Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 22, 600 Akureyri, ground floor of a two-story wooden building, built in 1955, with a single main entrance facing the street. No elevator. Street parking available. Building has basic fire safety equipment. Current conditions: 8°C, clear skies, good visibility. GPS coordinates: 65.6810° N, 18.0890° 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:

65-year-old male, experiencing severe shortness of breath. Primary symptoms: Labored breathing, wheezing, and chest tightness. Secondary symptoms: Mild confusion, cyanosis around lips. Patient is sitting upright, leaning forward, appears distressed. Medical history: COPD diagnosed 5 years ago, hypertension. Medications: Salbutamol inhaler (as needed), Beclometasone inhaler (2 puffs twice daily), Amlodipine 10mg daily. Known allergy to penicillin. Last meal was a sandwich at 10:00. Patient was watching TV when symptoms started.

History of Events

Timeline:
11:15 hours: Patient reports mild shortness of breath began.
11:20 hours: Symptoms worsened, patient began wheezing.
11:25 hours: Patient used his Salbutamol inhaler, with no improvement.
11:30 hours: Patient experiencing severe shortness of breath, chest tightness, and mild confusion. Patient called his son for help.
11:35 hours: Son arrived, called emergency services.
11:38 hours: Current time, patient still experiencing severe symptoms.

Prior Events: Patient reports frequent exacerbations of COPD, usually controlled with inhalers. No recent illnesses or changes in medications. Last medical check-up 2 months ago, routine follow-up. Patient lives alone, son lives nearby.

Diagnostics

Initial Assessment

Initial Impression: Acute Exacerbation of COPD
Justification for F2 Classification:
- High probability of respiratory compromise based on symptoms and medical history.
- Patient experiencing severe shortness of breath, wheezing, and cyanosis.
- Time-sensitive condition requiring prompt medical intervention and oxygen support.

Differential Diagnoses:
1. Acute Exacerbation of COPD (high probability)
2. Pulmonary Embolism (less likely given chronic history)
3. Pneumonia (less likely given no fever)
4. Acute Heart Failure (less likely given no significant history of heart disease)

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:
- Initial SpO2 was 88% on room air, improved with oxygen.
- Chest auscultation revealed diffuse wheezing and diminished breath sounds.
- ECG showed sinus tachycardia, no signs of acute cardiac event.
- Arterial blood gas showed respiratory acidosis, confirming hypoxemia.

Outcome validated F2 priority assignment. Rapid dispatch and oxygen therapy were crucial. Patient stabilized with oxygen and bronchodilators in the ambulance and was admitted to the hospital for further management.

Learning Points:
1. F2 classification was appropriate due to the need for timely oxygen therapy and respiratory support.
2. Initial assessment accurately identified the high likelihood of COPD exacerbation.
3. Prompt oxygen administration and bronchodilator therapy were essential for patient stabilization.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is having trouble breathing! He's really struggling.

Dispatcher Okay, I'm sending help. What is your address?

Caller It's Hafnarstræti 22 in Akureyri, ground floor.

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

Caller He has COPD, and he's suddenly become very short of breath. He's wheezing and looks very pale.

Dispatcher Has he used his inhaler?

Caller Yes, he used his Salbutamol, but it didn't help. He's getting worse.

Dispatcher Is he awake and talking to you?

Caller Yes, but he's a bit confused. He's leaning forward, trying to catch his breath.

Dispatcher Okay, the ambulance is on its way. Try to keep him calm. I'll stay on the line with you.

Caller Okay, thank you. I'm very worried about him.