Cardiac emergencies commonly present with chest pain or pressure, pain radiating to the arm, jaw, or back, shortness of breath, diaphoresis, and nausea. EMTs may assist the patient in taking aspirin (162–324 mg chewed) to reduce clot formation, provided there are no contraindications such as known allergy, active GI bleeding, or recent use of blood thinners that increase bleeding risk. Nitroglycerin, administered sublingually, can relieve chest pain of cardiac origin but is contraindicated when systolic blood pressure falls below protocol threshold (often under 100 mmHg) or when the patient has recently used erectile dysfunction medications. Congestive heart failure and pulmonary edema present with shortness of breath, crackles or rales on auscultation, pink frothy sputum, jugular vein distension, and peripheral edema; these patients breathe most easily in an upright high-Fowler's position.
Respiratory emergencies include asthma, COPD, and hyperventilation. Asthma attacks are managed by assisting with the patient's prescribed metered-dose inhaler and administering oxygen, with severe attacks signaled by wheezing, accessory muscle use, tripod positioning, tachypnea, and inability to speak full sentences. COPD, encompassing chronic bronchitis and emphysema, causes long-term airflow limitation. Hyperventilation from anxiety or emotional causes is treated by coaching slow breathing and reassurance rather than by paper bag rebreathing. The mnemonic AEIOU-TIPS helps recall causes of altered mental status: Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke/shock, with hypoglycemia being a particularly common and reversible cause that must always be considered.
Neurological emergencies include stroke and seizures. The FAST mnemonic (Face drooping, Arm drift, Speech difficulty, Time to call 911 and note last known well) identifies stroke; documenting the time the patient was last known well is critical because it determines eligibility for time-sensitive hospital treatments such as fibrinolytics. A seizure lasting longer than 5 minutes or recurring without return to consciousness is status epilepticus, a medical emergency requiring rapid transport. During an active seizure, EMTs protect the patient from injury without restraining them or placing anything in their mouth, then manage the postictal period of confusion, fatigue, and altered mental status. Diabetic emergencies present as hypoglycemia (rapid-onset confusion, diaphoresis, pale/clammy skin, weakness, tachycardia, combativeness) or hyperglycemia (gradual onset, warm/dry skin, fruity breath, Kussmaul respirations, excessive thirst and urination). A conscious diabetic able to swallow can receive oral glucose between the cheek and gum.
Anaphylaxis is a severe, life-threatening allergic reaction causing widespread vasodilation and airway swelling, presenting with hives, facial or throat swelling, wheezing, difficulty breathing, hypotension, and a weak rapid pulse. Treatment involves assisting with a prescribed epinephrine auto-injector. Opioid overdose, characterized by respiratory depression and altered mental status, is managed by supporting the airway and breathing and administering naloxone if available and within scope. Ingested poisoning is addressed by contacting poison control or medical direction without inducing vomiting unless specifically instructed; activated charcoal can absorb certain poisons but is contraindicated when the patient has altered mental status, cannot swallow, or has ingested acids, alkalis, or petroleum. Carbon monoxide exposure requires immediate removal from the source and administration of 100% high-flow oxygen. Other medical conditions include acute abdomen (severe pain, rigidity, guarding, rebound tenderness, nausea or vomiting), with patients placed in a position of comfort, often with knees flexed, and behavioral emergencies, where scene safety, verbal de-escalation, and possibly law enforcement or restraint per protocol are used when the patient poses a danger to self or others, such as during active suicidal or homicidal ideation with a plan and means.