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Medical Emergencies & Emergency Drugs — Comprehensive Guide

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🔴 TYPES OF MEDICAL EMERGENCIES

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💊 EMERGENCY DRUGS — Detailed Overview

Sources: Miller's Anesthesia 10e, Barash Clinical Anesthesia 9e, Tintinalli's Emergency Medicine, Plum & Posner's Diagnosis and Treatment of Stupor and Coma

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1. 🟥 EPINEPHRINE (Adrenaline)

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2. 🔶 ATROPINE

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3. 🟨 AMIODARONE

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4. 🟨 LIDOCAINE (Lignocaine)

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5. 🟩 ADENOSINE

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6. 🔵 VASOPRESSIN

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7. 🟧 SUCCINYLCHOLINE

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8. 🟧 ROCURONIUM

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9. 🟦 PROPOFOL

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10. 🔴 SODIUM BICARBONATE

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11. 🟩 MAGNESIUM SULFATE

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12. 🟦 NALOXONE

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13. 🟩 FLUMAZENIL

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14. 🔴 GLUCOSE (Dextrose)

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📋 QUICK REFERENCE: Emergency Drug by Situation

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⚠️ Key Principles from Guidelines (2020 AHA/ACLS)

1. Epinephrine — standard dose (1 mg q3–5 min); early use in non-shockable rhythms improves survival
2. Vasopressin — removed from ACLS algorithm; no advantage over epinephrine
3. Amiodarone/Lidocaine — for shock-refractory VF/pVT only; neither proven to improve long-term survival
4. Sodium bicarbonate & Magnesium — NOT for routine use in cardiac arrest
5. All emergency drugs should be pre-drawn, organized, and dose-checked before any procedure or induction — Barash Clinical Anesthesia 9e

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🚨 100 Types of Medical Emergencies — Drugs & Management

Sources: Rosen's Emergency Medicine, Tintinalli's Emergency Medicine, Miller's Anesthesia 10e, Barash Clinical Anesthesia 9e, Harrison's Principles of Internal Medicine 22e, Lippincott Pharmacology, Goodman & Gilman's Pharmacological Basis of Therapeutics

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🫀 A. CARDIAC EMERGENCIES (1–15)

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1. Ventricular Fibrillation (VF)

• Drug: Epinephrine 1 mg IV q3–5 min + Amiodarone 300 mg IV bolus
• Management: Immediate CPR → Defibrillation (200J biphasic) → Epinephrine → Amiodarone after 3rd shock → Continue CPR cycles

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2. Pulseless Ventricular Tachycardia (pVT)

• Drug: Amiodarone 300 mg IV; Lidocaine 1–1.5 mg/kg IV (alternative)
• Management: Unsynchronized cardioversion → CPR → Epinephrine → Amiodarone

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3. Asystole

• Drug: Epinephrine 1 mg IV every 3–5 min (early administration critical)
• Management: High-quality CPR → IV/IO access → Epinephrine ASAP → Find reversible causes (Hs & Ts)

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4. Pulseless Electrical Activity (PEA)

• Drug: Epinephrine 1 mg IV q3–5 min
• Management: CPR → Epinephrine → Identify & treat reversible causes (tension pneumothorax, tamponade, PE, hypovolemia, hyperkalemia, hypoxia)

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5. Symptomatic Bradycardia

• Drug: Atropine 0.5–1 mg IV (repeat to max 3 mg); Dopamine 2–10 mcg/kg/min; Epinephrine 2–10 mcg/min infusion
• Management: Atropine → Transcutaneous pacing if refractory → Transvenous pacing

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6. Supraventricular Tachycardia (SVT)

• Drug: Adenosine 6 mg rapid IV push (flush immediately) → 12 mg if no response (repeat once)
• Management: Vagal maneuvers first → Adenosine → If unstable: synchronized cardioversion (50–100J)

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7. Atrial Fibrillation (Rapid Ventricular Rate)

• Drug (Rate control): Metoprolol 5 mg IV OR Diltiazem 0.25 mg/kg IV; Anticoagulation: Heparin
• Drug (Rhythm): Amiodarone 150 mg IV over 10 min; DC cardioversion if unstable (120–200J)
• Management: Assess stability → Rate vs rhythm control → Anticoagulation if >48h

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8. Torsades de Pointes (TdP)

• Drug: Magnesium sulfate 2 g IV over 5–20 min; Isoproterenol infusion; Overdrive pacing
• Management: Stop QT-prolonging drugs → Magnesium IV → Correct electrolytes → Defibrillation if degenerates to VF

