Emergency Scenario 400_f3

Location Information

Full Location:

Hlíðarvegur 14, 400 Ísafjörður, single-story residential building. Built in 1965. Main entrance at ground level, no stairs. No security features. Street parking available. Current conditions: 7°C, overcast, good visibility. GPS coordinates: 66.0753° N, 23.1269° W. Nearest landmark: Ísafjörður Hospital.

Municipality: Ísafjörður

Postal Code: 400

Emergency Details

Type: Medical Evaluation Transfer

Priority Level: F3

Response Time Goal: Standard (30-60 minutes)

Description:

72-year-old female, known history of COPD and heart failure, scheduled for transfer from Ísafjörður Health Clinic to Ísafjörður Hospital for further evaluation of worsening dyspnea and peripheral edema. Patient is stable but requires oxygen support. Patient is alert and oriented. No acute distress but reports increased shortness of breath over the past 24 hours. Patient is seated in a chair at the clinic, ready for transport. Medical history: COPD diagnosed 15 years ago, heart failure diagnosed 5 years ago, hypertension. Medications: Salbutamol inhaler PRN, Fluticasone/Salmeterol inhaler BID, Furosemide 40mg daily, Ramipril 5mg daily, Digoxin 0.125mg daily. No known allergies. Last meal was a light lunch at 13:00.

History of Events

Timeline:
1000 hours: Patient visited the clinic for a routine follow-up, reporting increased shortness of breath.
1030 hours: Clinic staff performed initial assessment, noting increased respiratory rate and peripheral edema.
1100 hours: Decision made to transfer the patient to Ísafjörður Hospital for further evaluation.
1115 hours: Transfer request made to emergency dispatch.
1130 hours: Current time, patient is stable, awaiting transport.

Prior Events: Patient has had several exacerbations of COPD and heart failure in the past year, requiring hospitalizations. Last hospitalization was 3 months ago. Patient reports compliance with medications. No recent illnesses or injuries. Patient lives alone, but has a caregiver who visits daily.

Diagnostics

Initial Assessment

Initial Impression: COPD and Heart Failure Exacerbation
Justification for F3 Classification:
- Patient is stable but requires transfer for further evaluation of worsening symptoms.
- No immediate life-threatening condition but requires timely medical attention.
- Patient is already under medical supervision at the clinic.

Differential Diagnoses:
1. COPD Exacerbation (high probability)
2. Heart Failure Exacerbation (high probability)
3. Pulmonary Embolism (lower probability, no acute chest pain)
4. Pneumonia (lower probability, no fever or productive cough)

Required Actions:
- Dispatch of BLS ambulance for inter-facility transfer
- Oxygen support during transport
- Monitoring of vital signs during transport
- Communication with receiving hospital regarding patient's condition and transfer details

Final Diagnosis

Final Diagnosis: Acute Exacerbation of COPD and Congestive Heart Failure
Key Findings:
- Chest X-ray revealed increased pulmonary congestion and hyperinflation consistent with COPD and heart failure exacerbation.
- Blood tests showed elevated BNP levels, indicating worsening heart failure.
- Patient's respiratory symptoms improved with oxygen therapy and diuretics.
- No evidence of pulmonary embolism or pneumonia was found.

Outcome validated F3 priority assignment. Transfer was completed without complications. Patient received appropriate treatment at the hospital.

Learning Points:
1. F3 classification appropriate for a stable patient requiring inter-facility transfer.
2. Initial assessment accurately identified the underlying conditions.
3. Monitoring and oxygen support during transport ensured patient safety.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller This is Guðrún Jónsdóttir calling from Ísafjörður Health Clinic. We need a transfer for a patient.

Dispatcher Okay, what is the patient's condition?

Caller It's a 72-year-old female with a history of COPD and heart failure. She's experiencing worsening shortness of breath and peripheral edema. She needs to be transferred to the hospital for further evaluation.

Dispatcher Is the patient stable at the moment?

Caller Yes, she's stable. She's sitting in a chair and receiving oxygen. Her vital signs are stable, but she's still short of breath.

Dispatcher What is the patient's name and social security number?

Caller Her name is Guðrún Jónsdóttir, social security number is ******-****.

Dispatcher Okay, we'll arrange a transfer for her. Please keep her comfortable and continue to monitor her.

Caller Thank you, we will wait here.