Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 23, 600 Akureyri, Ground floor of a two-story wooden building, built in 1955, with a single main entrance. Parking available on the street. No security features other than a standard lock. Current conditions: 7°C, overcast, light wind. GPS coordinates: 65.6811° N, 18.0897° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Respiratory Distress

Priority Level: F2

Response Time Goal: Within 15 minutes

Description:

68-year-old male, experiencing severe shortness of breath. Primary symptoms: severe dyspnea, productive cough with yellowish sputum, chest tightness. Secondary symptoms: Mild cyanosis around lips, patient is anxious and agitated. Patient is sitting upright in a chair, visibly struggling to breathe. Medical history: COPD diagnosed 5 years ago, history of smoking, hypertension. Medications: Salbutamol inhaler (as needed), Fluticasone/Salmeterol inhaler (twice daily), Amlodipine 10mg daily. Known allergy to penicillin. Last meal was a light lunch at 12:00.

History of Events

Timeline:
1300 hours: Patient reports feeling slightly unwell with a mild cough
1330 hours: Cough worsened, began producing yellowish sputum
1400 hours: Shortness of breath began, progressively worsening
1415 hours: Patient used salbutamol inhaler with minimal relief
1420 hours: Patient called his son for help
1425 hours: Son arrived and called emergency services
1427 hours: Current time, patient struggling to breathe, sitting upright.

Prior Events: Patient had a COPD exacerbation 6 months ago requiring hospitalization. He reports not adhering to his medication regimen consistently. No recent travel or known exposure to infectious agents. Last medical check-up was 4 months ago.

Diagnostics

Initial Assessment

Initial Impression: Acute Exacerbation of COPD
Justification for F2 Classification:
- Moderate respiratory distress with signs of hypoxia (cyanosis)
- Patient has known COPD with acute worsening of symptoms
- Time-sensitive condition requiring prompt intervention to prevent respiratory failure

Differential Diagnoses:
1. Acute Exacerbation of COPD (most likely)
2. Pneumonia (possible, given productive cough)
3. Pulmonary Embolism (less likely, no sudden onset of symptoms)
4. Acute Heart Failure (less likely, no significant history of heart disease)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen therapy initiation
- Bronchodilator administration
- Continuous monitoring of vital signs
- Preparation for transport to hospital with respiratory support

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Secondary Pneumonia
Key Findings:
- Chest X-ray revealed infiltrates consistent with pneumonia in the right lower lobe
- Patient's oxygen saturation remained low despite supplemental oxygen
- Sputum culture confirmed bacterial pneumonia
- Patient required non-invasive ventilation initially and antibiotic therapy

Outcome validated F2 priority assignment. Early intervention with oxygen and bronchodilators were crucial, but the underlying pneumonia required additional treatment. Patient was hospitalized for 5 days.

Learning Points:
1. Initial assessment correctly identified COPD exacerbation, but pneumonia was a complicating factor.
2. Importance of thorough assessment to identify potential underlying infections
3. Prompt oxygen therapy and bronchodilator administration improved patient's condition, but further interventions were necessary.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is having trouble breathing! He can't catch his breath.

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

Caller It's Hafnarstræti 23, ground floor in Akureyri.

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

Caller He has COPD, and he started coughing a lot, and now he can't breathe. He's coughing up yellow stuff.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he looks really bad. His lips are a bit blue.

Dispatcher Does he have any other medical conditions or allergies?

Caller He has high blood pressure and is allergic to penicillin. He has inhalers, but they aren't helping.

Dispatcher Okay, the ambulance is on its way. Keep him sitting upright if possible. Try to keep him calm.

Caller Okay, thank you. I will stay with him.