Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri. Third floor apartment 3B in a four-story building. Concrete construction, built in 1968, with a single elevator and stairwell access. Main entrance has an intercom system. Street parking available. Weather: 3°C, light snow, moderate visibility. GPS coordinates: 65.6824° N, 18.0912° W. Landmark: Akureyri Art Museum is across the street.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Respiratory Distress

Priority Level: F2

Response Time Goal: Within 20 minutes

Description:

68-year-old male, experiencing severe shortness of breath. Primary symptoms: Rapid, labored breathing, wheezing, unable to speak in full sentences. Secondary symptoms: Cyanosis around lips, increased heart rate, patient is anxious and agitated. Patient is sitting upright on the edge of his bed. History of COPD and heart failure. Medications: Salbutamol inhaler (2 puffs as needed), Furosemide 40mg daily, Ramipril 5mg daily. Known allergy to penicillin. Last meal was a light lunch at 13:00. No recent illnesses.

History of Events

Timeline:
1500 hours: Patient began experiencing increased shortness of breath.
1510 hours: Symptoms worsened rapidly, patient began wheezing and struggling to breathe.
1515 hours: Patient attempted to use his salbutamol inhaler with minimal relief.
1520 hours: Patient called his son for assistance.
1522 hours: Son arrived and called emergency services.
1525 hours: Current time, patient still struggling to breathe, cyanotic around lips.

Prior Events: Patient has a long history of COPD and heart failure, with multiple hospitalizations in the past year. Last COPD exacerbation 2 months ago. Recent check-up 1 week ago, stable at that time. Patient lives alone.

Diagnostics

Initial Assessment

Initial Impression: Acute Exacerbation of COPD with Respiratory Distress
Justification for F2 Classification:
- Severe respiratory distress with signs of hypoxia (cyanosis)
- History of COPD and heart failure, indicating high risk of decompensation
- Patient unable to speak in full sentences, rapid breathing, wheezing
- Time-sensitive condition requiring rapid intervention

Differential Diagnoses:
1. Acute Exacerbation of COPD (most likely)
2. Acute Heart Failure (possible, given history)
3. Pneumonia (less likely, no reported fever or cough)
4. Pulmonary Embolism (less likely, no sudden onset of chest pain)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen administration upon arrival
- Possible need for nebulized bronchodilators and/or steroids
- Preparation for rapid transport to hospital with respiratory services

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Acute Respiratory Failure
Key Findings:
- Arterial blood gas (ABG) analysis revealed severe hypoxemia and hypercapnia.
- Patient's respiratory distress did not improve significantly with initial interventions.
- Chest X-ray showed hyperinflation consistent with COPD and no signs of pneumonia.
- ECG showed sinus tachycardia but no acute ischemic changes.

Outcome validated F2 priority assignment. Rapid response and advanced airway management were crucial. Patient required non-invasive ventilation (NIV) upon arrival at the hospital. Patient was admitted to the ICU for respiratory support.

Learning Points:
1. F2 classification was appropriate due to the severity of respiratory distress.
2. Initial assessment accurately identified the high likelihood of a COPD exacerbation.
3. Early oxygen administration and advanced airway management were critical for patient outcome.

Emergency Call Transcript

Dispatcher Emergency services, what is 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 18, apartment 3B, third floor in Akureyri.

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

Caller He started getting short of breath about half an hour ago. It's getting worse, he's wheezing really badly.

Dispatcher Is he awake and talking to you?

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

Dispatcher Does he have any medical conditions?

Caller He has COPD and heart failure. He uses an inhaler.

Dispatcher Has he used his inhaler?

Caller Yes, but it's not helping.

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

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