Module 5: Medical Emergencies

Section 1: Neurological Emergencies

1.1 Stroke (Cerebrovascular Accident - CVA)

• Types:

  • Ischemic Stroke: Caused by a blood clot obstructing blood flow to the brain

  • Hemorrhagic Stroke: Caused by bleeding in the brain

• Signs and Symptoms:

  • Sudden onset of facial droop, arm or leg weakness (typically unilateral), and speech difficulty

  • Severe headache (hemorrhagic)

  • Altered mental status (AMS)

• Assessment:

  • Use the Cincinnati Stroke Scale or FAST method

    • Facial droop: Ask the patient to smile

    • Arm drift: Ask the patient to hold both arms up

    • Speech: Assess clarity of speech

  • Determine the time of onset of symptoms (critical for treatment eligibility)

• Prehospital Care:

  • Administer oxygen to maintain SpO₂ >94%.

  • Keep the patient in a supine or slightly elevated position to improve cerebral perfusion

  • Avoid lowering BP unless directed by medical control or it exceeds 220/120 mmHg

  • Notify the receiving stroke center early for preparation of thrombolytic therapy

1.2 Seizures

• Types:

  • Generalized (tonic-clonic): Whole-body convulsions

  • Partial (focal): Localized movements or symptoms

  • Status Epilepticus: A seizure lasting longer than 5 minutes or multiple seizures without regaining consciousness

• Signs and Symptoms:

  • Uncontrolled muscle movements, foaming at the mouth, incontinence, and postictal confusion

• Prehospital Care:

  • Protect the patient from injury (move objects away, cushion the head)

  • Do not restrain the patient or place anything in their mouth

  • Administer benzodiazepines for status epilepticus

    • Midazolam 2.5-5 mg IV/IM

  • Monitor airway and suction secretions if necessary

  • Assess for underlying causes, such as hypoglycemia or trauma

1.3 Altered Mental Status (AMS)

• Causes:

  • Use AEIOU-TIPS mnemonic:

    • Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychosis, Stroke

• Assessment:

  • Check blood glucose levels (treat hypoglycemia with D10W or D50W IV)

  • Look for signs of trauma or intoxication

  • Assess vital signs for infection or sepsis clues

• Prehospital Care:

  • Administer naloxone 0.4-2 mg IV/IN if opioid overdose is suspected

  • Provide supportive care based on findings

Section 2: Endocrine Emergencies

2.1 Diabetic Emergencies

• Hypoglycemia:

  • Signs and Symptoms: Confusion, diaphoresis, AMS, tachycardia, seizures

  • Treatment:

    • Administer oral glucose if the patient is conscious and able to swallow

    • Administer D10W or D50W IV for altered LOC

    • Glucagon 1 mg IM/IN if IV access is unavailable

• Hyperglycemia:

  • Signs and Symptoms: Polydipsia, polyuria, Kussmaul respirations, fruity odor on breath

  • Treatment:

    • Monitor and maintain hydration with IV fluids (e.g., normal saline)

    • Transport for further evaluation of potential diabetic ketoacidosis (DKA)

2.2 Thyroid Emergencies

• Thyroid Storm:

  • Signs and Symptoms: Hyperthermia, tachycardia, AMS, hypertension

  • Treatment: Initiate cooling measures and provide supportive care

• Myxedema Coma:

  • Signs and Symptoms: Hypothermia, bradycardia, respiratory depression

  • Treatment: Warm the patient and provide ventilatory support

Section 3: Infectious Disease Emergencies

3.1 Sepsis

• Definition: A life-threatening systemic response to infection

• Signs and Symptoms:

  • Fever or hypothermia, tachycardia, hypotension, AMS

• Prehospital Care:

  • Recognize sepsis early using qSOFA criteria:

    • Respiratory rate ≥22

    • Systolic BP ≤100 mmHg

    • Altered mentation

  • Administer oxygen to maintain SpO₂ >94%

  • Start fluid resuscitation with 500-1000 mL bolus of normal saline

3.2 Meningitis

• Signs and Symptoms:

  • Fever, neck stiffness, photophobia, AMS

• Prehospital Care:

  • Use droplet precautions

  • Provide oxygen therapy and supportive care

Section 4: Toxicological Emergencies

4.1 Opioid Overdose

• Signs and Symptoms:

  • Respiratory depression, pinpoint pupils, cyanosis, AMS

• Prehospital Care:

  • Administer naloxone 0.4-2 mg IV/IN/IM

  • Provide ventilatory support using a BVM if necessary

4.2 Carbon Monoxide Poisoning

• Signs and Symptoms:

  • Headache, dizziness, confusion, nausea, and bright red skin

• Prehospital Care:

  • Remove the patient from the exposure

  • Administer 100% oxygen via NRB or BVM