Medical Emergency Protocols

• Medical emergency protocols

Lifesaver App Goals

• Understand legal obligations.
• Recognize common signs and symptoms of medical emergencies.
• Know immediate management and medications for emergencies.
• Practice using the ABCDE assessment
• Learn to use the SBAR communication tool when contacting emergency services.

Common Medical Emergencies

• Fainting/syncope.
• Epilepsy.
• Hypoglycemia.
• Asthma attack.
• Cardiac emergencies (angina/myocardial infarction/cardiac arrest).
• Anaphylaxis.
• Airway obstruction/choking.
• Adrenal crisis.

ABCDE Assessment

• Airway: Ensure it is clear and unobstructed.
• Breathing: Assess breathing and chest movement.
• Circulation: Check patient's color and pulse.
• Disability: Check reaction to light.
• Exposure: Fully examine the patient while respecting dignity and minimizing heat loss.
• Initial assessment: Regularly reassess.
• Address life-threatening issues first.
• Evaluate treatment effects.
• Call for help early.

SBAR Communication Tool

• Situation: Identify yourself, the location, the patient by name, and the reason for the call. Describe the concern and situation.
• Background: Explain medical history, diagnoses, date of admission, current medications, allergies, recent tests, and relevant issues.
• Assessment: Report ABCDE findings, breathing status, airway, circulation, and other observations such as swelling or hives.
• Recommendation: State what you need, such as emergency services.

Airway Management

• Note signs of obstruction: Gurgling, snoring, or stridor.
• Managing obstructions: If the airway is obstructed, listen for signs.
• Not Clear - Hypoxia: Can cause brain, kidney, or cardiac damage/arrest.
• If airway is partly/fully obstructed, treat the underlying issue.
• Head tilt: Lift the chin to open the airway.
• If needed: suction vomit/blood, specialist intervention.

Breathing Assessment

• Assessing breathing: Patient posture, use of accessory muscles, and skin color.
• Respiratory rate: Normal is 12-20 per minute.
• Respiratory rate of under 12, or above 20 can be life threatening.
• Breathing depth: hyper/hypoventilating/oxygen saturation (SpO2) below 94% indicates respiratory issues.
• Breathing sounds: Listening for obstructions, talking, or ratting in airway, ability to speak properly.

Circulation Assessment

• Check for a pulse.
• Carotid or radial pulse.
• Skin color and temperature.
• Noting chest pain or crushing chest pain that could indicate cardiac issues.

Disability Assessment

• Check the patient's level of consciousness: Can they respond to vocal, painful stimuli, and or unresponsive?
• Pupils: Check reactions to light.
• Check Glucose
• Note if the patient is drowsy.
• Check medical history.

Exposure Assessment

• Assess safety of the area.
• Check body temperature.
• Look for drug use, open wounds, bleeding, or head trauma.

SBAR Communication specifics

• Developed by the US military
• Identify yourself and location, the patient by name, and the reason for calling.
• Describe concerns and the situation.
• Provide medical history, diagnoses, admission date, medications, allergies, recent tests, and relevant issues.
• What you need, emergency services?
• Category of delivery-prioritized.
• Stay calm instructions, speak slowly, location, handover.

Cardiac Emergencies

Angina

• Patient doesn't lose consciousness.
• Administer GTN spray (400-800mcg).
• Repeat if no relief.
• Administer aspirin unless allergic.
• Call 999 using SBAR, prepare for CPR.

Myocardial Infarction (MI)

• Death of heart muscle due to loss of blood supply, potentially very serious.
• Patient may lose consciousness.
• Administer aspirin unless allergic.
• Call 999 using SBAR, prepare for CPR.

Cardiac Arrest

• Sudden loss of heart function, resulting in collapse and loss of consciousness.
• Call 999 using SBAR , perform CPR

Cardiac Signs and Symptoms

• Sudden onset, chest pain (crushing/pressure/heaviness).
• Pain in the arm, neck, jaw, or stomach.
• Sweating, lightheadedness, nausea.

Emergency Drugs and Equipment checklist

• Ensure the box is up to date.
• AED (defibrillator), Epinephrine, Aspirin, Glucose/Glucagon, GTN spray, Midazolam, Salbutamol, Oxygen.

Defibrillator

• Cardiac emergency.
• Any patient at risk from cardiac interruptions

Adrenaline

• Adult dosage: 500mg/0.5ml (1:1000 concentration).
• Children 6-12 yrs: 300mg/0.30ml; under 6 yrs: 150mg/0.15ml.
• Administer via IM injection, repeat at 5-min intervals.
• Condition: Anaphylaxis

GTN Spray (Glyceryl Trinitrate)

• Dosage: 400-800mcg (2 actuations).
• Administer sublingually for quick response.
• Condition: Angina or suspected heart attack

Salbutamol (Bronchodilator)

• Dosage: 100mg (2 actuations inhaled).
• Use a spacer if needed.
• Condition: Asthma

Dispersible Aspirin

• Dosage: 300 mg.
• Administer orally.
• Chewed.
• Condition: Suspected cardiac conditions

Glucose

• Dosage: 15-20mg.
• Orally.
• Condition: Hypoglycemia (co-operative patient)

Glucagon

• Dosage: 1mg per vial (0.5mg for children under 8).
• Intra-muscular
• Condition: Severe hypoglycemia (unconscious patient).
• Kept in fridge and needs mixing

Midazolam

• Adults: 10mg.
• Children 5-10 yrs: 7.5mg; 1-5 yrs: 5mg.
• Route: Oral buccal mucosa.
• Condition: Status epilepticus, seizure beyond 5 min

Oxygen

• Use face mask. Condition: Almost everything

Most Common Medical Emergency

• Choking/FBAO (foreign body airway obstruction).
  • Signs: Coughing, breathing problems, grasping the throat, cyanosis.
  • Symptoms: Unlikely to be able to explain, common with Tablets/Eating/drinking.
  • Management: Assess severity like cough.
  • Prevention: Risk assessment, history.
  • Rubber dam use.

