Emergency Medicine
Showing 33 of 33 topics
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Classify severity by core temperature and mental status; use active external and internal rewarming strategies and anticipate afterdrop and arrhythmias.
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Accidental hypothermia is an unintentional core temperature below 35 C. Management depends on clinical severity, cardiovascular stability, and available resources. Prevent further heat loss, handle the patient gently, assess vital signs carefully, use passive and active external rewarming for stable patients, and direct unstable severe hypothermia or hypothermic cardiac arrest toward extracorporeal rewarming when appropriate.
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Use symptom triggered or fixed dose benzodiazepines; add phenobarbital or dexmedetomidine as adjuncts in selected severe cases; correct electrolytes and give thiamine.
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Alcohol withdrawal results from abrupt reduction or cessation after sustained heavy alcohol exposure and ranges from tremor and autonomic hyperactivity to seizures and delirium. Benzodiazepines are first-line therapy because they reduce symptoms, seizures, and delirium. Treatment intensity should be based on current severity, history of complicated withdrawal, medical comorbidity, and reliability of symptom scoring. Withdrawal management is only the acute phase of care and should be linked to treatment for
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Anaphylaxis is life‑threatening; give intramuscular epinephrine immediately in the mid‑anterolateral thigh, repeat as needed, and manage airway/respiration/circulation with adjuncts and observation.
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Carbon monoxide poisoning causes tissue hypoxia by forming carboxyhemoglobin and impairing oxygen delivery and utilization. Diagnosis depends on exposure history, symptoms, and co-oximetry rather than pulse oximetry. Remove the patient from exposure, give 100% oxygen promptly, evaluate neurologic and cardiac injury, and consider hyperbaric oxygen for severe presentations or high-risk patients.
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Adult blunt cervical-spine clearance should use a validated clinical decision rule in appropriate alert, stable patients. Patients who fail NEXUS or Canadian C-Spine Rule criteria generally require multidetector CT rather than plain radiographs; persistent neurologic deficit or concern for ligamentous or spinal cord injury requires specialist evaluation and often MRI.
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Use START (adults) and JumpSTART (peds) for mass‑casualty triage to rapidly categorize patients (Immediate/Delayed/Minor/Expectant) based on respiration, perfusion, and mental status.
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Drowning is a hypoxic respiratory injury after submersion or immersion. Immediate rescue priorities are safe removal from the water, ventilation and oxygenation, and CPR with rescue breaths when cardiac arrest is present. Hospital care focuses on respiratory failure, hypothermia, aspiration-related lung injury, neurologic injury, and the circumstances that caused the event.
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The BLUE protocol uses lung ultrasound profiles to differentiate causes of acute dyspnea (A‑profile, B‑profile, A’/B’ with DVT, PLAPS). Rapidly narrows diagnosis at bedside.
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Ultrasound‑guided nerve blocks provide rapid ED analgesia (e.g., femoral/fascia iliaca for hip fracture, serratus/PECs for rib fractures, forearm blocks for hand injuries). Emphasize safety, dosing, and LAST prevention.
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Electrical injury can cause occult deep tissue damage, dysrhythmia, rhabdomyolysis, neurologic injury, trauma from falls or tetany, and thermal burns that are much more extensive than the skin appearance suggests. Initial management prioritizes scene safety, trauma resuscitation, ECG assessment, burn evaluation, and targeted cardiac monitoring based on voltage, symptoms, ECG findings, and current pathway.
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Anion‑gap ketoacidosis with glucose often <250 mg/dL in patients on SGLT2 inhibitors, during starvation, pregnancy, or perioperatively. Stop SGLT2 agent, initiate fluids, start insulin infusion with concurrent dextrose to clear ketones, correct electrolytes, and address triggers.
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Core temperature ≥40°C with CNS dysfunction. Begin rapid cooling immediately—prefer cold-water immersion for exertional heat stroke or aggressive evaporative cooling with ice packs if immersion unavailable. Avoid antipyretics. Manage rhabdomyolysis, DIC, AKI, and electrolyte derangements; admit to ICU for severe cases.
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Risk stratify upper/lower GI bleeding, resuscitate, give PPI for suspected upper GI bleed, reverse anticoagulation as appropriate, and coordinate early endoscopy/consults.
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Heat stroke is severe hyperthermic illness with central nervous system dysfunction. Diagnosis is clinical and should not be delayed for laboratory confirmation. Measure core temperature rectally when feasible and begin immediate whole-body cooling. Cold-water immersion is the fastest preferred method when practical, cooling to roughly 38.3 to 38.8 C, while simultaneously treating airway, circulatory, electrolyte, coagulation, renal, hepatic, and rhabdomyolysis complications.
