Medical Emergencies

Question 1

How do I treat Anaphylaxis?

Answer 1

• Dial 999
• Remove trigger
• 1:1000 Adrenaline (IM - 2ml syringe)
• Apply SP02 probe
• Consider NPA/OPA
• After 5 mins, repeat IM Adrenaline

Question 2

How do I treat LIFE-THREATENING Asthma in adults?

Answer 2

• Dail 999
• Move to calm place if pt able to do so safely
• Encourage pt to sit upright/tripod
• Encourage use of own inhaler - 2 puffs every 2 minutes (max of 10 puffs)
• Monitor RR & SPO2
• Be wary of silent chest on ausc
• If life-threatening, administer:
  1. ADULTS ONLY -
  IM Hydrocortisone (100mg powdered, reconstituted with 2ml water for injections - 2ml syringe)
  2. ADULTS ONLY -
  IM Adrenaline (1:1000)

Question 2

How do I treat a collapse?

Answer 2

• Dail 999
  UNCONSCIOUS?
  1. rapid head to toe assessment for head injuries, c-spine, pelvic or femural fractures.
  *If there is a C-spine injury, maintain C-spine and have a 2nd person do the following:

2. Consider inserting NPA/OPA
3. Inspect pupils - are they pinpoint, dilated or unequal? If so, this may be a head injury/concussion
4. Pinpoint pupils? BE CAREFUL!
   This may be a drug overdose - consider administering IM 400mcg NALOXONE (2ml syringe),OR 200mcg up each nostril with Naloxone nasal spray.
   Repeating dose after 3 mins if no improvement.
5. Move pt into recovery position if no C-spine concerns
6. Monitor SPO2, RR, BP and GCS
7. Keep them warm

CONSCIOUS?
1. rapid head to toe assessment
2. If no c-spine pain, allow them free upper body movement, pillow, etc
3. If no pelvic/NOF injuries - raise their legs using cushion/jacket
3. Monitor BP and GCS
4. Keep them warm

If pt has a head injury, they may display agitated/aggressive behaviour - try to keep them lying down, but consider your own personal safety FIRST. Forcing pt to lie down can cause further damage to their injuries. Sometimes it is best to remotely monitor if pt is difficult to manage and await SAS arrival.

Question 2

How do I treat chest pain?

Answer 2

• Dial 999
• Request an AED to be brought to you and pt
• Move pt to calm place if possible, BUT do not have pt walking more than a few steps!
• Sit pt down - W position on the floor
• Administer 300mg Aspirin
• Administer 800mcg GTN spray (if available)
• Note time of drugs and pain scores/presentation before and after
• Monitor pts:
  SPO2, Pulse (is it reg/irreg?), BP, GCS

If pt becomes unconscious:
1. Lay pt on supine on floor
2. Expose their chest
3. Look, listen & feel for breathing and/pulse.
3. If they are breathing/have a pulse:
- Apply head-tilt-chin-lift
- Consider NPA/OPA
- Continuously monitor RR

If pt stops breathing/you are unable to find a pulse or establish breathing, apply AED pads and follow the automated instructions - which will include administering chest compressions.

Check pt BP prior to GTN spray - if systolic is lower than 110, be wary

Question 3

How do I manage a Seizure?

Answer 3

1. Dial 999
2. Start a stop watch to time the seizure
3. Try to protect pt’s head by placing something soft under their head (be careful to avoid being accidentally hit by their limbs)
4. If you have concerns for their airway - attempt to insert an NPA. You may insert 1 NPA in each nostril.
   NB: Do NOT insert an OPA as you risk ur fingers!!
5. Monitor their SP02 when possible
6. Note down:
   - number of seizures had
   - duration of seizure(s)
7. If possible, find out if pt has Epilepsy or has a hx of seizures (this info may not be available to you).
8. If in public place, try to protect their modesty by covering them with a blanket (as they are likely to soil themselves).
9. Whenever the seizure stops, note their:
   RR, SPO2, Pulse, Pupil sizes.
10. During the post-ictal phase they will be confused due to lack of oxygen during their seizure. Try to be reassuring and continue assessing their GCS whilst waiting for ambulance.

Question 4

How do I manage a STROKE?

Answer 4

1. Dial 999
2. Carry out a FAST test:
   - assess if there is any facial droop
   - weakening of arms
   - any slurred or muddled speech or pt is suddenly unable to speak
3. IMPORTANT!!!
   Ascertain the onset time of these symptoms. If within the last 4 hours, they are likely to be eligible for thrombolysis or a thrombolectomy, so RAPID transport to A&E is crucial!
4. If it’s possible to take the PT to A&E quicker than the Ambulance, and the PT is able to do so, take them up yourself!
   DO NOT WAIT - TIME IS OF THE ESSENCE!!
5. Don’t delay to collect obs.

Question 5

How do I manage a CARDIAC ARREST?

Answer 5

1. Dial 999
2. Start chest compressions
3. Shout for help
4. Request an AED - when it comes, apply pads and follow instructions
5. When assessing rhythm, insert an OPA.
   NB: If there’s 2 of you:
   - One person does chest compressions and AED
   - The other person is on airway, which includes OPA, head tilt chin lift maneuver, and rescue breaths (if you have a non-return valve mask or BVM).

REVERSIBLE CAUSES:
4H’s & 4T’s

1. Hypothermia
   WARM THEM UP!
2. Hypovolemia
   STOP ANY CATASTROPHIC HAEMORRHAGE!
3. Hypoxia
   NEED OXYGEN!
4. Hypo/hyperkalemia
   ELECTROLYTE IMBALANCE. NEED A&E.

………………………………

1. Tension pneumothorax
   COLLAPSED LUNG! NEED A&E.
2. Tamponade
   FLUID IN PERICARDIUM. NEED A&E.
3. Toxins
   DRUG OVERDOSE! IF PINPOINT PUPILS, ADMINISTER NALOXONE!!
4. Thrombosis
   BLOCKED ARTERY. NEED CHEST COMPRESSSIONS, A&E AND PPCI.