Module 7 - Medical Emergencies

• Inadequate Perfusion:
• - Hypovoleamia
• - Cardiac Arrhythmias
• - Distributive shock
• - Neurogenic Shock
• - Raised ICP
• Altered Metabolic States
• - Hypoglycaemia & Hyperglycaemia
• - Hypoxia
• Intoxication or poisoning
• - Drug overdose
• - Alcohol Intoxication
• - Carbon Monoxide poisoning
• Medical Conditions
• - Stroke
• - Subarachnoid Haemorrhage
• - Epilepsy
• - Meningitis
• - Hypo & Hyperthermia
• Head Injury

• 4 - Opens spontaneously
• 3 - Opens to voice
• 2 - Opens to pain
• 1 - None

• 5 - Orientated
• 4 - Confused
• 3 - Inappropriate words
• 2 - Incomprehensible sounds
• 1 - No Verbal Response

• 6 - Obeys Commands
• 5 - Localises Pain
• 4 - Withdraws from pain
• 3 - Decorticate posturing
• 2 - Decerebrate posturing
• 1 - No response to pain

• - Headache of severe, sudden (thunderclap) onset
• - Headache localised to the vertex
• - Escalating headache of unusual nature
• - Changed visual acuity
• - Changed mental state and inappropriate behaviour
• - Newly presenting ataxia

• - Assess GCS
• - Only give O2 if Hypoxaemic
• - Consider symptomatic pain relief
• - Avoid morphine
• - Time critical transfer to nearest A&E

• - Meningococcal Septicaemia
• - UTI
• - Pneumonia
• - Herpes Simplex encephalitis
• - Septic Arthritis
• - Kawasaki's disease

• - Antipyretics should not be given purely to treat fever.
• - Antipyretics are not proven to decrease the risk of seizure
• - Antipyretics may relieve other unpleasant symptoms of febrile illness
• - Antibiotics should not be given unless diagnosis is known.

• - Any child under 5 fulfilling the red criteria
• - Any febrile baby <1 month old.
• - Any febrile child less than <3 months, unless obvious cause (as a minimum a urgent urine sample would be required)
• - Those aged under 3 years without an obvious cause, if a urine sample cannot ne obtained through GP.
• - Those with any signs of serious illness.
• - Any child with significant fever but not localising symptoms or signs, who has received antibiotics within 48 hours.

• Stridor
• 0 - None
• 1 - Only on crying
• 2 - At rest
• 3 - Severe (Biphasic)
• Recession
• 0 - None
• 1 - Only on crying, exertion
• 2 - At rest
• 3 - Severe (Biphasic)

Mild = 1-2 Moderate = 3-4 Severe = 5-6

• -Systemic reaction to prolonged heat exposure (hours to days)
• -Temperature >37 and <40
• - Headache, dizziness, nausea, vommiting and tachycadia
• - Hypotension, sweating, muscle pain, weakness and cramps.

A 'Systemic inflammatory response' to a core body temperature >40.6°C in addtion to a change in mental status and organ dysfunction (European resuscitation guidelines)

• - Core temperature >40°C
• - Hot, dry skin (Sweating is present in about 50% of cases of exertional heat stroke)
• - Early signs and symptoms e.g. extreme fatigue, headache, fainting, facial flushing, vommiting and diahorrhea.
• - Cardiovascular dysfunction including arrythmias and hypotension
• - Respiratory disfunction including seizures and coma.
• - Liver and renal failure
• - Coagulopathy
• - Rhabdomyolysis.

• - Adults Aim for target O2 saturations of 94-98%
• - Children Administer high flow Oxygen
• - Perform 12 Lead ECG
• - Entonox initally, but not for long periods of time.
• - Opiates should be administered orally or subcutaneously rather than IV, dose should be guided by the patients hand held record.

• Sudden onset or rapid progression
• Airway and/or Breathing problems (e.g. dyspnoea, hoarseness, stridor, wheeze, throat or chest tightness)
• and/or Circulation (e.g. hypotension, syncope, prnounded tachycardia)
• and/or Skin (e.g. erythema, uticaria, mucosal changes) problems

• - Administer high levels of supplimentary Oxygen
• - Administer Adrenaline IM
• - Consider fluid therapy
• - Consider chlophenamine
• - Consider administering hydrocortisone
• - Consider nebulised Salbutamol for bronchospasm.
• - Monitor - reassess ABC

• - PEF 33-50% of best or predicted
• - Respiratory rate >25 BPM
• - Heart Rate > 110 BPM
• - Inability to complete sentances in one breath 

• - Altered LOC
• - Exhaustion
• - Arrythmia
• - Hypotension
• - Cyanosis
• - Silent Chest
• - Poor respiratory effort
• - PEF <33% Predicted
• - SPO2 <92%

• - Administer Adrenaline
• - Positive pressure ventiallation with bag-valve-mask and 'T' piece

• Mild to Moderate Asthma
• - Move to calm enviroment
• - Encourage use of own inhaler, preferibly using spacer. Ensure correct technique is used; two puffs followed by two puffs every 2 minutes to a maximum of ten puffs.
• - Administer high levels of supplimentary oxygen
• - Administer nebulised salbutamol using oxygen driven nebuliser
• Severe Asthma
• - If no improvement, administer ipratropium bromide by nebuliser
• - Administer steroids
• - Continous Salbutamol nebulisation may be administered unless clinically significatn side effects occour.
• Life Threatning Asthma
• - Administer IM adrenaline
• - PPV with T piece neb