Hafnarstræti 18, 600 Akureyri, ground floor of a two-story wooden building, built in 1950, main entrance facing the street, no security features. Street parking available. Current conditions: 8°C, overcast, moderate visibility. GPS coordinates: 65.6817° N, 18.0896° W. Nearest landmark: Akureyri Art Museum.
78-year-old male, experiencing severe shortness of breath. Primary symptoms: Difficulty breathing, rapid and shallow respirations, audible wheezing, using accessory muscles to breathe, cyanosis around lips. Patient is conscious but appears anxious and distressed. Secondary symptoms: Chest tightness, productive cough with clear sputum, mild confusion. Patient sitting upright in a chair. 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. Known allergies: Penicillin. Last meal was a light lunch at 13:00.
Timeline: 1400 hours: Patient started feeling slightly short of breath. 1415 hours: Shortness of breath worsened, patient began using salbutamol inhaler, no improvement. 1430 hours: Symptoms progressed to severe dyspnea, audible wheezing, and chest tightness. 1435 hours: Patient called his son for help. 1440 hours: Son arrived and called emergency services. 1442 hours: Current time, patient is still struggling to breathe, cyanosis observed. Prior Events: Patient has had several COPD exacerbations in the past, requiring hospitalization. Last exacerbation was 3 months ago. Recent upper respiratory infection 2 weeks ago, resolved with rest. No recent changes in medication.
Initial Impression: Acute Exacerbation of COPD Justification for F2 Classification: - Severe respiratory distress with signs of hypoxia (cyanosis) - Rapid onset of symptoms and failure to respond to usual treatment - Potential for rapid deterioration without intervention - Time-sensitive condition requiring prompt medical evaluation and respiratory support Differential Diagnoses: 1. COPD Exacerbation (high probability) 2. Acute Pulmonary Embolism (less likely given history and gradual onset) 3. Pneumonia (possible, but less likely given lack of fever and acute onset of dyspnea) 4. Acute Heart Failure (less likely given lack of leg edema and clear lung sounds) Required Actions: - Dispatch of ground EMS with ALS capabilities - Oxygen therapy initiation - Bronchodilator administration - Preparation for transport to nearest hospital with respiratory support