Emergency Medicine
Astra Clinical Library
Emergency medicine
Practical emergency medicine guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
70 guides
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Orthopaedic Trauma
Open Fracture Management
Open fractures require immediate contamination control, antibiotic prophylaxis, neurovascular assessment, stable skeletal management, and timely definitive soft-tissue coverage. This review prioritizes actions that reduce fracture-related infection, avoid missed vascular or compartment injury, and align debridement, fixation, and reconstruction with injury severity.Emergency Medicine and General Surgery
Acute Abdomen
Acute abdomen requires parallel resuscitation and diagnosis: identify patients with peritonitis, shock, obstruction, ischemia, or hemorrhage who need urgent surgical or procedural management, while using focused laboratory testing and imaging to distinguish operative disease from conditions appropriate for monitored conservative care.Emergency Medicine and Endocrinology
Adult Diabetic Ketoacidosis
Adult diabetic ketoacidosis requires immediate recognition of insulin deficiency, volume depletion, electrolyte derangement, and its precipitant. This review focuses on rapid diagnostic confirmation, diabetes-type reassessment, safe insulin-dependent care, and prevention of recurrent hyperglycemic crises using currently supplied evidence.Endocrinology and Emergency Medicine
Hyperosmolar Hyperglycemic Syndrome
Hyperosmolar hyperglycemic syndrome is a life-threatening hyperglycemic emergency requiring prompt recognition, volume resuscitation, electrolyte-directed insulin therapy, and evaluation for precipitating illness. The supplied search results do not contain HHS-specific diagnostic thresholds or treatment protocols; current emergency guidance should be consulted.Medical Toxicology
Acetaminophen Toxicity
Acetaminophen toxicity requires rapid exposure clarification, timed serum concentration testing, early antidotal therapy when risk cannot be excluded, and escalation for evolving hepatic failure. This review emphasizes actionable diagnostic limits and the evidence gaps within the supplied sources.Medical Toxicology and Emergency Medicine
Carbon Monoxide Poisoning
Carbon monoxide poisoning is a time-sensitive clinical diagnosis requiring immediate oxygen therapy, co-oximetry confirmation, cardiopulmonary assessment, and selective hyperbaric consultation. Carboxyhemoglobin supports exposure but does not grade injury reliably after oxygen or delayed presentation; neurologic and cardiac findings drive disposition.Medical Toxicology and Emergency Medicine
Carbon Monoxide Toxicity
Carbon monoxide toxicity requires exposure-based diagnosis, prompt oxygenation, and assessment for occult neurologic and cardiac injury. Carboxyhemoglobin alone does not define severity or disposition; serial clinical assessment and targeted cardiac evaluation identify patients at risk for acute complications and delayed sequelae.Pediatric endocrinology and emergency medicine
Pediatric Diabetic Ketoacidosis
Pediatric diabetic ketoacidosis requires rapid confirmation of hyperglycemia, ketonemia, and acidosis; protocolized isotonic fluid resuscitation, potassium replacement, and delayed low-dose intravenous insulin; and intensive neurologic surveillance for cerebral edema while treating the precipitant and preventing recurrence.[21]Emergency Medicine
Foreign Body Airway Obstruction
Foreign body airway obstruction requires immediate distinction between effective coughing, complete obstruction, and retained distal aspiration. Early airway clearance is time-critical; persistent symptoms or a credible aspiration history warrant imaging and specialist-directed endoscopic evaluation even when radiographs are normal.Emergency Medicine
Heat Stroke
Heat stroke is a time-critical hyperthermic emergency defined by central nervous system dysfunction with markedly elevated core temperature. Immediate active cooling—particularly for exertional collapse—takes priority over transport, while clinicians evaluate and manage evolving renal, hepatic, muscle, and coagulation injury.Emergency Medicine and Orthopedic Surgery
