D118 Unit 3 Study Guide
Managing In-Office Health Emergencies
What are the most commonly encountered office emergencies?
Family practice offices often face urgent medical situations including asthma exacerbations, anaphylaxis, shock, seizures, and cardiac arrest. These emergencies require rapid identification and immediate treatment to prevent severe outcomes or fatality. Early recognition of symptoms and having established emergency protocols in place can significantly improve patient prognosis during such critical events (American Academy of Family Physicians, 2022).
What emergency supplies (equipment and medications) are recommended for family practice offices?
Recommended Emergency Equipment
| Equipment | Description |
|---|---|
| Intubation tools and AED | Essential for airway management and cardiac arrest resuscitation |
| Bag mask ventilator | Available in two sizes with multiple mask options for ventilation support |
| Blood pressure cuffs | Multiple sizes to fit all patient age groups |
| Glucose meter | Allows rapid measurement of blood glucose in hypoglycemic patients |
| Intraosseous needles | 18 and 16 gauge needles for emergency vascular access |
| Intravenous catheters | Butterfly needles from 24 to 18 gauge for IV therapy |
| IV extension tubing and T-connectors | Facilitate effective management of intravenous lines |
| Nasal airway | Maintains airway patency in obstructed patients |
| Nasogastric tubes (NG tubes) | Used for gastrointestinal decompression |
| Nebulized and MDI spacers and face masks | Assist in respiratory treatments |
| Non-rebreather mask | Delivers high concentrations of oxygen |
| Oxygen mask | Provides supplemental oxygen |
| O2 tank and flow meter | Portable oxygen delivery system |
| Portable suction | Clears airway secretions |
| Pulse oximeter | Monitors oxygen saturation levels |
| Resuscitation tape (color-coded) | Helps rapid assessment of vital signs |
| Universal precautions supplies | Gloves, masks, and other infection control materials |
Recommended Emergency Medications
| Medication | Indication or Use |
|---|---|
| Acetaminophen | Pain and fever management |
| Albuterol | Bronchodilator for asthma exacerbations |
| Aspirin | Antiplatelet agent during cardiac events |
| Ceftriaxone | Broad-spectrum antibiotic |
| Corticosteroids | Reduce inflammation, especially in allergic reactions |
| Dextrose 25% | Treatment for hypoglycemia |
| Diazepam (Valium) | Controls seizures and muscle relaxation |
| Benadryl | For allergic reactions |
| Epinephrine (Epi) | First-line treatment for anaphylaxis and severe allergies |
| Flumazenil | Reverses benzodiazepine overdose |
| Lorazepam | Seizure management |
| Morphine | Severe pain management |
| Naloxone | Reverses opioid overdose |
| Nitroglycerine spray | Relieves chest pain (angina) |
| Normal saline | Fluid resuscitation during shock or dehydration |
Anaphylaxis
How is anaphylaxis clinically presented, examined, and treated?
Anaphylaxis can manifest in various severities, presenting either as a uniphasic or biphasic reaction. Symptoms may arise immediately after exposure to an allergen or may be delayed by up to 10–12 hours, with prolonged cases lasting days. Clinical presentation ranges from mild rashes to life-threatening systemic involvement.
A detailed patient history is critical, including previous allergic episodes, underlying medical conditions, recent exposures (foods, drugs, insect stings), and medications. This history guides the urgency and direction of treatment.
Diagnostic assessments include monitoring oxygen saturation via pulse oximetry, arterial blood gases (ABG), electrocardiograms (ECG), and serum glucose tests to rule out other causes like hypoglycemia. Specialized lab tests such as plasma histamine and serum tryptase levels confirm mast cell activation. Chest X-rays may be necessary when respiratory complications are suspected.
The cornerstone of treatment is intramuscular administration of epinephrine (0.2 to 0.5 mg), preferably into the lateral thigh. Continuous airway, breathing, and circulation (ABCs) monitoring is essential. Supportive measures include oxygen therapy and intravenous fluids for shock management (Lieberman & Camargo, 2019).
Bites and Stings
What are the clinical presentations, examinations, and treatments for bites and stings from various sources?
Initial emergency assessment should prioritize airway, breathing, and circulation, particularly to identify anaphylaxis. The injury site needs inspection for severity, possible infection, and systemic involvement.
