What are the standard protocols for emergency care in life-threatening situations?

Emergency Care Protocols for Life-Threatening Situations

Immediate Priorities: The ABC Approach

For any life-threatening emergency, immediately prioritize Airway, Breathing, and Circulation (ABC) using standard Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) protocols before attempting any specific diagnosis or treatment—this foundational approach determines survival. 1, 2

Initial Assessment and Activation

• Check for unresponsiveness and immediately activate emergency medical services (EMS/9-1-1) without delay while simultaneously beginning assessment 1
• Never delay calling for help while attempting interventions or awaiting response to treatments 1
• If alone with a victim, provide approximately 2 minutes of CPR before leaving to activate EMS 1

Cardiac Arrest Management

For patients in confirmed or suspected cardiac arrest (unresponsive with no breathing or only gasping), immediately begin high-quality CPR with chest compressions plus ventilation as the primary life-saving intervention. 1

CPR Protocol

• Deliver compressions at 100-120 per minute with depth of at least 2 inches (5 cm) in adults, allowing complete chest recoil between compressions 1
• Provide ventilations with compressions in a 30:2 ratio for single rescuers or 15:2 for two-rescuer pediatric CPR 1
• Minimize interruptions in chest compressions—any pause reduces perfusion and worsens outcomes 1
• Apply automated external defibrillator (AED) as soon as available and deliver shocks for ventricular fibrillation/pulseless ventricular tachycardia 1

Common Pitfall

Do not waste time checking for a pulse if you are not highly trained—if the patient is unresponsive with no normal breathing, assume cardiac arrest and begin CPR immediately 1

Respiratory Arrest (Pulse Present, No Breathing)

For patients with a definite pulse but absent or only gasping respirations, immediately provide rescue breathing or bag-mask ventilation until spontaneous breathing returns. 1

• Deliver one breath every 5-6 seconds (10-12 breaths per minute) for adults 1
• Deliver one breath every 3-5 seconds (12-20 breaths per minute) for infants and children 1
• Recheck pulse every 2 minutes; if pulse is lost, immediately begin full CPR 1

Airway Obstruction (Choking)

For severe airway obstruction in a responsive adult (cannot speak, silent cough, cyanosis), immediately perform abdominal thrusts (Heimlich maneuver) repeatedly until the object is expelled or the victim becomes unresponsive. 1

• If the victim becomes unresponsive, lower them to the ground and begin CPR 1
• Each time you open the airway during CPR, look for a visible object in the mouth and remove it if seen—do not perform blind finger sweeps 1

Opioid Overdose

For suspected opioid overdose with respiratory arrest (definite pulse present but no normal breathing), provide rescue breathing or bag-mask ventilation as the primary intervention, then administer intranasal or intramuscular naloxone as an adjunct. 1

Naloxone Administration Protocol

• Administer naloxone 0.4-2 mg intranasal or intramuscular as soon as available 1
• Continue ventilatory support—naloxone does not replace the need for airway management and breathing support 1
• If the patient is in cardiac arrest (no definite pulse), focus on high-quality CPR; naloxone has no proven benefit during cardiac arrest and should not delay resuscitation 1
• Observe patients for at least 2 hours after naloxone administration, longer for long-acting or sustained-release opioids 2

Poisoning and Toxidromes

Immediately stabilize airway, breathing, and circulation before attempting toxidrome identification—supportive care determines survival, not specific antidote administration. 2, 3

Toxidrome Recognition

• Contact Poison Control Center (1-800-222-1222) or medical toxicologist early in management to prevent deterioration 2
• Identify constellation of signs suggesting specific toxin class: altered mental status, vital sign abnormalities, pupil size, skin findings, and seizures 2

Specific Toxin Management

• For organophosphate poisoning with seizures, administer benzodiazepines as first-line anticonvulsant therapy 3
• For methemoglobinemia, administer methylene blue 1-2 mg/kg IV over 5 minutes as the definitive treatment 1
• Perform dermal decontamination by removing contaminated clothing and copious irrigation with soap and water 3

