9.6 Medical Emergencies

Medical Emergencies

Emergency items test the first action under pressure. Default to airway-breathing-circulation, then activate help. The LPN/VN initiates basic life support and prepares emergency drugs while the RN/provider/code team responds.

Cardiac Arrest and Basic Life Support

The Chain of Survival: early recognition and activation → early CPR (compressions first) → rapid defibrillation → advanced life support → post-arrest care → recovery.

AED: power on, attach pads to a bare, dry chest, clear everyone during analysis, deliver the shock if advised, and immediately resume compressions for 2 minutes before reanalyzing. Shockable rhythms: ventricular fibrillation and pulseless ventricular tachycardia. Non-shockable: asystole and pulseless electrical activity — these get CPR and epinephrine, not defibrillation. A common trap: you cannot "shock" asystole.

Choking and Airway Obstruction

Never perform a blind finger sweep — it can push the object deeper.

Anaphylaxis

Steps: stop the trigger, call for help, maintain the airway, and prepare epinephrine. Adult dose: 0.3–0.5 mg IM (1 mg/mL / 1:1000) into the anterolateral thigh (vastus lateralis), repeat every 5–15 minutes as needed. Epinephrine is first-line because it reverses bronchospasm, supports blood pressure, and reduces angioedema within minutes. Position supine with legs elevated unless respiratory distress demands upright. Adjuncts (antihistamines, corticosteroids, bronchodilators, IV fluids) never replace epinephrine.

Hemorrhage and Hypovolemic Shock

Control bleeding: direct pressure first, elevate the extremity, apply a pressure dressing, then a tourniquet for limb-threatening hemorrhage. Do not remove impaled objects — stabilize them in place. Classify hypovolemic shock by loss:

Note that blood pressure stays normal until Class III — tachycardia and anxiety come first.

Hypoglycemia, Seizure, and Stroke Emergencies

• Severe hypoglycemia: if conscious and able to swallow, 15 g fast-acting carbs; if unable to swallow or unconscious, glucagon IM or IV dextrose 50%.
• Status epilepticus (seizure >5 minutes or back-to-back without recovery): call for help, protect the airway and side-lie after the active phase, prepare IV benzodiazepines (lorazepam, diazepam), monitor SpO₂, and document.
• Stroke — time is brain: note the exact time of symptom onset, activate the stroke protocol, keep NPO, and prepare for a non-contrast CT to rule out hemorrhage. Eligible ischemic-stroke patients receive IV thrombolytics within 4.5 hours of onset (extended to 24 hours in selected patients with advanced imaging, per the 2026 AHA/ASA guideline).

Burns

Rule of Nines (adult): head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%. Emergency care: stop the burning with cool water (never ice), remove jewelry and non-adherent clothing, assess the airway for inhalation injury (singed nares, hoarseness, soot — the true priority in facial/enclosed-space burns), cover with a clean dry dressing, and start IV fluid resuscitation for major burns.

Emergency Documentation

Record the time of the event, assessment findings, interventions performed, the patient's response, who was notified and when, and ongoing reassessment — accurate, objective, and chronological.

Triage and Prioritization Under Pressure

When an emergency item lists several patients, apply the ABC order and the rule that actual threats outrank potential ones. Airway compromise (stridor, choking, a GCS ≤8 who cannot protect the airway) comes first, then breathing (severe respiratory distress, SpO₂ falling despite oxygen), then circulation (uncontrolled hemorrhage, signs of shock).

In a mass-casualty triage scheme, red/immediate tags go to patients with life-threatening but survivable injuries, yellow/delayed to serious-but-stable, green/minor to the walking wounded, and black/expectant to those with non-survivable injuries — a deliberate shift from "sickest first" to "greatest good for the greatest number."

Poisoning and Overdose Antidotes

The exam expects a handful of antidote pairs cold, because giving the reversal agent is often the priority action:

• Opioids → naloxone (watch for re-sedation as it wears off; redose as needed)
• Benzodiazepines → flumazenil (use cautiously; can precipitate seizures)
• Acetaminophen → N-acetylcysteine (most effective within 8 hours of ingestion)
• Warfarin → vitamin K (fresh frozen plasma for active major bleeding)
• Heparin → protamine sulfate
• Magnesium sulfate → calcium gluconate
• Iron → deferoxamine

For most ingestions, do not induce vomiting; activated charcoal may be ordered, and caustic or hydrocarbon ingestions are managed without emesis to avoid re-injuring the airway and esophagus.

First Actions: The Recurring Theme

Across every emergency in this chapter, the highest-yield habit is the same: assess and protect the airway, ensure breathing and circulation, then activate help and deliver the indicated drug or intervention. Recognizing the deteriorating patient early — the restless hypoxic patient, the tachycardic pre-shock patient, the seizing patient past five minutes — and acting within scope while summoning the RN or code team is precisely the clinical judgment the NCLEX-PN is built to measure.