What are the most common medical emergencies and their management?

Most Common Medical Emergencies and Their Management

The most common medical emergencies requiring immediate intervention include cardiac arrest, hypertensive emergencies, anaphylaxis, head and neck injuries, heat illness, respiratory distress, and diabetic emergencies, with high-quality CPR and early defibrillation being critical first steps in cardiac arrest management.

Cardiac Emergencies

Cardiac Arrest

• Recognition of cardiac arrest requires prompt activation of emergency response system and immediate initiation of cardiopulmonary resuscitation (CPR) 1
• High-quality CPR includes:
  • Adequate compression depth (2-2.4 inches/5-6 cm)
  • Appropriate rate (100-120 compressions per minute)
  • Minimal interruptions in compressions 1
• Early defibrillation with concurrent high-quality CPR is critical for survival in ventricular fibrillation or pulseless ventricular tachycardia 1
• Administration of epinephrine (1 mg IV/IO every 3-5 minutes) improves survival, particularly in patients with non-shockable rhythms 1, 2
• The probability of survival drops by 7-10% for every minute of active cardiac arrest without intervention 1
• Survival rate approaches 89% with properly administered CPR and automated external defibrillator (AED) use 1
• AEDs should be strategically located to ensure arrival at the scene with a target goal of collapse-to-shock in less than 3 minutes 1

Hypertensive Emergencies

• Defined as severe blood pressure elevation (typically >180/120 mmHg) with evidence of acute end-organ damage 1, 3
• Target organs affected include heart, retina, brain, kidneys, and large arteries 1, 3
• Management requires:
  • Immediate but careful BP reduction based on the type of organ damage 1
  • Reduction of systolic BP by maximum 25% within the first hour 3
  • If stable, aim for 160/100 mmHg within 2-6 hours, then gradual normalization within 24-48 hours 3
• First-line intravenous medications include:
  • Nicardipine: Initial dose 5 mg/h, increasing by 2.5 mg/h every 5 minutes to maximum 15 mg/h 3
  • Clevidipine: Initial dose 1-2 mg/h, doubling every 90 seconds until approaching target 3
  • Sodium nitroprusside: Initial dose 0.3-0.5 μg/kg/min 3
  • Nitroglycerin: Initial dose 5 μg/min, increasing by 5 μg/min every 3-5 minutes 3

Allergic Emergencies

Anaphylaxis

• Emergency treatment requires prompt administration of epinephrine 2
• Dosing for adults and children ≥30 kg: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly into anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2
• Dosing for children <30 kg: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly into anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2
• Do not inject epinephrine into buttocks, digits, hands, or feet due to risk of tissue damage 2
• Monitor for adverse reactions including anxiety, tremor, dizziness, palpitations, headache, and respiratory difficulties 2

Traumatic Emergencies

Head and Neck Injuries

• Require immediate stabilization of the cervical spine and airway management 1
• Assessment for signs of increased intracranial pressure including altered mental status, pupillary abnormalities, and abnormal posturing 1
• Maintain adequate cerebral perfusion by avoiding hypotension and hypoxia 1
• For suspected concussion, follow a comprehensive protocol for diagnosis, management, and return to activity 1

Environmental Emergencies

Heat Illness and Heat Stroke

• Exertional heatstroke is characterized by extreme hyperthermia (>40.0°C/104°F) and central nervous system dysfunction 1
• Core body temperature should be measured using rectal thermometry, as other methods (axillary, tympanic, temporal, oral, skin) are not reliable 1
• Full-body immersion in cold water (1.7°C–15.0°C/35°–59°F) is the most effective immediate treatment 1
• Continue cooling until body temperature is below 38.9°C/102°F 1
• Monitor body temperature continuously with rectal thermometry during cooling 1
• Transport should occur after cooling has begun, not before 1

Metabolic Emergencies

Diabetic Emergencies

• Require rapid assessment of blood glucose levels and mental status 1
• For hypoglycemia:
  • Conscious patients: Administer oral glucose (15-20g) 1
  • Unconscious patients: Administer IV dextrose (D50W 25-50 mL) or glucagon 1 mg IM/SC 1
• For hyperglycemic crisis (DKA/HHS):
  • Begin fluid resuscitation with normal saline 1
  • Administer insulin per protocol (typically 0.1 units/kg/hr IV) 1
  • Monitor electrolytes, particularly potassium 1

Respiratory Emergencies

Asthma/Respiratory Distress

• Immediate assessment of airway, breathing, and circulation 1
• Administration of bronchodilators (albuterol via nebulizer or metered-dose inhaler with spacer) 1
• Supplemental oxygen to maintain saturation >94% 1
• For severe cases, consider systemic corticosteroids and magnesium sulfate 1
• Schools and other institutions should maintain emergency supplies of medications for children with known asthma 1

Special Considerations

Opioid-Associated Emergencies

• The opioid epidemic has resulted in increased opioid-associated out-of-hospital cardiac arrest 1
• Management includes activation of emergency response systems and high-quality CPR 1
• Administration of naloxone for suspected opioid overdose 1

Mental Health Emergencies

• Require assessment for risk of harm to self or others 1
• Ensure patient and provider safety 1
• De-escalation techniques should be employed when possible 1
• Consider pharmacological intervention for acute agitation when necessary 1

Emergency Response Planning

Emergency Action Plans

• All institutions should develop well-rehearsed, venue-specific emergency action plans for common emergencies 1
• Plans should include specific protocols for:
  • Head and neck injury
  • Cardiac arrest
  • Heat illness and heat stroke
  • Exertional rhabdomyolysis
  • Exertional collapse associated with sickle cell trait
  • Any exertional or non-exertional collapse
  • Asthma
  • Diabetic emergency
  • Mental health emergency 1
• Regular practice of emergency protocols through simulated exercises or "mock codes" improves response 1
• Equipment necessary to execute emergency action plans should be readily available at all venues 1

Post-Emergency Care

Post-Cardiac Arrest Care

• A critical component of the Chain of Survival requiring comprehensive, structured, multidisciplinary care 1
• Targeted temperature management for patients who do not follow commands after return of spontaneous circulation 1
• Accurate neurological prognostication to ensure patients with recovery potential receive appropriate care 1
• Recovery plans addressing treatment, surveillance, and rehabilitation should be provided to survivors 1

Follow-up for Hypertensive Emergencies

• Patients who have experienced a hypertensive emergency remain at increased risk for cardiovascular and renal disease 1
• Regular follow-up visits should be scheduled to monitor blood pressure control and organ function 1
• Medication adherence counseling is crucial for preventing recurrence 1

Common Pitfalls in Emergency Management

• Delayed recognition of cardiac arrest leading to delayed CPR initiation 1
• Inadequate compression depth or excessive interruptions during CPR 1
• Using non-rectal temperature measurement methods in suspected heat stroke 1
• Failure to promptly administer epinephrine in anaphylaxis 2
• Excessive blood pressure reduction (>25% in first hour) in hypertensive emergencies 3
• Injecting epinephrine into incorrect anatomical locations (buttocks, digits, hands, feet) 2
• Inadequate post-emergency monitoring and follow-up 1