Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 23, 600 Akureyri, ground floor of a two-story wooden building, built in 1950. Main entrance is street-level, no steps. No elevator. One main entrance/exit, plus a back door to the parking lot. No security features. Weather: 8°C, overcast, light breeze. GPS coordinates: 65.6829° N, 18.0889° W. Landmark: Near the 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: Rapid, shallow breathing, use of accessory muscles, audible wheezing, cyanosis around lips. Secondary symptoms: Agitation, confusion, chest tightness. Patient is sitting upright on a chair. Medical history: COPD diagnosed 5 years ago, hypertension, previous myocardial infarction. Medications: Salbutamol inhaler (2 puffs as needed), Fluticasone/Salmeterol inhaler (1 puff twice daily), Ramipril 5mg daily, Aspirin 75mg daily. Allergies: None known. Last meal was a small lunch at 13:00.

History of Events

Timeline:
1400 hours: Patient started feeling unwell, with mild shortness of breath.
1415 hours: Shortness of breath worsened rapidly, accompanied by wheezing.
1420 hours: Patient became agitated and confused, cyanosis noted.
1425 hours: Caller (patient's son) called emergency services.
1427 hours: Current time, patient still experiencing severe respiratory distress.

Prior Events: Patient has had several COPD exacerbations in the past year, requiring hospitalization. No recent changes in medications. Patient has been compliant with his inhaler use. No recent respiratory infections reported. Last medical check-up was 2 months ago, routine follow-up.

Diagnostics

Initial Assessment

Initial Impression: Severe COPD Exacerbation with Respiratory Distress
Justification for F2 Classification:
- Patient experiencing severe respiratory distress with cyanosis, indicating potential respiratory failure.
- Agitation and confusion suggest hypoxemia.
- Time-sensitive condition requiring immediate medical intervention and oxygen therapy.

Differential Diagnoses:
1. COPD Exacerbation (high probability)
2. Acute Pulmonary Embolism (less likely, no history of DVT)
3. Pneumonia (possible, needs further assessment)
4. Acute Heart Failure (less likely, no significant edema or JVD reported)

Required Actions:
- Dispatch of ground EMS with ALS capabilities.
- Immediate oxygen therapy if available.
- Continuous monitoring of vital signs.
- Preparation for intubation if necessary.
- Rapid transport to nearest hospital with respiratory support capabilities.

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Hypoxemic Respiratory Failure
Key Findings:
- Arterial blood gas analysis showed severe hypoxemia and hypercapnia.
- Chest X-ray revealed hyperinflation consistent with COPD, no evidence of pneumonia or pulmonary embolism.
- Patient's respiratory distress did not improve with initial oxygen therapy.
- Patient required non-invasive ventilation (NIV) upon arrival at the hospital.

Outcome validated F2 priority assignment. Rapid dispatch and intervention were crucial. Patient required several days of hospitalization for respiratory support.

Learning Points:
1. F2 classification appropriate due to the severity of respiratory distress and risk of respiratory failure.
2. Early recognition of hypoxemia and need for advanced respiratory support is critical.
3. Dispatch should ensure that EMS is equipped with appropriate respiratory equipment, including oxygen and NIV.

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, in Akureyri. It's on the ground floor.

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

Caller He has COPD, and he's been getting worse quickly. He's wheezing and his lips are turning blue. He seems confused.

Dispatcher Is he awake and talking to you?

Caller Yes, but he's very agitated. He's struggling to breathe. He's sitting up in a chair.

Dispatcher Does he have any other medical conditions?

Caller He has high blood pressure and had a heart attack a few years ago. He takes inhalers and some pills.

Dispatcher Okay, the ambulance is on its way. Try to keep him calm. Do you have any oxygen at home?

Caller No, we don't have oxygen here. Please hurry!

Dispatcher Okay, we are on our way. Stay with him and keep him as comfortable as possible.