Acute Compartment Syndrome
Acute compartment syndrome is a time-critical clinical diagnosis in which escalating intracompartmental pressure compromises muscle and nerve perfusion. Serial examination, urgent surgical involvement, selective pressure measurement in unreliable examinations, and prompt complete fasciotomy are the decisions most likely to preserve limb function.Emergency Medicine, Trauma Surgery, Critical Care
Hemorrhagic Shock
Hemorrhagic shock demands immediate recognition, mechanical hemorrhage control, rapid blood-product delivery, and parallel definitive operative or endovascular management. This review emphasizes time-sensitive actions, reassessment, trauma-specific diagnostic limitations, and important evidence gaps in resuscitation targets and adjunctive pharmacotherapy.Emergency Medicine and General Surgery
Small Bowel Obstruction
Small bowel obstruction requires rapid imaging-based confirmation, assessment for ischemia or strangulation, resuscitation, and early operative triage. Stable adhesive obstruction can often undergo monitored nonoperative management, whereas peritonitis, ischemia, or clinical deterioration mandates urgent surgical evaluation.Emergency Medicine
Epiglottitis
Epiglottitis is an airway-threatening supraglottic infection requiring immediate risk stratification, avoidance of destabilizing examination, coordinated airway planning, and antimicrobial treatment after airway priorities are addressed. Children and adults require different diagnostic approaches, but deterioration can be abrupt in either group.Emergency Medicine
Tension Pneumothorax
Tension pneumothorax is a time-critical clinical diagnosis of respiratory and/or circulatory compromise from pleural air under pressure. Decompress immediately when instability or severe respiratory compromise is present; do not delay for imaging, then provide definitive pleural drainage.Emergency Medicine
Hypothermia
Hypothermia requires core-temperature confirmation, recognition of temperature-dependent cardiovascular and neurologic depression, gentle handling, prevention of further heat loss, and escalation of rewarming support according to severity and circulatory status.Emergency Medicine and Neurology
Acute Headache
Acute headache evaluation hinges on recognizing secondary causes before treating presumed primary headache. Sudden onset and abnormal neurologic examination are especially predictive red flags; persistent concern for subarachnoid hemorrhage after nondiagnostic CT warrants further evaluation, commonly lumbar puncture.Cardiology and Emergency Medicine
Syncope
Evaluate syncope by first identifying unstable cardiac, structural, pulmonary, hemorrhagic, or neurologic mimics; then use history, orthostatic vital signs, examination, and 12-lead ECG to direct selective testing, disposition, rhythm correlation, and cause-specific treatment.Emergency Medicine and Neurology
Thunderclap Headache
Thunderclap headache requires urgent exclusion of subarachnoid hemorrhage and targeted evaluation for vascular, hemorrhagic, venous, pituitary, and pressure-related disorders. Recurrent attacks, triggers, examination, cerebrospinal fluid, and vascular imaging direct evaluation toward reversible cerebral vasoconstriction syndrome or competing secondary causes.Emergency Medicine and Vascular Surgery
Acute Mesenteric Ischemia
Acute mesenteric ischemia requires immediate CT angiography, resuscitation, and coordinated vascular-surgical management. Etiology—arterial embolism, arterial thrombosis, nonocclusive hypoperfusion, venous thrombosis, or strangulation—determines revascularization, anticoagulation, laparotomy, and bowel-preservation strategy.Emergency Medicine
Thermal Burns
Evaluate thermal burns by confirming airway risk, measuring partial- and full-thickness TBSA accurately, initiating response-titrated resuscitation for major injury, controlling pain, protecting wounds, and transferring patients whose size, depth, location, or inhalation risk requires burn-center care.Trauma Surgery
Pelvic Fracture
