MEDICAL EMERGENCIES AND THEIR ALGORITHMS

RESPIRATORY

LARYNGOSPASM

1. Administer 100% oxygen
2. Suction foreign material
3. Push on chest, listen for air
4. Attempt positive-pressure ventilation
5. Administer succinylcholine (Anectine) 10 to 40mg IV

BRONCHOSPASM

1. Provide positive-pressure oxygen
2. Provide Albuterol inhaler
3. Administer Epinephrine 5 ml 1:10, 000 Solution (0.3-0.5 mg 1:1, 000 solution)

EMESIS AND ASPIRATION

1. Allow patient to cough
2. Position head down or to side
3. Remove foreign material
4. Administer 100% oxygen

If No Improvement:

1. Place patient in Trendelenburg position 15 degrees on right side
2. Remove foreign material
3. Intubate
4. Administer 100% oxygen
5. Transfer to hospital

AIRWAY OBSTRUCTION

• Chin lift/jaw thrust
• Perform Heimlich maneuver
• If unable to ventilate, perform Cricothyrotomy / Tracheostomy

CARDIOVASCULAR

STABLE ANGINA

1. Terminate surgery
2. Administer nitroglycerin (one tab)
3. Administer 100% oxygen
4. Monitor patient
5. Repeat nitroglycerin administration after 5 minutes
6. Assume myocardial infarction if there is no relief after third dose of nitroglycerin; Proceed to morphine, oxygen, nitroglycerin, aspirin to chew

UNSTABLE ANGINA/MYOCARDIAL INFARCTION

1. Activate emergency medical services (911)
2. Administer 100% oxygen
3. Administer nitroglycerin if systolic BP is greater than 90 mmHg
4. Administer nonenteric aspirin 160-325 mg to chew
5. Administer morphine
6. Monitor electrocardiography, blood pressure, pulse oximetry
7. Establish intravenous lines
8. Treat dysrhytmisas

HYPOTENSION

1. Indentify cause and correct
2. Administer 100% oxygen and terminate procedure
3. Administer intravenous drugs if needed

HYPERTENSION

1. Identify cause and correct
2. Administer 100% oxygen and terminate procedure
3. Administer intravenous drugs if needed

VENIPUNCTURE COMPLICATIONS

PHLEBITIS:

1. Apply moist heat
2. Administer drugs: aspirin, steroids, antibiotics
3. Limit motion of affected limb
4. If symptoms persist, refer for consultation

INTRA-ARTERIAL INJECTION:

1. Leave needle in place
2. Administer 10 ml 1% Lidocaine (Xylocaine)
3. Refer to hospital for possible heparinization and/or stellate ganglion block after consultation with a vascular surgeon.

OTHER

SYNCOPE

1. Place patient in a supine position and raise feet
2. Administer oxygen

HYPERVENTILATION SYNDROME

1. Monitor patient and provide verbal reassurance
2. Increase carbon dioxide intake with artificial dead space (e.g. paper bag, mask and anesthesia bag with low-flow oxygen)
3. Possibly administer intravenous diazepam (Valium)

SEIZURES

1. Prevent injury
2. Administer intravenous diazepam (Valium)
3. Monitor patient after grand mal seizure for possible respiratory depression

MALIGNANT HYPERTHERMIA

1. Discontinue all anesthetic agents, administer 100% oxygen, and hyperventilate
2. Activate emergency medical services (911)
3. Administer Dantrolene (Dantrium) 1 to 3 mg/kg (up to 10 mg/kg possible)
4. Cool patient’s body
5. Treat ventricular dysrhythmias
6. Treat hyperkalemia with bicarbonate, intravenous insulin 0.25 to 0.3 U/kg and glucose 0.25 to 0.5 mg/kg
7. Prevent renal failure from myoglobinuria
8. Obtain coagulation studies

SEVERE ALLERGIC REACTION

1. Maintain airway and administer 100% oxygen
2. Place patient in supine or Trendelenburg position
3. Monitor
4. Administer intravenous fluids
5. Administer drugs: a. Epinephrine 0.3 mg (repeat until stable) b. Diphenhydramine (Benadryl) 50mg

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