Emergency Scenario 600_f3

Location Information

Full Location:

Hafnarstræti 91, 600 Akureyri, first floor apartment 1B. Three-story concrete building built in 1965. Main entrance with a coded lock, code is 1965. There are two entrances, one facing the street, one in the back. No elevator, central stairwell. Street parking available. Current conditions: 7°C, cloudy, good visibility. GPS coordinates: 65.6825° N, 18.0938° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Gastrointestinal Emergency

Priority Level: F3

Response Time Goal: Standard (30-60 minutes)

Description:

68-year-old male, experiencing severe abdominal pain, nausea, and vomiting for the past 6 hours. Primary symptoms: Intense cramping abdominal pain, located in the epigastric region, radiating to the back. Secondary symptoms: Nausea, frequent vomiting, diaphoresis. Patient reports feeling weak and dizzy. Patient is alert and oriented but in distress. Medical history: Type 2 diabetes, hypertension, history of peptic ulcers. Medications: Metformin 500mg twice daily, Lisinopril 10mg daily, Omeprazole 20mg daily. No known allergies. Last meal was a light soup at 18:00 yesterday.

History of Events

Timeline:
0200 hours: Patient woke up with mild abdominal discomfort.
0300 hours: Pain intensified, nausea started.
0400 hours: First episode of vomiting, continued intermittently.
0600 hours: Pain became severe, radiating to the back, dizziness started.
0800 hours: Patient called emergency services. 

Prior Events: Patient reports occasional heartburn and indigestion, managed with over-the-counter antacids. No recent changes in medication. Last medical check-up 6 months ago, routine follow-up. Patient lives alone.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Gastroenteritis or Peptic Ulcer Exacerbation
Justification for F3 Classification:
- Significant discomfort and symptoms (abdominal pain, nausea, vomiting), but no immediate life-threatening signs (e.g., severe hypotension, altered mental status)
- Patient is stable but requires medical evaluation and pain management
- Time-sensitive due to the duration and severity of symptoms

Differential Diagnoses:
1. Acute Gastroenteritis (high probability, given vomiting and abdominal pain)
2. Peptic Ulcer Exacerbation (moderate probability, given past history)
3. Pancreatitis (lower probability, no alcohol history reported)
4. Cholecystitis (lower probability, pain location less typical)

Required Actions:
- Dispatch of ground EMS for medical assessment and pain management
- Assessment of dehydration level and electrolyte imbalance
- Possible transport to hospital for further evaluation and treatment

Final Diagnosis

Final Diagnosis: Acute Peptic Ulcer Perforation
Key Findings:
- Upon arrival, patient's condition had worsened, with signs of peritonitis, including rebound tenderness on abdominal exam.
- Patient's vital signs showed tachycardia and mild hypotension, indicating hypovolemia.
- Abdominal CT scan confirmed a perforated peptic ulcer with free air in the peritoneal cavity.
- Initial diagnosis of gastroenteritis was revised due to the development of peritonitis and findings on imaging.

Outcome: Initial F3 priority assignment was initially appropriate, but the condition escalated to a surgical emergency requiring immediate intervention. The patient underwent emergency surgery to repair the perforation.

Learning Points:
1. Symptoms of peptic ulcer perforation can initially mimic gastroenteritis, requiring careful assessment for signs of peritonitis
2. Patient history of peptic ulcers should raise suspicion for ulcer-related complications
3. Reassessment of patient condition during transport is crucial to identify deteriorating cases and escalate care as needed

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I have terrible stomach pain. I’ve been throwing up for hours, and it's getting worse.

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

Caller It's Hafnarstræti 91, apartment 1B, first floor in Akureyri.

Dispatcher Help is on its way. Can you tell me more about the pain?

Caller It's really bad, like a cramping pain in my stomach, and it's going to my back. I feel so sick.

Dispatcher Are you able to stand or sit up?

Caller Yes, I'm sitting down, but I feel weak and dizzy.

Dispatcher Do you have any medical conditions or take any medications?

Caller Yes, I have diabetes and high blood pressure. I take Metformin, Lisinopril, and Omeprazole.

Dispatcher Okay, the ambulance is on its way. Try to stay calm and don't eat or drink anything.

Caller Okay, thank you, I will wait.