Emergency Scenario 600_f2_363

Location Information

Hafnarstræti 18, 600 Akureyri, ground floor of a two-story wooden building, built in 1935. Main entrance is street-level, no steps. No elevator. Building has basic fire safety equipment. Weather conditions: 8°C, overcast, light wind. GPS coordinates: 65.6817° N, 18.0910° W. Nearest landmark: Akureyri Art Museum.

Emergency Details

68-year-old male, experiencing severe shortness of breath. Primary symptoms: Labored breathing, wheezing, chest tightness. Secondary symptoms: Agitation, cyanosis around lips. Patient is conscious but struggling to speak. Medical history: COPD diagnosed 5 years ago, history of smoking, mild hypertension. Medications: Salbutamol inhaler (as needed), Beclomethasone inhaler (daily), Lisinopril 10mg daily. Allergies: None known. Last meal was soup at 12:00.

History of Events

Timeline:
1400 hours: Patient started experiencing shortness of breath, initially mild
1415 hours: Shortness of breath worsened, wheezing started
1420 hours: Patient used his salbutamol inhaler, with minimal relief
1425 hours: Symptoms continue to worsen, patient feels chest tightness, became agitated
1430 hours: Patient's son called emergency services
1432 hours: Current time, patient struggling to breathe, lips turning blue

Prior Events: Patient has had several COPD exacerbations in the past year, requiring hospitalizations. Last medical check-up 2 months ago. Patient reports he has been feeling unwell for the past 3 days with a mild cough.

Diagnostics

Initial Assessment

Initial Impression: Severe COPD Exacerbation
Justification for F2 Classification:
- Respiratory distress with signs of hypoxia (cyanosis)
- Patient's history of COPD and lack of response to inhaler
- Time-sensitive condition requiring immediate medical intervention

Differential Diagnoses:
1. COPD Exacerbation (high probability)
2. Pneumonia (possible given recent cough)
3. Pulmonary Embolism (less likely given gradual onset)
4. Acute Heart Failure (less likely given patient's history)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen administration and airway management
- Bronchodilator administration
- Preparation for transport to nearest hospital with respiratory care

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Bronchospasm
Key Findings:
- Arterial blood gas showed severe hypoxia and hypercapnia
- Chest X-ray revealed hyperinflation consistent with COPD, no consolidation
- Patient responded to nebulized bronchodilators and supplemental oxygen

Outcome validated F2 priority assignment. Rapid dispatch and intervention were critical to stabilize the patient. Patient required hospitalization for respiratory support and further management.

Learning Points:
1. F2 classification was appropriate given the severity of respiratory distress
2. Initial assessment accurately identified the most likely diagnosis
3. Prompt oxygen therapy and bronchodilator administration were crucial

Emergency Call Transcript