Emergency Scenario 900_f2

Location Information

Full Location:

Heimagata 7, 900 Vestmannaeyjar, single-story residential house. Main entrance faces south. No security features. Weather: 10°C, overcast, light wind, good visibility. GPS coordinates: 63.4406° N, 20.2715° W. Nearest landmark: Vestmannaeyjar Swimming Pool.

Municipality: Vestmannaeyjar

Postal Code: 900

Emergency Details

Type: Obstetric Emergency

Priority Level: F2

Response Time Goal: Within 30 minutes

Description:

32-year-old female, 38 weeks pregnant, experiencing sudden onset of severe abdominal pain and vaginal bleeding. Primary symptoms: Intense lower abdominal pain, bright red vaginal bleeding, contractions every 5 minutes, patient feels lightheaded. Secondary symptoms: Nausea, anxiety. Patient is alert but distressed. Medical history: Previous uncomplicated pregnancy, no known allergies. Medications: Prenatal vitamins only. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1430 hours: Patient experienced a sudden sharp pain in her lower abdomen.
1432 hours: Patient noticed bright red vaginal bleeding and contractions started.
1435 hours: Contractions are regular, every 5 minutes. Patient reports increasing pain and lightheadedness.
1438 hours: Patient called her husband for help, who then called emergency services.
1440 hours: Current time, patient is lying on the couch, bleeding continues, contractions ongoing.

Prior Events: Patient had a routine check-up 2 days ago, everything was normal. No prior history of bleeding or complications in this pregnancy. No recent falls or trauma.

Diagnostics

Initial Assessment

Initial Impression: Suspected Placental Abruption or Preterm Labor with Hemorrhage
Justification for F2 Classification:
- Presence of vaginal bleeding and abdominal pain in a late-term pregnancy poses a risk to both mother and fetus
- Potential for rapid deterioration and hemodynamic instability
- Time-sensitive condition requiring prompt medical evaluation and intervention

Differential Diagnoses:
1. Placental Abruption (high probability given pain and bleeding)
2. Preterm Labor with Hemorrhage (possible, but abrupt onset suggests abruption)
3. Placenta Previa (less likely given pain)
4. Uterine Rupture (less likely but must be considered)

Required Actions:
- Dispatch of ground EMS with ALS capabilities
- Rapid transport to the nearest hospital with obstetric services
- Continuous monitoring of maternal vital signs and fetal heart rate (if possible)
- Preparation for potential need for blood transfusion and emergency C-section

Final Diagnosis

Final Diagnosis: Placental Abruption with Preterm Labor
Key Findings:
- Ultrasound at the hospital confirmed a partial placental abruption with significant retroplacental hematoma
- Patient was in active preterm labor
- Fetal heart rate was initially reactive but later showed signs of distress, necessitating an emergency C-section
- Patient received blood transfusion to address blood loss

Outcome validated F2 priority assignment. Rapid dispatch and transport were critical. Patient and baby survived but required intensive care post-delivery.

Learning Points:
1. F2 classification was appropriate due to the high risk nature of the situation
2. Initial assessment accurately identified the high likelihood of a serious obstetric complication
3. Prompt transport and emergency interventions were crucial for the positive outcome

Emergency Call Transcript

Dispatcher Emergency services, what is your emergency?

Caller My wife is pregnant and she's bleeding and has terrible pain! We need help!

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

Caller It's Heimagata 7 in Vestmannaeyjar.

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

Caller She suddenly started having very bad pain in her belly and then she started bleeding. She's 38 weeks pregnant!

Dispatcher Is she awake and talking to you?

Caller Yes, she's awake but she's very scared and in a lot of pain. She says she feels lightheaded.

Dispatcher Are the contractions regular?

Caller Yes, they are about every 5 minutes. The bleeding is bright red.

Dispatcher Okay, the ambulance is on its way. Don't try to move her. Stay with her and keep her calm.

Caller Okay, thank you. I will wait here with her.