Emergency Scenario 900_f4_16

Location Information

Heilsugæslustöð Vestmannaeyja, Bárustígur 1, 900 Vestmannaeyjar. Single-story medical clinic, built in 1975. Main entrance is accessible via ramp. Parking lot in front. Clinic equipped with basic medical equipment. Current conditions: 10°C, overcast, good visibility. GPS coordinates: 63.4419° N, 20.2714° W. Nearest landmark: Vestmannaeyjar Hospital.

Emergency Details

45-year-old male, post-operative day 2 following an appendectomy. Patient is stable, afebrile, and reports mild pain at the surgical site (rated 3/10). Requires transfer from Vestmannaeyjar Health Clinic to Landspítali University Hospital in Reykjavík for further observation and follow-up due to a history of previous complications post-surgery. Patient is ambulatory and has no active complaints other than the surgical pain. Patient is currently in a hospital bed at the clinic.

History of Events

Timeline:
Two days ago: Patient underwent an uncomplicated appendectomy at Vestmannaeyjar Hospital.
Post-op day 1: Patient tolerated oral intake, ambulated without issue, and had stable vital signs. Pain controlled with oral analgesics.
Post-op day 2: Patient remains stable, afebrile, with mild surgical site pain. No signs of infection or other complications. Transfer requested by surgeon for continued observation and specialist follow-up due to previous surgical complications in a different surgery 2 years ago. 
Prior Events: Patient had a previous abdominal surgery 2 years ago that resulted in a post-operative ileus requiring prolonged hospitalization. No other significant medical history. No known allergies. Medications: Paracetamol 1g every 6 hours and Ibuprofen 400mg every 8 hours as needed for pain. Last oral intake was a light breakfast at 08:00 today. Patient is currently in a stable condition.

Diagnostics

Initial Assessment

Initial Impression: Stable post-operative patient requiring routine transfer for observation.
Justification for F4 Classification:
- Patient is hemodynamically stable with no acute complaints.
- Transfer is for routine follow-up and monitoring, not for an emergency condition.
- No time-critical interventions are required during transfer.

Differential Diagnoses:
1. Post-operative pain (confirmed)
2. Surgical site infection (unlikely, afebrile, no signs of infection)
3. Post-operative ileus (low probability, tolerating oral intake)
4. Thromboembolic event (low probability, no signs or symptoms)

Required Actions:
- Coordinate non-emergency transport to Landspítali University Hospital.
- Ensure patient's pain is controlled prior to transfer.
- Provide transfer documentation including surgical history and medications.

Final Diagnosis

Final Diagnosis: Stable post-appendectomy patient for routine transfer.
Key Findings:
- Full clinical assessment at Vestmannaeyjar Health Clinic confirms a stable patient with no signs of complications.
- Patient's pain is well controlled with oral analgesics.
- No signs of infection, ileus, or thromboembolic events detected.
- Transfer to Landspítali University Hospital is for observation and follow-up as a precaution due to previous surgical complications, not for an acute issue.

Outcome validated F4 priority assignment. The patient was transferred without incident. 

Learning Points:
1. F4 classification was appropriate given the patient's stable condition and the non-emergent nature of the transfer.
2. Initial assessment accurately identified the patient's stable post-operative status.
3. Thorough documentation and communication facilitated a smooth and safe transfer.

Emergency Call Transcript