Medical and Thoracic Emergencies
Core concepts
Medical and thoracic emergencies require rapid differentiation of time-critical conditions: acute coronary syndrome, pulmonary edema, severe asthma or COPD, pulmonary embolism, pneumothorax, pleural effusion, and thoracic trauma. Know indications for aspirin, nitroglycerin, CPAP, bronchodilators, corticosteroids, and antiarrhythmics, plus when these are contraindicated. Understand that STEMI care is destination-driven: early recognition, aspirin when appropriate, and transport to PCI capability. Thoracic emergencies may need needle decompression, chest tube planning, or positive-pressure support.
Traps
Common traps include giving nitroglycerin in right ventricular infarction or recent phosphodiesterase inhibitor use, missing a silent chest in severe asthma, and using CPAP in an unstable patient or one with an untreated pneumothorax. A normal oxygen saturation does not rule out serious pulmonary embolism or pneumothorax. Do not delay transport for nonessential diagnostics.
Rule of thumb
For suspected STEMI, recognize early, give aspirin if not contraindicated, and prioritize transport to a PCI-capable center. For severe asthma, a silent chest is a danger sign, not improvement.
Worked example
A young patient with sudden dyspnea, pleuritic chest pain, tachycardia, and clear lungs may have a pulmonary embolism. Oxygen, monitoring, and transport are priorities; avoid assuming anxiety. If hypotension develops, reassess for right-heart strain and consider cautious fluid and vasopressor support rather than large fluid boluses.