and monitoring
- Bronchodilator therapy initiation
- Preparation for potential intubation and mechanical ventilation
- Transport to nearest hospital with respiratory support

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Respiratory Failure
Key Findings:
- Arterial blood gas analysis showed severe hypoxemia and hypercapnia
- Chest X-ray showed hyperinflation consistent with COPD
- Patient's condition deteriorated requiring intubation and mechanical ventilation

Outcome validated F2 priority assignment. Rapid dispatch and aggressive respiratory support were crucial. Patient required ICU admission for several days.

Learning Points:
1. F2 classification appropriate due to the need for timely respiratory support
2. Initial assessment accurately identified the high likelihood of a severe COPD exacerbation
3. Prompt oxygen administration and bronchodilator therapy were essential

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father can't breathe! He's really struggling.

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

Caller It's Hafnarstræti 18 in Akureyri, ground floor.

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

Caller He has COPD, and he's suddenly gotten much worse. He's wheezing really badly.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he can barely speak. He's turning blue around his lips.

Dispatcher Does he have any medications he takes regularly?

Caller Yes, he has inhalers, and takes steroids daily.

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

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