Medical Emergencies

LPN/VNs must recognize medical emergencies and initiate appropriate interventions. Quick action can mean the difference between life and death.

Cardiac Arrest and Basic Life Support

Chain of Survival:

1. Early recognition and activation of emergency response
2. Early CPR with emphasis on chest compressions
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post-cardiac arrest care
6. Recovery

High-Quality CPR:

AED Use:

1. Power on the AED
2. Attach pads to bare, dry chest
3. Analyze rhythm (ensure no one touching patient)
4. If shock advised, ensure clear and deliver shock
5. Immediately resume CPR for 2 minutes
6. Repeat analysis

Shockable Rhythms:

• Ventricular fibrillation (V-fib)
• Pulseless ventricular tachycardia (V-tach)

Non-Shockable Rhythms:

• Asystole
• Pulseless electrical activity (PEA)

Respiratory Emergencies

Choking/Airway Obstruction:

Acute Respiratory Failure:

• SpO2 rapidly declining
• PaO2 < 60 mmHg on room air
• PaCO2 > 50 mmHg with acidosis
• Treatment: Supplemental O2, possible intubation, treat cause

Anaphylaxis

Immediate Actions:

1. STOP the causative agent
2. Call for help/activate emergency response
3. Maintain airway
4. Prepare for epinephrine administration
5. Position: supine with legs elevated (unless respiratory distress)
6. Oxygen administration
7. Establish IV access for fluids

Epinephrine Dosing:

• Adults: 0.3-0.5 mg IM (anterolateral thigh)
• May repeat every 5-15 minutes

Additional Medications:

• Antihistamines (diphenhydramine)
• Corticosteroids
• Bronchodilators (for bronchospasm)
• IV fluids (for hypotension)

Hemorrhage and Shock

Hemorrhage Control:

1. Apply direct pressure to wound
2. Elevate bleeding extremity above heart level
3. Apply pressure dressing
4. If severe, consider tourniquet (limb-threatening hemorrhage)
5. Do NOT remove impaled objects

Signs of Hypovolemic Shock:

Hypoglycemia Emergency

Signs of Severe Hypoglycemia:

• Confusion, disorientation
• Seizures
• Loss of consciousness
• Inability to swallow

Treatment:

Seizure Emergency

Status Epilepticus: Continuous seizure activity > 5 minutes OR recurrent seizures without recovery between

Management:

1. Call for emergency assistance
2. Protect airway; position on side after active seizure
3. Prepare benzodiazepines (lorazepam, diazepam)
4. Monitor vital signs, oxygen saturation
5. Document seizure characteristics and duration

Stroke Emergency

Time Is Brain:

• Every minute of ischemia = loss of millions of neurons
• tPA window: Within 4.5 hours of symptom onset

Immediate Actions:

1. Activate stroke protocol
2. Note TIME OF SYMPTOM ONSET
3. Rapid neurological assessment
4. Prepare for CT scan (rule out hemorrhage before tPA)
5. Nothing by mouth (NPO) until swallow evaluation

NIHSS (National Institutes of Health Stroke Scale):

• Standardized assessment of stroke severity
• Guides treatment decisions

Burns

Burn Classification:

Rule of Nines (Adult):

• Head: 9%
• Each arm: 9%
• Anterior trunk: 18%
• Posterior trunk: 18%
• Each leg: 18%
• Perineum: 1%

Emergency Burn Care:

1. Stop the burning process (cool water, NOT ice)
2. Remove jewelry, non-adherent clothing
3. Cover with clean, dry dressing
4. Assess airway (inhalation injury?)
5. IV access and fluid resuscitation for major burns
6. Pain management

Emergency Documentation

Critical Elements:

• Time of event
• Patient status/findings
• Interventions performed
• Patient response
• Notifications made (who, when)
• Ongoing assessment findings