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9. STEMI (Acute MI)

• Drugs: Aspirin 325 mg PO + Clopidogrel/Ticagrelor + Heparin/Enoxaparin + Nitroglycerin IV/SL + Morphine 2–4 mg IV (if pain refractory) + Beta-blocker (Metoprolol)
• Management: Dual antiplatelet → Anticoagulation → Primary PCI within 90 min (door-to-balloon) → Fibrinolysis if PCI unavailable

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10. Acute Decompensated Heart Failure / Pulmonary Edema

• Drugs: Furosemide 40–80 mg IV; Nitroglycerin 0.4 mg SL/IV infusion; Morphine 2–4 mg IV; Dobutamine (if low CO); BiPAP/CPAP
• Management: Upright positioning → O₂/NIV → Diuresis → Vasodilation → Treat underlying cause

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11. Hypertensive Emergency

• Drugs: Sodium nitroprusside 0.25–10 mcg/kg/min IV; Labetalol 20 mg IV bolus; Nicardipine 5–15 mg/h IV; Hydralazine 10–20 mg IV
• Management: Reduce MAP by no more than 25% in first hour, then gradual reduction — Harrison's 22e; ICU monitoring; treat end-organ damage

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12. Aortic Dissection

• Drugs: Esmolol IV (HR <60) + Sodium nitroprusside (if hypertensive); Morphine for pain; avoid thrombolytics
• Management: HR/BP control → Urgent surgical consultation (Type A) → Medical management (Type B)

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13. Cardiac Tamponade

• Drug: IV fluid bolus (temporizing); Dopamine/Norepinephrine (hemodynamic support)
• Management: Emergency pericardiocentesis → Surgical drainage; avoid positive pressure ventilation

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14. Wolff-Parkinson-White (WPW) with AF

• Drug: Procainamide 15–17 mg/kg IV; Electrical cardioversion if unstable
• Avoid: Adenosine, digoxin, beta-blockers, calcium channel blockers (can accelerate conduction via accessory pathway → VF)

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15. Complete Heart Block (Third-Degree AV Block)

• Drug: Atropine 1 mg IV; Dopamine/Epinephrine infusion
• Management: Transcutaneous pacing → Transvenous pacing → Permanent pacemaker

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🫁 B. RESPIRATORY EMERGENCIES (16–25)

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16. Respiratory Arrest

• Drug: Bag-valve-mask ventilation → Succinylcholine 1.5 mg/kg IV for RSI
• Management: Open airway (head-tilt/chin-lift) → BVM ventilation → Definitive airway (ETT) → Treat cause

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17. Severe Acute Asthma (Status Asthmaticus)

• Drugs: Salbutamol (Albuterol) nebulization q20 min; Ipratropium 0.5 mg nebulized; IV Methylprednisolone 1–2 mg/kg; MgSO₄ 2 g IV; IV Epinephrine 0.3 mg IM (severe); Heliox; Ketamine 1–2 mg/kg IV (intubation)
• Management: O₂ → SABA → Steroids → Magnesium → NIV → Intubation (last resort)

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18. Tension Pneumothorax

• Drug: No drug primary — needle decompression is treatment
• Management: Immediate needle decompression (2nd ICS, MCL) → Chest tube insertion (5th ICS, AAL) → O₂

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19. Massive Pulmonary Embolism

• Drugs: Heparin 80 units/kg IV bolus → infusion; Alteplase (tPA) 100 mg IV over 2h (massive PE with hemodynamic instability); Norepinephrine (shock)
• Management: O₂ → Anticoagulation → Thrombolysis if massive → Surgical embolectomy/catheter-directed therapy

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20. Acute Respiratory Distress Syndrome (ARDS)

• Drugs: Neuromuscular blockers (Cisatracurium infusion) early; Steroids (methylprednisolone, selected cases); Vasopressors for hemodynamic support
• Management: Lung-protective ventilation (tidal volume 6 mL/kg, PEEP, FiO₂ titration); prone positioning

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21. Laryngospasm

• Drug: Propofol 0.5–1 mg/kg IV; Succinylcholine 0.1–1 mg/kg IV (or 4 mg/kg IM)
• Management: Positive pressure O₂ → Jaw thrust → Propofol → Succinylcholine if complete spasm — Barash 9e

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22. Bronchospasm (Intraoperative/Acute)

• Drug: Salbutamol MDI (4–8 puffs) or nebulization; IV Epinephrine 0.1–0.3 mg; Propofol 1 mg/kg; IV Steroids
• Management: Remove trigger → O₂ → Bronchodilators → Epinephrine → Steroids

