medical emergency management

1. WELCOME!
Orientation on
Medical Emergency Management
(MEM)

2. Learning Objective
• Identify and initiate management of common medical
emergency using a systematic approach
• Demonstrate Basic Life Support skills/ Cardio Pulmonary
Resuscitation (CPR)
• List medicines and equipment in an emergency pack
• Explain the need to have arrangements for emergency
transfer to a competent referral hospital in a medical
emergency
• Explain the need to keep appropriate record of an
emergency management
• Begin to identify who could play (and not play) which roles in
the management of an emergency

3. Medical emergencies?
• Life-threatening situations
• FP & SA clients are usually young and healthy and a competent
provider use good screening and simple, excellent procedures
which keep complications to a minimum
• The unexpected can still happen during or after a procedure
• Client may have an undiagnosed condition or be unwell on arrival
• Attendants or clinic staff members themselves may suddenly become ill
• The situation can change rapidly
• Little thinking time and people feel stressed

4. Common medical emergencies
• Haemorrhage - Serious loss of blood
• Sepsis - Serious “whole body” infection
• Anaphylaxis - Serious “whole body” allergic reaction
• Seizure - Fitting
• Fainting (e.g. vasovagal)
• Hypoglycaemia - Low blood sugar
• Cardiac Emergency
• Asthma

5. Quality Medical Emergency Management
Outputs
• Zero Avoidable/
preventable deaths
• Correct interventions
carried out in the right
order at the right time
• Appropriate and timely
transfer to a competent
referral centre
• Client satisfaction
Inputs
• Trained Staff
• Emergency medicines &
equipment accessible
• Agreement with
competent referral centres
• Emergency transport
quickly accessible
• Proper Documentation

6. HOW TO APPROACH
A CLIENT IN
MEDICAL EMERGENCY?

7. WHAT WE LEARNT
IN FIRST YEAR
AT SCHOOL WILL HELP!
0123456789…………………

8. A AIRWAY
BREATHING
CIRCULATION
DISABILITY
EXPOSURE &
ENVIRONMENT
B
C
D
E

9. Why ABCDE?
• A systematic and structured approach
• prevents important signs and symptoms from being missed
• What harms fastest gets treated first
• A simple framework
• Easily remembered in stressful situations
• Each letter represents a component of assessment and
intervention
• Where life-threatening symptoms are found, intervention and action
should be taken before moving onto the next part of the
assessment

10. A AIRWAY
Problems affecting airway may be
immediately life-threatening and
require early identification and
intervention to correct the problem.
B
C
D
E

11. Airway Assessment
Signs of Airway obstruction or blockage:
• Snoring - a sign that tongue and oropharynx are partially
obstructing the airway
• ‘Crowing’ sound (stridor) suggests an upper airway
obstruction, for example caused by a foreign body or an
allergic reaction causing swelling

12. Managing an obstructed airway
• If any visible foreign body or gurgling sound present, clear
it using forceps or suction before opening the airway else
aspiration
• Tongue is the most common cause of airway obstruction
and can be moved using:
• Head-tilt/chin lift
• Oropharyngeal airway insertion (in unconscious)
• Oxygen administration to maintain saturation above 92%

13. Airway opening manoeuvre
Head-tilt/ chin lift

14. Jaw Thrust
This four-step method of airway opening is applied when there
may be suspected injury to the cervical spine or where the spine
has been immobilised-
1. first, identify both angles of the jaw, where the mandible
connects to the skull
2. place the first two fingers of each hand in the groove of the
angle of the jaw
3. place thumbs on the cheekbones to provide counter traction
4. gently pull the mandible forward – in the case of a casualty in
the supine position this would be upwards towards the ceiling

15. Jaw Thrust

16. A
BREATHING
B
C
D
E

17. Breathing Assessment
• Number of respirations per minute
• a rate either less than 8 or more than 25 would indicates difficulty
• Use of accessory muscles – neck and chest wall
muscles
• Skin colour, specifically any blue (cyanosis) or grey tinge
to the skin indicating a lack of oxygen
• Wheezing - an indicator of either anaphylaxis or asthma
attack.

