Hafnarstræti 18, 600 Akureyri, third floor apartment 3B. A three-story brick building constructed in 1955. The main entrance is accessible via a code-protected door (code is 1955). There is a single narrow staircase, no elevator. Street parking is available. Building has basic fire safety equipment. Current conditions: 8°C, overcast, moderate wind. GPS coordinates: 65.6821° N, 18.0914° W. Nearest landmark: Akureyri Art Museum.
70-year-old male, experiencing severe shortness of breath. Primary symptoms: Difficulty breathing, wheezing, and chest tightness. Patient is sitting upright, leaning forward. Secondary symptoms: Mild cyanosis around the lips, increased heart rate. Patient is alert but anxious. Medical history: Chronic Obstructive Pulmonary Disease (COPD), diagnosed 5 years ago, hypertension. Medications: Salbutamol inhaler (as needed), Tiotropium inhaler daily, Lisinopril 10mg daily, Atorvastatin 20mg daily. Allergies: Penicillin. Last meal: Light lunch at 13:00. Patient reports that he had a mild cold last week.
Timeline: 1400 hours: Patient started feeling slightly short of breath. 1415 hours: Symptoms worsened rapidly, with increased wheezing and chest tightness. 1420 hours: Patient used his salbutamol inhaler with minimal relief. 1425 hours: Patient called his son for help. 1430 hours: Son arrived, found patient in severe respiratory distress, called emergency services. 1432 hours: Current time, patient is still struggling to breathe, sitting up, leaning forward. 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 was 6 months ago, routine follow-up. Patient lives alone, son lives nearby.
Initial Impression: Acute COPD Exacerbation Justification for F2 Classification: - Significant respiratory distress with objective findings (wheezing, cyanosis) - Patient has a known history of COPD, making exacerbation likely - Time-sensitive condition requiring prompt medical intervention to prevent further deterioration Differential Diagnoses: 1. Acute COPD Exacerbation (high probability) 2. Pneumonia (less likely without fever or productive cough) 3. Pulmonary Embolism (less likely without sudden onset chest pain and risk factors) 4. Acute Heart Failure (less likely given patient's known COPD and primary respiratory symptoms) Required Actions: - Dispatch of ground EMS with ALS capabilities - Administration of oxygen therapy - Bronchodilator administration - Preparation for transport to nearest hospital with respiratory services