Critical Pitfall

Never delay emergency response activation or basic resuscitation while attempting decontamination or awaiting antidote availability 2, 3

Drowning

Remove the drowning victim from water by the fastest means available and immediately begin rescue breathing—provide 5 initial rescue breaths before starting chest compressions if needed. 1

• Provide 5 cycles (approximately 2 minutes) of CPR before leaving a lone victim to activate EMS 1
• Do not attempt abdominal thrusts or other maneuvers to remove water—water does not act as an obstructive foreign body and such maneuvers delay CPR 1
• Consider spinal immobilization only if there is obvious injury, diving into shallow water, or alcohol intoxication 1

Hypothermia

For unresponsive hypothermic patients with no normal breathing, begin CPR immediately—do not wait to check temperature or attempt rewarming before starting resuscitation. 1

• Check for pulse up to 10 seconds (breathing and pulse may be very slow), but if no definite pulse is felt, begin CPR immediately 1
• Remove wet clothing, insulate from further heat loss, and ventilate with warm humidified oxygen if available 1
• Continue resuscitation efforts until the patient is evaluated by advanced care providers—patients are not dead until they are warm and dead 1
• If ventricular fibrillation is detected, deliver shocks using standard protocols 1

Positioning and Movement

Do not move an ill or injured person unless the area is unsafe or the airway is obstructed—movement may worsen spinal or pelvic injuries. 1

Recovery Position

• For unresponsive patients with normal breathing and no suspected spinal injury, place in lateral side-lying recovery position to maintain airway patency 1
• Extend one arm above the head, roll to the side so the head rests on the extended arm, and bend both legs for stability 1

Spinal Precautions

• For suspected neck, back, hip, or pelvic injury, leave the patient in the position found unless the airway is blocked or the area is unsafe 1
• Move only as minimally necessary to open the airway or reach safety 1

Seizure Management in Emergency Settings

For active seizures, protect the patient from injury, position on their side if possible, and administer benzodiazepines if seizures persist beyond 5 minutes or recur. 3

• Midazolam 0.2 mg/kg intramuscular (maximum 10 mg) is the preferred benzodiazepine for out-of-hospital seizure management 4
• Ensure immediate availability of oxygen, bag-valve-mask equipment, and airway management tools before administering benzodiazepines due to respiratory depression risk 4
• Monitor continuously for hypoventilation, airway obstruction, or apnea with pulse oximetry 4

Pediatric Considerations

Calculate all medication doses on a mg/kg basis for pediatric patients—younger children (under 6 years) generally require higher mg/kg doses than older children and adults. 4

• For obese pediatric patients, calculate doses based on ideal body weight, not actual weight 4
• Pediatric patients require age- and size-appropriate equipment for airway management and resuscitation 4
• A dedicated individual other than the proceduralist should monitor deeply sedated pediatric patients throughout procedures 4

Critical Care Triage in Mass Casualty Events

When resources are overwhelmed, prioritize patients most likely to survive with available interventions—focus on those with reversible life-threatening conditions. 1

Exclusion Criteria for Critical Care (When Resources Scarce)

• Unwitnessed cardiac arrest or cardiac arrest unresponsive to defibrillation 1
• Severe trauma with predicted mortality >80% 1
• Severe burns in patients >60 years with >40% body surface area affected and inhalation injury 1
• End-stage organ failure (NYHA Class III-IV heart failure, severe COPD with FEV1 <25%, Child-Pugh score ≥7) 1

Essential Equipment and Personnel Requirements

All settings where sedation or emergency procedures occur must have immediately available oxygen, resuscitative drugs, age-appropriate bag-valve-mask equipment, intubation supplies, and personnel trained in airway management. 4

• Continuous monitoring with pulse oximetry is mandatory during any sedation or high-risk procedure 4
• Flumazenil (benzodiazepine reversal agent) should be immediately available whenever benzodiazepines are administered 4
• Vital signs must continue to be monitored throughout the recovery period 4