What is the first step in managing a patient requiring emergency treatment?

Emergency Treatment Sequence (ETC) for Patient Management

The first step in managing a patient requiring emergency treatment is early recognition of an emergency followed by immediate activation of the emergency response system. 1

Initial Assessment and Management Algorithm

1. Recognition and Activation

• Immediately recognize signs of emergency
• Activate emergency response system without delay 1
• Do not wait for patient response to interventions before activating emergency services 1

2. Airway, Breathing, Circulation (ABC) Assessment

• Airway: Ensure patency by opening the airway
• Breathing: Assess for normal breathing vs. gasping/absence of breathing
• Circulation: Check for pulse (healthcare providers) 1

3. Intervention Based on Assessment

• If patient is unresponsive with no breathing or abnormal breathing (gasping):

  • Begin high-quality CPR immediately
  • Compression rate: at least 100/min
  • Compression depth: at least 2 inches (5 cm)
  • Allow complete chest recoil between compressions
  • Minimize interruptions 1

• If respiratory arrest but pulse present:

  • Provide rescue breathing or bag-mask ventilation
  • Continue until spontaneous breathing returns 1

• If cardiac arrest:

  • Focus on high-quality CPR with compressions plus ventilation
  • Standard resuscitative measures take priority over medication administration 1

4. Early Defibrillation

• Retrieve AED as soon as possible (if available)
• Apply and use AED according to prompts
• Resume chest compressions immediately after shock 1

Special Considerations

Opioid Overdose Management

• For suspected opioid overdose with pulse but no normal breathing:
  • Administer naloxone while continuing standard care 1
  • Observe patient in healthcare setting after return of spontaneous breathing 1

Poisoning Management

• For specific toxins, consider appropriate antidotes:
  • High-dose insulin for β-blocker/calcium channel blocker poisoning
  • Sodium bicarbonate for cocaine or sodium channel blocker toxicity
  • Hydroxocobalamin for suspected cyanide poisoning 2

Common Pitfalls to Avoid

1. Delaying activation of emergency response system while attempting interventions 1
2. Prioritizing medication administration over high-quality CPR in cardiac arrest 1, 2
3. Inadequate compression depth or allowing interruptions during CPR 1
4. Failing to recognize respiratory arrest versus cardiac arrest 1
5. Insufficient observation period after successful resuscitation, especially with opioid overdoses 1, 2

Evidence Quality and Considerations

The American Heart Association guidelines provide the strongest evidence for emergency treatment sequence, with clear recommendations for prioritizing early recognition, emergency system activation, and proper ABC assessment 1. The evidence emphasizes that addressing airway and ventilation in periarrest patients is of highest priority, particularly in cases like opioid overdose where respiratory depression precedes cardiac arrest 1.

Recent evidence suggests that in specific trauma scenarios with exsanguinating injuries, a CAB (Circulation, Airway, Breathing) approach may be beneficial 3, but the standard ABC approach remains the foundation for most emergency situations 4, 5.