What are the common medical emergencies?

Common Medical Emergencies

The most common medical emergencies requiring immediate recognition and treatment include cardiac arrest, respiratory emergencies (severe asthma, choking, anaphylaxis), injuries with hemorrhage and shock, seizures, hypoglycemia, stroke, heatstroke, and drug overdose. 1

Life-Threatening Emergencies by Population

In Children and Young Adults

Injuries represent the leading cause of death in children and young adults, surpassing all other diseases combined. 1 These typically present with:

• Respiratory distress or airway obstruction leading to secondary cardiac arrest 1
• Hemorrhagic shock from blood loss requiring immediate hemorrhage control and breathing support 1
• Severe asthma requiring bronchodilator administration and possible rescue breathing 1

In Adults

The most frequent life-threatening emergencies include:

• Cardiac arrest (particularly sudden cardiac arrest in adults during school activities or work) 1
• Severe asthma requiring immediate inhaler use or nebulized bronchodilators 1, 2
• Anaphylaxis (severe allergic reactions from bee stings, food, latex, or medications) requiring epinephrine autoinjector administration 1
• Choking requiring airway opening maneuvers 1
• Drug overdose including opioids and QT-prolonging medications 1, 3
• Heatstroke requiring immediate cooling measures 1

Respiratory Emergencies

Severe Asthma

Severe asthma can progress to respiratory arrest with extreme hypercapnia (mean PaCO2 97 mm Hg) and severe acidosis (mean pH 7.01), with death resulting from asphyxia rather than cardiac arrhythmias. 2 Key features include:

• Sudden onset with rapidly progressive crisis in patients with long disease history 2
• Delay in seeking medical care as a critical risk factor 2
• Immediate bronchodilator administration via metered-dose inhaler with spacer is essential 1

Anaphylaxis

Anaphylaxis can progress to cardiac arrest within minutes despite prompt recognition and treatment, with a 2.5% cardiac arrest rate even in hospital settings with immediate protocol implementation. 4 Critical management includes:

• Immediate epinephrine 0.3 mg intramuscularly for adults and children >30 kg, or 0.15 mg for children 15-30 kg 1
• Repeat dosing after 5-10 minutes if no response and advanced care delayed 1
• More aggressive approach with intravenous epinephrine infusion for potentially fatal presentations 4
• Drug-related triggers represent a substantial and growing risk, particularly in older adults 5

Choking

For witnessed choking with visible obstruction in infants, deliver 5 back blows followed by 5 chest thrusts, checking the mouth between cycles. 6 Critical technique points:

• Hold infants prone along forearm with head lower than chest for back blows 6
• Use chest thrusts (never abdominal thrusts) in infants under 1 year to avoid visceral rupture 6

Cardiac Emergencies

Cardiac Arrest

In children, cardiac arrest is typically secondary to respiratory failure or shock rather than primary cardiac events, requiring emphasis on early CPR and rescue breathing. 1 Management priorities:

• Chest compressions at 100/minute with 5:1 compression-to-ventilation ratio regardless of rescuer number 6
• Compression depth of one-third chest diameter 6
• Cardioversion starting at 0.5-1 J/kg, increasing to 2 J/kg if unsuccessful 6
• Immediate bystander CPR doubles survival in adults with sudden cardiac arrest 1

Chest Pain/Myocardial Infarction

Call EMS immediately for anyone with chest pain or heart attack signs rather than attempting self-transport. 1 While waiting:

• Encourage aspirin administration if signs suggest heart attack and no allergy or contraindication exists 1
• Do not encourage aspirin if chest pain appears non-cardiac or provider is uncertain 1

Metabolic Emergencies

Severe Hypoglycemia

For severe hypoglycemia with altered mental status, immediately administer 10-20 grams IV 50% dextrose, stop insulin infusion, and recheck glucose in 15 minutes with repeat dosing until glucose exceeds 70 mg/dL. 7, 8 Critical distinctions:

• Unconscious, seizing, or unable to follow commands = immediate EMS activation 8
• Conscious and able to swallow = 15-20 grams oral glucose immediately 1, 7, 8
• Glucagon 1 mg IM can be administered by family members when IV access unavailable 7, 8
• Never attempt oral glucose in unconscious patients due to aspiration risk 7
• Recheck glucose every 15 minutes until stabilized above 70 mg/dL 7

Dehydration

For exertional dehydration without shock, confusion, or swallowing difficulty, assist with oral rehydration using carbohydrate-electrolyte drinks. 1 If unavailable, potable water may be used. 1

Neurological Emergencies

Stroke

Use a stroke assessment system for first aid provider evaluation. 1 Immediate EMS activation is critical for time-dependent interventions.

Seizures

Seizures represent one of the most common pediatric emergencies in primary care settings. 1 Management includes:

• Protect from injury during seizure activity
• Position on side to maintain airway
• Time seizure duration (>5 minutes requires EMS activation)
• Do not restrain or place objects in mouth

Toxic Emergencies

Chemical Eye Injury

Rinse eyes exposed to toxic chemicals immediately with copious tap water for at least 15 minutes or until advanced care arrives. 1 If tap water unavailable, normal saline or commercial eye irrigation solution may be used. 1

Drug Overdose

Drug overdose represents a significant cause of cardiac arrest in young adults, including opioids and QT-prolonging medications. 1, 3 Immediate priorities:

• Airway management and ventilatory support
• Urine toxicology testing 3
• Reversal agents when indicated (naloxone for opioids)
• Cardiac monitoring for arrhythmias

Environmental Emergencies

Heatstroke

Immediate cooling measures are time-dependent and critical for survival. 1 Management includes:

• Remove from heat source immediately
• Active cooling with ice packs to groin, axillae, neck
• Continuous temperature monitoring
• Rapid EMS transport

Critical Pitfalls to Avoid

The most dangerous pitfall is delay in EMS activation—67% of schools activate EMS for students and 37% for adults annually, yet delays in seeking care contribute significantly to mortality. 1 Additional pitfalls:

• Underestimating severity of asthma exacerbations (undertreatment contributes to mortality) 2
• Attempting oral glucose in unconscious patients (aspiration risk) 7
• Using abdominal thrusts in infants (visceral rupture risk) 6
• Delaying epinephrine in anaphylaxis (progression to arrest can occur within minutes) 4
• Routine hyperventilation in head injury (avoid unless specific indications) 6

Preparedness Requirements

Primary care offices see a median of 24 emergencies per year, with 82% encountering at least one emergency monthly, yet many practices lack adequate equipment and training. 1 Essential preparedness includes:

• First aid training for all staff in recognition and initial treatment 1
• CPR and AED training (improves survival when bystander-initiated) 1
• Emergency equipment including epinephrine autoinjectors, bronchodilators, oxygen, glucose, and AED 1
• Emergency action plans for high-risk patients with chronic conditions 1