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23. Epiglottitis

• Drug: Ceftriaxone 2 g IV; Dexamethasone 0.15 mg/kg IV; Epinephrine nebulization
• Management: Secure airway (awake fiberoptic or inhalational induction) → IV antibiotics → ICU

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24. Foreign Body Airway Obstruction

• Drug: None primary
• Management: Conscious adult: Heimlich maneuver → Back blows; Unconscious: CPR + direct laryngoscopy + Magill forceps

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25. Hemoptysis (Massive)

• Drugs: Tranexamic acid 1 g IV; Vasopressin; Blood products
• Management: Position bleeding lung down → Protect airway → Bronchoscopy → IR embolization → Surgery

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🧠 C. NEUROLOGICAL EMERGENCIES (26–36)

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26. Status Epilepticus

• Drugs (stepwise):
  • 1st line: Lorazepam 4 mg IV (or Diazepam 10 mg IV/rectal)
  • 2nd line: Levetiracetam 60 mg/kg IV OR Valproate 40 mg/kg IV OR Fosphenytoin 20 PE/kg IV
  • 3rd line: Propofol infusion OR Midazolam infusion OR Thiopental (refractory)
• Management: ABCs → Glucose check → Benzodiazepine → Escalate → Continuous EEG monitoring

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27. Ischemic Stroke (Acute)

• Drug: Alteplase (tPA) 0.9 mg/kg IV (max 90 mg) within 4.5 hours of symptom onset; Aspirin 325 mg (if no thrombolysis); Heparin (cardioembolic)
• Management: CT head (exclude hemorrhage) → tPA → Thrombectomy (large vessel occlusion within 24h) → Stroke unit

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28. Hemorrhagic Stroke / ICH

• Drugs: Labetalol/Nicardipine IV (BP control, target SBP <140); Reversal of anticoagulation (Vitamin K, PCC, FFP, Andexanet alfa for NOAC)
• Management: Airway protection → BP control → Neurosurgical consultation; avoid hyperosmolar therapy with mannitol if needed

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29. Raised Intracranial Pressure (ICP)

• Drugs: Mannitol 0.5–1 g/kg IV; Hypertonic saline 3% (bolus); Dexamethasone (vasogenic edema from tumors); Fosphenytoin (seizure prophylaxis)
• Management: HOB 30° → Hyperventilation (temporary) → Osmotherapy → Surgical decompression

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30. Meningitis (Bacterial)

• Drugs: Ceftriaxone 2 g IV q12h + Dexamethasone 0.15 mg/kg IV q6h (before or with first antibiotic dose); add Ampicillin if Listeria suspected (elderly, immunocompromised)
• Management: Blood cultures first → Antibiotics IMMEDIATELY → LP if safe → Steroids

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31. Encephalitis

• Drug: Acyclovir 10 mg/kg IV q8h (HSV); Empiric antibiotics; Steroids (autoimmune)
• Management: Airway → Acyclovir → MRI brain → LP → EEG

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32. Wernicke's Encephalopathy

• Drug: Thiamine 500 mg IV three times daily × 3 days (BEFORE glucose administration)
• Management: Thiamine first → Correct glucose → Correct electrolytes → Nutritional support

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33. Hypertensive Encephalopathy

• Drugs: Labetalol IV or Nicardipine IV; Sodium nitroprusside
• Management: Gradual BP reduction (max 25% in first hour) → Rule out stroke → ICU

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34. Spinal Cord Compression (Acute)

• Drug: Dexamethasone 10–16 mg IV bolus → 4 mg q6h
• Management: MRI spine → High-dose steroids → Urgent decompression surgery or radiotherapy

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35. Coma (Unknown Cause)

• Drugs: "Coma cocktail" — Glucose 50% 50 mL IV + Thiamine 100 mg IV + Naloxone 0.4–2 mg IV + Flumazenil 0.2 mg IV
• Management: ABCs → Coma cocktail → Blood glucose → CT head → Consider toxicology screen

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36. Guillain-Barré Syndrome (Acute)

• Drug: IVIG 0.4 g/kg/day × 5 days OR Plasmapheresis
• Management: Monitor respiratory function → ICU if VC <20 mL/kg → Mechanical ventilation if needed

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🩸 D. SHOCK STATES (37–42)

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37. Hypovolemic / Hemorrhagic Shock