Pelvic fracture management hinges on early mechanical stabilization, rapid identification of competing bleeding sources, and pathway selection between laparotomy, preperitoneal packing, and angioembolization. Hemodynamic instability demands simultaneous damage-control resuscitation and definitive hemorrhage control at a trauma-capable center.Emergency Medicine and Psychiatry
Neuroleptic Malignant Syndrome
Treat suspected neuroleptic malignant syndrome as a medical emergency: stop dopamine-blocking drugs, stabilize hyperthermia and rhabdomyolysis, exclude mimics, and escalate to intensive care when autonomic, respiratory, renal, or consciousness abnormalities are present.Hematology and emergency medicine
Hyperviscosity Syndrome
Treat symptomatic hyperviscosity as an oncologic emergency: recognize retinal, mucosal bleeding, neurologic, and cardiopulmonary injury; obtain viscosity and cause-directed studies without delaying plasma exchange; then suppress the responsible paraprotein-producing or leukemic process.Medical Toxicology
Serotonin Syndrome
Recognize serotonin syndrome clinically after a serotonergic exposure, prioritize cessation and physiologic stabilization, and rapidly identify severe hyperthermia, rigidity, autonomic instability, or coma requiring monitored critical care.Trauma Surgery
Rib Fracture
Manage rib fracture as a thoracic-trauma risk problem: identify pneumothorax, hemothorax, pulmonary contusion, flail physiology, and respiratory compromise; use imaging selectively; and escalate analgesia or stabilization when pain or chest-wall instability impairs ventilation.Emergency Medicine and Neurocritical Care
Traumatic Brain Injury
Traumatic brain injury management hinges on early prevention of hypoxia and hypotension, CT-defined lesion recognition, timely neurosurgical escalation, and structured surveillance for intracranial hypertension and delayed functional sequelae.Emergency Medicine, Critical Care, Burn Surgery
Inhalation Injury
Manage inhalation injury as concurrent upper-airway edema, tracheobronchial and alveolar toxic injury, and carbon monoxide or cyanide poisoning. Early airway control, toxin-directed treatment, bronchoscopy-guided airway clearance, and serial respiratory reassessment address deterioration that can evolve after the initial examination.Emergency Medicine and Cardiology
Ventricular Fibrillation
Ventricular fibrillation requires immediate defibrillation, uninterrupted high-quality CPR between shocks, protocolized epinephrine and antiarrhythmic therapy when shock-refractory, and rapid reassessment for recurrent versus persistent VF. Refractory cases require center-specific escalation decisions, including alternative pad vectors and selected extracorporeal CPR pathways.Emergency Medicine
Hypertensive Emergency Targets
Manage hypertensive emergency by identifying the injured organ before selecting a blood pressure target. Most patients require controlled intravenous reduction of mean arterial pressure, while aortic dissection, stroke, pulmonary edema, acute coronary syndromes, and pregnancy require syndrome-specific targets and agents.Cardiology and emergency medicine
Temporary Pacing for Bradycardia
Use temporary pacing for hemodynamically unstable bradycardia, high-grade conduction disease, or impending bradyasystolic collapse when pharmacologic reversal is ineffective, inappropriate, or too slow. Select transcutaneous pacing for immediate bridging and transvenous pacing when reliable support must continue.Cardiology and Emergency Medicine
Wide Complex Tachycardia
Manage any adult wide complex tachycardia by first identifying instability and delivering synchronized cardioversion when needed. In stable patients, obtain a 12-lead ECG, presume ventricular tachycardia until evidence supports another mechanism, and avoid AV-nodal blockade when pre-excitation is possible.Emergency Medicine
Asthma Exacerbation Discharge Criteria
Discharge after an asthma exacerbation requires sustained clinical improvement after treatment, objective airflow assessment when feasible, no ongoing respiratory distress, relapse-risk assessment, controller prescribing, inhaler technique review, and prompt outpatient follow-up rather than reliance on transient symptom relief alone.Endocrinology and Emergency Medicine
Adrenal Crisis
