by Miss Lesley Watson (Emergency Medicine Consultant), published 26 January 2023.
When a person presents to the Emergency Department or Accident & Emergency Department they often require life-saving treatment. A significant portion of these treatments must be administered within a specific timeframe in order for them to be effective, optimise the chance of survival, and decrease the risk of disability. Below is a rundown of medical emergencies and the rapid treatments required in the Emergency Department.
| Emergency | What it is | Emergency Treatment | Timeframe |
| Acute aortic dissection | An acute disruption (tear) to the wall of the aorta (largest artery in the body). | Diagnosis with a bedside aortic ultrasound scan followed by immediate discussion with a regional Vascular Service to discuss transfer for surgical intervention. | The patient must leave the referring unit within 30 minutes of a decision to transfer to a Specialist Centre. (NICE Guideline NG156 2020) |
| Anaphylaxis | A severe allergic reaction occurring within seconds – minutes of exposure to the triggering substance. The reaction leads to swelling of the soft tissues, airway compromise, tachycardia (high heart rate, and hypotension (low blood pressure). | Intramuscular (IM) adrenaline, establish airway, high flow oxygen. Adrenaline may be administered a further time if no response within 5 minutes of the initial dose, followed by an IV fluid bolus, sometimes with IV infusion of adrenaline. | Immediate treatment should be administered. Blood samples should be taken as soon as treatment has been given, with a further sample taken no later than 4 hours after. This is called a mast cell tryptase test. (NICE Guideline [CG134], 2021) |
| Arrhythmias with circulatory compromise | The heart does not beat in the usual fashion (sinus rhythm) leading to inadequate circulation of blood around the body. | Emergency electrical cardioversion. | Immediate treatment should be administered. (BNF Arrhythmias. 2023) |
| Asthma attack (severe) | The airways become swollen and inflamed, and the muscles of the airways begin to spasm, inhibiting an individuals ability to breathe. | High-dose inhaled short-acting beta2 agonist (such as salbutamol) administered by an oxygen-driven nebuliser. Adrenaline may be required with IV magnesium and an anaesthetic assessment may be necessary for consideration of intubation. | Immediate treatment should be administered. (BNF Asthma, Acute. 2023) |
| Cardiac arrest | The sudden loss of heart function. The individual will have no palpable pulse with no signs of life. | Cardiopulmonary resuscitation (CPR) with/without defibrillation. | Immediate treatment should be administered as per National Guidelines. (BNF CPR. 2023) |
| Chemicals in eye | Chemicals, including alkalines and acids, can cause damage to the eye leading to vision impairment or even sight loss. | Ocular anaesthetic drops administered followed by high-volume irrigation of the eye for at least 30 minutes using an eye-irrigation kit. The pH of the eye should be tested before and at least 15 minutes after irrigation. The eye should then be examined using a slit lamp. | Immediate treatment should be administered. (RCOphth, February 2020) |
| External Haemorrhage | A sudden, rapid loss of blood outside the body, often due to a penetrating wound or limb injury. | Control the source of bleeding asap with compression and tourniquets, giving cautious fluids replacement until surgical intervention. | Immediate treatment should be administered. (NICE Guideline, [NG39], 2016) |
| Internal Haemorrhage | A sudden, rapid loss of blood from the circulatory system, often accumulating within body cavities. | Cautious fluid resuscitation, with consideration of tranexamic acid, followed by imaging to identify the location of the bleeding before progressing to surgical intervention. | Immediate treatment should be administered. (NICE Guideline, [NG39], 2016) |
| Hyperkalaemia with ECG changes | High levels of potassium in the blood leading to disruption in the beating of the heart. | IV calcium gluconate, followed by IV insulin and glucose. Further management will be given depending on the response to initial emergency treatment. | Immediate treatment should be administered. (BNF Fluids and Electrolytes. 2023) |
| Hypoglycaemia (severe) | Very low levels of sugar in the blood, usually in a diabetic individual, which can lead to coma and/or death. | If conscious and able to swallow – fast-acting carbohydrate by mouth should be given. If unconscious – IM glucagon, followed by IV glucose infusion if no response to injection after 10 minutes. | Immediate treatment should be administered. (BNF, Hypoglycaemia. 2023) |
| Ischaemic stroke | A sudden focal neurological deficit resulting from an obstructed blood vessel supplying blood to the brain (thrombus). | Imaging of the brain should be performed to rule out a haemorrhagic stroke, then thrombolysis or thrombectomy should be undertaken. All patients should be admitted to a Specialist Stroke Unit. | Thrombolysis needs to be given within 4.5hours of the onset of symptoms. Thrombectomy needs to be performed within 6hours of the onset of symptoms. (NICE Guideline NG128, 2022) |
| Massive pulmonary embolism | A blood clot found in the lungs which obstructs more than exceeds 50% of the cross-sectional area, causing acute and severe cardiopulmonary failure from right ventricular overload i.e., the blood clot is so large that is causes severe hypotension, respiratory collapse, and then cardiac arrest. | CTPA or echocardiogram to diagnosis the massive pulmonary embolism, followed by thrombolysis. | Thrombolysis needs to be given within 4.5hours of the onset of symptoms. Thrombectomy needs to be performed within 6hours of the onset of symptoms. (BTS, Thorax. 2003) |
| Myocardial infarction (MI) | A heart attack; a blood clot occludes one or more of the blood vessels supplying the heart muscle, often leading to death of a section of the heart muscle. | GTN, IV morphine, and a loading dose of aspirin. Following confirmation of a ST-elevation MI, percutaneous coronary intervention (PCI) should be undertaken. Further management will be undertaken. | Immediate delivery of GTN, IV morphine, and aspirin. PCI should be undertaken within 12 hours of the onset of symptoms. (BNF, Acute Coronary Syndromes. 2023) |
| Respiratory arrest | The sudden cessation of breathing. | Open the airway, supply oxygen, and mechanical ventilation. | Immediate treatment should be administered. |
| Sepsis | The body’s extreme reaction to an infection leading to organ failure, tissue damage, and sometimes death. | IV fluid bolus and antibiotics (broad spectrum if sepsis of unknown origin), oxygen, and refer to Critical Care. | Patient should be reviewed within 30 minutes of arrival to A&E. IV fluid bolus and antibiotics should be given within one hour. (UKST EM TOOLKIT 2016) |
| Status epilepticus | A prolonged seizure of more than 5 minutes or repeated seizures without regaining consciousness. This can lead to brain damage and/or death. | IV benzodiazepine, followed by a second dose if the seizure does not stop within 5 to 10 minutes of the first dose. Further medications and anaesthesia with intubation may be considered if the individual continues to have seizures. | Immediate treatment should be administered. (NICE Guideline [NG217], 2022) |
| Upper airway obstruction | The upper airways (nose, mouth, throat) become obstructed, usually from a foreign object, resulting in obstructed breathing. | Remove the foreign object and secure the airway. Anaesthetic assistance may be required or the creation of a surgical airway. | Immediate treatment should be administered. (Lynch J, Crawley SM. Management of airway obstruction. BJA Educ. 2018) |
Our A&E expert witnesses have a wealth of experience managing the above medical emergencies and can provide medicolegal reports covering breach of duty, causation, current condition, and prognosis on cases surrounding treatment in the Emergency Department or Accident & Emergency Department.
Disclaimer
This information is for educational purposes only and should not be relied upon in a Court of law or legal proceedings. The contents of this article are correct as of the date of publishing. Current guidance should be sought from official governing bodies.