• Drugs: Crystalloids (Normal saline/Ringer's lactate) → Packed RBCs → FFP → Platelets (1:1:1 ratio massive transfusion); Tranexamic acid 1 g IV within 3h of trauma
• Management: Stop bleeding → IV access × 2 → Fluid resuscitation → Massive transfusion protocol → Surgery

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38. Septic Shock

• Drugs: IV Norepinephrine 0.1–0.3 mcg/kg/min (vasopressor of choice); Add Vasopressin 0.03 units/min (adjunct); Hydrocortisone 200 mg/day IV (refractory shock); Broad-spectrum antibiotics within 1 hour; IV fluid 30 mL/kg crystalloid
• Management: Surviving Sepsis Campaign: cultures → antibiotics → fluids → vasopressors → lactate clearance

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39. Cardiogenic Shock

• Drugs: Dobutamine 2–20 mcg/kg/min; Norepinephrine (if severe hypotension); Furosemide; Aspirin + anticoagulation (if STEMI)
• Management: Treat underlying cause (PCI for STEMI) → IABP/ECMO → Vasopressors

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40. Neurogenic Shock

• Drug: IV fluids + Norepinephrine or Dopamine (to maintain MAP >85 mmHg in spinal cord injury)
• Management: Spinal immobilization → Fluids → Vasopressors → Atropine (if bradycardia) → Methylprednisolone (controversial)

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41. Obstructive Shock (Tension PTX / PE / Tamponade)

• Management: Treat underlying cause (needle decompression / pericardiocentesis / thrombolysis)

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42. Distributive Shock (Anaphylactic)

• Drug: Epinephrine 0.3–0.5 mg IM (anterolateral thigh) — FIRST-LINE; repeat every 5–15 min; IV fluids 1–2 L; Diphenhydramine 25–50 mg IV; Ranitidine 50 mg IV; Methylprednisolone 125 mg IV; Salbutamol nebulization (bronchospasm)
• Management: Epinephrine FIRST → Fluids → Antihistamines → Steroids → Airway management

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☠️ E. TOXICOLOGICAL EMERGENCIES (43–55)

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43. Opioid Overdose

• Drug: Naloxone 0.4–2 mg IV/IM/IN; repeat every 2–3 min; infusion if needed (2/3 of reversal dose/hour)
• Management: Airway → Naloxone → Observe (re-narcotization risk as naloxone wears off sooner than opioid)

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44. Benzodiazepine Overdose

• Drug: Flumazenil 0.2 mg IV over 15 sec, repeat 0.1 mg q60 sec; max 1 mg
• Management: Supportive care → Flumazenil (caution: can precipitate seizures in dependent patients)

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45. Tricyclic Antidepressant (TCA) Overdose

• Drug: Sodium bicarbonate 1–2 mEq/kg IV (for wide QRS or hypotension); target pH 7.45–7.55; IV lipid emulsion 20%
• Management: ABCs → ECG → Sodium bicarbonate → Benzodiazepines (seizures) → Avoid physostigmine

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46. Beta-Blocker Overdose

• Drugs: Glucagon 5–10 mg IV bolus → 1–10 mg/h infusion; High-dose Insulin euglycemia (1 unit/kg bolus → infusion); Calcium chloride; IV lipid emulsion; High-dose Epinephrine
• Management: Atropine → Glucagon → High-dose insulin → Vasopressors → ECMO

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47. Calcium Channel Blocker Overdose

• Drugs: Calcium gluconate 3 g IV or Calcium chloride 1 g IV; High-dose Insulin (1 unit/kg/h) + Dextrose; Glucagon; Lipid emulsion 20%; Norepinephrine
• Management: Same as beta-blocker OD; consider ECMO for refractory cases

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48. Organophosphate / Nerve Agent Poisoning

• Drugs: Atropine 2–4 mg IV every 5–10 min until secretions dry (no max dose in severe cases); Pralidoxime (2-PAM) 1–2 g IV over 15–30 min; Diazepam 10 mg IV (seizures)
• Management: Decontamination (SAFETY FIRST) → Atropine titration → Pralidoxime → Airway

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49. Cyanide Poisoning

• Drug: Hydroxocobalamin 5 g IV over 15 min (preferred); Sodium thiosulfate 12.5 g IV; Sodium nitrite 300 mg IV (alternative kit)
• Management: Remove from source → O₂ 100% → Hydroxocobalamin → Supportive care

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50. Carbon Monoxide Poisoning

• Drug: Oxygen 100% via non-rebreather mask; Hyperbaric O₂ (HBO) therapy
• Indications for HBO: LOC, cardiac involvement, neurologic symptoms, CO-Hb >25%, pregnancy
• Management: Remove patient from source → 100% O₂ → HBO if indicated

