“Critical medical emergencies are life-threatening situations that require immediate medical attention. Timely intervention in these cases can be the difference between life and death.

List of Critical Medical Emergency

1. ABDOMINAL AORTIC ANEURYSM
2. SYSTEMATIC INFLAMMATION RESPONSE SYNDROME
3. PULMONARY EMBOLISM
4. SEPTIC ARTHRITIS
5. MENINGITIS
6. RHABDOMYOLYSIS
7. MYXEDEMA COMA
8. SEROTONIN SYNDROME

ADBOMINAL AORTIC ANEURYSM Critical Medical Emergency

1. Abdominal aortic aneurysm: Critical Medical Emergency
   • Prominent, pulsating mass in abdomen, at or above umbilicus
   • Systolic bruit over the aorta
   • Tenderness on deep palpation
   • Abdominal pain
   • RISK OF RUPTURE.
   • IF RUPTURE:
     • HYPOTENSION, Increased pulse rate
     • Signs of SHOCK
     • Severe abdominal pain, back pain, Lumbar pain
     • Hematoma at flank area
     • Throbbing sensation
   • Instruct the client with an AAA to report immediately the occurrence of chest pain, back pain, shortness of breath, difficult swallowing, or hoarseness.

SYSTEMATIC INFLAMMATION RESPONSE SYNDROME

1. SIRS: SYSTEMATIC INFLAMMATION RESPONSE SYNDROME: Critical Medical Emergency
   • It is characterized by generalized inflammation in organs separate from the initial affected area.
   • Caused by severe bacterial infection, trauma, or pancreatitis.
   • Hypotension, Shock, Respiratory failure
   • Fever, hypothermia, low PaCO2
   • Low platelets
   • ARDS: Acute respiratory distress syndrome
   • AKI: acute kidney injury

PULMONARY EMBOLISM

1. PULMONARY EMBOLISM:
   • Occurs when a thrombus forms, detaches, travels to the right side of the heart and then lodges in a branch of the pulmonary artery.
   • Life threatening emergency OR Critical Medical Emergency
   • Clients prone to PE are those at risk for DVT including those with prolonged immobilization. surgery, obesity, pregnancy, heart failure, advanced age, or a history of thromboembolism, estrogen contain contraceptive pills.
   • Nurse Interventions in case suspected PE:
     • Notify the Rapid response team and PHCP if client restless, chest pain, blood-tinged sputum, crackles, wheezes on auscultation, cyanosis, distended neck veins, dyspnea, hypotension, petechiae over the chest and axilla, tachypnea, tachycardia.
     • Reassurance and elevate the head of the bed.
     • Prepare for oxygen.
     • Check vital signs, lung sounds.
     • Obtain ABG
     • Prepare for administration of Heparin therapy.
     • Documentation.

SEPTIC ARTHRITIS

1. SEPTIC ARTHRITIS:
   • Hip infection, fever, pain, refusal to bear the weight on affected extremity.
   • It is important for the nurse to inform this Critical Medical Emergency to HCP to prevent permanent joint destruction.

MENINGITIS

1. MENINGITIS:
   • Inflammation of the protective membranes covering the brain and spinal cord, typically caused by bacterial, viral, fungal, or parasitic infections.
   • Neck stiffness, irritability, rash, discomfort to bright lights (photophobia), vomiting or sickness, drowsiness, headache, seizures or fits.
   • BRUDZINSKI’S SIGN (when the client flexes the hip and knees in response to the nurse gently flexing the hips and knees in response to the nurse gently flexing the head and neck onto the chest.) and KERNIG’S SIGN (when the client feels pain and spasm of the hamstring muscles when the leg is fully flexed at the knee and hip) are the indications of meningeal irritation.
   • Prompt recognition and intervention are critical in managing meningitis to prevent potentially life-threatening complications.
   • Early assessment and diagnosis (necessary). Closely monitoring vital signs, including temperature, heart rate, and blood pressure, as well as assessing neurological status regular.
   • Assess the sign of increased ICP.
   • Initiate seizures precautions.
   • Nurses also administer prescribed medications, such as antibiotics for bacterial meningitis or supportive therapies for viral meningitis.

Maintain isolation precautions for the client with bacterial meningitis. Transmission of meningitis is by direct contact, including droplet spread.

SEIZURE PRECAUTIONS: a. Airway, oxygen, suctioning equipment are kept available at the bedside. b. The side rails of the bed are padded, and the bed is kept in the lowest position. c. The client has an IV access in place to have a readily accessible route if antiseizure medications must be administered.

