Emergency Scenario 900_f2_21

Location Information

Heiðarvegur 15, 900 Vestmannaeyjar, single-story residential house. Built in 1968, wood frame construction. Main entrance faces the street, no security features. Small porch with two steps. Current conditions: 8°C, overcast, light wind. GPS coordinates: 63.4421° N, 20.2744° W. Nearest landmark: Vestmannaeyjar Golf Club.

Emergency Details

68-year-old male, experiencing severe shortness of breath. Primary symptoms: Significant dyspnea, audible wheezing, rapid breathing. Secondary symptoms: Chest tightness, mild cyanosis around lips, anxious demeanor. Patient is conscious but struggling to speak. Patient sitting upright in a chair. Medical history: COPD diagnosed 5 years ago, history of smoking, hypertension. Medications: Salbutamol inhaler (2 puffs as needed), Fluticasone inhaler (2 puffs daily), Lisinopril 10mg daily. Known allergy: Penicillin. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1400 hours: Patient began feeling slightly short of breath while watching TV.
1415 hours: Shortness of breath worsened, patient used Salbutamol inhaler, no relief.
1420 hours: Patient's breathing became labored, developed chest tightness.
1425 hours: Caller (patient's son) arrived at the house, found patient in distress, called emergency services.
1428 hours: Current time, patient is still experiencing severe respiratory distress, unable to speak full sentences.

Prior Events: Patient had a COPD exacerbation 6 months ago, required hospitalization for 3 days. Reports using his inhalers regularly. No recent illnesses, but reports worsening shortness of breath over the past week. Last medical check-up 2 months ago, routine follow-up for COPD.

Diagnostics

Initial Assessment

Initial Impression: Acute COPD Exacerbation with Respiratory Distress.
Justification for F2 Classification:
- Significant respiratory distress with wheezing and cyanosis, indicating a potential threat to airway and breathing.
- Patient has a history of COPD, making this a high-risk situation.
- Time-sensitive condition requiring prompt medical intervention and potential respiratory support.

Differential Diagnoses:
1. Acute COPD Exacerbation (most likely)
2. Pneumonia (less likely, no fever reported)
3. Pulmonary Embolism (less likely, no sudden onset chest pain)
4. Acute Heart Failure (less likely, no history of heart disease)

Required Actions:
- Dispatch of ground EMS with ALS capabilities.
- Oxygen administration protocol initiation.
- Continuous vital signs monitoring.
- Preparation for possible assisted ventilation and transport to nearest hospital.

Final Diagnosis

Final Diagnosis: Acute COPD Exacerbation with Bronchospasm.
Key Findings:
- Auscultation revealed widespread wheezing and decreased breath sounds.
- Pulse oximetry showed oxygen saturation of 88% on room air.
- Arterial blood gas analysis confirmed hypercapnia and hypoxia.
- Patient responded positively to nebulized bronchodilators and supplemental oxygen.

Outcome validated F2 priority assignment. Rapid dispatch and treatment were essential to prevent respiratory failure. Patient was admitted to hospital for further management and monitoring.

Learning Points:
1. F2 classification appropriate given the patient's respiratory distress and history.
2. Initial assessment accurately identified COPD exacerbation as the primary cause.
3. Prompt bronchodilator administration and oxygen therapy were critical for stabilizing the patient.

Emergency Call Transcript