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51. Acetaminophen (Paracetamol) Overdose

• Drug: N-Acetylcysteine (NAC) — oral: 140 mg/kg loading → 70 mg/kg q4h × 17 doses; IV: 150 mg/kg over 1h → 50 mg/kg over 4h → 100 mg/kg over 16h
• Management: Rumack-Matthew nomogram → NAC ASAP (most effective <8–10h) → Liver transplant evaluation if ALF

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52. Salicylate (Aspirin) Overdose

• Drug: Sodium bicarbonate IV (urinary alkalinization); Hemodialysis (severe cases, salicylate >100 mg/dL, AKI, altered mental status)
• Management: Activated charcoal if early → Bicarbonate → Hemodialysis

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53. Digoxin Toxicity

• Drug: Digoxin-specific Fab antibody fragments (Digibind/DigiFab) — dose based on ingested amount; Atropine (bradycardia); Magnesium sulfate
• Management: ECG monitoring → Digoxin-specific antibodies → Correct hypokalemia

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54. Alcohol Withdrawal / Delirium Tremens

• Drug: Diazepam 5–10 mg IV (symptom-triggered) OR Lorazepam 2–4 mg IV; Thiamine 100 mg IV; Phenobarbital (refractory); Propofol infusion (ICU)
• Management: CIWA-Ar scoring → Benzodiazepines → Thiamine → Treat complications (seizures, ARDS)

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55. Methanol / Ethylene Glycol Poisoning

• Drug: Fomepizole 15 mg/kg IV (ADH inhibitor — preferred); Ethanol IV (if fomepizole unavailable); Folinic acid (methanol); Pyridoxine + thiamine (ethylene glycol); Hemodialysis
• Management: Correct acidosis → Fomepizole → Hemodialysis if severe

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🩺 F. METABOLIC EMERGENCIES (56–63)

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56. Diabetic Ketoacidosis (DKA)

• Drugs: Regular Insulin 0.1 units/kg/h IV infusion; Normal saline 1 L/h initially → switch to 0.45% NS; KCl replacement (when K >3.5); Bicarbonate only if pH <6.9
• Management: Fluid → Insulin → Potassium → Monitor glucose, electrolytes, pH every 1–2h; transition to subcutaneous insulin when anion gap closes

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57. Hyperosmolar Hyperglycemic State (HHS)

• Drug: IV Normal saline (aggressive); Regular insulin (lower rate than DKA); Potassium replacement
• Management: Fluids are the priority → Gentle insulin → Correct slowly to prevent cerebral edema

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58. Severe Hypoglycemia

• Drug: 50% Dextrose 50 mL IV (adults); 25% Dextrose 2–4 mL/kg (pediatric); Glucagon 1 mg IM/SC (if no IV access)
• Management: Check glucose → Dextrose IV → Recheck glucose → Identify and treat cause

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59. Adrenal Crisis (Addisonian Crisis)

• Drug: Hydrocortisone 100 mg IV bolus → 50–100 mg IV q6–8h; Normal saline 1 L rapidly; Dextrose (if hypoglycemic)
• Management: Hydrocortisone → Fluids → Identify precipitating cause → Fludrocortisone after acute phase

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60. Thyroid Storm

• Drugs: Propylthiouracil (PTU) 600 mg PO/NG → 200–400 mg q8h; Lugol's iodine (1h after PTU); Propranolol 60–80 mg q4h PO or 0.5–1 mg IV; Hydrocortisone 100 mg IV q8h; Paracetamol (fever — avoid aspirin, displaces T4)
• Management: Block synthesis → Block release → Block peripheral conversion → Treat precipitant → ICU

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61. Myxedema Coma

• Drug: T4 (Levothyroxine) 200–500 mcg IV loading → 100 mcg/day; T3 (Liothyronine) 5–20 mcg IV (faster acting); Hydrocortisone 100 mg IV q8h (concurrent adrenal insufficiency)
• Management: Airway → Warm passively → Thyroid hormone IV → Steroids → Treat precipitant

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62. Severe Hyperkalemia (K⁺ >6.5 mEq/L)

• Drugs (stepwise):
  1. Calcium gluconate 10 mL of 10% IV (cardiac membrane stabilization — FIRST)
  2. Insulin 10 units IV + Dextrose 50% 50 mL (shift K intracellularly)
  3. Salbutamol 10–20 mg nebulized (shift K intracellularly)
  4. Sodium bicarbonate (if acidotic)
  5. Kayexalate/Patiromer (eliminate K)
  6. Hemodialysis (definitive)
• Management: ECG first → Calcium → Shift → Remove → Monitor

