Medical Signs & Symptoms Management

Emergency
Syncope o Feels faint/light o Airway Breathing Circulation
headed/dizzy Disability Exposure
o Collapse& loss of o Lie flat, elevate legs, loosen
consciousness clothes, oxygen not necessary
o Pallor, slow pulse, sweating, o Once consciousness returns offer
low BP glucose in water or sweet tea
o Nausea/Vomiting o Slow recovery: consider alternative
diagnosis: unresponsive: check
signs of life
Hypoglycemia o Shaking & trembling o Airway Breathing Circulation
o Slurred speech & vagueness Disability Exposure
o Sweating & pallor o Offer 15 or 20 mg quick acting
o Blurred vision carbohydrate e.g 4 to 5 Glucotabs
o Tiredness/lethargy or 1.5 to 2 tubes of Glucogel
o Confusion/aggression
o Stroppy/moody In case of unconsciousness or
o Unconsciousness unable to swallow safely
o Call Medical Emergency Response
Team, recovery position, Glucagon
1g IM
o Once consciousness returns, offer
oral carbohydrate
o If able, measure blood sugar level
to confirm diagnosis
Pediatric Glucagon dose, less than 8 years
of age or < 25 Kg: 0.5mg IM
Cardiac Symptoms may vary but most o Airway Breathing Circulation
Emergencies commonly Disability Exposure
o Chest pain or discomfort o Call Medical Emergency Response
that suddenly occurs and team, state “heart attack” SBAR
does not go away. It may o Comfortable position (usually
feel like pressure, squeezing sitting up)
or heaviness in your chest o GTN spray 400 to 800mcg (typically
o Pain that may spread to your 1 to 2 activations) sublingual
right or left arm or that may o Dispersible aspirin 300mg to chew
spread to your neck, jaw, (unless there is evidence of allergy
back or stomach to it)
o Feeling sick, sweaty, light NB: Known angina: sit down, rest, GTN: no
headed or short of breath relief after few minutes repeat GTN.Still no
relief after a few minutes call response
team: follow heart attack protocol, SBAR
and aspirin.
Epileptic o Sudden collapse and loss of o Airway Breathing Circulation
Seizures consciousness Disability Exposure
o Rigidity and cyanosis o Safe environment may prevent
 o Jerking movement of limbs injury, do not put anything into
o Noisy breathing mouth, do not restrain
o Tongue may be bitten o Administer oxygen 15 litres/min,
o Frothing at mouth note timings of seizure
o Incontinence may occur o Once jerking movements seize:
recovery position
Prolonged convulsive disorder (more than
5 mins) or repeated rapidly
Midazolam oromucosal solution can be
given via the buccal route as a single dose
of 10mg
Pediatric dosage
1 to 4 years: 5mg, 5 to 9 years: 7.5mg, 10
to 18 years: 10mg
Anaphylaxis o Sudden onset o Airway Breathing Circulation
o Utricaria, pallor & flushing Disability Exposure
o Respiratory distress: stridor, o Call Medical Emergency Response
wheeze, & or hoarseness team, state “anaphylaxis”, SBAR
o Hypotension & tachycardia o Lie flat, elevate legs (if breathing
Anaphylaxis likely: not impaired): administer oxygen
o Sudden onset & rapid 15 litres/min
progression of symptoms o Administer Adrenaline 500mg IM
o Life threatning A &/ or B &/ (0.5ml of 1:1000)
or C o Repeat adrenaline at 5 min interval
until response is received
Pediatric dosage of adrenaline
<6 years: 150mg (0.15ml of 1:1000), 6 to
12 years: 300mg (0.30ml of 1:1000), >12
years: 500mg (0.5ml of 1:1000)

Asthma o Breathlessness & expiratory o Airway Breathing Circulation

wheeze Disability Exposure
o Severe: unable to complete o Sit upright: if available follow
sentence in one breath patient personalized action plan
RR>25/min, Pulse>100/min (PAAP)
o Life threatening: RR or o 2 puffs (100mg/puff)
cyanosis <8/min, pulse bronchodilator e.g Salbutamol,
<50/min, exhaustion, repeat doses may be necessary
confusion, decreased level of (early use of spacer device)
consciousness o Unsatisfactory response, severe or
life threatening call Medical
Response team, SBAR
o While awaiting ambulance: Oxygen
15 litres/min, B2 bronchodilator
given via spacer one puff at a time,
inhaled separately via tidal volume,
give another puff every 60 seconds
 upto maximum of 10 puffs
Adrenal Crisis o Collapse, cold & clammy skin o Airway Breathing Circulation
o Hypotension & dizziness Disability Exposure
o Vomiting & diarrhea o Call Medical Emergency Response
team, state “adisonian crisis”,
SBAR
o Lie flat, administer oxygen 15
litres/min
o Patients hydrocortisone
emergency IM kit at hand,
hydrocortisone 100mg IM.
Stroke o Facial weakness o Airway Breathing Circulation
o Arm weakness Disability Exposure
o Speech problems o Act FAST & Call Medical Emergency
Response team
o Administer oxygen 15 litres/min
o Nil by mouth, appropriate position
Department of Periodontology

Lahore Medical & Dental College

Standard Operating Procedure (SOPs) in case of Medical Emergencies