Medical Emergency Framework

Overview – Medical Emergency Framework

The medical emergency framework is a structured approach used by healthcare professionals to assess and manage critically unwell patients. It ensures timely triage, life-saving interventions, effective pain control, and identification of reversible causes in life-threatening scenarios. Mastery of this framework is essential for final-year medical students preparing for real-world emergency presentations.

Definition

  • Emergency: A medical condition requiring immediate treatment (not always life-threatening).
  • Triage: The process of sorting patients based on urgency of care needs.
  • Resuscitation: Reviving someone from unconsciousness or apparent death.
  • Primary Survey (ABCDE):
    • Airway
    • Breathing
    • Circulation
    • Disability
    • Expose
  • Retrieval Medicine: Pre-hospital emergency care via ambulance, helicopter, etc.
  • National Triage Scale: Localized, standard triage guidelines (may differ by region and specialty).

Emergency Assessment Framework

1. Triage

  • Performed by specially trained emergency department (ED) nurses.
  • Establishes priority of care using standardized scales.
  • Asks: “This patient should wait for medical assessment no longer than ___ minutes?”
  • Scales vary by region (e.g., Australian and UK triage systems).
  • Children and psychiatric patients may require separate triage tools.
1- Triage

2. 30-Second Primary Survey (ABCDE)

Airway (with C-spine control)

  • Assess ability to speak: e.g. “Tell me your name”
  • If able to respond → airway patent, breathing adequate, and BP likely >80 mmHg systolic
  • If unresponsive → immediate airway/breathing/circulation issue

Breathing

  • Observe for visible chest rise, respiratory effort
  • Ask: “How are you today?” → Helps assess oxygenation and respiratory status

Circulation

  • Ask: “Where does it hurt?” → Identify location and assess perfusion
  • Simultaneously check:
    • Pulse – rate, rhythm, volume
    • Skin – temperature, sweating
    • Colour – cyanosis, jaundice, pallor
    • Neck – JVP, thyroid, trauma

You now have an approximation of:

  • Respiratory rate
  • Pulse (e.g. tachycardic, bradycardic, bounding)
  • Skin temperature (e.g. hot, cold)
  • Oxygen saturation (e.g. presence of cyanosis)

Disability

  • Assess mental status, pain, and neurological response

Exposure

  • Visual inspection of chest, abdomen, limbs
  • Full exposure while preserving dignity and temperature
The Primary Survey
The Primary Survey

3. Pain Assessment

After stabilizing ABCs, pain assessment is the next priority

Pain Features:

  • Site – Localisation and radiation
  • Onset – Sudden vs gradual, with or without trauma
  • Character – Sharp, dull, burning, etc.
  • Intensity – At rest and with movement
  • Duration – Continuous or intermittent
  • Aggravating factors

Somatic vs Visceral Pain:

  • Somatic – Sharp, localised, tender
  • Visceral – Dull, poorly localised, with referred symptoms

Pain Scales:

  • Categorical – Mild/Moderate/Severe
  • Numeric – 0 to 10
  • Visual Analogue – Emoticon-based (useful for deaf, foreign, or paediatric patients)
medical emergency framework: Pain Scales

Importance of Early Analgesia:

  • Reduces pain and anxiety
  • Improves cooperation and communication
  • May reduce physiological symptoms (e.g. tachycardia)

Common Analgesic Options:

  • Oral (e.g. Paracetamol) – Cheap, but limited potency
  • Parenteral (e.g. IM/IV opioids) – Effective, but complex
  • Regional nerve blocks – Best for isolated injuries

4. Mnemonic: AMPLE

Useful for gathering emergency history:

  • Allergies
  • Medications
  • Past medical history
  • Last meal
  • Events leading to presentation

5. Early Management Goals

  • Prevent complications: Intervene early to limit organ/system damage
  • Minimise suffering: Timely, accurate care reduces distress and enhances outcomes

Basic Life Support

medical emergency framework: BASIC LIFE SUPPORT

Disclaimer: Follow your local/hospital guidelines
Initial resuscitation in unresponsive patients includes basic airway support, chest compressions, and calling for help (resuscitation team).

Advanced Life Support

Disclaimer: Follow your local/hospital guidelines

Key Priorities:

  • Lay patient flat
  • Precordial thump (only within seconds of arrest if no defibrillator present)
  • Head tilt–chin lift
  • Begin CPR if unresponsive and not breathing
  • Call resuscitation team
medical emergency framework: ADVANCED LIFE SUPPORT

Potentially Reversible Causes of Cardiac Arrest (4 H’s & 4 T’s)

The 4 H’s

  • Hypoxia:
  • Hypovolaemia:
    • Causes: Trauma, GI bleed, ruptured AAA, ectopic pregnancy
    • Give stat fluids, identify source, alert surgical teams
  • Hypo/Hyperkalaemia & Metabolic causes:
    • Check electrolytes
    • Treat with calcium chloride (10 mL of 10%) or K+ bolus (5 mmol IV) as needed
  • Hypothermia:
    • Core rewarming for severe hypothermia (<30°C)
    • Consider pleural/peritoneal lavage or extracorporeal methods

The 4 T’s

  • Thrombosis (e.g. PE):
    • Consider fluid bolus, CPR, and thrombolysis
  • Tamponade:
  • Toxins:
    • Consider based on history (e.g. TCA overdose)
    • Treat with antidotes or supportive care
  • Tension Pneumothorax:
    • Rapid needle decompression → chest drain

Post-Resuscitation Care

  • Continue CPR until pulse and signs of life return
  • Maintain SpO₂ between 94–98%
  • Check ABGs (PaCO₂ 35–45 mmHg)
  • Insert gastric tube
  • Contact cardiology if suspected acute coronary syndrome
  • Treat seizures (e.g. midazolam, lorazepam, diazepam)
  • Maintain blood glucose (6–10 mmol/L)
  • Transfer to ICU or cardiac unit

Summary – Medical Emergency Framework

The medical emergency framework outlines a structured, life-saving approach to critically unwell patients, incorporating triage, ABCDE survey, pain control, and advanced life support. Recognising reversible causes and delivering early management is crucial for improving outcomes. For a broader context, see our Emergency Medicine Overview page.

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