5.2 Medical Emergencies II

Why This Section Matters

This section continues the high-weight Medical/Obstetrics/Gynecology domain with the time-critical conditions an AEMT can reverse in the field. Anaphylaxis and opioid overdose are the two presentations where a correct, rapid AEMT intervention most directly changes survival, so they are heavily represented on the exam.

Allergic Reaction and Anaphylaxis

An allergic reaction is an immune response to an allergen. A mild reaction is limited (localized hives, itching). Anaphylaxis is a severe, rapid, multi-system reaction that involves two or more body systems or causes hypotension or airway compromise.

Epinephrine is the first-line, life-saving drug for anaphylaxis. It is given intramuscularly (IM) into the lateral thigh (vastus lateralis). Do not delay epinephrine to give antihistamines or to wait for wheezing to worsen; early epinephrine reverses bronchospasm, supports blood pressure through vasoconstriction, and reduces airway edema. After epinephrine, support the airway, give high-flow oxygen, treat for shock (supine with legs elevated unless breathing is compromised), and transport. Be prepared for a biphasic reaction, where symptoms recur hours later.

Poisoning and Overdose

A poison can enter the body by four routes of exposure: ingestion, inhalation, injection, and absorption. The critical field history is the substance, the amount, the time of exposure, and any interventions already attempted. Contact medical control or a poison center per protocol.

Opioid Overdose and Naloxone

Opioid toxicity produces the classic triad: decreased level of consciousness, respiratory depression, and pinpoint (miotic) pupils. The AEMT priority is ventilation first — support breathing with a bag-valve mask and oxygen, then administer naloxone (intranasal or intramuscular per protocol). Naloxone is a competitive opioid antagonist; titrate it to restore adequate spontaneous breathing rather than to full agitated wakefulness. Because naloxone may wear off before the opioid does, watch for re-sedation and always transport.

Gastrointestinal and Genitourinary (GI/GU) Emergencies

Gastrointestinal (GI) emergencies include GI bleeding (bright red or coffee-ground emesis, black tarry melena), bowel obstruction, and acute abdominal pain. Treat the patient for shock if there are signs of significant blood loss: position of comfort, oxygen as indicated, and IV fluids per protocol. Genitourinary (GU) complaints include urinary retention, kidney stones (severe flank pain radiating to the groin), and urinary tract infection that can progress to urosepsis, especially in older adults who may present only with confusion. Treat hypoperfusion and transport.

Endocrine Emergencies

Beyond diabetes, the AEMT should recognize adrenal crisis (history of steroid use or Addison disease, profound hypotension and weakness) and severe thyroid storm (extreme hyperthermia, tachycardia, agitation) versus myxedema (hypothermia, decreased mentation). Field care is largely supportive: airway, oxygen, fluids for hypoperfusion, temperature management, and rapid transport, because definitive treatment is in-hospital.

Infectious Disease

Field providers rarely know a patient's infectious status, so standard precautions apply to every contact. Match PPE to the likely route:

• Gloves for any contact with blood or body fluids
• Eye protection and mask when splashing or droplets are possible
• N95 or higher respirator for suspected airborne disease (e.g., tuberculosis)

Decontaminate equipment, manage sharps safely, and follow your service exposure-reporting policy after any potential exposure.

Behavioral and Psychiatric Emergencies

A behavioral emergency is when a patient's behavior is unsafe to themselves or others or interferes with care. Scene safety is the first priority: do not enter an unsafe scene, request law enforcement when needed, and keep an exit path. Always rule out organic causes of altered behavior first — hypoglycemia, hypoxia, head injury, toxins, and infection can all mimic a primary psychiatric problem.

Excited (agitated) delirium is a medical emergency characterized by extreme agitation, profound combativeness, hyperthermia, and resistance to restraint, with a high risk of sudden cardiac arrest. Use de-escalation, minimize physical struggle, never restrain a patient in a prone position that can compromise breathing, monitor closely, and transport. For suicidal or homicidal ideation, do not leave the patient unattended and document statements objectively.