16.5 Emergency Management in the Clinic: CPR and AED, Choking, Anaphylaxis, Hypoglycemia, Seizures, and Falls

16.5 Emergency Management in the Clinic: CPR and AED, Choking, Anaphylaxis, Hypoglycemia, Seizures, and Falls

Quick Answer: Emergency management is 5% of the 2026 BIOM exam. The outline asks you to recognize situations that need special or emergency care (such as seizures, falls, anaphylactic reactions, and hypoglycemia) and to implement emergency protocols such as CPR. NCBAHM recertification requires a current CPR certificate. Needling emergencies (needle shock, pneumothorax, broken needles) are covered in Section 11.3, and medical emergencies such as stroke and heart attack in Chapter 14.

Clinic Emergency Preparedness

• A written emergency plan with assigned roles, the clinic address posted by the phone, and regular practice drills.
• Current CPR and AED certification for all clinical staff.
• An AED, gloves, a CPR barrier mask, a glucose source (tablets or gel), first-aid supplies for burns and bleeding, and, where state law and clinic policy allow, epinephrine.
• Incident documentation after every event: what happened, the time, actions taken, who was notified, and follow-up.

Adult CPR and AED Use (2025 AHA Guidelines)

1. Check that the scene is safe, tap the patient, and shout.
2. If the patient is unresponsive and not breathing normally (or only gasping), call 911 and get the AED.
3. Begin chest compressions in the center of the chest: 100-120 per minute, at least 2 inches (5 cm) but no more than 2.4 inches (6 cm) deep, allowing full chest recoil and minimizing pauses.
4. Trained rescuers give 30 compressions and 2 breaths; untrained bystanders may give hands-only CPR.
5. Use the AED as soon as it arrives: turn it on and follow the prompts. Remove any needles from the chest, place the pads on dry, bare skin, and make sure no one touches the patient during rhythm analysis and shocks.
6. Continue until EMS takes over or the patient starts to move or breathe normally.

Choking

• Mild obstruction (the patient can cough and speak): encourage coughing and stay with the patient.
• Severe obstruction in an adult or child (cannot speak, cough, or breathe; hands at the throat): under the 2025 AHA guidelines, give 5 back blows between the shoulder blades, then 5 abdominal thrusts, and alternate until the object comes out or the person becomes unresponsive. Use chest thrusts for pregnant patients and people too large for abdominal thrusts.
• Infants: alternate 5 back blows and 5 chest thrusts; never give abdominal thrusts to an infant.
• If the person becomes unresponsive, call 911 and begin CPR, looking in the mouth for the object before giving breaths.

Anaphylaxis

Triggers in a clinic include latex, adhesive tape, topical products, herbs, insect stings, and foods. Signs develop within minutes: hives, swelling of the lips, tongue, or throat, wheezing, hoarseness, difficulty breathing, vomiting, dizziness, and low blood pressure.

1. Call 911.
2. Give intramuscular epinephrine into the outer thigh as soon as possible: 0.3 mg for adults and children weighing 30 kg or more and 0.15 mg for children 15-30 kg. A nasal epinephrine spray is also approved. A second dose may be given after 5-15 minutes if there is no improvement.
3. Lay the patient flat with the legs raised, or sitting up if breathing is difficult. Do not let the patient stand or walk.
4. Remove the trigger and needles, and begin CPR if the patient stops breathing normally.
5. The patient must go to the emergency department even after improving, because symptoms can return.

Antihistamines treat hives but do not reverse airway swelling or shock. Use latex-free gloves for patients with latex allergy.

Hypoglycemia

Low blood sugar (below 70 mg/dL) is most common in patients taking insulin or sulfonylureas, especially after skipping a meal. Signs include shakiness, sweating, hunger, fast heartbeat, irritability, confusion, and, if severe, seizures or loss of consciousness. Beta blockers can mask the warning signs.

• Conscious patient: give 15 grams of fast-acting carbohydrate (glucose tablets or about 4 oz of juice), recheck in 15 minutes, and repeat if needed (the Rule of 15, Section 12.4). Follow with a snack.
• Unresponsive patient: give nothing by mouth, call 911, and give glucagon (nasal or injectable) if available and trained.
• Prevention: ask patients with diabetes whether they have eaten and when they last took medication.

Seizures

1. Stay calm and time the seizure.
2. Ease the patient to the floor or keep them safely on the table, cushion the head, and clear away hard objects.
3. Do not restrain the patient or put anything in the mouth.
4. Remove needles when it is safe to do so, and protect the patient from injury.
5. Once the jerking stops, turn the patient onto the side (recovery position) and stay until they are fully awake.

Call 911 if the seizure lasts 5 minutes or longer, another seizure follows, the patient has trouble breathing or does not wake up, is injured, is pregnant or has diabetes, or has never had a seizure before.

Falls

Prevention: screen for fall risk (a fall in the past year, feeling unsteady, or worry about falling), help patients on and off the table, use a sturdy step stool, keep floors dry and clear, and have patients sit up slowly before standing to avoid orthostatic hypotension. Older adults, patients with Parkinson's disease, and patients taking sedatives or blood pressure medicines are at highest risk.

After a fall: do not move a patient who may have a head, neck, or back injury. Check responsiveness, breathing, and injuries. Call 911 for loss of consciousness, a head injury in a patient taking anticoagulants, inability to bear weight, deformity, severe pain, or new confusion. Complete an incident report.

Burns and Other Clinic Injuries

• Burns from moxibustion or heat lamps: cool with cool running water (not ice) for at least 10 minutes, do not break blisters, cover with a clean nonstick dressing, and refer large or deep burns (Section 12.10).
• Bleeding and hematoma: apply firm, direct pressure.
• Fainting (needle shock): remove the needles, lay the patient flat with the legs raised, and monitor (Section 11.3).

Document every emergency and follow-up action in the patient's record and the clinic incident log.