Medical Emergencies & Therapeutics

While trauma is dramatic, medical emergencies make up the majority of pre-hospital calls. Recognition and rapid transport to the correct facility are key.

1. Acute Coronary Syndrome (ACS) / STEMI

ACS involves ischemia (lack of blood flow) to the heart muscle.

• Presentation: Crushing, heavy chest pain, often radiating to the left arm or jaw. Diaphoresis (sweating), nausea, shortness of breath.
• Special Populations: Women, diabetics, and the elderly may have "atypical" presentations (e.g., just sudden weakness, epigastric pain, or isolated shortness of breath).
• Basic Level Management:
  • Position of comfort (usually semi-seated).
  • O2 ONLY if SpO2 < 94% (Hyperoxia causes coronary vasoconstriction).
  • Aspirin 300mg chewed (if not allergic, no active bleeding).
  • Rapid transport to a PCI-capable facility.

Coronary Circulation & STEMI

Interactive Atlas

Selected Landmark

Left Anterior Descending (LAD)

Also known as the 'Widowmaker' artery. Supplies blood to the anterior wall of the left ventricle and septum.

Tactical Clinical Pearl

"Occlusion causes massive anterior STEMI (V1-V4). High risk of cardiogenic shock or sudden ventricular fibrillation."

Left Anterior Descending (LAD)Right Coronary Artery (RCA)Circumflex Artery

FIGURE: Blockage in the coronary arteries leads to myocardial infarction.

2. Anaphylaxis

A severe, multi-system allergic reaction that is rapidly fatal due to airway swelling and vasodilatory shock.

• Presentation: Sudden onset. Urticaria (hives), swelling of lips/tongue, stridor, wheezing, profound hypotension.
• Basic Level Management:
  • Epinephrine (Adrenaline) 1:1000 IM (Intramuscular). This is the ONLY life-saving drug for anaphylaxis. Do not delay.
  • Dose: 0.5mg (Adult) via the anterolateral thigh.
  • High-flow O2 and fluid resuscitation for shock.

3. Hypoglycemia

Low blood sugar mimicking a stroke, intoxication, or psychiatric episode.

• Presentation: Altered mental status, aggressive behavior, diaphoresis, tachycardia.
• Assessment: Always check a DXT (blood glucose) on ANY patient with altered mental status. Normal is 4.0 - 7.0 mmol/L. < 4.0 is hypoglycemia.
• Basic Level Management:
  • If conscious and able to swallow: Oral glucose paste, sweet drinks.
  • If unconscious: Do NOT give oral fluids (choking hazard). Requires IV Dextrose or IM Glucagon (Master level). Transport rapidly.

4. Seizures (Status Epilepticus)

• Presentation: Tonic-clonic movements, loss of consciousness, post-ictal confusion.
• Basic Level Management:
  • Do NOT restrain the patient.
  • Do NOT put anything in their mouth (no bite blocks, no fingers).
  • Move dangerous objects away.
  • Once the seizure stops, place in the recovery position to protect the airway and administer O2.
  • If the seizure lasts > 5 minutes, it is considered Status Epilepticus (a true emergency).