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

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.