Obstetric, Pediatric, and Mental Health Emergencies
Three populations, three assessment frames
Pregnancy alters every vital sign: plasma volume rises, haemoglobin dilutes, heart rate increases, blood pressure falls in mid-pregnancy, and the diaphragm rises. After 20 weeks, place the patient in a left lateral tilt of 15–30 degrees to relieve aortocaval compression. Eclampsia is treated with magnesium sulfate; monitor deep tendon reflexes, respiratory rate and urine output, and keep calcium gluconate at the bedside as the antidote for toxicity. Postpartum haemorrhage is worked through the four T's: tone, trauma, tissue, thrombin. In maternal cardiac arrest, perimortem caesarean delivery is performed within about four minutes of arrest, with delivery by five minutes, to save both mother and fetus.
Paediatric assessment uses the triangle of appearance, work of breathing, and circulation to skin. Doses are weight-based and double-checked. Hypotension is a late sign; a systolic below 70 + (2 × age in years) in children aged 1–10 is the working threshold. Febrile seizures are usually brief and generalised; focus on the source of fever and on excluding meningitis.
Mental health emergencies are assessed with the same rigour. Screen for suicide risk directly and privately, remove means, and avoid leaving an at-risk patient unwatched. For agitation, de-escalation and verbal engagement come before chemical sedation, and physical restraint requires a documented order, continuous monitoring of airway, circulation and psychological state, and frequent review. Confidentiality yields only to defined exceptions such as imminent risk or statutory reporting.
Trap: applying adult vital sign norms to a child, or adult drug doses to a pregnant patient.