Management of Acute and Episodic Medical Emergencies
Sort by the intervention clock
Priority is set by how fast treatment must start, not by how dramatic the presentation is: cardiac arrest, lost airway, anaphylaxis, tension pneumothorax, major hemorrhage, STEMI, stroke, sepsis, status epilepticus, DKA, and symptomatic electrolyte emergencies.
Patterns worth memorizing
- Sepsis: cultures before antibiotics but never a delay that costs the patient; broad-spectrum antibiotics, about 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, then norepinephrine to a MAP goal of ≥65 mmHg.
- DKA: isotonic fluid first, check potassium before insulin - if K+ is <3.3 mEq/L, hold insulin and replace potassium. Add dextrose when glucose falls below roughly 200–250 mg/dL.
- Anaphylaxis: IM epinephrine 0.3–0.5 mg of the 1 mg/mL concentration into the anterolateral thigh, repeated every 5–15 minutes; fluids and adjuncts follow and never replace it.
- STEMI: chewed aspirin, P2Y12 inhibitor and anticoagulation per protocol, reperfusion with a door-to-balloon goal ≤90 minutes.
- Acute ischemic stroke: noncontrast head CT promptly, thrombolysis in eligible patients up to 4.5 hours, thrombectomy in selected large-vessel occlusion up to 24 hours.
Traps
Giving a beta-blocker to a hypotensive asthmatic; cardioverting before addressing reversible instability; waiting for a lactate before antibiotics; giving insulin when potassium is low; assuming a normal glucose means resolved DKA without checking gap and bicarbonate.
Rule of thumb
When a patient is crashing, cycle airway–breathing–circulation and the reversible causes (Hs and Ts) before chasing a precise diagnosis.