Updated: September 12, 2025
Introduction
Adult patients presenting to the emergency department may suffer from a wide range of critical conditions: acute asthma, severe pneumonia, pulmonary embolism, pulmonary edema, exacerbations of COPD, poisoning, status epilepticus, or trauma. While ATLS and ACLS protocols provide structured guidance for trauma and cardiac patients, clinicians must also be prepared for other emergencies. This article outlines a practical and systematic approach for initial stabilization and management.
1. Patient Positioning
Correct positioning is essential for maintaining airway patency and optimizing physiological function.
Unconscious patient: Place head-down in the left lateral position with neck flexed and head extended (unless cervical spine injury is suspected). This prevents tongue obstruction and reduces aspiration risk.
Dyspnoeic patient: Most prefer sitting upright. This maximizes accessory muscle use and reduces hypoxia, especially in pulmonary edema.
Child with partial airway obstruction: Best managed sitting upright on a parent’s lap—calming and airway-protective.
Shock patient: Supine position ensures optimal perfusion. Trendelenburg is no longer routinely recommended.
Head injury: Elevate head 30° unless contraindicated by shock or spinal injury—reduces intracranial pressure.
Facial trauma: Encourage self-positioning to maintain airway patency and reduce aspiration of blood.
Pregnant patient (third trimester): Avoid supine hypotension by placing a wedge under the right flank or left lateral tilt.
2. Airway
Maintain a patent airway at all times.
Use standard maneuvers (chin lift, jaw thrust).
Protect cervical spine if trauma suspected.
Consider oropharyngeal/nasopharyngeal adjuncts or definitive intubation if needed.
3. Breathing
Assess respiratory rate, rhythm, and SpO₂.
If SaO₂ < 95% without need for ventilation → administer oxygen by appropriate face mask.
If inadequate → assist ventilation with bag-valve-mask (BVM) connected to oxygen.
4. Circulation
If in cardiac arrest → start CPR immediately.
Otherwise:
Check pulse, blood pressure, capillary refill.
Attach cardiac monitor, correct arrhythmias.
Insert IV cannula, take blood samples for labs and cross-match.
If shock → give fluids and vasopressors as appropriate.
5. Disability
Record Glasgow Coma Scale (GCS) and pupil reactions.
If GCS ≤ 8 → prepare for intubation to protect airway.
6. Additional Measures
Check temperature and blood glucose (finger prick).
Continuous monitoring: ECG, SpO₂, blood pressure.
Conclusion
Emergency management of adult patients requires rapid assessment, correct positioning, and immediate intervention. By following a structured approach—position, airway, breathing, circulation, disability, and monitoring—clinicians can stabilize life-threatening conditions effectively. Updated protocols emphasize patient safety, reduced fluid overload, and careful airway management. Regular training and practice remain essential for improving outcomes in critical emergencies.
Emergency Medicine, Adult Patients, Airway, Resuscitation, Healthcare
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