Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, third floor apartment 3B. A five-story concrete building, constructed in 1992. Main entrance has a key code and an intercom system. There is one elevator and a central staircase. Street parking available. The building is equipped with a fire alarm system. Current conditions: 7°C, overcast, light winds, good visibility. GPS coordinates: 65.6823° N, 18.0897° 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: Severe dyspnea, wheezing, use of accessory muscles for breathing, cyanosis around lips. Patient reports feeling like he's 'suffocating'. Secondary symptoms: Agitation, mild chest tightness, productive cough with small amount of white sputum. Patient is conscious but anxious. Medical history: COPD diagnosed 5 years ago, hypertension, Type 2 diabetes. Medications: Salbutamol inhaler (as needed), Tiotropium inhaler (daily), Metformin 500mg twice daily, Lisinopril 10mg daily. Allergies: Penicillin. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1415 hours: Patient began experiencing increased shortness of breath.
1420 hours: Patient used his salbutamol inhaler, with minimal relief.
1425 hours: Patient's breathing worsened, started wheezing and coughing.
1430 hours: Patient called his son for help, son called emergency services.
1432 hours: Current time, patient is sitting upright, struggling to breathe. 

Prior Events: Patient has had several COPD exacerbations in the past year, requiring hospitalizations. Last check-up 2 months ago, routine follow-up. Patient lives alone, but his son lives nearby. He has had a mild cold for the past 3 days.

Diagnostics

Initial Assessment

Initial Impression: Acute Exacerbation of COPD with Respiratory Distress
Justification for F2 Classification:
- High probability of significant respiratory compromise based on symptoms and history.
- Patient is using accessory muscles, cyanotic, and reporting severe dyspnea.
- Time-sensitive condition requiring prompt medical evaluation and respiratory support.

Differential Diagnoses:
1. Acute Exacerbation of COPD (high probability)
2. Pulmonary Embolism (less likely given presentation but should be considered)
3. Acute Heart Failure (less likely, no reported chest pain)
4. Pneumonia (possible, needs further assessment)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen therapy administration
- Continuous monitoring of vital signs and respiratory status
- Preparation for transport to nearest hospital with respiratory services

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Hypoxemia
Key Findings:
- Arterial blood gas analysis revealed significant hypoxemia and hypercapnia.
- Chest X-ray showed signs of hyperinflation and mild peribronchial thickening, consistent with COPD.
- Patient responded positively to nebulized bronchodilators and oxygen therapy.

Outcome validated F2 priority assignment. Rapid dispatch and respiratory support were essential. Patient was admitted to the hospital for ongoing management of his COPD exacerbation.

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

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, apartment 3B, third floor in Akureyri.

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

Caller He has COPD, and he suddenly got very short of breath. He's wheezing badly.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake, but he's struggling to breathe. He looks very pale.

Dispatcher Does he have any other medical conditions or allergies?

Caller He has high blood pressure, diabetes, and he's allergic to penicillin. He uses inhalers.

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

Caller Okay, thank you. I'll stay with him.