Initial Impression: Acute Asthma Exacerbation
Justification for F2 Classification:
- Patient experiencing severe respiratory distress, not responding to initial treatment.
- Presence of accessory muscle use and cyanosis indicates significant airway obstruction.
- Time-sensitive condition requiring prompt medical intervention to prevent respiratory failure.
Differential Diagnoses:
1. Acute Asthma Exacerbation (most likely)
2. Anaphylaxis (less likely, no known allergens triggered)
3. Acute Bronchitis (less likely, no fever or recent illness)
4. Pneumothorax (less likely, no reported chest trauma)
Required Actions:
- Dispatch of ground EMS with ALS capabilities.
- Oxygen administration.
- Bronchodilator therapy (nebulized if possible).
- Corticosteroid administration.
- Preparation for transport to nearest hospital with respiratory support capabilities.
Final Diagnosis: Severe Acute Asthma Exacerbation
Key Findings:
- Pulse oximetry showed an oxygen saturation of 88% on room air, improved to 94% with supplemental oxygen.
- Auscultation revealed diffuse wheezing and decreased breath sounds bilaterally.
- Patient's peak expiratory flow rate (PEFR) was significantly reduced.
- Arterial blood gas (ABG) analysis showed respiratory acidosis.
Outcome validated F2 priority assignment. Rapid dispatch, oxygen administration, and bronchodilator therapy were crucial. Patient required intensive care unit admission for ongoing respiratory support. Patient responded well to treatment and was discharged after 48 hours.
Learning Points:
1. F2 classification appropriate due to the need for timely intervention and potential for rapid deterioration.
2. Initial assessment accurately identified the severe nature of the asthma exacerbation.
3. Patient's poor adherence to maintenance medication was a significant contributing factor.