Medical Signs & Symptoms
Emergency
Syncope o Feels faint/light
headed/dizzy
o Collapse& loss of
consciousness
o Pallor, slow pulse, sweating,
low BP
o Nausea/Vomiting
Hypoglycemia o Shaking & trembling
o Slurred speech & vagueness
o Sweating & pallor
o Blurred vision
o Tiredness/lethargy
o Confusion/aggression
o Stroppy/moody
o Unconsciousness
Cardiac Symptoms may vary but most
Emergencies commonly
o Chest pain or discomfort
that suddenly occurs and
does not go away. It may
feel like pressure, squeezing
or heaviness in your chest
o Pain that may spread to your
right or left arm or that may
spread to your neck, jaw,
back or stomach
o Feeling sick, sweaty, light
headed or short of breath
Epileptic o Sudden collapse and loss of
Seizures consciousness
o Rigidity and cyanosis
Management
o Airway Breathing Circulation
Disability Exposure
o Lie flat, elevate legs, loosen
clothes, oxygen not necessary
o Once consciousness returns offer
glucose in water or sweet tea
o Slow recovery: consider alternative
diagnosis: unresponsive: check
signs of life
o Airway Breathing Circulation
Disability Exposure
o Offer 15 or 20 mg quick acting
carbohydrate e.g 4 to 5 Glucotabs
or 1.5 to 2 tubes of Glucogel
In case of unconsciousness or
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
o Airway Breathing Circulation
Disability Exposure
o Call Medical Emergency Response
team, state “heart attack” SBAR
o Comfortable position (usually
sitting up)
o GTN spray 400 to 800mcg (typically
1 to 2 activations) sublingual
o Dispersible aspirin 300mg to chew
(unless there is evidence of allergy
to it)
NB: Known angina: sit down, rest, GTN: no
relief after few minutes repeat GTN.Still no
relief after a few minutes call response
team: follow heart attack protocol, SBAR
and aspirin.
o Airway Breathing Circulation
Disability Exposure
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
o Severe: unable to complete
sentence in one breath
RR>25/min, Pulse>100/min
o Life threatening: RR or
cyanosis <8/min, pulse
<50/min, exhaustion,
confusion, decreased level of
consciousness
Disability Exposure
o Sit upright: if available follow
patient personalized action plan
(PAAP)
o 2 puffs (100mg/puff)
bronchodilator e.g Salbutamol,
repeat doses may be necessary
(early use of spacer device)
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

Adrenal Crisis o Collapse, cold & clammy skin
o Hypotension & dizziness
o Vomiting & diarrhea
Stroke o Facial weakness
o Arm weakness
o Speech problems
Department of Periodontology
upto maximum of 10 puffs
o Airway Breathing Circulation
Disability Exposure
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.
o Airway Breathing Circulation
Disability Exposure
o Act FAST & Call Medical Emergency
Response team
o Administer oxygen 15 litres/min
o Nil by mouth, appropriate position

Lahore Medical & Dental College

Standard Operating Procedure (SOPs) in case of Medical Emergencies