Medical Emergency

Any health condition which is deviating from the normal and inclines deteriorating if not addressed timely including death. These medical emergencies may perhaps occur with symptoms like fever, breathing difficulty, chest pain, wheeze, urticaria chest pain, vomitings, abdominal pain, confusion, seizures, decrease in urine output, muscle cramps etc. When a patient comes to ED with these symptoms, the patient will be assessed by checking Airway, Breathing, Circulation, Disability along with vital parameters like Heart rate, Respiratory rate, Saturations, Blood pressures, Random blood sugars, temperatures(Active interventions will be done in case of ABCDE compromise ), taking appropriate history, Clinical examination of the patient, getting initial tests like ECG, ABG, Bedside 2DEcho. Patients with the above symptoms and quick emergency examination will be categorised into these medical emergencies like

Sepsis, Septic shock, Diabetic Ketoacidosis, Anaphylaxis, Acute kidney injury/Renal failure, Pneumothorax, Electrolyte imbalances like hyponatremia, Status asthmaticus, Status epileptics, Hypertensive emergencies, Tetanus, Rabies etc.

SEPSIS: Sepsis is a heterogeneous syndrome characterised by widespread inflammation and organ distress initiated by any microorganisms. Early recognition, early reversal of haemodynamic compromise, early infection control are goals in Sepsis management. Clinical actions between initial recognition and first 3 hrs include measuring lactates, Sending cultures( blood/urine/endotracheal) before antibiotic administration, Appropriate antibiotics, Adequate intravenous fluids, Reassessment of lactates if increased. A simple screening tool (q- SOFA) is used to identify patients at higher risk of death.

SEPTIC SHOCK: A subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to increase mortality. The patient requires additional intravenous fluid bolus therapy, initiating Vasopressors if low blood pressure persists, reassessing hemodynamics.

DIABETIC KETOACIDOSIS: It is an acute life-threatening complication of diabetes mellitus. It occurs due to a deficiency of insulin and an increase in counterregulatory hormones(glucagon, cortisol, growth hormone). This presents as high blood sugar levels, increased ketones resulting in acidity in the blood, volume depletion. In the ED, Assessment of Blood sugar levels, Acid-base imbalance, volume depletion, electrolyte imbalance, and factors correlating to DKA like decrease insulin injection, Infection, Myocardial Infarction etc. will be done. Every 2hr monitoring of electrolytes, Vitals, Level of consciousness, Volume status will be done.

ANAPHYLAXIS: It is a serious allergic reaction with rapid onset, may cause death. Signs and symptoms begin suddenly, often immediately, usually within 60minutes of exposure to the allergen. The initial presentation usually starts as urticaria as inflammatory mediators synergistic action progress patient goes into respiratory distress and decrease in the level of consciousness. Half of the anaphylactic fatalities occur within the first hour. These require emergency diagnosis and treatment. In ED, the patient will be assessed if meeting the Criteria for anaphylaxis. The patient will be dealt with Airway and Oxygenation, Decontamination, Epinephrine administration, Intravenous fluids that have an immediate effect in the acute stage.

ACID-BASE IMBALANCE: Alkaline environment is required for the most efficient maintenance of body processes and organ functioning. The homeostatic control of hydrogen ion concentration is the essential requirement of life. The degree of acidity and alkalinity of a solution is dictated by pH. A robust system for the maintenance of plasma pH is therefore required to defend an alkaline environment in the face of daily acid load in the form of CO2. In ED, all those patients presenting with symptoms fitting into Sepsis, DKA, etc and those on clinical examination suspecting acid-base imbalance would be getting Acid-base gas analysis (ABG). Based on ABG, patients will be made the initial diagnosis as Acidosis (Metabolic/Respiratory), Alkalosis (Metabolic/Respiratory) with or without a compensatory mechanism(Respiratory/Renal) and treated accordingly with Intravenous fluids, Bicarbonates, non-invasive ventilator/ ventilator support.

HYPERTENSIVE EMERGENCIES: High blood pressure doubles the risk of Coronary artery disease, Congestive heart failure, Ischemic and haemorrhage stroke, Renal failure.

In ED, Patients will be categorised into two groups based on symptoms and BP into HTN urgency (With no end-organ damage)HTN emergency ( With end-organ damage to heart, brain, aorta, lungs, eyes). In case of HTN emergency, continuous BP monitoring, Intravenous antihypertensive, a gradual decrease in BP is done to balance the hypoperfusion of the Brain, Heart, Kidney. Aggressive BP control is required in Aortic dissection, Pheochromocytoma crisis, Eclampsia, Intracranial bleed.

STATUS ASTHMATICUS: It is acute severe asthma that doesn’t improve with inhaled bronchodilators and corticosteroids. Patients will present with increased respiratory rate, heart rate, low oxygen levels, Accessory muscle use, wheeze, or a silent chest if the airway is severely compromised. Rapid and aggressive treatment is the key to preventing cardiopulmonary arrest. This includes Continuous bronchodilator nebulization, Steroids (inhalational and intravenous), Magnesium sulphate, Non-invasive ventilation and Mechanical ventilation.