What are the most critical medical emergencies in acute care, sorted by system?

Critical Medical Emergencies in Acute Care by System

The most effective management of medical emergencies in acute care requires a system-based approach with standardized protocols for rapid recognition and intervention to optimize patient outcomes. 1

Cardiovascular System Emergencies

Acute Coronary Syndromes

• Immediate 12-lead ECG within 10 minutes of arrival for patients with chest pain or suspected ACS 1
• Rapid triage and risk stratification using vital signs (HR >100 bpm, SBP <100 mmHg) and signs of pulmonary congestion to identify high-risk patients 1
• Early administration of aspirin, nitroglycerin (if SBP >90 mmHg), and consideration of anticoagulation 1
• Activation of catheterization laboratory for STEMI with goal door-to-balloon time <90 minutes 2
• Continuous cardiac monitoring for arrhythmia detection 1

Cardiac Arrest

• High-quality CPR with minimal interruptions (30:2 compression-to-ventilation ratio) 1
• Early defibrillation for shockable rhythms (VF/pVT) 1
• Advanced airway management and IV/IO access for medication administration 1
• Post-resuscitation care including targeted temperature management and hemodynamic optimization 1

Cardiogenic Shock

• Immediate assessment of vital signs, tissue perfusion, and cardiac function 1
• Judicious fluid resuscitation if no pulmonary edema 1
• Vasopressor/inotropic support to maintain MAP >65 mmHg 1
• Early consideration of mechanical circulatory support in refractory cases 1

Respiratory System Emergencies

Respiratory Failure

• Rapid assessment of airway patency, breathing adequacy, and circulation 3
• Supplemental oxygen to maintain SpO2 >94% (88-92% in COPD) 1
• Positioning to optimize ventilation (upright for pulmonary edema, lateral for secretions) 3
• Early consideration of non-invasive ventilation for appropriate patients 1
• Endotracheal intubation for severe respiratory distress or failure 3

Status Asthmaticus

• Immediate administration of inhaled beta-agonists and anticholinergics 1
• Systemic corticosteroids for all moderate to severe exacerbations 1
• Consideration of IV magnesium sulfate for severe cases 1
• Continuous monitoring of respiratory status and response to therapy 3

Pulmonary Embolism

• Risk stratification based on hemodynamic stability 1
• Anticoagulation for stable patients without contraindications 1
• Consideration of thrombolysis for massive PE with hemodynamic compromise 1
• Supportive care with oxygen and hemodynamic support as needed 1

Neurological System Emergencies

Acute Stroke

• Rapid neurological assessment using standardized stroke scales 1
• Immediate CT imaging to differentiate ischemic from hemorrhagic stroke 1
• For ischemic stroke: consideration of thrombolysis within appropriate time window 1
• For hemorrhagic stroke: blood pressure control and reversal of anticoagulation if indicated 4
• Maintenance of adequate cerebral perfusion and oxygenation 1

Status Epilepticus

• Airway protection and oxygen administration 4
• First-line treatment with benzodiazepines (lorazepam or midazolam) 4
• Second-line treatment with antiepileptic drugs (fosphenytoin, valproate, or levetiracetam) 4
• Continuous EEG monitoring for refractory cases 4
• Treatment of underlying causes 4

Increased Intracranial Pressure

• Elevation of head of bed to 30 degrees 4
• Maintenance of adequate cerebral perfusion pressure 4
• Consideration of hyperosmolar therapy (mannitol or hypertonic saline) 4
• Avoidance of hypercapnia and hypoxemia 4
• Neurosurgical consultation for potential surgical intervention 4

Metabolic/Endocrine Emergencies

Diabetic Ketoacidosis

• Aggressive fluid resuscitation with isotonic fluids 1
• Insulin therapy (IV insulin infusion) 1
• Electrolyte replacement, particularly potassium 1
• Frequent monitoring of glucose, electrolytes, and acid-base status 1
• Treatment of precipitating factors 1

Severe Electrolyte Disturbances

• Hyperkalemia: ECG monitoring, calcium gluconate for cardiac protection, insulin with glucose, sodium bicarbonate, and dialysis in severe cases 1
• Hypokalemia: Potassium replacement and correction of underlying causes 1
• Hyponatremia: Rate of correction based on acuity, with caution to avoid osmotic demyelination 1
• Hypernatremia: Free water replacement at appropriate rate 1
• Hypercalcemia: IV fluids, bisphosphonates for severe cases 1

