Hafnarstræti 18, 600 Akureyri, first floor of a two-story commercial building. The building is of older construction, made of concrete and wood, with a single main entrance facing the street. There is a small parking lot in front of the building. The building is not equipped with an elevator. The main entrance is accessible via a short flight of three steps. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6825° N, 18.0912° W. Nearest landmark: Akureyri Art Museum.
65-year-old male, experiencing severe shortness of breath. Primary symptoms: Significant difficulty breathing, wheezing, chest tightness, and productive cough with greenish sputum. Patient is conscious but anxious, using accessory muscles to breathe. Secondary symptoms: Mild cyanosis around lips, reported feeling of impending doom. Patient is seated in a chair in his office. Medical history: Chronic Obstructive Pulmonary Disease (COPD), diagnosed 5 years ago, hypertension, and type 2 diabetes. Medications: Salmeterol/Fluticasone inhaler (25/250 mcg, 2 puffs twice daily), Metformin 500mg twice daily, Amlodipine 5mg daily, Albuterol inhaler (as needed). Allergies: Reported allergy to penicillin. Last meal was a light lunch at 12:30.
Timeline: 13:00 hours: Patient started experiencing mild shortness of breath 13:15 hours: Symptoms worsened, developed chest tightness and wheezing 13:20 hours: Patient used his albuterol inhaler, with minimal relief 13:25 hours: Patient's breathing became significantly more labored, developed productive cough 13:30 hours: Patient called emergency services 13:32 hours: Current time, patient is in severe respiratory distress Prior Events: Patient reports a recent upper respiratory infection 3 days ago, which he thought was improving. He has had several similar exacerbations of his COPD in the past year, requiring hospitalization. Last medical check-up was 2 months ago, routine follow-up. Patient works as an accountant, and lives alone.
Initial Impression: Acute Exacerbation of COPD with Possible Lower Respiratory Infection Justification for F2 Classification: - Significant respiratory distress, with labored breathing, wheezing, and cyanosis - Patient has a history of COPD and recent upper respiratory infection - Potential for rapid deterioration requiring immediate intervention - Time-sensitive condition requiring prompt medical evaluation and treatment Differential Diagnoses: 1. Acute Exacerbation of COPD (high probability) 2. Pneumonia (possible, given productive cough) 3. Pulmonary Embolism (less likely, no sudden onset of symptoms) 4. Acute Heart Failure (less likely, no history of heart failure) 5. Allergic Reaction (less likely, no known recent exposure to allergens) Required Actions: - Dispatch of ground EMS with ALS capabilities - Oxygen administration and monitoring - Bronchodilator administration - Preparation for transport to nearest hospital with respiratory services