Treatment involves systemic epinephrine for allergic reactions. Local care includes stinger removal, wound cleaning, ice application, antihistamines for itching, topical steroids for inflammation, antibiotics for infection prevention, NSAIDs for pain, and elimination of the offending insect.
| Bite Type | Clinical Presentation | Treatment |
|---|---|---|
| Tick bites | Pruritic papule; risk of secondary infection | Proper removal, antiseptic cleansing; antibiotics if Lyme disease suspected (>36 hours attached) |
| Bee stings | Localized pain to systemic allergic reactions | Local care, epinephrine if systemic; antihistamines; NSAIDs |
| Spider bites | Brown recluse: erythema to necrosis, systemic symptoms (fever, hemolysis) | Wound care, tetanus prophylaxis, antibiotics, possible surgical debridement |
| Black widow: pain, erythema, muscle cramps, hypertension risk | Supportive care, pain control (narcotics, benzodiazepines), calcium gluconate, antivenom if severe | |
| Mosquito bites | Pruritic, painful papules | Symptomatic relief with antihistamines and local care |
| Animal bites | Variable, high infection risk | Wound cleaning, tetanus prophylaxis, antibiotics as indicated |
| Parasitic infestations | Symptoms vary by parasite type | Specific antiparasitic treatment according to diagnosis |
(Centers for Disease Control and Prevention, 2021; Blee & Mir, 2018)
Cardiac Arrhythmias
What are the clinical presentations, examinations, and management strategies for cardiac arrhythmias?
General Considerations
Patients presenting with arrhythmias causing hemodynamic instability or myocardial ischemia require immediate hospital transfer and cardiology consultation.
Tachyarrhythmias
Symptoms commonly include palpitations, dizziness, syncope, or shortness of breath. Atrial fibrillation often causes fatigue due to irregular ventricular rates. Severe presentations may include hypotension, chest pain, or heart failure. Management focuses on hydration, oxygenation, electrolyte correction, stress reduction, and tailored antiarrhythmic medications (Zimetbaum & Josephson, 2017).
Bradyarrhythmias
Symptoms can include fatigue, confusion, dizziness, and signs of heart failure. Cognitive changes like forgetfulness may occur. Treatment involves cessation of causative drugs (e.g., beta blockers), atropine to increase heart rate, and pacemaker insertion if required.
Physical Examination
Vital signs, mental status, respiratory effort, diaphoresis, and orthostatic vital signs help distinguish underlying causes such as dehydration or hypovolemia, which can provoke reflex tachycardia.
Patient Hydration and Cardiovascular Assessment
Evaluation of skin turgor, mucous membranes, jugular venous distension (JVD), carotid pulse palpation and auscultation, heart sounds, and lung exam assists in diagnosis.
Diagnostic Tools
| Diagnostic Tool | Description |
|---|---|
| 12-lead ECG | Baseline electrical activity of the heart |
| Holter Monitor | 24-hour ambulatory ECG for intermittent arrhythmias |
| Laboratory Tests | CBC, electrolytes, renal function, thyroid tests |
| Ankle-Brachial Index | Screening for peripheral arterial disease |
| Echocardiography | Assessment of cardiac valves and structure |
| Electrophysiologic Study | Invasive mapping of arrhythmia sources |
| Cardiac MRI | Detailed heart imaging |
| Cardiac Catheterization | Coronary artery and heart chamber visualization |
| Stress Test | Evaluates exercise-induced arrhythmias |
| Event Monitor | Long-term rhythm tracking for rare symptoms |
| Tilt-Table Test | Evaluates syncope due to autonomic dysfunction |
| Carotid Sinus Massage/Valsalva | Tests vagal effects on heart rhythm |
(UpToDate, 2024; Zimetbaum & Josephson, 2017)
Clinical Presentation and Treatment of Acute Bronchospasm
Patients with acute bronchospasm present with wheezing, chest tightness, coughing, and breathlessness, varying from mild to severe. Immediate evaluation and referral to emergency care are warranted if respiratory distress, oxygen saturation below 92%, or poor response to nebulized therapy occur.
Treatment involves supplemental oxygen and inhaled short-acting beta2-agonists like albuterol. Anticholinergic agents such as ipratropium bromide and systemic corticosteroids like prednisone may be used for enhanced symptom control (American Academy of Family Physicians, 2022).