Treat suspected adrenal crisis immediately with parenteral hydrocortisone and isotonic saline; obtain diagnostic blood samples first only if this does not delay therapy. Continue stress-dose glucocorticoid replacement, correct hypoglycemia and electrolyte abnormalities, identify the precipitant, and transition only after hemodynamic and clinical stabilization.Emergency Medicine and Infectious Diseases
Pyelonephritis Imaging Indications
Do not image a first, uncomplicated presentation of acute pyelonephritis. Obtain urgent imaging when obstruction, severe illness, high-risk host factors, or failure to improve raises concern for a drainable or gas-forming complication.Emergency Medicine and Neurology
Acute Headache Imaging
Urgent neuroimaging is indicated when acute headache has thunderclap onset, focal deficits, altered consciousness, fever, papilledema, pregnancy or puerperium, cancer, immunosuppression, coagulopathy, trauma, or a progressive new pattern. Test selection should follow the suspected vascular, infectious, pressure-related, or sellar emergency.Emergency Medicine and Neurology
Subarachnoid Hemorrhage Diagnostic Testing
Evaluate suspected subarachnoid hemorrhage with immediate noncontrast CT, using headache timing and CT interpretation quality to determine whether lumbar puncture, CT angiography, or vascular imaging is still required.Emergency Medicine and Neurology
Spinal Cord Compression
Urgent spinal imaging and parallel management preserve neurologic function when cord or cauda equina compression is suspected. This guide distinguishes malignant, traumatic, infectious, degenerative, and neuraxial causes; selects MRI versus CT myelography; and directs immediate decompression, corticosteroid, radiation, and surgical escalation.Emergency Medicine and Neurology
Acute Vertigo Evaluation
Evaluate acute vertigo by syndrome and examination target, not symptom quality. In continuous vestibular symptoms with spontaneous nystagmus, trained HINTS-plus examination can identify central patterns that warrant stroke imaging and management despite an early negative MRI.Pediatric Emergency Medicine
Pediatric Croup Treatment
Treat croup severity at the bedside: give single-dose dexamethasone for children seeking care, add nebulized epinephrine for stridor at rest or increased work of breathing, observe after epinephrine, and escalate promptly when hypoxemia, exhaustion, or poor response suggests impending airway failure.Pediatric Emergency Medicine and Critical Care
Pediatric Asthma Escalation
Escalate pediatric asthma care according to response to initial bronchodilation, oxygenation, work of breathing, and trajectory. This guide defines practical triggers for intravenous magnesium, continuous albuterol, noninvasive support, PICU transfer, intubation planning, and avoidance of low-value rescue therapies.Emergency Medicine and Nephrology
Hyperkalemia Emergency Treatment
Treat hyperkalemia as an electrical emergency when potassium exceeds 6.0 mmol/L or ECG toxicity is present: monitor, stabilize myocardium with IV calcium, shift potassium intracellularly, remove total-body potassium, and reassess for rebound or dialysis need.Emergency Medicine
Syncope Admission Criteria
Admit syncope patients when a serious condition is identified or suspected after focused evaluation. Use ECG, hemodynamics, cardiac history, troponin, and clinical impression to distinguish patients needing inpatient treatment from those appropriate for discharge or structured observation.Emergency Medicine and Cardiology
Chest Pain Troponin Interpretation
Interpret high-sensitivity troponin with the ECG, symptom timing, serial change, and assay-specific thresholds—not as an isolated binary test—to distinguish acute myocardial infarction, acute nonischemic injury, chronic myocardial injury, and patients eligible for safe ED discharge.Emergency Medicine and Cardiovascular Medicine
Pulmonary Embolism Risk Stratification
Risk stratification in acute pulmonary embolism separates patients requiring immediate reperfusion from those appropriate for anticoagulation, monitored escalation, or outpatient care by integrating hemodynamics, clinical severity scores, right-ventricular assessment, and cardiac biomarkers.Endocrinology and Emergency Medicine
