Hafnarstræti 18, 600 Akureyri, first floor of a three-story commercial building. The building is of concrete construction, built in 1965. Main entrance is on the street level with double glass doors, no security features. No elevator, only a central staircase. Street parking available. Current conditions: 7°C, overcast, light wind. GPS coordinates: 65.6828° N, 18.0915° W. Nearest landmark: Akureyri Art Museum.
68-year-old male, sudden onset of severe shortness of breath. Primary symptoms: Labored breathing, rapid respiratory rate, audible wheezing. Secondary symptoms: Chest tightness, mild cyanosis around lips. Patient is conscious but anxious. Patient is sitting upright in his office. Medical history: Chronic obstructive pulmonary disease (COPD) diagnosed 5 years ago, hypertension, type 2 diabetes. Medications: Salbutamol inhaler (as needed), Fluticasone/Salmeterol inhaler (twice daily), Metformin 1000mg daily, Lisinopril 10mg daily. Allergies: Penicillin. Last meal was a light lunch at 13:00.
Timeline: 1415 hours: Patient was working at his desk, began to feel mild shortness of breath 1420 hours: Symptoms rapidly worsened, developed severe shortness of breath and chest tightness 1422 hours: Patient used his salbutamol inhaler with no relief 1425 hours: Patient called his son, who called emergency services 1427 hours: Current time, patient is still experiencing severe respiratory distress Prior Events: Patient reports a recent upper respiratory infection 2 weeks ago, treated with over-the-counter medication. No recent hospitalizations. Last medical check-up 6 months ago, routine follow-up for COPD. Smokes 10 cigarettes daily for the past 40 years.
Initial Impression: Acute Exacerbation of COPD Justification for F2 Classification: - Severe respiratory distress with rapid onset - Patient has a history of COPD, making this an urgent situation - Potential for rapid deterioration and need for respiratory support Differential Diagnoses: 1. Acute Exacerbation of COPD (most likely) 2. Pulmonary Embolism (less likely given presentation) 3. Acute Heart Failure (less likely given history and symptoms) 4. Pneumothorax (less likely given no reported chest pain) Required Actions: - Dispatch of ground EMS with ALS capabilities - Oxygen therapy initiation - Bronchodilator administration - Preparation for transport to nearest hospital with respiratory services