5.1 Medical Emergencies I

Why This Section Matters

The Medical/Obstetrics/Gynecology domain is 25-29% of the NREMT Advanced Emergency Medical Technician (AEMT) cognitive exam, second only to Clinical Judgment. The single most tested skill across this domain is recognizing a medical pattern early and selecting the correct AEMT-scope intervention. This section builds that foundation with the most common non-traumatic complaints: altered mental status, diabetic emergencies, stroke, seizures, and syncope.

Altered Mental Status (AMS)

Altered mental status (AMS) is any deviation from a patient's normal baseline level of awareness, orientation, or responsiveness. It is a presentation, not a diagnosis, so the AEMT job is to support airway, breathing, and circulation while working a structured differential.

Use the AEIOU-TIPS mnemonic to organize causes:

Assessment priorities for any AMS patient: protect the airway (consider positioning and suction), apply oxygen if hypoxic, obtain a blood glucose reading, get a full set of vital signs, and check pupils. Always look for and correct the reversible causes an AEMT can treat in the field: hypoglycemia, hypoxia, and opioid toxicity.

Diabetic Emergencies

Glucose is the brain's primary fuel, so disorders of blood glucose are a leading cause of AMS. Hypoglycemia (low blood glucose, generally below 70 mg/dL) develops quickly: pale, cool, diaphoretic skin, tachycardia, confusion, combativeness, seizures, and ultimately unresponsiveness. Hyperglycemia with diabetic ketoacidosis (DKA) develops over hours to days: warm dry skin, deep rapid (Kussmaul) breathing, fruity acetone breath odor, polyuria, polydipsia, and dehydration.

AEMT Scope for Diabetic Emergencies

Key teaching point: never give anything by mouth to a patient who cannot protect the airway. Glucagon mobilizes stored liver glycogen, so it works slower than IV dextrose and is less effective in malnourished or alcoholic patients with depleted glycogen stores. Always recheck blood glucose after treatment and watch for recurrence.

Stroke

A stroke (cerebrovascular accident, CVA) is an interruption of cerebral blood flow, either ischemic (clot, ~87% of strokes) or hemorrhagic (bleed). The prehospital priorities are rapid recognition, a documented last known well (LKW) time, glucose check to rule out hypoglycemia mimic, and fast transport to an appropriate stroke center.

Use a validated screening tool. The Cincinnati Prehospital Stroke Scale (CPSS) checks three findings:

• Facial droop — ask the patient to smile or show teeth
• Arm drift — arms extended, eyes closed, for 10 seconds
• Speech — slurred, wrong words, or unable to speak

Any single abnormal finding gives roughly a 72% probability of stroke. Larger-vessel scales such as the Los Angeles Motor Scale (LAMS) or BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) help identify severe strokes that may need a thrombectomy-capable center. Document the exact LKW time, not the time symptoms were discovered, because reperfusion therapy windows are measured from LKW.

Seizures

A seizure is abnormal, excessive electrical activity in the brain. A generalized tonic-clonic seizure has a tonic (rigid) phase then a clonic (rhythmic jerking) phase, followed by a postictal period of confusion and gradual recovery. The AEMT role during an active seizure is protection: clear the area, protect the head, do not restrain limbs, and never force anything into the mouth.

Status epilepticus is a continuous seizure lasting longer than 5 minutes, or two or more seizures without full recovery of consciousness between them. It is a true emergency that threatens the airway and causes cerebral hypoxia. Manage the airway with positioning and suction, apply oxygen, check glucose (hypoglycemia is a treatable seizure cause), and transport rapidly. Benzodiazepine administration for seizures may fall within some AEMT protocols depending on the state and medical director.

Syncope

Syncope is a transient, self-limited loss of consciousness caused by a temporary drop in cerebral perfusion, with spontaneous full recovery. Causes group into:

• Cardiac — dysrhythmia, structural heart disease; highest risk, often sudden or exertional with no warning
• Vasovagal (reflex) — triggered by pain, fear, or standing; usually has a prodrome of nausea, warmth, or tunnel vision
• Orthostatic — volume depletion or medications; occurs on standing

The AEMT must distinguish true syncope from a seizure or a near-arrest event. Red flags pointing toward dangerous cardiac syncope: syncope during exertion, no prodrome, palpitations beforehand, a family history of sudden death, or an abnormal pulse. Obtain orthostatic vital signs when safe, monitor the patient, and transport for evaluation.