Hafnarstræti 18, 600 Akureyri. Ground floor of a two-story wooden building, built in 1935. Main entrance at street level, no steps. Secondary entrance via back alley, typically locked. Street parking available. Building has a fire alarm system. Current conditions: 7°C, clear skies, good visibility. GPS coordinates: 65.6821° N, 18.0923° W. Nearest landmark: Akureyri Art Museum.
68-year-old male, experiencing severe shortness of breath. Primary symptoms: Rapid and labored breathing, audible wheezing, use of accessory muscles. Secondary symptoms: Chest tightness, cyanosis around lips, mild confusion. Patient is sitting upright on a chair. Medical history: Chronic Obstructive Pulmonary Disease (COPD), diagnosed 5 years ago, Type 2 Diabetes. Medications: Salbutamol inhaler (as needed), Tiotropium inhaler (daily), Metformin 500mg twice daily. Allergies: None known. Last meal was a light lunch at 12:30. Smoker for 40 years, quit 2 years ago.
Timeline: 1400 hours: Patient started feeling slightly short of breath 1415 hours: Symptoms worsened rapidly, with increased wheezing and chest tightness 1420 hours: Patient used his Salbutamol inhaler, with minimal relief 1425 hours: Patient became increasingly distressed, called his son for help 1430 hours: Son arrived and called emergency services 1432 hours: Current time, patient is still experiencing severe respiratory distress Prior Events: Patient had a mild respiratory infection 2 weeks ago, which he recovered from. No recent hospitalizations. Follow-up with pulmonologist 4 months ago, medication dosages unchanged. Patient has had several exacerbations of COPD in the past, usually responding to inhaler use.
Initial Impression: Acute Exacerbation of COPD with Respiratory Distress Justification for F2 Classification: - High probability of a significant respiratory compromise based on symptoms and history - Patient exhibits signs of severe distress, including use of accessory muscles and cyanosis - Time-sensitive condition requiring immediate medical intervention Differential Diagnoses: 1. Acute Exacerbation of COPD (high probability) 2. Pneumonia (possible, but less likely given no fever) 3. Pulmonary Embolism (less likely given gradual onset) 4. Acute Heart Failure (less likely given lack of edema and history) Required Actions: - Dispatch of ground EMS with ALS capabilities - Oxygen administration and respiratory support - Preparation for transport to nearest hospital with respiratory services