# Medical Emergencies in the Emergency Department

> Emergency and Critical Care Technology notes on medical emergencies: chest pain pathway, asthma, DKA, hypertensive crisis and status epilepticus management.

- Canonical URL: https://prepelephant.com/topics/allied/emergency-and-critical-care-technology/medical-emergencies-ecct
- Exam / course: Allied Health · Subject: Emergency and Critical Care Technology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Medical Emergencies in the Emergency Department", PrepElephant, https://prepelephant.com/topics/allied/emergency-and-critical-care-technology/medical-emergencies-ecct

## Direct answer

Medical emergencies — acute coronary syndromes, severe asthma and chronic obstructive airway disease, diabetic ketoacidosis, hypertensive crisis, status epilepticus and the acute abdomen — follow the same architecture as trauma: a rapid physiological assessment, a time-critical intervention, and a defined disposition. Each carries a number the exam can test: ECG within 10 minutes of chest pain, an arterial blood gas within 15 minutes of severe asthma, glucose at the door for every altered patient, and benzodiazepines by a clock for seizures that pass five minutes. The skill the ECCT student needs is not to manage each alone but to run these pathways in parallel at 2 am, which is what the observation ward and the resuscitation bay exist to absorb.

## What you must remember

- **Chest pain protocol:** ECG within 10 minutes shown to a decision-maker; aspirin 300 mg chewed once ACS is suspected; troponin per the unit's pathway; STEMI moves to reperfusion — door-to-needle within 30 minutes where angioplasty is unavailable.
- **Severe asthma assessment:** inability to speak in sentences, saturation below 92, a silent chest; oxygen-driven nebulised salbutamol, ipratropium and systemic steroids within the hour — a normal or rising carbon dioxide is a deterioration marker, not reassurance.
- **Diabetic ketoacidosis numbers:** glucose above 250 mg/dL, pH below 7.3, bicarbonate below 15 with ketonaemia; fluid first (about 1 L in the first hour), then insulin at 0.1 units/kg/hour, potassium replaced first if low.
- **Hypertensive emergency versus urgency:** the emergency has acute end-organ damage (encephalopathy, dissection, eclampsia) needing controlled intravenous reduction; urgency has high numbers alone, managed orally over hours.
- **Status epilepticus threshold:** five minutes of seizure or two without recovery; a benzodiazepine at correct weight dosing, repeated once, then a second-line agent — with oxygen, positioning and glucose early.
- **Acute abdomen triad-thinking:** rupture, obstruction and ischaemia kill — pain out of proportion to findings suggests mesenteric ischaemia; a silent abdomen with sepsis suggests perforation; both are surgical calls.
- **Anaphylaxis and hypoglycaemia** are minutes-responsive: intramuscular adrenaline for the former, 15-20 g oral glucose or IV dextrose for the latter, with observation for relapse.

## Running four pathways on one night shift

The resuscitation phone goes at 1:40 am. A 58-year-old with crushing chest pain gets the chest-pain pathway: ECG at minute 8 shows inferior ST elevation, aspirin chewed, the thrombolysis checklist read aloud (onset under 12 hours, no contraindications), consent taken, streptokinase running at minute 29 — the door-to-needle stamp audits the whole department. While it runs, a 24-year-old wheezing since midnight speaks in broken words at 91 per cent saturation; after three salbutamol-ipratropium nebulisations and hydrocortisone she speaks in sentences, her carbon dioxide normalising — the plan converts from "possible ventilator" to "steroids and review at dawn". The third trolley carries a known diabetic, drowsy and breathing deeply: glucose 480, pH 7.1, ketones large — ketoacidosis. Fluids run by protocol and the potassium of 3.2 is replaced before the insulin starts, since insulin drives it lower and provokes arrhythmia. The fourth arrival is the quiet one the nurse flags from the corridor: an elderly man post-ictal after a feverish week — positioning, oxygen, glucose, and a history separating first seizure from missed doses. None needed heroics; each needed a pathway started at the correct minute.

## Where students slip

The classic error is treating numbers as the diagnosis: the headache-free patient with a pressure of 190 and no organ damage gets oral urgency management — intravenous agents risk the stroke they meant to prevent. In asthma, a normalising carbon dioxide is misread as improvement — in a tiring asthmatic it means fatigue and the answer is escalation. In ketoacidosis, insulin is the headline while fluid and potassium decide the outcome — the viva asks "what comes before the pump?" Indian exam frames also test the system: streptokinase remains a legitimate reperfusion agent where primary angioplasty access is hours away, so the expected answer includes door-to-needle bookkeeping and referral documentation, not a lament about catheters.

## Frequently asked questions

### What is the ECG time target for chest pain and the thrombolysis target?

An ECG within 10 minutes of arrival, and thrombolysis within 30 minutes of a STEMI diagnosis where angioplasty is not accessible — both time stamps are standard audit measures.

### Why is a normal carbon dioxide worrisome in severe asthma?

A tiring asthmatic should hyperventilate into respiratory alkalosis, so a normalising or rising carbon dioxide signals fatigue and impending respiratory failure demanding escalation.

### What comes before insulin in diabetic ketoacidosis?

Fluid resuscitation and a potassium check — insulin without potassium risks lethal hypokalaemia, and the first litre of crystalloid is a treatment, not a formality.

### How does hypertensive emergency differ from urgency?

Emergency means high pressure with acute end-organ damage and needs controlled intravenous lowering; urgency has no organ damage and is managed orally over hours to avoid precipitating ischaemia.

### When is a seizure treated as status epilepticus?

At five minutes of continuous seizureing or two seizures without recovery between — benzodiazepine, repeated once if needed, then a second-line agent alongside oxygen, glucose and cause-hunting.