Emergency Scenario 600_f2

Location Information

Full Location:

Hlíðarvegur 17, 600 Akureyri. A single-family home, two stories, wooden construction, built in 1985. Main entrance faces west, accessible via a short walkway. No security features. Street parking available. Current weather: 8°C, overcast, light breeze, good visibility. GPS coordinates: 65.6734° N, 18.0856° W. Nearest landmark: Glerárkirkja church.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Obstetric Emergency

Priority Level: F2

Response Time Goal: Urgent (15-30 minutes)

Description:

28-year-old female, 38 weeks pregnant, experiencing sudden onset of severe abdominal pain and vaginal bleeding. Patient reports decreased fetal movement. Patient is pale and appears distressed. No previous pregnancy complications. History of mild asthma, controlled with inhaler. No known allergies. Last meal was a sandwich at 12:00.

History of Events

Timeline:
14:30 hours: Patient experienced a sudden sharp abdominal pain, followed by vaginal bleeding.
14:35 hours: Patient reports decreased fetal movement.
14:40 hours: Patient called her husband who was at work. Husband called emergency services.
14:45 hours: Current time, patient is lying on her side in the living room, pale and anxious.

Prior Events: Normal pregnancy until today. Regular prenatal checkups with no complications. No prior history of bleeding during this pregnancy. Last checkup was 3 days ago, all normal. Patient reports feeling mild contractions earlier today, but nothing significant until the sudden onset of pain.

Diagnostics

Initial Assessment

Initial Impression: Suspected Placental Abruption
Justification for F2 Classification:
- Significant vaginal bleeding in late pregnancy, associated with severe abdominal pain and decreased fetal movement
- High risk of fetal compromise and maternal complications
- Time-sensitive condition requiring prompt medical evaluation and intervention

Differential Diagnoses:
1. Placental Abruption (high probability)
2. Placenta Previa (less likely due to severe pain)
3. Preterm Labor (less likely given sudden onset of pain and bleeding)
4. Uterine Rupture (less likely, no history of uterine scarring)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Rapid transport to the nearest hospital with obstetric services
- Continuous fetal monitoring if available
- Preparation for potential C-section

Final Diagnosis

Final Diagnosis: Confirmed Placental Abruption with Fetal Distress
Key Findings:
- Ultrasound at the hospital confirmed significant placental abruption
- Fetal heart rate monitoring showed signs of fetal distress (bradycardia)
- Patient's blood pressure dropped during transport, requiring fluid resuscitation
- Emergency C-section was performed

Outcome validated F2 priority assignment. Rapid transport and intervention were critical for maternal and fetal survival.

Learning Points:
1. F2 classification was essential given the high risk nature of the condition
2. Initial assessment accurately identified the high probability of placental abruption
3. Prompt transport and fetal monitoring were critical in this case

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My wife is pregnant and she's bleeding! She's in a lot of pain!

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

Caller It's Hlíðarvegur 17 in Akureyri.

Dispatcher Help is on its way. How far along is your wife in her pregnancy?

Caller She's 38 weeks. She suddenly got a bad pain in her stomach and started bleeding. She says the baby isn't moving much.

Dispatcher Is she awake and talking to you?

Caller Yes, she's awake but she's pale and very scared. She’s breathing fast.

Dispatcher Does she have any medical conditions or allergies?

Caller She has mild asthma, but she uses an inhaler. No allergies. She was fine before this. Please hurry!

Dispatcher The ambulance is on its way. Try to keep her calm and comfortable. Don't give her anything to eat or drink.

Caller Okay, thank you. We'll wait here.