Emergency Scenario 400_f3_10

Location Information

Hafnarstræti 2, 400 Ísafjörður, ground floor apartment. Two-story wooden residential building constructed in 1950. Main entrance at street level, no steps. No elevator. Street parking available. Building has basic fire alarm system. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 66.0756° N, 23.1265° W. Nearest landmark: Ísafjörður Harbor.

Emergency Details

72-year-old female, known history of COPD and heart failure, requires transfer from her home to the Ísafjörður Health Center for routine evaluation of increased shortness of breath and lower extremity edema. Patient is stable but requires oxygen therapy at 2L/min via nasal cannula. Patient is alert and oriented. Currently resting in her living room.

History of Events

Timeline:
0700 hours: Patient woke up with increased shortness of breath.
0800 hours: Patient took her usual morning medications.
0900 hours: Patient noticed increased swelling in her ankles and lower legs.
1000 hours: Patient contacted her family doctor who recommended transfer to the health center for evaluation.
1030 hours: Daughter called emergency services for transport.
1035 hours: Current time, patient is stable, resting at home.

Prior Events: Patient has a history of COPD diagnosed 10 years ago, managed with inhalers and occasional oral steroids. Heart failure diagnosed 5 years ago, managed with diuretics and ACE inhibitors. Last hospital admission was 6 months ago for a COPD exacerbation. Patient has a home oxygen concentrator and uses oxygen at 2L/min regularly. Last medical check-up was 2 weeks ago, routine follow-up. Patient lives with her daughter who is her primary caregiver.

Diagnostics

Initial Assessment

Initial Impression: COPD exacerbation with possible heart failure decompensation, requiring routine medical evaluation.
Justification for F3 Classification:
- Patient is stable, alert, and oriented.
- Symptoms are not acutely life-threatening.
- Patient requires transfer for further medical evaluation.
- Time-sensitive, but not requiring immediate emergency response.

Differential Diagnoses:
1. COPD exacerbation (likely)
2. Heart failure decompensation (possible)
3. Pulmonary embolism (less likely given slow onset of symptoms)
4. Infection (possible, but no fever reported)

Required Actions:
- Dispatch of BLS ambulance for routine transfer
- Ensure patient's oxygen therapy is maintained during transport
- Transport to Ísafjörður Health Center for further evaluation

Final Diagnosis

Final Diagnosis: Acute on Chronic COPD exacerbation with fluid overload secondary to heart failure
Key Findings:
- Chest X-ray showed increased lung hyperinflation and pulmonary congestion.
- ECG showed no acute ischemic changes.
- Blood tests revealed elevated BNP levels and mild hypercapnia.
- Physical exam confirmed bilateral lower extremity edema and mild respiratory distress.

Outcome validated F3 priority assignment. Patient was treated with increased oxygen, IV diuretics, and nebulized bronchodilators. Her symptoms improved significantly over the next 24 hours.

Learning Points:
1. F3 classification was appropriate for a stable patient requiring medical evaluation.
2. Initial assessment correctly identified the likely underlying conditions.
3. Prompt transfer and medical intervention led to a positive outcome

Emergency Call Transcript