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Hyperthermia with CNS dysfunction requires immediate whole‑body cold‑water immersion (exertional) or aggressive evaporative cooling; target core 39°C. Manage airway, fluids, rhabdomyolysis, DIC, and organ failure; avoid antipyretics.
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Life threatening hyperthermia with CNS dysfunction; initiate whole body cold water immersion or other rapid cooling and support airway, circulation, and complications.
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Hyperkalemia can cause sudden fatal arrhythmia and requires treatment according to potassium concentration, ECG findings, symptoms, kidney function, and the rate of rise. Emergency therapy has three goals: stabilize the myocardium when indicated, shift potassium into cells, and remove potassium from the body while preventing rebound.
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Treat ECG changes and K≥6 promptly: stabilize myocardium (calcium), shift K intracellularly (insulin/dextrose, β‑agonist, bicarbonate if acidotic), and remove K (diuresis, binders, dialysis).
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BP with acute target‑organ injury (encephalopathy, ACS, APE, aortic dissection, AKI). Reduce MAP by ~20–25% in the first hour (except aortic dissection/ischemic stroke with unique targets) using IV agents (nicardipine, clevidipine, labetalol). Identify/ treat precipitating cause and avoid rapid overcorrection.
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Use multimodal analgesia and regional anesthesia to reduce opioid exposure while achieving adequate pain control; provide safe prescribing when opioids are necessary and arrange follow‑up.
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Identify toxidromes (anticholinergic, cholinergic, opioid, sedative‑hypnotic, sympathomimetic, serotonin syndrome). Stabilize ABCs, decontaminate judiciously, give antidotes when indicated, and involve poison control early.
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Emergency department procedural sedation requires deliberate patient selection, a clearly defined sedation target, continuous physiologic monitoring, immediate airway rescue capability, and recovery to an appropriate baseline before discharge. Urgency, comorbidity, procedure type, and sedation depth matter more than a rigid fasting interval.
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Ensure medical stability, assess decision‑making capacity and suicide/homicide risk, and follow jurisdictional laws for involuntary holds; document thoroughly and coordinate with psychiatry/social work.
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Muscle breakdown with CK elevation causes electrolyte derangements and AKI. Treat with early, high-volume isotonic fluids, correct hyperkalemia, and consider urine alkalinization in select cases; avoid nephrotoxins and monitor urine output/CK trends.
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Muscle injury with marked CK elevation leads to myoglobin-induced AKI and electrolyte disturbances. Initiate early aggressive isotonic fluids, monitor and treat hyperkalemia and hypocalcemia, and consider urine alkalinization selectively; identify and remove precipitating factors.
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Sepsis is life-threatening organ dysfunction from infection. Recognize shock and organ dysfunction early, obtain cultures when they will not delay care, give prompt source-appropriate antimicrobials, use crystalloid with frequent reassessment for hypoperfusion, start norepinephrine for persistent septic shock, and pursue source control as soon as practical.
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High‑risk patients with autonomic instability, hallucinations, agitation, or seizures need aggressive benzodiazepine therapy (symptom‑triggered or front‑loaded), early phenobarbital adjunct in refractory cases, thiamine before glucose, electrolyte repletion, and ICU monitoring.
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Syncope is transient loss of consciousness caused by global cerebral hypoperfusion, with rapid onset, brief duration, and spontaneous complete recovery. The initial evaluation is driven by history, physical examination including orthostatic vital signs when appropriate, and a 12-lead ECG. The major task is to distinguish benign reflex or orthostatic syncope from cardiac or other high-risk causes. Routine broad laboratory panels, brain imaging, carotid imaging, and EEG have low yield when there are no specif
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Tension pneumothorax is obstructive shock caused by rising intrapleural pressure that compromises ventilation and venous return. In an unstable patient with a compatible clinical picture, immediate decompression is a bedside diagnosis and treatment decision and must not wait for chest radiography or CT.
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Clinical diagnosis of life-threatening obstructive shock. Do not wait for imaging: perform immediate needle decompression followed by definitive tube thoracostomy; in monitored settings, prefer finger thoracostomy. Address underlying trauma or barotrauma and reassess ventilation.
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Thunderclap headache is a maximal-intensity headache that reaches peak severity within seconds to a minute and requires urgent exclusion of subarachnoid hemorrhage and other vascular causes. Early noncontrast head CT is the first test in most patients, followed by CTA or lumbar puncture when residual SAH risk remains or another vascular diagnosis is suspected.
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