Medical Emergencies

Stroke (CVA)

A stroke occurs when blood supply to part of the brain is cut off (ischemic, 87% of strokes) or a vessel ruptures (hemorrhagic, 13%). Brain cells begin dying within minutes. Time is brain — every minute of stroke costs approximately 1.9 million neurons.

Cincinnati Prehospital Stroke Scale (CPSS)

• Facial Droop: Ask patient to show teeth or smile. Abnormal = one side droops or doesn't move.
• Arm Drift: Ask patient to close eyes and hold both arms out for 10 seconds. Abnormal = one arm drifts down or doesn't move.
• Speech: Ask patient to say "You can't teach an old dog new tricks." Abnormal = slurred, wrong words, or unable to speak.

Any ONE abnormal finding = 72% probability of stroke. All three abnormal = very high probability.

Seizures

Seizures are abnormal electrical discharges in the brain. Generalized tonic-clonic (grand mal) seizures involve full-body convulsions — the most dramatic type but usually self-limiting in 1–3 minutes.

During a seizure:

• Protect from injury — move hard objects, pad the ground, do not restrain
• Never put anything in the mouth — people do not swallow their tongues (this is a myth). You will get bitten and the patient can aspirate.
• Position on their side (recovery position) if possible to prevent aspiration
• Note duration — timing matters
• Manage airway: suction if needed post-seizure; oxygen via NRB

After the seizure (postictal phase):

• Altered mental status, confusion, exhaustion, headache are normal — last minutes to hours
• Assess for injury from the seizure
• Get a thorough history — new onset vs. known epileptic, last medication dose, compliance

Status epilepticus: Seizure lasting >5 minutes or two seizures without regaining consciousness. Life-threatening. ALS immediately — benzodiazepines required.

Diabetic Emergencies

Hypoglycemia (Low Blood Sugar — <70 mg/dL)

More dangerous and more immediately treatable than hyperglycemia. Signs: altered mental status, weakness, diaphoresis, shakiness, tachycardia, anxiety, irritability. Can progress to seizure and coma.

• Conscious, can swallow: Oral glucose (15–20g of fast-acting carbohydrates). Check glucose 15 min later. Repeat if still <70.
• Unconscious or can't swallow: Do NOT give oral glucose — aspiration risk. ALS for IV dextrose (D50).
• Always check a blood glucose on any patient with altered mental status

Hyperglycemia / DKA

Signs: gradual onset, polyuria (frequent urination), polydipsia (excessive thirst), nausea/vomiting, fruity breath (ketones), Kussmaul respirations (deep, rapid). BLS treatment: IV access (ALS), fluids, transport. Not an immediate life threat like hypoglycemia but needs hospital care.

Anaphylaxis

A severe, life-threatening systemic allergic reaction. The entire body is affected — vasodilation causes hypotension, bronchospasm causes respiratory distress, airway edema causes stridor. Can kill within minutes if untreated.

Signs of anaphylaxis (must have systemic involvement):

• Hives, flushing, itching
• Angioedema (swelling of face, lips, tongue, throat)
• Bronchospasm — wheeze, stridor
• Hypotension, tachycardia
• GI symptoms — nausea, vomiting, cramping

Treatment:

• Epinephrine 0.3 mg IM (anterolateral thigh) — first and most important
• High-flow oxygen
• Position: supine with legs elevated if hypotensive; sitting up if respiratory distress
• Repeat epinephrine in 5–15 min if no improvement
• ALS — IV epinephrine may be needed; diphenhydramine and corticosteroids are adjuncts only
• Transport immediately — epinephrine is temporary

Opioid Overdose

The opioid overdose triad: pinpoint pupils + respiratory depression + decreased LOC. Fentanyl and synthetic opioids are dramatically more potent than heroin — onset is faster, overdose is more severe.

Treatment:

• Airway management is paramount — position, OPA/NPA, BVM if needed
• Naloxone (Narcan) 0.4–2 mg IN/IM/IV — reverses opioid receptor binding, restoring respiration
• Titrate to adequate ventilation, not full reversal — full reversal causes acute withdrawal, combativeness, and vomiting
• Naloxone half-life is shorter than most opioids — patient can re-narcotize after it wears off. Transport all overdoses.

Altered Mental Status (AMS)

AMS is a symptom, not a diagnosis. Use AEIOU-TIPS to remember causes:

• Alcohol / Acidosis
• Epilepsy / Electrolytes
• Insulin (diabetic emergency)
• Opiates / Overdose
• Uremia (kidney failure)
• Trauma / Temperature
• Infection (sepsis, meningitis)
• Psychiatric / Poison
• Stroke / Structure (bleed, tumor)

Always check glucose first — hypoglycemia is the most common and most immediately treatable cause of AMS. Give oxygen. Get a full history. Transport.