RHABDOMYOLYSIS: Critical Medical Emergency

1. RHABDOMYOLYSIS:
   • It is a medical emergency condition characterized by the breakdown of muscle tissue, leading to the release of muscle fiber contents into the bloodstream. These contents include myoglobin, a protein that can damage the kidneys if it reaches high levels in the blood. Rhabdomyolysis can be caused by various factors, including:
     • Trauma or crush injuries: Direct trauma or crushing injuries to muscles can cause them to break down and release myoglobin into the bloodstream.
     • Extreme physical exertion: Intense physical activity, particularly in untrained individuals or during extreme conditions such as extreme heat, can lead to muscle breakdown.
     • Drug abuse: Certain drugs, such as cocaine, amphetamines, and statins, can increase the risk of rhabdomyolysis.
     • Electrolyte imbalances: Imbalances in electrolytes such as potassium and phosphate can contribute to muscle breakdown.
     • Infections: Severe infections, especially those causing sepsis, can lead to rhabdomyolysis due to the release of toxins and inflammatory substances.
   • Symptoms of rhabdomyolysis
     • Muscle pain, weakness, dark urine (due to the presence of myoglobin), and in severe cases, kidney failure.
   • Treatment
     • Typically involves addressing the underlying cause, maintaining hydration to prevent kidney damage, and sometimes hospitalization for intravenous fluid therapy and monitoring of kidney function. In some cases, dialysis may be necessary to support kidney function until they recover.
     • Early recognition and treatment are important to prevent complications.
     • REPORT TO HCP if client taking statin report muscle aches, weakness. (Early sign of rhabdomyolysis)

MYXEDEMA COMA

1. MYXEDEMA COMA:
   • It is a rare but life-threatening complication of severe hypothyroidism.
   • Most severe form of thyroid hormone deficiency.
   • Precipitating Factors:
     • Infections,
     • Cold exposure,
     • Trauma, surgery
     • Discontinuation of thyroid hormone replacement therapy in patients with known hypothyroidism.
   • Symptoms:
     • Altered mental status (such as confusion, lethargy, or coma),
     • Hypothermia (low body temperature),
     • Respiratory depression,
     • Bradycardia (slow heart rate),
     • Hypotension (low blood pressure)
     • Hyponatremia (low sodium levels).
   • Risk Factors:
     • Untreated or inadequately treated hypothyroidism,
     • older age, female gender,
     • underlying psychiatric disorders,
     • certain medications such as sedatives or opioids.
   • Emergency Management:
     • Prompt recognition and intervention.
     • The initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement.
     • Supportive measures:
       • Airway management,
       • Intravenous fluids,
       • Warming measures,
       • Administration of thyroid hormone replacement therapy, typically with intravenous levothyroxine.
       • Complications:
         • Respiratory failure,
         • Cardiovascular collapse,
         • Coma, and death.
       • Long-Term Management:
         • Thyroid hormone replacement therapy.
         • Adherence to thyroid hormone replacement therapy,
         • Recognition of early warning signs,
         • Strategies for preventing triggers (such as avoiding cold exposure and managing infections promptly).

SEROTONIN SYNDROME

1. Serotonin syndrome:
   • It is a potentially life-threatening condition
   • An excess of serotonin in the body, typically resulting from the use of certain medications that increase serotonin levels.
   • Serotonin is a neurotransmitter involved in regulating mood, appetite, sleep, and other bodily functions. When serotonin levels become too high, it can lead to a range of symptoms, from mild to severe.
   • Causes:
     • Use of medications:
       • selective serotonin reuptake inhibitors (SSRIs),
       • serotonin-norepinephrine reuptake inhibitors (SNRIs),
       • monoamine oxidase inhibitors (MAOIs),
       • tricyclic antidepressants,
       • certain opioids,
       • triptans (used to treat migraines),
       • some illicit drugs such as MDMA (ecstasy).
   • Symptoms:
     • Agitation, confusion,
     • Rapid heart rate (tachycardia), high blood pressure (hypertension),
     • Dilated pupils, muscle rigidity, tremors, sweating,
     • Diarrhea, fever,
     • In severe cases, seizures or loss of consciousness.
   • Treatment:
     • Discontinuing the offending medication(s) causing the condition
     • supportive care.
     • In severe cases, hospitalization may be necessary for close monitoring and intravenous fluids.
     • Medications such as benzodiazepines may be used to control agitation and muscle rigidity.
     • In rare cases, serotonin receptor antagonists may be administered to block the effects of excess serotonin.
   • Prevention:
     • Healthcare providers should carefully evaluate a patient’s medication history and potential drug interactions before prescribing medications that affect serotonin levels.
     • Patients should be educated about the signs and symptoms of serotonin syndrome and advised to seek medical attention if they experience any concerning symptoms while taking serotonergic medications.

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