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Top 20 Medical Emergencies Presenting in the Emergency Department and How to Deal with Them

Discussion in 'Emergency Medicine' started by Egyptian Doctor, May 20, 2024.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Mar 21, 2011
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    1. Acute Myocardial Infarction (AMI)
    • Presentation: chest pain, diaphoresis, nausea, shortness of breath.
    • Initial Management:
      • Administer oxygen.
      • Perform an ECG within 10 minutes.
      • Administer aspirin and nitroglycerin.
      • Consider morphine for pain.
      • Initiate anticoagulation (heparin).
      • Prepare for possible thrombolysis or PCI.
    2. Stroke
    • Presentation: Sudden onset of weakness, facial droop, speech difficulties, altered consciousness.
    • Initial Management:
      • Perform a rapid neurological assessment (NIHSS score).
      • Immediate CT scan to differentiate between ischemic and hemorrhagic stroke.
      • For ischemic stroke, administer tPA if within the window period (usually 4.5 hours).
      • Control blood pressure cautiously.
      • Initiate supportive care and monitor for complications.
    3. Sepsis
    • Presentation: Fever, chills, hypotension, tachycardia, altered mental status.
    • Initial Management:
      • Early recognition and aggressive management are crucial.
      • Obtain blood cultures and other relevant cultures.
      • Initiate broad-spectrum antibiotics within the first hour.
      • Administer intravenous fluids (30 mL/kg of crystalloid).
      • Monitor urine output and consider vasopressors if hypotension persists.
    4. Pulmonary Embolism (PE)
    • Presentation: Sudden onset of dyspnea, chest pain, tachypnea, tachycardia.
    • Initial Management:
      • Assess using Wells score or Geneva score.
      • Perform a CT pulmonary angiogram.
      • Administer anticoagulation therapy (heparin).
      • Consider thrombolytic therapy for massive PE with hemodynamic instability.
      • Monitor for signs of right heart strain.
    5. Anaphylaxis
    • Presentation: Urticaria, angioedema, wheezing, hypotension, gastrointestinal symptoms.
    • Initial Management:
      • Immediate administration of intramuscular epinephrine (0.3-0.5 mg).
      • Maintain airway and provide oxygen.
      • Administer antihistamines and corticosteroids.
      • Start intravenous fluids for hypotension.
      • Observe the patient for at least 4-6 hours due to the risk of biphasic reaction.
    6. Acute Asthma Exacerbation
    • Presentation: Shortness of breath, wheezing, cough, chest tightness.
    • Initial Management:
      • Administer nebulized albuterol and ipratropium.
      • Administer systemic corticosteroids.
      • Provide supplemental oxygen to maintain SpO2 > 92%.
      • Monitor peak expiratory flow rate.
      • Consider magnesium sulfate for severe cases.
    7. Cardiac Arrest
    • Presentation: Unresponsive, no pulse, apnea or agonal breathing.
    • Initial Management:
      • Initiate immediate CPR with high-quality chest compressions.
      • Use an automated external defibrillator (AED) if available.
      • Advanced cardiac life support (ACLS) protocols: airway management, IV access, administration of epinephrine.
      • Identify and treat reversible causes (Hs and Ts).
    8. Trauma
    • Presentation: Varies depending on the mechanism (e.g., blunt, penetrating); often includes altered consciousness, obvious injuries, and hemodynamic instability.
    • Initial Management:
      • Follow Advanced Trauma Life Support (ATLS) protocols.
      • Perform primary survey (ABCDE approach).
      • Control hemorrhage and stabilize the patient.
      • Obtain imaging (e.g., FAST scan, X-rays).
      • Coordinate with trauma surgery for definitive care.
    9. Diabetic Ketoacidosis (DKA)
    • Presentation: Polyuria, polydipsia, nausea, vomiting, abdominal pain, altered mental status, fruity breath odor.
    • Initial Management:
      • Confirm diagnosis with blood glucose, ketones, and arterial blood gas.
      • Initiate IV fluids (normal saline).
      • Administer insulin infusion.
      • Correct electrolyte imbalances, especially potassium.
      • Monitor for signs of cerebral edema.
    10. Acute Respiratory Distress Syndrome (ARDS)
    • Presentation: Severe dyspnea, hypoxemia, bilateral infiltrates on chest X-ray.
    • Initial Management:
      • Provide mechanical ventilation with low tidal volumes.
      • Apply positive end-expiratory pressure (PEEP).
      • Treat underlying cause (e.g., sepsis, trauma).
      • Ensure adequate sedation and analgesia.
      • Monitor and adjust ventilator settings based on blood gases.