Managing Hypotension, Syncope, and Hypovolemic Shock
Hypotension arises from disruptions in vascular tone, blood volume, or cardiopulmonary function. Evaluation includes vital signs, ECG, hemoglobin, electrolytes, renal function, and pregnancy testing for women of reproductive age to rule out ectopic pregnancy.
Syncope must be differentiated from seizures or other altered consciousness causes and categorized as neurally mediated, orthostatic, or cardiac. Diagnostics exclude life-threatening causes such as ischemia, embolism, or arrhythmias. During syncope, the patient should be positioned supine with loose clothing to prevent aspiration.
Management of hypovolemic shock prioritizes oxygen delivery, hemorrhage control, and fluid resuscitation (American College of Emergency Physicians, 2023).
Sepsis and Septic Shock: Risk Factors, Symptoms, and Management
Sepsis is a systemic inflammatory response to infection, potentially progressing to septic shock and organ failure. Risk factors include immunosuppression, chronic illness, implanted devices, and advanced age.
Symptoms include fever, hypotension, tachypnea, leukocytosis, and elevated inflammatory markers such as C-reactive protein (CRP). Management begins with airway and circulatory support, fluid resuscitation guided by central venous pressure, and prompt broad-spectrum antibiotic administration within one hour. Glycemic control and corticosteroids may be added selectively (American College of Emergency Physicians, 2023).
Phases of Emergency Management
The Federal Emergency Management Agency (FEMA) identifies four critical phases in emergency management:
Mitigation: Implementing policies and structural changes to reduce disaster impact (e.g., fire safety protocols).
Preparedness: Developing emergency plans, stockpiling supplies, and training personnel.
Response: Immediate rescue, medical aid, and evacuation efforts during disasters.
Recovery: Long-term restoration of infrastructure and community resilience (Federal Emergency Management Agency, n.d.).
Acute Illnesses of the Eye, Ear, Nose, and Throat (EENT)
Eye Disorders: Hordeolum, Blepharitis, and Chalazion
Anterior blepharitis affects the eyelid margin, often linked to staphylococcal infections or seborrhea, while posterior blepharitis involves meibomian glands and is sometimes associated with rosacea. Both conditions disrupt the ocular surface and increase susceptibility to hordeola or chalazia.
A hordeolum is an acute, painful eyelid infection with erythema and swelling; if untreated, it may evolve into a painless, chronic chalazion granuloma.
Treatment focuses on lid hygiene with warm compresses, gentle scrubs, antibiotic ointments like erythromycin, and artificial tears for dryness (Mayo Clinic, 2023).
Conjunctivitis: Types and Management
| Type | Clinical Features | Management |
|---|---|---|
| Viral | Red eyes, watery discharge, conjunctival follicles | Supportive care; self-limited |
| Bacterial | Thick purulent discharge, sticky eyelids | Antibiotics if persistent |
| Allergic | Itching, clear discharge, periorbital changes (“allergic shiners”) | Antihistamines and allergen avoidance |
| Vernal/Atopic | Intense itching, thick discharge, cobblestone papillae | Mast cell stabilizers, antihistamines |
Corneal Surface Defects and Foreign Bodies
Corneal abrasions, often caused by trauma or chemical exposure, present with severe pain, photophobia, redness, tearing, and blurred vision. Fluorescein staining under cobalt blue light aids diagnosis. Eye protection is critical in prevention.
General Eye Examination Components
The eye exam should include visual acuity assessment, pupil reaction, eyelid and conjunctiva inspection, corneal clarity, anterior chamber depth, and evaluation for inflammation or injury. Urgent ophthalmology consultation is indicated for hypopyon, irregular pupils, or penetrating trauma (American Academy of Ophthalmology, 2024).
Eye Conditions Requiring Ophthalmology Referral
Referral criteria include:
Acute eye pain, vision loss, or severe photophobia
Persistent conjunctivitis beyond one week
Suspected herpetic infections
Complicated corneal abrasions
Globe puncture injuries
Common Eye Conditions: Signs and Treatments
| Condition | Symptoms | Treatment |
|---|---|---|
| Pterygium | Conjunctival growth causing irritation | Referral if vision impaired |
| Subconjunctival hemorrhage | Bright red conjunctival patch | Usually self-limited |
| Pinguecula | Yellow conjunctival nodule | Typically no treatment necessary |
| Dry Eye Syndrome | Burning, foreign body sensation | Artificial tears, lid hygiene |
| Dacryostenosis | Tear duct obstruction | Surgical referral |
| Xanthelasma | Yellow plaques on eyelids | Cosmetic removal if desired |
| Periorbital Cellulitis | Eyelid swelling, erythema, pain | Antibiotics, urgent referral |
| Iritis | Eye pain, photophobia, blurred vision | Corticosteroids, urgent referral |
| Angle Closure Glaucoma | Severe pain, halos, nausea, vision loss | Emergency pressure-lowering treatment |
| Cataracts | Gradual vision loss | Surgical removal |
Common ENT Conditions: Clinical Features and Management
Tinnitus: Ringing or buzzing sound; managed by removing ototoxic drugs, hearing aids, and cognitive therapies.
