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).
• PHLS L1 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.

<biodigital id="heart-anatomy" title="Coronary Circulation" caption="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.
• PHLS L1 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.

<redflag> Antihistamines (like chlorpheniramine) do NOT save lives in anaphylaxis. They only treat the rash. Epinephrine is the mandatory first-line treatment to reverse airway swelling and shock. </redflag>

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.
• PHLS L1 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 (NACP level). Transport rapidly.

4. Seizures (Status Epilepticus)

• Presentation: Tonic-clonic movements, loss of consciousness, post-ictal confusion.
• PHLS L1 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).

<goldenrule> The most critical period of a seizure is the post-ictal phase (after the shaking stops). The brain is exhausted, and the patient may be apneic or have an obstructed airway. Guard the airway closely! </goldenrule>