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63. Severe Hyponatremia (Na⁺ <120 with symptoms)

• Drug: Hypertonic saline 3% at 1–2 mL/kg/h; Tolvaptan (V2 antagonist — SIADH); Demeclocycline
• Management: Correct Na at max 8–10 mEq/L/day (risk of osmotic demyelination) → Monitor q2h → Treat underlying cause

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🧬 G. HEMATOLOGICAL EMERGENCIES (64–68)

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64. Massive Hemorrhage / DIC

• Drugs: Tranexamic acid 1 g IV over 10 min (within 3h); FFP 15 mL/kg; Cryoprecipitate (fibrinogen); Platelets; Packed RBCs; Vitamin K; PCC (if on warfarin)
• Management: Massive transfusion protocol (1:1:1 RBC:FFP:PLT) → Treat underlying cause

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65. Warfarin / Vitamin K Antagonist Reversal

• Drug: Vitamin K 10 mg IV (slow); PCC (4-factor) 25–50 units/kg; FFP (if PCC unavailable); Phytonadione
• Management: Hold warfarin → Vitamin K → PCC for rapid reversal → Monitor INR

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66. NOAC Reversal

• Dabigatran: Idarucizumab (Praxbind) 5 g IV
• Rivaroxaban/Apixaban: Andexanet alfa IV; PCC (off-label)
• Management: Hold NOAC → Specific antidote → Supportive care

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67. Heparin Overdose / HIT

• Drug: Protamine sulfate 1 mg per 100 units of heparin (slow IV, max 50 mg); For HIT: Stop heparin → Argatroban or Bivalirudin (direct thrombin inhibitors)
• Management: Stop heparin → Protamine (unfractionated) → Monitor aPTT

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68. Sickle Cell Crisis (Acute Chest Syndrome)

• Drugs: O₂; IV fluids; Morphine 0.1–0.15 mg/kg IV q3–4h; Cefuroxime + Azithromycin; Blood transfusion (exchange transfusion if severe); Hydroxyurea (prophylaxis)
• Management: Analgesia → Hydration → O₂ → Antibiotics → Exchange transfusion if hypoxic

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🤰 H. OBSTETRIC EMERGENCIES (69–73)

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69. Eclampsia

• Drug: Magnesium sulfate 4 g IV over 5–10 min (loading) → 1–2 g/h maintenance; Labetalol 20 mg IV or Hydralazine 5 mg IV (BP control); Diazepam (refractory seizures)
• Management: Secure airway → MgSO₄ → BP control → Deliver baby (definitive)

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70. Postpartum Hemorrhage (PPH)

• Drugs: Oxytocin 10–40 units IM/IV; Ergometrine 0.25 mg IM; Carboprost (Hemabate) 0.25 mg IM q15 min; Misoprostol 800–1000 mcg rectally; Tranexamic acid 1 g IV; Blood transfusion
• Management: Uterine massage → Oxytocics → Surgical (B-Lynch suture, hysterectomy if needed)

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71. Placenta Previa / Abruption

• Drugs: IV fluids; Blood products; Corticosteroids (if preterm); Tocolytics (abruption — controversial)
• Management: Stabilize → Fetal monitoring → Emergency cesarean section

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72. Amniotic Fluid Embolism

• Drugs: Epinephrine (cardiac arrest); Dopamine/Norepinephrine; Hydrocortisone 500 mg IV; FFP/platelets (DIC); Oxytocin; Inhaled nitric oxide
• Management: Resuscitation → Delivery → Treat DIC → ECMO in refractory cases

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73. HELLP Syndrome

• Drugs: MgSO₄ (seizure prophylaxis); Antihypertensives; Dexamethasone 10 mg IV q12h (accelerates platelet recovery); Blood products
• Management: Stabilize → Deliver after 34 weeks; earlier if deteriorating

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👶 I. PEDIATRIC EMERGENCIES (74–79)

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74. Pediatric Cardiac Arrest

• Drugs: Epinephrine 0.01 mg/kg IV/IO q3–5 min; Amiodarone 5 mg/kg IV (VF/pVT); Atropine 0.02 mg/kg (bradycardia)
• Management: High-quality CPR → Defibrillation 2 J/kg (VF) → Epinephrine → Amiodarone

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75. Croup (Severe)