Diabetic Ketoacidosis Insulin and Potassium Management
In DKA, insulin reverses ketogenesis but can precipitate fatal hypokalemia. Use beta-hydroxybutyrate and acid-base criteria to guide therapy, withhold insulin when potassium is below 3.5 mEq/L, continue treatment through ketoacidotic resolution, and overlap intravenous with subcutaneous insulin.Neurology and Emergency Medicine
Status Epilepticus Treatment Sequence
Treat convulsive status epilepticus as a timed emergency: stabilize immediately, give benzodiazepine therapy promptly, load one second-line antiseizure medication if seizures persist, and escalate to ICU anesthetic management with EEG guidance for refractory or nonconvulsive status epilepticus.Pediatric Emergency Medicine
Febrile Infant Workup
Evaluate well-appearing febrile infants by age, urinalysis, blood culture, and inflammatory markers; reserve lumbar puncture, empiric antibiotics, and hospitalization for higher-risk profiles while preserving reliable follow-up for selected older low-risk infants.Emergency Medicine and Hospital Medicine
Acute Anemia
Manage acute anemia by first identifying unstable hemorrhage or oxygen-delivery failure, then separating blood loss from hemolysis and impaired production with serial hemoglobin, reticulocyte response, smear, and targeted hemostatic testing. Transfuse to physiologic need while obtaining definitive bleeding control or cause-directed therapy.Emergency Medicine and Acute Care Surgery
Necrotizing Fasciitis
Necrotizing fasciitis is a surgical emergency: recognize disproportionate pain and systemic toxicity, obtain focused laboratory assessment and selective imaging, but do not permit testing to delay operative exploration, broad intravenous antimicrobials, and serial source control.Emergency Medicine and Trauma Surgery
Geriatric Cervical Spine Injury
In older adults after blunt trauma, age alone makes the Canadian C-Spine Rule positive and should lower the threshold for CT-based cervical evaluation. Treat neurologic deficits, unreliable examination, and CT-detected injury as distinct pathways requiring immobilization, trauma-spine consultation, and individualized operative risk assessment.Emergency Medicine and Critical Care
Pulseless Electrical Activity
Manage pulseless electrical activity as a nonshockable arrest: deliver uninterrupted high-quality CPR, give early epinephrine, verify true pulselessness, and simultaneously identify a reversible mechanical, metabolic, toxic, thrombotic, or hypoxic cause.Cardiology and Emergency Medicine
Unstable Angina
Evaluate suspected unstable angina as a troponin-negative ischemic syndrome: obtain prompt ECG and serial high-sensitivity troponin testing, exclude infarction, then use ischemic features and risk stratification to select invasive angiography or noninvasive coronary evaluation.Emergency Medicine and Medical Toxicology
Amphetamine Toxicity
Amphetamine toxicity is a clinical sympathomimetic emergency requiring rapid recognition of hyperthermia, agitation, seizures, cardiovascular ischemia or dysrhythmia, rhabdomyolysis, and co-ingestion, followed by targeted monitoring and escalation for organ-specific complications.Emergency Medicine and Medical Toxicology
Anticholinergic Toxicity
Recognize the clinical antimuscarinic pattern, identify sodium-channel blockade or competing toxidromes, stabilize hyperthermia and agitation, and select physostigmine only for consequential delirium after electrocardiographic risk assessment.Emergency Medicine and Medical Toxicology
Benzodiazepine Toxicity
Manage benzodiazepine toxicity by prioritizing airway and ventilation, actively identifying opioid, alcohol, and proconvulsant co-ingestion, and reserving flumazenil for exceptional pure exposures without seizure risk or benzodiazepine dependence.Emergency Medicine and Medical Toxicology
Beta-Blocker Toxicity
Manage suspected beta-blocker toxicity as a time-critical cardiotoxic poisoning: identify conduction delay, shock, hypoglycemia, seizures, and coingestants; initiate resuscitation and monitored antidotal therapy; and escalate refractory cardiogenic shock promptly to high-dose insulin and advanced critical care.Medical Toxicology and Emergency Medicine