18. Managing Breathing
• If breathing is absent or not sufficient then support
breathing with a bag valve mask (Ambu-bag) with high
flow oxygen.
• Bag valve mask ventilation can provide the highest
concentration of oxygen delivery to someone who is
collapsed – approximately 85%.
• Squeeze air from the bag just sufficiently for the chest to show
visible signs of movement
• Rescue breaths (to casualties having respiratory arrest) should be
delivered at a rate of 10 per minute (5 second pauses between
breaths)

19. A
CIRCULATION
This assesses the adequacy of
blood flow to the brain and
heart.
B
C
D
E

20. Circulation - Assessment
• Pulse
• use carotid pulse as radial pulses may be weak or absent
in casualty
• Blood Pressure
• Skin
• Blue lips – lack of oxygen centrally
• Capillary refill time:
• Apply pressure for 5 seconds on the forehead or a finger (nail
bed) held at heart level with enough pressure to cause
blanching (paleness)
• After the pressure is released, the colour of skin should returns
within 2 seconds

21. Managing Circulation
• Hypovolaemia (from rapid and significant loss of blood)
should be considered as a primary cause when there are
signs of shock or low blood pressure until proven
otherwise
• finding and stopping further bleeding and intravenous fluid support
is vital.
• Relevant blood samples can be taken simultaneously

22. A
DISABILITY
A rapid easy assessment of the
conscious level
B
C
D
E

23. A Alert – Person Talking to you
Voice – Not talking but responds to
your voice
Pain – less conscious but responds to
pain (pinch side of finger, trapezius or
supraorbital pressure)
Unresponsive – Pupil size and
reaction
V
P
U
Decreasing conscious level

24. Reasons for decreased conscious levels
• Drugs which sedate
• Hypovolaemia/ blood loss
• Hypoxia
• Low blood sugar
• Other illness such as stroke.

25. A
EXPOSURE &
ENVIRONMENT
B
C
D
E

26. Exposure & Environment Assessment
• Examination to determine the cause of illness
(head to toe)
• Any rash (sign of severe sepsis or an allergic reaction)
• Fever
• Examining the abdomen - looking for distension or pain
• Obvious or excessive vaginal bleeding
• Swelling of ankles (may indicate heart failure)
• Any track marks which could indicate drug usage
• Ensure that the environment is safe
• Ensuring that the emergency equipment is available
• Keeping the casualty warm in the recovery position, if
required until help arrives

27. Recovery Position
• The recovery position is used to safely manage a casualty
who is both breathing and has a pulse, but is
unresponsive
Moving a casualty into the recovery position

28. Recovery Position

29. A Checklist
B
C
D
E

30. EMEREGENCY TRANSFER TO
REFERRAL FACILITY

31. Referral & Handover
• Agreement with competent referral centres
• Emergency transport (ambulance) quickly accessible
• Accompanied referral
• It is very important for continuity of care that a full
handover is given
• Completed referral form
• Oral handover report to the transfer crew

32. AMPLE
A is for Allergies Are there any known allergies
M is for Medication Current prescribed Medication..?
What drugs have been Given..?
P is for Past Medical history General Medical History…..
 Previous Heart Attack
 Epilepsy
 Other recent Treatment
L is for Last meal What did they last eat…?
E is for Events What happened before, during and after
the Emergency…?

33. MEM IS TEAMWORK

34. What’s your role in managing an emergency?
1. The person in-charge…
2. The person managing the airway…
3. The person with responsibility for intravenous support…
4. The ‘runner’…
5. The chest compression people…
6. The record keeper…
• The stress during medical emergency situation can be
reduced significantly with effective communication and
everyone being clear about their role.
• Staff should undertake only those actions which they feel
competent to perform.

35. MEDICAL EMERGENCY
EQUIPMENT AND DRUGS

36. When an emergency occurs, time is critical!
• Emergency supplies should be readily available and kept
in an accessible place.
• Equipment should be in working condition.
• A team member should be responsible for
• Replacing supplies as soon as they are used or past their use-by
date.
• Weekly recorded checks of equipment and supplies

37. Storage of Emergency Drugs & Supplies

38. MEM Checklist
Emergency
Equipment List
Emergency
Medicines &
Fluids List

39. BASIC LIFE SUPPORT
For a casualty

40. Collapsed Patient
Many cases of collapse will be the result of a
simple faint, otherwise known as syncope or
vasovagal episode.
• Easily treated by laying the casualty flat and
elevating the legs to aid recovery.
HOW TO APPROACH A COLLAPSED PATIENT?