• Drugs: Nebulized Epinephrine 0.5 mL/kg (max 5 mL) of 1:1000; Dexamethasone 0.6 mg/kg IM/PO/IV; Budesonide nebulization
• Management: Minimize agitation → Steroids → Nebulized epinephrine → Intubation (if severe)

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76. Febrile Seizure (Complex)

• Drug: Diazepam 0.5 mg/kg rectal OR Midazolam 0.2 mg/kg IM/buccal; Lorazepam 0.1 mg/kg IV
• Management: Benzodiazepine → Treat fever (paracetamol) → Rule out meningitis

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77. Neonatal Resuscitation

• Drugs: Epinephrine 0.01–0.03 mg/kg IV (if HR <60 despite ventilation and compressions); Normal saline 10 mL/kg (volume); Sodium bicarbonate (prolonged arrest)
• Management: Warm → Dry → Stimulate → Ventilate → Chest compressions → Epinephrine

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78. Diabetic Ketoacidosis (Pediatric)

• Drugs: Normal saline 10 mL/kg (no bolus unless shocked — risk cerebral edema); Insulin 0.05–0.1 units/kg/h (start 1h after fluid); KCl replacement
• Management: Slow fluid correction → Insulin → Electrolyte monitoring → Neuro checks

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79. Epiglottitis (Pediatric)

• Drugs: Ceftriaxone 50 mg/kg IV; Dexamethasone 0.6 mg/kg IV; Nebulized epinephrine
• Management: Minimize disturbance → Emergency airway (OR intubation preferred) → IV antibiotics

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🌡️ J. ENVIRONMENTAL EMERGENCIES (80–85)

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80. Heatstroke

• Drugs: None specific — cooling is treatment; IV normal saline; Benzodiazepines (shivering during cooling); Dantrolene (refractory)
• Management: Immediate cooling (ice water immersion) → IV fluids → ICU → Monitor for multi-organ failure

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81. Hypothermia (Severe, <30°C)

• Drugs: Warmed IV fluids (42°C); Epinephrine (hold until temp >30°C, then use); Amiodarone; Vasopressors
• Management: Rewarm → Warmed humidified O₂ → Warmed saline → ECMO (if cardiac arrest)

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82. Near-Drowning

• Drug: Supportive — O₂, ventilation, bronchodilators, steroids (if aspiration)
• Management: CPR → Airway → O₂ → Warm IV fluids (if hypothermic) → ICU monitoring

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83. Electrical Injury / Lightning Strike

• Drug: IV fluids (aggressive for rhabdomyolysis: target UO 1–2 mL/kg/h); Sodium bicarbonate (myoglobinuria); Furosemide (if UO inadequate)
• Management: CPR if arrest → ECG (arrhythmia) → Burn care → Fasciotomy (compartment syndrome)

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84. Anaphylaxis (Drug/Bee Sting)

• Drug: Epinephrine 0.3 mg IM (anterolateral thigh) — FIRST and MOST IMPORTANT; repeat q5–15 min; IV fluids 1–2 L; Salbutamol; Diphenhydramine; Hydrocortisone 200 mg IV
• Management: Epinephrine → Position → Fluids → Antihistamines → Steroids → Airway if needed

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85. Malignant Hyperthermia (Intraoperative)

• Drug: Dantrolene 2.5 mg/kg IV bolus; repeat up to 10 mg/kg (cumulative); Sodium bicarbonate; Insulin+Glucose (hyperkalemia); active cooling
• Management: STOP triggering agents → 100% O₂ → Hyperventilate → Dantrolene → Cool patient → ICU

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🔪 K. TRAUMA EMERGENCIES (86–90)

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86. Traumatic Brain Injury (Severe)

• Drugs: Mannitol 0.5–1 g/kg IV OR Hypertonic saline 3%; Fosphenytoin (seizure prophylaxis × 7 days); Propofol/Midazolam (sedation); Vasopressors (maintain CPP >60 mmHg)
• Management: Intubate → Controlled ventilation → ICP monitoring → Neurosurgical evacuation of mass lesion

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87. Burns (Major)

• Drugs: Morphine IV (analgesia); Ringer's lactate (Parkland formula: 4 mL/kg/% BSA over 24h — first half in 8h); Tetanus prophylaxis; Silver sulfadiazine topical
• Management: Airway (early intubation if inhalation burn) → Fluid resuscitation → Wound care → ICU

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88. Crush Syndrome / Rhabdomyolysis