    11. Pneumothorax
    • Presentation: Sudden onset of pleuritic chest pain, dyspnea, decreased breath sounds on the affected side.
    • Initial Management:
      • Perform a chest X-ray to confirm diagnosis.
      • For tension pneumothorax, perform immediate needle decompression followed by chest tube placement.
      • For simple pneumothorax, insert a chest tube if the patient is symptomatic.
      • Monitor for resolution and complications.
    12. Acute Pancreatitis
    • Presentation: Severe epigastric pain radiating to the back, nausea, vomiting, abdominal tenderness.
    • Initial Management:
      • Confirm diagnosis with elevated serum amylase and lipase levels.
      • Administer IV fluids aggressively.
      • Provide pain management (e.g., opioids).
      • Monitor for complications (e.g., pseudocyst, necrosis).
      • Address underlying causes (e.g., gallstones, alcohol).
    13. Acute Kidney Injury (AKI)
    • Presentation: Oliguria, elevated serum creatinine, fluid overload, electrolyte abnormalities.
    • Initial Management:
      • Identify and treat the underlying cause (e.g., dehydration, sepsis).
      • Administer IV fluids for pre-renal causes.
      • Adjust medications that may be nephrotoxic.
      • Monitor electrolytes and acid-base balance.
      • Consider dialysis if indicated.
    14. Severe Hypertension (Hypertensive Emergency)
    • Presentation: Severe headache, visual disturbances, chest pain, neurological deficits.
    • Initial Management:
      • Measure blood pressure and confirm hypertensive emergency.
      • Administer IV antihypertensive agents (e.g., nitroprusside, labetalol).
      • Monitor blood pressure closely.
      • Evaluate for end-organ damage (e.g., ECG, urinalysis, CT scan).
      • Gradually reduce blood pressure to avoid rapid changes.
    15. Upper Gastrointestinal Bleeding
    • Presentation: Hematemesis, melena, hypotension, tachycardia.
    • Initial Management:
      • Stabilize the patient with IV fluids and blood transfusions as needed.
      • Administer proton pump inhibitors (PPIs) intravenously.
      • Perform an urgent endoscopy for diagnosis and treatment.
      • Consider octreotide for variceal bleeding.
      • Monitor for re-bleeding and complications.
    16. Meningitis
    • Presentation: Fever, headache, neck stiffness, photophobia, altered mental status.
    • Initial Management:
      • Perform a lumbar puncture for cerebrospinal fluid analysis.
      • Administer empirical antibiotics immediately after blood cultures (e.g., ceftriaxone, vancomycin).
      • Consider dexamethasone to reduce inflammation.
      • Isolate the patient to prevent the spread of infection.
      • Monitor for complications such as seizures.
    17. Status Epilepticus
    • Presentation: Continuous or repetitive seizures without regaining consciousness between episodes.
    • Initial Management:
      • Ensure airway patency and provide oxygen.
      • Administer IV benzodiazepines (e.g., lorazepam) as the first-line treatment.
      • Follow with IV antiepileptics (e.g., fosphenytoin or valproate).
      • Monitor vital signs and maintain continuous EEG if possible.
      • Identify and treat underlying causes.
    18. Acute Heart Failure
    • Presentation: Severe dyspnea, orthopnea, edema, jugular venous distention, crackles on lung auscultation.
    • Initial Management:
      • Administer oxygen and consider non-invasive ventilation (CPAP or BiPAP).
      • Administer IV diuretics (e.g., furosemide).
      • Use vasodilators (e.g., nitroglycerin) for blood pressure control.
      • Monitor fluid balance and electrolyte levels.
      • Treat underlying causes (e.g., myocardial infarction, arrhythmias).
    19. Hypoglycemia
    • Presentation: Sweating, tremors, confusion, seizures, loss of consciousness.
    • Initial Management:
      • Check blood glucose levels.
      • Administer oral glucose if the patient is conscious and able to swallow.
      • For unconscious patients, administer intravenous dextrose.
      • Monitor glucose levels and adjust treatment to maintain normoglycemia.
      • Identify and address the underlying cause of hypoglycemia.
    20. Hyperkalemia
    • Presentation: Muscle weakness, palpitations, ECG changes (peaked T waves, widened QRS).
    • Initial Management:
      • Confirm hyperkalemia with serum potassium levels.
      • Administer calcium gluconate to stabilize the cardiac membrane.
      • Use insulin and glucose to shift potassium into cells.
      • Administer sodium bicarbonate and beta-agonists if needed.
      • Consider dialysis in severe cases or if refractory to medical management.
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    Last edited: May 26, 2024

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