Medical Emergencies: Cardiac, Respiratory, and Neurological
Objective. Students will recognize and manage cardiac arrest (CPR and AED), acute coronary syndrome, respiratory distress, stroke (using a validated stroke screening tool), and altered mental status using current evidence-based BLS protocols.
This lesson, its worked examples and its practice questions has not yet been verified by a licensed professional in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it as instructions for work on a job site or on live equipment. Always follow your instructor, your supervising professional, and current official references and regulations.
VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.
Medical Emergencies: Cardiac, Respiratory, and Neurological
Recognizing and managing time-sensitive medical emergencies is one of the most critical skills an EMT carries into the field. This lab lesson covers four priority conditions: cardiac arrest and acute coronary syndrome (ACS), respiratory distress, stroke, and altered mental status (AMS). All management steps in this lesson follow current evidence-based BLS protocols.
Cardiac Arrest and CPR/AED
Cardiac arrest occurs when the heart stops producing an effective pulse. