Emergency Scenario 900_f4_19

Location Information

Heilsugæslustöð Vestmannaeyja, Bárustígur 1, 900 Vestmannaeyjar. Single-story concrete building built in 1985. Main entrance with ramp access. No elevators. Parking available on site. Building equipped with fire alarm system. Current conditions: 8°C, overcast, moderate visibility. GPS coordinates: 63.4412° N, 20.2705° W. Nearest landmark: Vestmannaeyjar Hospital.

Emergency Details

58-year-old male, post-operative day 3 following an elective laparoscopic cholecystectomy. Patient is stable, afebrile, and tolerating oral intake. Requires transfer from Vestmannaeyjar Health Clinic to Landspítali National University Hospital in Reykjavik for routine follow-up and further investigations related to incidental findings during surgery. Patient has no active complaints at present. Patient is ambulatory and able to assist with transfer.

History of Events

Timeline:
Day 0: Elective laparoscopic cholecystectomy performed at Vestmannaeyjar Hospital due to symptomatic gallstones.
Day 1: Patient recovered well from anesthesia, started oral intake, and was ambulatory with minimal discomfort.
Day 2: Patient remained stable with no complications. Incidental finding noted on pathology report requiring further investigation at Landspítali.
Day 3: Current time, patient is stable, and transfer is being arranged. No new symptoms reported. Patient has no known allergies. Medications: Paracetamol 500mg PRN, no other regular medications. Past medical history: Mild hypertension, controlled with diet. Last meal was a light breakfast at 08:00. Patient has been afebrile since surgery. Vital signs: HR 78 bpm, BP 130/80 mmHg, RR 16 breaths/min, SpO2 98% on room air, Temp 36.8°C. Patient is alert and oriented to person, place, and time.

Diagnostics

Initial Assessment

Initial Impression: Post-Operative Transfer - Stable Patient
Justification for F4 Classification:
- Patient is stable, afebrile, and ambulatory
- No acute symptoms or signs of complications
- Transfer is for routine follow-up, not an emergency
- No immediate life threats

Differential Diagnoses:
1. Post-Operative Recovery (primary diagnosis)
2. Incidental Finding Requiring Further Investigation (reason for transfer)
3. Potential for Post-Operative Complications (low probability due to stable status)

Required Actions:
- Arranging routine transport for patient transfer
- Ensuring patient comfort during transport
- Transfer of relevant medical documentation to Landspítali
- Communication of incidental findings to receiving team

Final Diagnosis

Final Diagnosis: Post-Operative Transfer - Stable Patient with Incidental Finding of Gallbladder Polyp
Key Findings:
- Pathology report from cholecystectomy revealed a small gallbladder polyp
- Patient's condition remained stable throughout the transfer
- Further investigations at Landspítali confirmed the benign nature of the polyp

Outcome validated F4 priority assignment. The transfer was completed without incident. Patient was discharged home after further investigation.

Learning Points:
1. F4 classification was appropriate given the patient's stable condition and the routine nature of the transfer
2. Clear communication of incidental findings was crucial for continuity of care
3. Pre-transfer assessment ensured no acute issues were missed

Emergency Call Transcript