Thyroid Storm

• Beta-blockers for sympathetic overactivity 1
• Thionamides to block new hormone synthesis 1
• Iodine solutions to block hormone release 1
• Corticosteroids to block peripheral conversion of T4 to T3 1
• Supportive care including cooling measures and treatment of precipitating factors 1

Gastrointestinal Emergencies

Upper GI Bleeding

• Rapid assessment of hemodynamic status and resuscitation 1
• Early administration of proton pump inhibitors 1
• Blood product transfusion based on hemoglobin levels and hemodynamic status 1
• Early endoscopy for diagnosis and potential intervention 1
• Consideration of vasoactive medications for suspected variceal bleeding 1

Acute Liver Failure

• Assessment of encephalopathy grade and coagulopathy 1
• Correction of hypoglycemia and electrolyte abnormalities 1
• Management of increased intracranial pressure if present 1
• N-acetylcysteine for acetaminophen-induced liver failure 1
• Early consultation with liver transplant center 1

Acute Pancreatitis

• Aggressive fluid resuscitation 1
• Pain management 1
• Nutritional support (enteral preferred over parenteral) 1
• Monitoring for and management of complications (necrosis, infection) 1
• ERCP for gallstone pancreatitis with cholangitis or persistent biliary obstruction 1

Renal Emergencies

Acute Kidney Injury

• Identification and treatment of underlying cause 1
• Optimization of volume status 1
• Avoidance of nephrotoxic medications 1
• Management of electrolyte abnormalities and acidosis 1
• Renal replacement therapy for refractory hyperkalemia, acidosis, volume overload, or uremic symptoms 1

Urinary Retention

• Bladder catheterization for immediate relief 1
• Treatment of underlying cause (BPH, neurogenic bladder, medication effect) 1
• Pain management as needed 1
• Monitoring for post-obstructive diuresis 1

Toxicological Emergencies

Opioid Overdose

• Airway management and ventilatory support 1
• Administration of naloxone for respiratory depression 1
• For patients in cardiac arrest, standard resuscitative measures should take priority over naloxone administration 1
• Continuous monitoring for recurrence of respiratory depression 1
• Early activation of emergency response systems 1

Toxic Alcohol Ingestion

• Administration of fomepizole or ethanol to block alcohol dehydrogenase 1
• Correction of metabolic acidosis 1
• Consideration of hemodialysis for severe cases 1
• Supportive care and monitoring 1

Tricyclic Antidepressant Overdose

• ECG monitoring for QRS prolongation and arrhythmias 1
• Sodium bicarbonate for QRS widening or ventricular arrhythmias 1
• Benzodiazepines for seizures 1
• Supportive care including airway management 1

Psychiatric Emergencies

Acute Agitation/Violence

• Ensuring staff safety and appropriate environment 1
• Verbal de-escalation as first-line approach 1
• Chemical restraint if necessary (benzodiazepines, antipsychotics) 1
• Physical restraint as last resort with continuous monitoring 1
• Assessment for underlying medical causes of agitation 1

Suicidal Ideation

• Immediate safety measures including constant observation 1
• Thorough risk assessment 1
• Treatment of underlying psychiatric conditions 1
• Involvement of psychiatric consultation 1
• Development of safety plan prior to disposition 1

Mass Casualty and Disaster Response

Mass Casualty Incidents

• Implementation of hospital incident command system 1
• Rapid triage using established systems (START, JumpSTART for pediatrics) 1
• Resource allocation based on surge capacity 1
• Coordination with regional healthcare coalition and emergency management 1
• Transition to crisis standards of care when necessary 1

Palliative Care in Disasters

• Integration of palliative care principles in disaster response 1
• Focus on symptom management for those unlikely to survive 1
• Psychological support for patients and families 1
• Ethical resource allocation 1

Common Pitfalls and Caveats

• Failure to recognize early signs of deterioration before overt decompensation occurs 5
• Delayed activation of specialized response teams (stroke, STEMI, trauma) 1
• Inadequate attention to airway management in altered mental status 3
• Underestimation of fluid resuscitation needs in shock states 1
• Overreliance on single interventions rather than comprehensive approach 2
• Neglect of mental health aspects during medical emergencies 1
• Failure to reassess patients after interventions 3
• Delayed transfer to definitive care settings 5