What are the initial steps in managing emergency medicine situations?

Initial Management of Emergency Medicine Situations

The initial approach to any emergency situation follows the ABC (Airway, Breathing, Circulation) sequence, with immediate assessment and simultaneous intervention by the team to address life-threatening problems first. 1

Primary Survey: The ABCDE Approach

A - Airway

• Immediately assess airway patency by looking for signs of obstruction: inability to speak in complete sentences, stridor, or absent breath sounds 1, 2
• If the airway is compromised, open it using head-tilt/chin-lift or jaw-thrust maneuvers 1
• Intubate immediately if the patient is unconscious, confused, or has severe respiratory distress - do not delay for the most experienced provider available 1
• Remove any visible foreign bodies or secretions 2

B - Breathing

• Administer 100% oxygen immediately to all patients in emergency situations via face mask or bag-mask device 1
• Assess respiratory rate (normal: 12-20 breaths/min; concerning if >25 breaths/min in adults) 1
• Look for signs of respiratory distress: use of accessory muscles, cyanosis, paradoxical chest movement 1
• If respiratory rate >25/min or patient cannot complete sentences, this indicates severe compromise requiring immediate intervention 1
• Provide ventilatory support with bag-mask device if spontaneous breathing is inadequate 1

C - Circulation

• Check pulse immediately - if absent, begin CPR with chest compressions at a rate of 100-120/min 1
• For healthcare providers: start with chest compressions rather than ventilation to minimize time to first compression 1
• Assess heart rate (concerning if >110 beats/min or bradycardia present) 1
• Establish large-bore IV access immediately (two sites preferred) 1
• Measure blood pressure - hypotension requires immediate fluid resuscitation 1

D - Disability

• Rapidly assess neurological status using AVPU (Alert, Voice, Pain, Unresponsive) or Glasgow Coma Scale 3
• If patient is unconscious or confused, call for immediate senior help and prepare for advanced airway management 1
• Check pupil size and reactivity 3

E - Exposure

• Fully expose the patient to identify injuries, rashes, or other signs of pathology 3
• Maintain temperature control to prevent hypothermia 3

Critical Decision Points

When to Call for Help

Call for help immediately if any of the following are present: 1

• Unconsciousness or confusion
• Respiratory rate >25/min or <10/min
• Heart rate >110/min or <50/min
• Systolic blood pressure <90 mmHg
• Inability to complete sentences
• Oxygen saturation <90% despite supplemental oxygen

Prioritization Between Patients

Treat patients with life-threatening airway, breathing, or circulation problems first, regardless of order of arrival 4

• Cardiac arrest takes absolute priority
• Severe respiratory distress or airway obstruction is second priority
• Uncontrolled hemorrhage is third priority

Specific Life-Threatening Scenarios

Anaphylaxis Recognition

If cardiovascular collapse, severe hypotension, or bronchospasm with recent allergen exposure: 1, 5

• Administer epinephrine 50 mcg IV (0.5 mL of 1:10,000) immediately - repeat every few minutes as needed 1, 5
• Give high-flow oxygen and elevate legs 1, 5
• Infuse normal saline rapidly: 1-2 L at 5-10 mL/kg in first 5 minutes (up to 7 L may be required) 5
• Remove all potential causative agents 1

Severe Asthma

If peak flow <50% predicted or inability to complete sentences: 1

• Administer oxygen 40-60% immediately 1
• Nebulized salbutamol 5 mg or terbutaline 10 mg via oxygen-driven nebulizer 1
• Prednisolone 30-60 mg orally or hydrocortisone 200 mg IV 1
• Arrange immediate hospital admission 1

Cardiac Arrest

Begin chest compressions immediately at 100-120/min, depth 2-2.4 inches 1

• Minimize interruptions in compressions 1
• Provide 2 breaths after every 30 compressions if trained 1
• Apply defibrillator/AED as soon as available 1

Common Pitfalls to Avoid

• Do not delay treatment to obtain complete history - intervene based on vital signs and general appearance first 4
• Do not assume the most probable diagnosis - always consider and protect against the most serious potential diagnosis first 4
• Do not perform procedures beyond your competence level - call for senior help early 1
• Do not give IV fluids slowly in shock states - aggressive fluid resuscitation with large-bore access is required 1, 5
• Do not delay epinephrine in suspected anaphylaxis - it is the definitive treatment and should be given immediately 1, 5, 6

Documentation Requirements

Record immediately: 1

• Time of presentation and time of each intervention
• Vital signs at presentation and after each intervention
• All medications administered with doses and times
• Response to treatment