Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 23, 600 Akureyri, third floor, apartment 3B. A five-story reinforced concrete building built in 1985. Main entrance has a coded lock, code is 1985. Elevator and stairwell access. Street parking available. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 65.6822° N, 18.0912° 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:

68-year-old male, experiencing severe shortness of breath. Primary symptoms: Rapid, labored breathing, use of accessory muscles, wheezing. Secondary symptoms: Chest tightness, anxiety, cyanosis around lips. Patient is conscious but distressed. Patient sitting upright on the sofa. Medical history: COPD diagnosed 5 years ago, hypertension, previous myocardial infarction 2 years ago. Medications: Salbutamol inhaler as needed, Beclomethasone inhaler twice daily, Metoprolol 50mg daily, Aspirin 75mg daily. Known allergy to penicillin. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1400 hours: Patient started feeling increasingly short of breath.
1415 hours: Symptoms worsened, patient began wheezing and felt chest tightness.
1420 hours: Patient used his salbutamol inhaler with minimal relief.
1425 hours: Patient called his son for help, who is now calling emergency services.
1430 hours: Current time, patient is struggling to breathe, appears cyanotic.

Prior Events: Patient reports a recent upper respiratory infection 3 days ago. He has been experiencing increased shortness of breath over the past week. Last medical check-up was 6 months ago for routine follow-up. Patient lives alone, son lives nearby.

Diagnostics

Initial Assessment

Initial Impression: Acute Exacerbation of COPD with Respiratory Distress
Justification for F2 Classification:
- Significant respiratory distress with rapid onset and use of accessory muscles
- Potential for rapid deterioration due to underlying COPD and cardiac history
- Time-sensitive condition requiring prompt medical intervention and potential airway management

Differential Diagnoses:
1. Acute Exacerbation of COPD (high probability)
2. Acute Pulmonary Embolism (consider due to cardiac history)
3. Acute Myocardial Infarction (consider due to chest tightness)
4. Pneumonia (less likely given rapid onset)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Supplemental oxygen administration
- Bronchodilator therapy (nebulized salbutamol)
- Continuous monitoring of vital signs and respiratory status
- Preparation for transport to nearest hospital with respiratory support

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Hypoxemia
Key Findings:
- Arterial blood gas analysis confirmed severe hypoxemia (low oxygen levels)
- Chest X-ray showed signs of hyperinflation consistent with COPD
- ECG did not show acute ischemic changes
- Patient responded well to oxygen therapy and bronchodilators

Outcome validated F2 priority assignment. Prompt oxygen and bronchodilator treatment were essential. Patient was admitted for observation and further management of COPD.

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

Emergency Call Transcript

Dispatcher Emergency services, what is 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 23, apartment 3B, third floor in Akureyri.

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

Caller He has COPD and he's really struggling to breathe. He's wheezing and his chest is tight.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he's very distressed. His lips look a bit blue.

Dispatcher Does he have any other medical conditions?

Caller Yes, he has high blood pressure and he had a heart attack a couple of years ago. He is also allergic to penicillin.

Dispatcher Okay, the ambulance is on its way. Does he have any oxygen at home?

Caller No, he only has his inhalers. I'll wait here with him.

Dispatcher Okay, stay with him and try to keep him calm. The ambulance will be there soon.