Otitis Externa: Ear canal pain and swelling; treated with topical antibiotics and analgesics.
Otitis Media: Ear pain and fever; treated with antibiotics and pain relief; complicated cases require specialized care.
Otitis Media with Effusion: Hearing loss and fullness; usually self-limited, nasal steroids or antihistamines may help.
Allergic Rhinitis: Nasal itching, sneezing, congestion; effectively treated with antihistamines and nasal steroids.
Acute Bacterial Rhinosinusitis: Facial pain and purulent nasal discharge; treated with antibiotics.
Chronic Rhinosinusitis, Pharyngitis, Influenza: Require symptom management and specific therapies.
(Centers for Disease Control and Prevention, 2023; National Institutes of Health, 2023)
Ophthalmology Same-Day Care Indications
Urgent ophthalmology referral is warranted for acute eye pain, sudden vision changes, trauma, or signs of severe infection.
Ocular Foreign Body Removal: Procedure and Precautions
Fluorescein staining helps identify abrasions or foreign bodies. Topical anesthetics are applied cautiously, followed by eyelid eversion to locate hidden foreign bodies. After removal, irrigation and follow-up care are essential to prevent complications.
Ear Foreign Body Removal: Indications and Procedure
Careful removal of ear canal foreign bodies is necessary to avoid injury. Contraindications include recent ear surgery or tympanostomy tubes. Vegetable matter foreign bodies should not be exposed to water due to swelling risks. The procedure requires gentle extraction and patient comfort monitoring.
Cerumen Disimpaction and Tympanometry
Cerumen removal is indicated when blockage causes hearing loss or discomfort. Tympanometry assesses middle ear function but is contraindicated in infants or during active infections.
Audiometry and Nasal Procedures: Emergency Considerations
Audiometry evaluates hearing loss. Urgent ENT consultation is needed for periorbital edema, diplopia, severe nosebleeds, or neurological symptoms.
Nasal Packing and Foreign Body Removal in the Nose
Nasal packing controls severe epistaxis, while foreign body removal requires careful technique to avoid trauma and complications.
Dental Trauma: Post-Tooth Avulsion or Fracture Management
Avoid manipulating teeth if facial fractures or socket lacerations are suspected. Avulsed teeth should be preserved in media like milk or saline. Immediate dental specialist referral is critical for optimal outcomes.
References
American Academy of Family Physicians. (2022). Clinical guidelines for in-office emergencies and management of acute illnesses.
American Academy of Ophthalmology. (2024). Corneal abrasions and foreign bodies.
American College of Emergency Physicians. (2023). Sepsis and septic shock management guidelines.
Blee, T., & Mir, M. (2018). Management of black widow and brown recluse spider bites. Emergency Medicine Clinics, 36(2), 355–368.
Centers for Disease Control and Prevention. (2021). Tickborne diseases of the United States. https://www.cdc.gov/ticks/diseases/index.html
Centers for Disease Control and Prevention. (2023). Management of otitis media and otitis externa.
Federal Emergency Management Agency. (n.d.). Emergency management phases. FEMA.gov.
Lieberman, P., & Camargo, C. A. (2019). Anaphylaxis: Clinical aspects and diagnosis. The Journal of Allergy and Clinical Immunology, 144(3), 594–602. https://doi.org/10.1016/j.jaci
Mayo Clinic. (2023). Eye conditions: Diagnosis and treatment.
National Institutes of Health. (2023). Allergic rhinitis and sinusitis: Diagnosis and treatment.
UpToDate. (2024). Cardiac arrhythmias: Diagnosis and management.
Zimetbaum, P., & Josephson, M. E. (2017). Evaluation and management of arrhythmias. Circulation, 135(3), 258–276.