Emergency Scenario 600_f3

Location Information

Full Location:

Hafnarstræti 18, 600 Akureyri, third floor apartment 3B. A three-story brick building constructed in 1955. Main entrance has a buzzer system. No elevator, only stairs. Street parking is available. Building has a basic fire alarm system. Current conditions: 7°C, clear skies, good visibility. GPS coordinates: 65.6819° N, 18.0915° W. Nearest landmark: Akureyri Art Museum.

Municipality: Akureyri

Postal Code: 600

Emergency Details

Type: Pediatric Respiratory Distress

Priority Level: F3

Response Time Goal: Standard (30-60 minutes)

Description:

3-year-old male, experiencing difficulty breathing. Primary symptoms: Increased respiratory rate, audible wheezing, nasal flaring, mild intercostal retractions. Secondary symptoms: Mild fever (38.2°C), slight cough, lethargy. Patient is conscious but distressed. Skin is pale and warm. Patient is sitting upright on his mother's lap. Medical history: History of bronchiolitis at 6 months old. No known allergies. Medications: None. Last oral intake was a small portion of yogurt at 09:00.

History of Events

Timeline:
1000 hours: Child started exhibiting a mild cough and runny nose.
1100 hours: Child developed a fever (38.0°C).
1200 hours: Child’s breathing became more labored with audible wheezing.
1215 hours: Mother called emergency services. Child is now breathing faster and with more effort.
1220 hours: Current time, child is sitting upright, pale, and distressed.

Prior Events: Child had a mild cold for the past two days. No recent travel or exposure to known respiratory illnesses. Last medical check-up was at 2 years old, routine vaccinations completed. Child attends a local daycare.

Diagnostics

Initial Assessment

Initial Impression: Pediatric Respiratory Distress, likely Bronchiolitis/Reactive Airway Disease.
Justification for F3 Classification:
- Child is exhibiting signs of respiratory distress (increased respiratory rate, wheezing, retractions)
- Condition is time-sensitive but not immediately life-threatening.
- Child is conscious and responsive, no signs of severe distress.

Differential Diagnoses:
1. Bronchiolitis (most likely given age and symptoms)
2. Reactive Airway Disease/Asthma (possible given history)
3. Viral Upper Respiratory Infection (contributing factor)
4. Foreign Body Aspiration (less likely given gradual onset)

Required Actions:
- Dispatch of ground EMS with pediatric capabilities
- Monitoring of respiratory status and oxygen saturation
- Supportive care, including positioning and comfort measures
- Preparation for transport to nearest pediatric-capable hospital

Final Diagnosis

Final Diagnosis: Acute Bronchiolitis exacerbation.
Key Findings:
- Physical exam revealed diffuse wheezing and increased work of breathing.
- Oxygen saturation was 92% on room air.
- No evidence of foreign body aspiration or other acute respiratory conditions.
- Viral swab positive for RSV.

Outcome validated F3 priority assignment. Rapid assessment and supportive care were crucial. Patient was treated with oxygen, bronchodilators, and supportive care. Patient improved over 24 hours and discharged after 3 days. 

Learning Points:
1. F3 classification appropriate given the child's age and presentation of moderate respiratory distress.
2. Initial assessment accurately identified the likely diagnosis of bronchiolitis.
3. Early intervention with oxygen and bronchodilators improved the patient's outcome.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My son is having trouble breathing! He's only three.

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

Caller It's Hafnarstræti 18, apartment 3B, third floor in Akureyri.

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

Caller He has been sick with a cold for a couple of days, but now he's breathing really fast and making a wheezing sound. He also has a fever.

Dispatcher Is he awake and talking to you?

Caller Yes, he's awake but he is very distressed and pale.

Dispatcher Does he have any known allergies or medical conditions?

Caller He had bronchiolitis when he was a baby, but no allergies.

Dispatcher Okay, the ambulance is on its way. Keep him sitting up and try to keep him calm. Don't give him anything to eat or drink.

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