Calcium Channel Blocker Toxicity
Manage suspected calcium channel blocker toxicity as a time-critical cardiovascular poisoning: establish invasive-ready monitoring, treat bradycardia and shock in parallel, begin vasopressors and high-dose insulin early for significant hypotension, and escalate refractory cardiogenic shock to mechanical circulatory support.Emergency Medicine and Medical Toxicology
Cocaine Toxicity
Manage cocaine toxicity by treating agitation, hyperthermia, seizures, and cardiovascular instability immediately while evaluating chest pain and focal neurologic deficits for acute coronary syndrome, aortic dissection, and stroke. Observation is appropriate only after recurrent symptoms and acute ischemia have been excluded.Emergency Medicine and Medical Toxicology
Cyanide Toxicity
Treat suspected severe cyanide toxicity immediately when a compatible exposure accompanies rapid neurologic or cardiovascular collapse and metabolic acidosis. Secure oxygenation and circulation, obtain targeted co-exposure testing, and give IV hydroxocobalamin without awaiting cyanide confirmation when clinical suspicion is high.Medical Toxicology
Ethylene Glycol Toxicity
Treat suspected ethylene glycol poisoning before confirmatory levels return when exposure history, high-anion-gap acidosis, osmolar gap, or oxalate crystalluria indicates evolving toxic metabolite production; use fomepizole promptly and add hemodialysis for acidosis, renal failure, or severe measured exposure.Medical Toxicology
Methanol Toxicity
Suspect methanol toxicity in unexplained high-anion-gap acidosis, especially with visual symptoms or an elevated osmolar gap. Start alcohol dehydrogenase blockade and bicarbonate immediately when clinically suspected; use hemodialysis for severe acidosis, organ toxicity, or impaired clearance.Emergency Medicine, Hematology, Medical Toxicology
Methemoglobinemia
Confirm suspected methemoglobinemia with blood-gas co-oximetry when cyanosis or low pulse oximetry is disproportionate to cardiopulmonary findings, immediately remove oxidant exposure, and use symptom-, concentration-, and oxygen-delivery risk–based antidotal treatment while avoiding methylene blue in G6PD deficiency.Emergency Medicine and Medical Toxicology
Organophosphate Toxicity
Treat suspected organophosphate toxicity as a clinical cholinergic emergency: protect staff, control airway and bronchorrhea, titrate atropine to a clear chest, add an oxime when indicated, and use cholinesterase testing as confirmation rather than a reason to delay resuscitation.Medical Toxicology
Selective Serotonin Reuptake Inhibitor Toxicity
SSRI overdose is usually mild but can produce serotonin toxicity, delayed seizures, QTc or QRS prolongation, dysrhythmia, and rhabdomyolysis. Triage hinges on exposure history, clonus-focused examination, serial ECG assessment, co-ingestant evaluation, supportive treatment, and prolonged monitoring when escitalopram or citalopram is involved.Emergency Medicine and Medical Toxicology
Sympathomimetic Toxicity
Recognize the hyperadrenergic syndrome early, stabilize agitation and hyperthermia with GABAergic sedation and cooling, then selectively investigate cardiac, neurologic, renal, and muscle complications that determine monitored versus critical-care disposition.Emergency Medicine and Medical Toxicology
Tricyclic Antidepressant Toxicity
Manage suspected tricyclic antidepressant toxicity by immediate airway and hemodynamic stabilization, continuous ECG monitoring, and early sodium bicarbonate for QRS widening, acidosis, dysrhythmia, or shock. Serial ECG, pH, and electrolyte results guide alkalinization and ICU-level escalation.Emergency Medicine, General Surgery, Vascular Surgery
Bowel Ischemia
Bowel ischemia requires immediate etiologic classification because arterial occlusion, venous thrombosis, and low-flow ischemia require different reperfusion strategies. Obtain contrast-enhanced biphasic CT angiography promptly, resuscitate shock, anticoagulate when not contraindicated, and operate for peritonitis or infarction.Emergency Medicine and General Surgery