Response

• If they can cough, check response. If they:
  • Cant cough: 5 black slaps between the shoulder blades, angled upwards.
  • After each blow check if blockage has gone.
  • If still not: abdominal thrust, 5 abdominal thrusts, after each one to see if blockage has been cleared.
  • Call 999 for an ambulance.

Anaphylaxis: Signs

• Can be severe allergic reactions.
• Sudden onset, angioedema (swelling), flushing, urticaria (rash).
• Respiratory distress (stridor/wheezing), hypotension, tachycardia.
  • Symptoms: Itchiness, breathing difficulty, face/tongue swelling.
  • Triggers: Known/unknown allergies to food/latex.
  • Management: Remove the trigger, call SBAR, ABCDE.
  • Lie flat/elevate legs, give 02 15L/min, intramuscular injection 500mg/0.5ml adults.
  • Repeat after 5 min until an adequate response.
  • Prevention: Risk assessment, history, preparation, team communication.

Asthma: Signs

• Difficult breathing expiratory wheezing, breathlessness, fast pulse.
• Resting Rate >25min.
• Pulse >110/min.
• Call 999 if life threatening like: Cyanosis, exhaustion, Level of consciousness, RR<8 min/Pulse <50/min.
  • Symptoms: Saying cannot breathe and looking for inhaler, exhaustion
  • Triggers: Allergy, Fear, Stress and extreme weather.
  • Management: Assess if life threatening 999 SBAR, sit upright to relieve breathing difficultly ABCDE.
  • Support pt taking 2 puffs of salbutamol continue to maximum of 10 puffs over 2 min.
  • Provide 02 15l/min, if no improvement call 999 SBAR.
  • Prevention: Risk assessment, team communication.

Epilepsy: Signs

• May lose consciousness, cry out, body rigid, noisy breathing, jerking movements, frothing, incontinence.
  • Symptoms: May smell flowers or feel an aura.
  • Triggers: Fear/Stress Brain injury/Alcohol withdrawal/Raised body temperature.
  • Brain tumors
  • Management: ABCDE, clear instruments, place in supine do not restrain.
  • If standing ease to the floor with cushion, and call for help.
  • call 999 if more than 5 min-SBAR, give 02 15L/min+ Midazolam.
  • Prevention: History, preparation, team communication.

Epilepsy care

• Do not undertake that day.
• Depending
• emergency services
• Never put anything in the mouth to prevent biting their tongue.
• Do and move them unless they are in immediate danger.
• Never restrain person.
• Do not give them anything at all to eat and drink until fully recovered.

Fainting/Syncope: Signs

• Pale, sweating, slow pulse, low BP.
  • Symptoms: Complains feeling dizzy/ sick/nausea.
  • Triggers: Fear/Stress/Hunger.
  • Management: ABCDE, lie flat,elevate legs
  • Once consciousness regained offer glucose drink.
  • Prevention: Risk assessment, team communication.

Stroke: Signs

• Stroke : 1 in 4 in younger people- Ischemic and Hemorrhagic
• Face-drooping, cant smile?
• Arm-limp-raise both arms and keep them there?
• speech-slurred?
• time-call 999 as one of these signs.
  • Triggers: Obesity, Cholesterol, Diabetes and stress
  • Management: Act fast and call 999 SBAR.
  • Give oxygen to the patient, make the patient comfortable
  • Do not give ASPIRIN

Hypoglycemia: Signs

• Shaking trembling, slurred speech and tremors.
• Sweating blurred vision
• Confusion and aggression can occur.
• Low blood glucose usually shows a reading of less than 4mmol/L or 72 mg/dl.
  • Symptoms: Feels shaky, dizzy and heart racing.
  • Triggers: Stress, Anxiety, Missing medication or not eating.
  • Management: ABCDE, offer 12-20g quick-acting glucose.
  • Call 999 - SBAR, Glucagon injection ( 1mg for adults; 0.5 mg for children under 8 ).
  • Prevention: History, team communication.

Adrenal Crisis: Signs

• Collapse pallor, Hypotension
• Vomiting/Diarrhea -Symptom
• Feeling dizzy and/or nauseous -Triggers include Stress/Anxiety Missing medication In appropriate management -Management
• ABCDE -CALL 99 addisonian crisis -lie flat -give oxygen 15L/min -use patient hydrocortisone emergency IM kit 100mg IM -Prevention -Risk assessment. Take a history -Drugs prior to txt. communicate with team. Bring emergency hydrocortisone and adrenal crisis letter

Sepsis: Signs

• Patient looks unwell.
• Heart rate above 130 per minute, needs 02 to keep oxygen saturation at 92%, non-blanching.
• Symptom does not feel well Triggers such Chemo within 6 weeks.
  • Infections.
  • Management: ABCDE Call 999 red flag sepsis and also SBAR.
  • Give oxygen 15L/min pre-alert red flag sepsis refer GDP red flag sepsis tool.
  • Prevention: risk assessment, preparation, observation, team communication.