Medical emergencies management

Basic aspects of the proteins of the blood coagulation system and of fibrinolysis are described in this chapter. Some fundamental aspects of platelet biology are also presented. Hemorrhagic and thrombotic states can cause serious medical emergencies, and thromboses in the coronary and cerebral arteries are major causes of death in many parts of the world. Rational management of these conditions requires a clear understanding of the bases of blood clotting and fibrinolysis. 

Signs and symptoms Prepubertal children often present with stuttering priapism. Older males can present with prolonged episodes that last for days and should be managed as medical emergencies. Urinary obstruction can occur in severe cases. 

Deaths from overdoses of other types of hallucinogens are rare, but not with PCP. Poisoning with this drug is a major medical emergency and requires great skill in management. Fortunately, the means are available for successful treatment. 

Lactic acidosis is a medical emergency that must be treated in a hospital setting. In a patient with lactic acidosis who is taking metformin, immediately discontinue the drug and promptly institute general supportive measures. Because metformin is dialyzable (with a clearance of up to 170 mL/min under good hemodynamic conditions), prompt hemodialysis is recommended to correct the acidosis and remove the accumulated metformin. Such management often results in prompt reversal of symptoms and recovery. 

Electric Power Research Institute Federal Emergency Management Agency Florida Institute of Phosphate Research Fcyi Medical Systems, U.S.A., Inc. 

Acute medical emergencies are a feature of this substance abuse with sometimes fatal results, and a wide variety of solvent-based products can be used. Management of these acute stages may include neuroleptics to control the agitation and toxic state which will settle over a few hours. No specific medical management is necessary after this, and a full network of support systems needs to be established. Education of the medical complications is crucial in any preventative programme and there needs to be community involvement in its management (Barnes 1979 Sourindhrin and Baird 1984). 

Severe cholinergic excess is a medical emergency, especially in rural communities where the use of cholinesterase inhibitor insecticides is common and in cultures where wild mushrooms are commonly eaten. The potential use of cholinesterase inhibitors as chemical warfare "nerve gases" also requires an awareness of the methods for treating acute poisoning (see Chapter 59 Management of the Poisoned Patient). 

Management of myxedema coma is a medical emergency. The patient should be treated in the intensive care unit, since tracheal intubation and mechanical ventilation may be required. 

Although intravenous diazepam is the preferred route, the undiluted intravenous solution of diazepam can be given rectally, and is effective in the emergency management of seizures in children (29). Rectal gel is an alternative, and can be given by non-medical personnel (30). Adverse effects of rectal diazepam are rare and mild. Animal studies and clinical experience have not shown damage to the rectal mucosa. 

Nurses must participate as full partners with both the medical community and emergency management community in all aspects of disaster response and recovery. 

Federal Emergency Management Agency (FEMA). (1992). The Metropolitan Medical Response System. Federal Response Plan (Pub. L. No. 93-288). Retrieved February 10, 2006, from https //www.mmrs.fema.gov/default.aspx... 

Maguire, B. J., Walz, B. J. (2004). Current emergency medical services workforce issues in the United States. Journal of Emergency Management, 2, 1-10. 

Currently, the most common model for disaster response in the hospital sector is the Incident Command System (ICS) model (Federal Emergency Management Agency [FEMA], 2001). In 1992 the Hospital Emergency Incident Command System (HEICS) was first developed by the California Emergency Medical Services Authority and the San Mateo County Health Services Agency. It is important to remember that HEICS is not a disaster plan, but rather a model on which a plan can be developed. In 2006 the model was updated and it is now known as the Hospital Incident Command System (HlCS). The newer model of incident command for hospitals includes ... 

ENA supports cooperative planning of the hazard vulnerability analysis with fire, police, emergency medical services, health departments, medical examiners, and emergency management agencies. 

ENA believes emergency management concepts apply to all hospitals and medical facilities. 

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