• Drugs: Aggressive IV fluid (NS 1–1.5 L/h); Sodium bicarbonate (alkalinize urine); Furosemide; Mannitol; Calcium gluconate (hyperkalemia); Hemodialysis
• Management: IV fluid immediately on extrication → Target UO 200–300 mL/h (brown urine) → Monitor electrolytes

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89. Hemothorax (Massive)

• Drug: Blood products; IV fluids; Tranexamic acid
• Management: Large-bore chest tube → Autotransfusion → Thoracotomy if drainage >1.5 L or ongoing >200 mL/h

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90. Abdominal Trauma with Shock

• Drugs: IV fluids; Blood products (massive transfusion protocol); Tranexamic acid 1 g IV; Vasopressors if needed
• Management: FAST ultrasound → Emergency laparotomy → Damage control surgery

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🏥 L. OTHER CRITICAL EMERGENCIES (91–100)

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91. Sepsis (Early Goal-Directed)

• Drugs: Broad-spectrum antibiotics within 1 hour; IV fluid 30 mL/kg crystalloid; Norepinephrine (MAP <65); Hydrocortisone 200 mg/day (refractory); Vasopressin 0.03 units/min
• Management: 1h bundle: lactate → cultures → antibiotics → fluids → vasopressors

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92. Acute Liver Failure

• Drugs: NAC infusion (all causes); Lactulose (encephalopathy); Rifaximin; Mannitol (cerebral edema); Fresh frozen plasma (bleeding); Broad-spectrum antibiotics
• Management: ICU → NAC → Treat cause → Liver transplant evaluation

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93. Acute Pancreatitis (Severe)

• Drugs: Aggressive IV fluids (Ringer's lactate preferred 250–500 mL/h); Morphine/Fentanyl (analgesia); Meropenem (infected necrosis); Octreotide (debated)
• Management: Fluid resuscitation → Analgesia → Nutritional support (enteral preferred) → ERCP if gallstone pancreatitis

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94. Bowel Obstruction / Strangulation

• Drugs: IV fluids; NG decompression; Broad-spectrum antibiotics (Piperacillin-tazobactam); Morphine (analgesia)
• Management: Resuscitate → NGT → CT abdomen → Emergency surgery if strangulation

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95. Pulmonary Hypertensive Crisis

• Drugs: Inhaled Nitric Oxide 20 ppm; IV Sildenafil; Epoprostenol (IV prostacyclin); Avoid hypoxia/hypercapnia/acidosis
• Management: O₂ → Inhaled NO → Vasodilators → ECMO

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96. Acute Kidney Injury (Oliguric)

• Drugs: IV fluids (if prerenal); Furosemide (optimize UO after fluid resuscitation); Sodium bicarbonate (acidosis); Stop nephrotoxins; Hemodialysis (refractory)
• Management: Identify cause → Fluid optimization → Nephrology → Dialysis indications: AEIOU (Acidosis, Electrolytes, Intoxication, Overload, Uremia)

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97. Acute Angle-Closure Glaucoma

• Drugs: IV Acetazolamide 500 mg; Timolol 0.5% eye drops; Pilocarpine 2% eye drops; IV Mannitol; Analgesics
• Management: Ophthalmology emergency → IV acetazolamide → Topical agents → Laser iridotomy (definitive)

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98. Testicular Torsion

• Drugs: IV analgesia (Morphine); Ketamine (procedural)
• Management: Surgical emergency — testicular detorsion within 6 hours (viability >90%) → bilateral orchidopexy

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99. Acute Psychosis / Violent Patient

• Drugs: Haloperidol 5–10 mg IM + Lorazepam 2 mg IM (B52 regimen); Droperidol 5 mg IM; Olanzapine 10 mg IM; Ketamine 4 mg/kg IM (excited delirium)
• Management: De-escalation → Chemical sedation → Safety → Rule out organic cause

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100. Priapism (Ischemic)

• Drug: Phenylephrine 200 mcg intracavernosal injection every 3–5 min (first-line); Aspiration ± saline irrigation; Terbutaline 0.25 mg SC
• Management: Emergency management → Intracavernosal phenylephrine → Surgical shunt if >4–6h — Kaplan & Sadock's Psychiatry

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📊 MASTER QUICK-REFERENCE TABLE

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Key Principle: In ALL emergencies — Airway → Breathing → Circulation (ABCs) first. Drugs are adjuncts to resuscitation, not replacements for it. Early definitive management and treating the underlying cause always take priority.

— Rosen's Emergency Medicine, Tintinalli's Emergency Medicine, Miller's Anesthesia 10e, Harrison's Internal Medicine 22e, Goodman & Gilman's Pharmacological Basis of Therapeutics