Hafnarstræti 18, 600 Akureyri, ground floor of a two-story wooden building built in 1930. Main entrance is street-level with no steps. No elevator. Building is not equipped with a fire alarm system. Street parking available. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 65.6825° N, 18.0912° W. Nearest landmark: Akureyri Art Museum.
68-year-old male, experiencing severe shortness of breath. Primary symptoms: Marked difficulty breathing, audible wheezing, rapid and shallow respirations, use of accessory muscles. Secondary symptoms: Cyanosis around lips, patient anxious and agitated, unable to speak in full sentences. Patient is sitting upright in a chair. Medical history: COPD diagnosed 5 years ago, mild heart failure, history of smoking. Medications: Salbutamol inhaler (2 puffs as needed), Fluticasone/Salmeterol inhaler (1 puff twice daily), Furosemide 40mg daily. Known allergy to penicillin. Last meal was a small lunch at 12:30.
Timeline: 13:45 hours: Patient started feeling slightly short of breath 14:00 hours: Shortness of breath worsened, started wheezing 14:10 hours: Patient used salbutamol inhaler, no relief 14:15 hours: Patient called his son for help 14:20 hours: Son arrived, called emergency services 14:22 hours: Current time, patient is in severe respiratory distress Prior Events: Patient has had several exacerbations of COPD in the past year, requiring hospital admissions. Last check-up was 2 weeks ago, routine follow-up with his pulmonologist. Patient reports a mild cold last week but no fever. Patient lives alone, but son lives nearby.
Initial Impression: Acute Exacerbation of COPD with Respiratory Distress Justification for F2 Classification: - Significant respiratory distress with signs of hypoxia (cyanosis) - Patient has a history of COPD and is not responding to usual treatment - Potential for rapid deterioration requiring immediate intervention Differential Diagnoses: 1. Acute Exacerbation of COPD (most likely) 2. Acute Pulmonary Edema (possible given history of heart failure) 3. Pneumonia (less likely, no reported fever) 4. Pulmonary Embolism (less likely, no sudden onset of chest pain) Required Actions: - Dispatch of ground EMS with ALS capabilities - Oxygen administration - Bronchodilator administration - Monitoring of vital signs - Preparation for possible intubation