Emergency Scenario 900_f4

Location Information

Full Location:

Heilsugæslustöð Vestmannaeyja, Kirkjuvegur 23, 900 Vestmannaeyjar. Single-story medical clinic, built in 1985. Main entrance facing Kirkjuvegur, with a secondary entrance for ambulance access on the south side. No security codes. Weather conditions: 8°C, overcast, light wind. Road conditions: paved, dry. GPS coordinates: 63.4407° N, 20.2704° W. Nearest landmark: Vestmannaeyjar Church.

Municipality: Vestmannaeyjar

Postal Code: 900

Emergency Details

Type: Post-Operative Transfer

Priority Level: F4

Response Time Goal: Routine (1-4 hours)

Description:

62-year-old male, post-operative day 2 following a laparoscopic cholecystectomy. Patient is stable but requires transfer to Landspítali in Reykjavik for further observation due to a complex medical history and mild persistent nausea. Patient reports mild discomfort at the surgical site, but no fever, chills, or signs of infection. Patient is fully ambulatory and able to tolerate oral fluids. Vital signs are stable. Transfer is routine, not emergent.

History of Events

Timeline:
Day 0: Patient underwent laparoscopic cholecystectomy at Heilsugæslustöð Vestmannaeyja due to symptomatic cholelithiasis.
Day 1: Patient recovered well post-surgery, tolerating oral fluids, and ambulating with minimal discomfort.
Day 2 (Current): Patient reports mild persistent nausea, no fever or signs of infection. Due to complex medical history and need for further observation, transfer to Landspítali is requested. No significant changes in condition since yesterday. Patient's vital signs have remained stable throughout the post-operative period. Patient is fully alert and oriented. Patient has received routine post-operative pain medication as prescribed. No new symptoms or complications have arisen.

Diagnostics

Initial Assessment

Initial Impression: Stable Post-Operative Patient for Routine Transfer
Justification for F4 Classification:
- Patient is hemodynamically stable, with no signs of acute distress.
- Mild persistent nausea is present but not severe enough to warrant a higher priority.
- Transfer is for observation due to complex medical history, not an acute emergency.
- Routine transfer aligns with the stable post-operative condition.

Differential Diagnoses:
1. Post-operative nausea (most likely)
2. Mild post-operative pain (controlled)
3. Potential for delayed complications (low probability)
4. No signs of infection or other acute conditions

Required Actions:
- Scheduled transfer to Landspítali with non-emergency transport.
- Patient records and transfer summary to be prepared.
- Routine vital signs monitoring prior to transfer.

Final Diagnosis

Final Diagnosis: Stable Post-Operative Patient, Routine Transfer Indicated
Key Findings:
- Patient remained stable during observation period, with no new symptoms.
- Nausea resolved with antiemetics, mild discomfort controlled with analgesics.
- Medical records and transfer summary were completed.
- No complications developed during transfer.

Outcome validated F4 priority assignment. Routine transfer was appropriate, and no emergent issues arose. Patient was transferred safely to Landspítali for further observation and care.

Learning Points:
1. F4 classification appropriate due to the patient's stable condition and routine transfer needs.
2. Initial assessment accurately identified the patient's low acuity.
3. Transfer was conducted smoothly and efficiently, with no complications.

Emergency Call Transcript

Dispatcher Emergency services, this is the dispatch center, what is your emergency?

Caller Good morning, this is Hildur Jónsdóttir calling from Heilsugæslustöð Vestmannaeyja. We need to arrange a routine transfer for a post-operative patient.

Dispatcher Okay, can you provide the patient's details and the reason for the transfer?

Caller Yes, the patient is a 62-year-old male, post-operative day two following a laparoscopic cholecystectomy. He is stable but needs to be transferred to Landspítali in Reykjavik for further observation.

Dispatcher Is the patient experiencing any acute symptoms?

Caller He has mild persistent nausea, but no fever, chills, or signs of infection. He's stable and fully ambulatory. We just need to arrange a non-emergency transfer.

Dispatcher Okay, I understand. What is the patient's name and kennitala?

Caller I cannot give you the patient's name or kennitala over an unsecured line, but he is post-operative, stable and needs to be transferred to Landspítali. The request has been approved by the doctor on call.

Dispatcher Understood. This is being logged as an F4 transfer. We will arrange for a non-emergency transport within the next 1-4 hours. Please ensure all patient documentation is ready.

Caller Thank you. We will ensure all documents are prepared. We appreciate your help.