Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, ground floor of a two-story wooden building. Main entrance is at street level. No elevator. Building is approximately 70 years old. Street parking available. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6833° N, 18.0878° W. Nearest landmark: Akureyri Art Museum.

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 and labored breathing, audible wheezing, chest tightness, cyanosis around the lips. Patient is conscious but agitated and struggling to speak. Secondary symptoms: Increased heart rate, diaphoresis. Patient is sitting upright in a chair. Medical history: Chronic obstructive pulmonary disease (COPD), hypertension. Medications: Salbutamol inhaler (as needed), Tiotropium inhaler daily, Lisinopril 10mg daily. Allergies: None known. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1400 hours: Patient began experiencing mild shortness of breath.
1415 hours: Shortness of breath worsened, patient used salbutamol inhaler with minimal relief.
1425 hours: Patient’s condition continued to deteriorate, developed chest tightness and wheezing.
1430 hours: Caller (patient’s son) arrived, found patient in severe respiratory distress, called emergency services.
1432 hours: Current time, patient still struggling to breathe, cyanotic around the lips.

Prior Events: Patient has had several COPD exacerbations in the past year, requiring hospitalization. Patient has been compliant with medication regimen. No recent infections or other significant changes in health. Last medical check-up 2 months ago, routine follow-up.

Diagnostics

Initial Assessment

Initial Impression: Severe COPD Exacerbation with Respiratory Distress
Justification for F2 Classification:
- High probability of respiratory failure based on symptoms and history
- Patient exhibiting severe shortness of breath, wheezing, cyanosis
- Time-sensitive condition requiring prompt medical intervention and oxygen therapy

Differential Diagnoses:
1. COPD Exacerbation (high probability)
2. Acute Pulmonary Embolism (less likely given history, but needs consideration)
3. Acute Heart Failure (less likely, no reported chest pain)
4. Pneumonia (less likely given the rapid onset, but needs to be considered)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen therapy initiation
- Bronchodilator administration
- Preparation for transport to nearest hospital with respiratory services

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Hypoxemia
Key Findings:
- Pulse oximetry reading of 88% on room air
- Arterial blood gas analysis confirmed hypoxemia and hypercapnia
- Chest X-ray showed hyperinflation consistent with COPD, no signs of pneumonia or pulmonary embolism
- Patient responded positively to oxygen therapy and nebulized bronchodilators

Outcome validated F2 priority assignment. Rapid dispatch and initiation of respiratory support were crucial. Patient was admitted to the hospital for further treatment and monitoring.

Learning Points:
1. F2 classification was appropriate due to the severity of respiratory distress and the need for rapid intervention.
2. Initial assessment accurately identified the high likelihood of a COPD exacerbation.
3. Prompt oxygen administration and bronchodilator treatment contributed to the patient's improvement.

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 18, ground floor in Akureyri.

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

Caller He has COPD, and he's been getting worse all afternoon. He's wheezing really badly and his lips are turning blue.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but struggling to speak. He's really scared. He's sitting up in a chair.

Dispatcher Has he used his inhaler?

Caller Yes, he used his blue one, but it didn't help much.

Dispatcher Okay, the ambulance is on its way. Try to keep him calm and sitting upright. Don't give him anything to eat or drink.

Caller Okay, thank you. I will stay with him and try to keep him calm.