Medical
The core decisions
Most medical calls reduce to three questions: is this time-critical (stroke, STEMI, sepsis, anaphylaxis, hypoglycemia), is the airway or breathing threatened, and what is the glucose?
Patterns to recognize
Asthma and COPD: albuterol plus ipratropium, steroids, magnesium for severe asthma, CPAP for distress. Pulmonary edema is wet, crackly, and cardiac - CPAP and nitrates. Anaphylaxis gets IM epinephrine 0.3-0.5 mg (1:1000) in the anterolateral thigh, repeated every 5-15 minutes; antihistamines are adjuncts, never first. Opioid overdose gets naloxone with ventilatory support and toxidromes guide the rest. Stroke: establish last known well, use BE-FAST, check glucose, and transport to a stroke center. Seizure: protect, time it, and treat anything beyond about five minutes with a benzodiazepine. Sepsis: signs of infection plus hypotension or altered mentation means early fluids and rapid transport. Eclampsia gets magnesium.
Traps
Writing off altered mental status as intoxication before checking glucose. Lowering blood pressure in an acute stroke. Giving nitrates to a right ventricular infarct. Assuming a seizure patient does not need a glucose. Missing pregnancy in a woman of childbearing age with abdominal pain or syncope - ectopic until proven otherwise.
Rule of thumb
Every altered mental status, seizure, or focal neurologic deficit gets a point-of-care glucose before you commit to a diagnosis.