What are the management protocols for common medical emergencies, including cardiac arrest, severe trauma, anaphylaxis, acute asthma attacks, and severe allergic reactions?

Management of Common Medical Emergencies

The management of common medical emergencies requires immediate recognition and systematic intervention following the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) to reduce morbidity and mortality. 1

1. Anaphylaxis Management

Immediate Management

• Use the ABC approach (Airway, Breathing, Circulation) with team-based simultaneous interventions 2
• Remove all potential causative agents (medications, latex, etc.) 2
• Call for help and note the time 2
• Maintain airway and administer 100% oxygen; intubate if necessary 2
• Elevate patient's legs if hypotension is present 2
• Start cardiopulmonary resuscitation if appropriate according to Advanced Life Support Guidelines 2

Medication Administration

• Administer epinephrine as early as possible - this is the cornerstone of anaphylaxis treatment 2
  • For non-arrest anaphylaxis: 0.2-0.5 mg (1:1000) intramuscularly, repeated every 5-15 minutes as needed 2
  • For anaphylactic shock with IV access: 0.05-0.1 mg IV (1:10,000) 2
  • For cardiac arrest from anaphylaxis: standard resuscitative measures with immediate epinephrine administration 2
• Consider epinephrine infusion (5-15 μg/min) if multiple doses are required 2
• Administer chlorphenamine 10 mg IV (adult dose) 2
• Administer hydrocortisone 200 mg IV (adult dose) 2
• For persistent bronchospasm, consider salbutamol infusion, metered-dose inhaler, aminophylline, or magnesium sulfate 2

Fluid Resuscitation

• Administer saline 0.9% or lactated Ringer's solution at high rate via appropriate gauge IV cannula 2
• Large volumes may be required to treat hypotension 2

Monitoring and Follow-up

• Close hemodynamic monitoring is essential in anaphylactic shock 2
• Arrange transfer to appropriate Critical Care area 2
• Obtain blood samples for Mast Cell Tryptase at specific intervals 2
  • Initial sample as soon as feasible after resuscitation starts
  • Second sample at 1-2 hours after symptom onset
  • Third sample at 24 hours or during convalescence

2. Cardiac Arrest Management

Basic Life Support (BLS)

• Follow standard BLS protocols with high-quality chest compressions 2
• Ensure minimal interruptions to chest compressions 2
• Use proper compression depth and rate according to current guidelines 2

Advanced Cardiac Life Support (ACLS)

• Establish advanced airway management as appropriate 2
• Administer epinephrine according to ACLS protocols 2
• Identify and treat reversible causes (H's and T's) 2
• Consider specific interventions based on arrest etiology 2

Special Considerations

• For hypothermic cardiac arrest: continue resuscitation until patient is rewarmed unless obviously dead 2
• For post-cardiac arrest care: implement temperature management and other supportive measures 3
• For cardiac arrest due to anaphylaxis: standard resuscitative measures with immediate epinephrine administration take priority 2

3. Acute Severe Asthma Management

Assessment and Initial Management

• Evaluate for tension pneumothorax, which is a rare but life-threatening complication 2
• Administer high-flow oxygen to maintain saturation 2
• Use lower tidal volumes, lower respiratory rate, and increased expiratory time to minimize air trapping 2

Ventilation Strategies

• Be alert for breath stacking in patients with limited ability to exhale 2
• Consider brief disconnection from ventilator or pause in bag-mask ventilation with thoracic compression to relieve hyperinflation 2
• Monitor for high airway pressure alarms or sudden blood pressure decreases 2

Medication Administration

• Administer bronchodilators (e.g., albuterol) via nebulizer or metered-dose inhaler 4
• Consider IV magnesium sulfate for severe bronchospasm 2
• Use corticosteroids for anti-inflammatory effect 2

4. Severe Trauma Management

Primary Survey

• Follow ABCDE approach with simultaneous interventions 1
• Control external hemorrhage with direct pressure 1
• Assess for signs of shock and initiate treatment 5
• Consider multiple etiologies of shock in trauma patients 5

Airway Management

• Secure airway while maintaining cervical spine protection if indicated 6
• Consider rapid sequence intubation if GCS < 8 or inability to protect airway 6
• Provide supplemental oxygen to maintain adequate saturation 6

Circulation Management

• Establish large-bore IV access (two sites if possible) 1
• Administer warmed crystalloid fluids for hypotension 2
• Consider blood product administration for hemorrhagic shock 1

Pitfalls and Caveats

• Delayed recognition of anaphylaxis can lead to rapid progression to cardiac arrest despite prompt management once identified 3
• Patients with anaphylaxis may present with hypotension as the sole clinical feature (approximately 10% of cases) 2
• Bradycardia rather than tachycardia occurs in approximately 10% of anaphylaxis cases 2
• Absence of cutaneous signs does not exclude anaphylaxis 2
• In severe asthma, avoid excessive ventilation rates which can worsen air trapping and decrease effective ventilation 2
• In hypothermia, patients may appear clinically dead but require continued resuscitation until rewarmed 2