Emergency Scenario 600_f2

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, ground floor of a two-story wooden building, built in 1930. Main entrance faces the street, no stairs at the entrance. One additional entrance on the side with a small step. Street parking available. Building has a simple alarm system, no security code required. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 65.6821° N, 18.0898° 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 and chest tightness. Patient is conscious but struggling to speak. Initial symptoms: Sudden onset of dyspnea, wheezing, and a productive cough with yellowish sputum. Patient reports feeling very weak and anxious. Medical history: COPD (Chronic Obstructive Pulmonary Disease) diagnosed 5 years ago, history of smoking. Medications: Salbutamol inhaler (as needed), Fluticasone/Salmeterol inhaler (twice daily), Prednisone 5mg daily. Known allergy: Sulfa drugs. Last meal: Light lunch at 12:00.

History of Events

Timeline:
13:15 hours: Patient reports feeling slightly unwell, increased cough
13:30 hours: Patient begins experiencing shortness of breath, tried using his inhaler with no relief
13:45 hours: Symptoms worsen, chest tightness, difficulty speaking
13:50 hours: Caller (patient's son) arrived at the house, called emergency services
13:55 hours: Current time, patient sitting upright, struggling to breathe

Prior Events: Patient has had several exacerbations of COPD in the past, requiring hospitalizations. Last hospitalization was 6 months ago for a similar episode. Patient has been non-compliant with his medications recently, reports forgetting to take them regularly. No recent infections or fever.

Diagnostics

Initial Assessment

Initial Impression: Acute Exacerbation of COPD
Justification for F2 Classification:
- Acute respiratory distress with signs of airway obstruction
- Patient has known COPD, increasing risk of rapid deterioration
- Requires prompt intervention to prevent respiratory failure

Differential Diagnoses:
1. Acute Exacerbation of COPD (high probability)
2. Pneumonia (possible, based on productive cough)
3. Pulmonary Embolism (less likely, no sudden chest pain)
4. Acute Heart Failure (less likely, no history of heart disease)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Oxygen administration
- Bronchodilator therapy
- Assessment of airway and breathing

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD with Lower Respiratory Tract Infection
Key Findings:
- Chest auscultation revealed diffuse wheezing and crackles
- Patient's oxygen saturation was 88% on room air
- Blood tests showed elevated white blood cell count and inflammatory markers
- Chest X-ray confirmed findings consistent with lower respiratory tract infection

Outcome validated F2 priority assignment. Rapid intervention was critical in stabilizing the patient. Patient was treated with oxygen, bronchodilators, and antibiotics. Hospital admission was required for further treatment.

Learning Points:
1. F2 classification appropriate due to the acute respiratory distress
2. Initial assessment correctly identified the high likelihood of COPD exacerbation
3. Additional findings of infection highlighted the importance of a thorough assessment

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My father is having trouble breathing! He's really struggling.

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

Caller It's Hafnarstræti 18, on the ground floor in Akureyri.

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

Caller He has COPD and he's very short of breath. He's coughing a lot and his chest is tight. He can barely talk.

Dispatcher Has he used his inhaler?

Caller Yes, he tried, but it's not helping. It's getting worse.

Dispatcher Is he awake and alert?

Caller Yes, he's awake but very weak. He looks really bad.

Dispatcher Okay, the ambulance is on its way. Try to keep him calm and sitting upright if he can. Don't let him lay down.

Caller Okay, I will. Thank you.