MANAGING EMERGENCIES

TABLE 7: MANAGING EMERGENCIES

MAINTAIN PATIENT SAFETY ● CALL FOR HELP ● ASSESS PATIENT CONDITION

Most likely Diagnosis

Symptoms and Context

Management

Important consideration

Anaphylaxis

If low BP: Start IV LR or NS

Hypovolemic Shock

Evaluate and manage source

Consider 4Ts / 6Ts (see Ch 6: Complication Table: Excessive Bleeding / Hemorrhage)

Vasovagal Reaction (Neurogenic Shock)

Prevent by keeping supine post-procedure
Place supine / Trendelenburg
Elevate legs
Isometric muscle contractions: Tense leg, buttock & arm muscles 20-30 times, 5-10 seconds each (Wang 2022)
Cool cloth/ice pack face/ neck
Alcohol or ammonia capsule
Oxygen

If persistent symptomatic bradycardia or hypotension:

Give IV fluids
Give Atropine 0.4-1.0mg IM / IV, ephedrine 5-10 mg, glycopyrrolate 0.2 mg (Malave 2022, Vidri 2021)

If no recovery (SBP<90, MAP<65, HR<50):

Cardio-Pulmonary Arrest

Every 2 minutes check pulse, rhythm, and switch compressors until EMS arrives

Seizure

If continues > 2 min:

Hyperventilation

Assure the person is stable before leaving the health center

Respiratory depression

Transfer via 911 to higher level care setting if not responding to initial measures

^{Health centers should have written protocols for the management of medical emergencies, including bleeding, perforation, respiratory depression/arrest, anaphylaxis, and emergency transfer.}
^{Health centers should have hospital transfer agreements outlining the means of communication and transport and the protocol for emergent transfer of care (NAF 2024).}
^{Emergency scenarios (TEACH) are available for role-plays, debrief, and teaching}

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