Emergency Scenario 700_f3

Location Information

Full Location:

Miðvangur 2, 700 Egilsstaðir, single-story detached house with a blue roof. Built in 1985. Main entrance is at the front with a single wooden door. No security system. Gravel driveway. Current conditions: 8°C, overcast, good visibility, dry roads. GPS coordinates: 65.2648° N, 14.3947° W. Nearest landmark: Egilsstaðir Airport.

Municipality: Egilsstaðir

Postal Code: 700

Emergency Details

Type: Gastrointestinal Emergency

Priority Level: F3

Response Time Goal: Standard (30-60 minutes)

Description:

58-year-old male, experiencing severe abdominal pain. Primary symptoms: Sharp, localized pain in the upper abdomen, nausea, and vomiting. Patient reports feeling lightheaded. Secondary symptoms: Sweating, pale skin. Patient is alert and oriented but appears distressed. Medical history: History of peptic ulcers, takes Omeprazole 20mg daily, no known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
14:00 hours: Patient began experiencing mild discomfort in the upper abdomen.
14:30 hours: Pain intensified, accompanied by nausea.
14:45 hours: Patient vomited twice, described as non-bloody.
15:00 hours: Patient felt lightheaded, and called emergency services.
15:05 hours: Current time, patient is sitting on the sofa, experiencing ongoing pain and nausea.

Prior Events: Patient has had previous episodes of abdominal pain related to peptic ulcers, usually controlled with medication. No recent changes in medication or diet. Last medical check-up 6 months ago, routine follow-up.

Diagnostics

Initial Assessment

Initial Impression: Suspected Peptic Ulcer Exacerbation or Acute Gastritis
Justification for F3 Classification:
- Patient is experiencing significant pain and gastrointestinal symptoms but is hemodynamically stable.
- Symptoms are not immediately life-threatening but require medical evaluation and pain management within a reasonable timeframe.
- No signs of severe complications such as perforation or bleeding are apparent from initial report.

Differential Diagnoses:
1. Peptic Ulcer Exacerbation (most likely given history)
2. Acute Gastritis (likely, based on symptoms)
3. Cholecystitis (less likely, pain is not typically in the right upper quadrant)
4. Pancreatitis (less likely, no reported back pain)
5. Gastroenteritis (possible, but pain is more localized)

Required Actions:
- Dispatch of ground EMS with BLS capabilities
- Assessment of vital signs and pain level
- Symptomatic treatment with antiemetics and analgesics as indicated
- Transport to nearest hospital for further evaluation and treatment

Final Diagnosis

Final Diagnosis: Perforated Peptic Ulcer
Key Findings:
- Patient developed signs of peritonitis during transport, including rebound tenderness and guarding on abdominal examination
- Initial assessment did not identify signs of perforation, which developed rapidly
- CT scan at the hospital confirmed a perforated peptic ulcer with free air in the abdomen

Outcome required upgrade to F2 upon signs of peritonitis during transport. Rapid surgical intervention was required.

Learning Points:
1. Initial F3 classification was based on the caller's report, which did not reveal the full extent of the condition.
2. Rapid deterioration of the patient's condition highlights the need for continuous monitoring during transport.
3. Initial assessment of non-specific abdominal pain can be challenging, requiring a high index of suspicion for serious underlying conditions.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller I'm having terrible stomach pain. It's really bad.

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

Caller It's Miðvangur 2 in Egilsstaðir.

Dispatcher Help is on its way. Can you describe the pain?

Caller It's sharp, right here in my upper stomach. I've been throwing up and feel lightheaded.

Dispatcher Have you had this pain before?

Caller Yes, I have peptic ulcers. I take Omeprazole for it.

Dispatcher Are you able to sit or stand?

Caller I'm sitting on the sofa, it's hard to move.

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

Caller Okay, thank you. I will wait here.