41. Three ‘S’s – Shake Squeeze, Shout
Rapid & Simple Test to
assess responsiveness
Call for Help!

42. Proceed to ABC assessment
• ‘Head Tilt - Chin lift’ once
airway is clear
• Look, listen and feel for up to
10 seconds for signs of normal
breathing while also checkling
for carotid pulse

43. If Casualty is Unresponsive &
No sign of Breathing and Circulation
• Get help
• Begin cardiopulmonary resuscitation (CPR) immediately
• The recommended compression rate is 100–120 per minute
• The more compressions are done in quick succession, the better
the circulation achieved
• The recommended compression-to-breathing ratio is 30
compressions to 2 ventilations
• If there are two people giving BLS, one should perform
rescue breathing while another gives chest compressions

44. Important to have your hands and arms in the correct
position for chest compressions to be both effective
and safe during CPR
Hand Position Arm Position
Push the chest down approximately
6 cm with each compression

45. Chest compressions
• Continue CPR without stopping unless the casualty
shows some sign of life. If they do, begin the
assessment process again from the beginning.
• BLS will rarely revive a casualty on its own, but when
performed properly, it will buy time until other definitive
measures can be started or other help arrives.

46. DEMONSTRATION
ABCDE Approach during medical emergency

47. Common medical emergencies
• Haemorrhage - Serious loss of blood
• Anaphylaxis - Serious “whole body” allergic reaction
• Sepsis - Serious “whole body” infection
• Seizure - Fitting
• Fainting (e.g. vasovagal)
• Hypoglycaemia - Low blood sugar
• Cardiac Emergency
• Asthma

48. Haemorrhage
• Excessive discharge of blood from the blood vessels is
called haemorrhage-
Sign and Symptoms-
very rapid heartbeat (tachycardia)
low blood pressure or hypotension
Hypovolemia
casualty is pale with a grey tinge and maybe blue lips
cold hands and feet
casualty is thirsty and produces very little urine
Breathless

49. Causes of Haemorrhage-
There are most Likely cause of haemorrhage in MSI
settings:
complications from MSI procedures.

50. Management of haemorrhage
There are three key principles in managing any
casualty with suspected or confirmed haemorrhage:
1. stop the source of bleeding wherever possible
2. resuscitate with appropriate fluids in line with the total
loss of fluid-
Crystalloids
Colloids
Blood Transfusion
3. give high level oxygen

51. Anaphylaxis
• Anaphylaxis is a severe life- threatening, generalized or
systematic hypersensitivity reaction which may or may
not be allergy-related.
Common causes include penicillin/antibiotics or any other
drug injections, anti-inflammatory drugs (NSAIDs).

52. sign and Symptom
Itchy raised red rash (urticaria)
Itching face, nose or lips
Running eyes and nose
Tight throat
Vomiting and diarrhoea.
Swelling of tongue and lips
Flushing or pallor
Tachycardia
Hypotension

53. Management of Anaphylaxis
The casualty should lie or sit in the position most
comfortable to them.
High flow oxygen (15 litres per minute) should be given
adrenaline (epinephrine) the initial dose is 0.5ml of 1
in1,000 adrenaline.
Supportive treatment such as antihistamines,
corticosteroids and intravenous fluids.

54. Hypoglycaemia ( Low Blood Sugar )
• Hypoglycemia is a condition characterized by an abnormally low
level of blood sugar or glucose (less than 4.0 mmol/litre or 72mg/dl).
Signs & Symptoms :
 Headache
 Blurry vision Ringing in the ears
 Tachycardia
 palpitations of heart
 Weakness or tiredness
 Trembling
 Feeling anxious
 Irritability
 Sweatiness

55. Management of Hypoglycaemia
Diagnose it with the use of handheld machine & Strips.
Sugary drink (e.g. milk with added sugar) can be given in a mild
episode.
Alternatively, a more rapid method is to give 50ml of 10% or 25%
glucose intravenously.
Blood glucose measurement after ten minutes should confirm
successful treatment in line with changes in symptoms.
If the casualty isn’t responding & experienced any emergency then it
should be transferred/shifted to an appropriate tertiary facility.

56. Fainting
• Fainting is loss of consciousness can be caused by a lack
of either oxygen or reduced blood flow to the Brain.
Signs & Symptoms :
Hypotension
Hypoxia
Dizziness or feeling light-headed
Slow pulse rate(Bradycardia); signs of shock
Pale or grey skin Colour
Nausea /vomiting
Becoming completely unresponsive

57. Management of fainting
Casualty should be placed flat as soon as possible.
If possible their legs should be raised above to the level
of heart to improve blood flow of the vital organs.
High flow oxygen should be administered.
inj. Atropine 0.5mg can be repeated in every 5mints. (up to 3mg
maximum).
Every effort should be made to arrange transfer if no signs of
improvement.

58. SCENARIO
Medical emergency Management
(Mock drill)

59. THANK YOU!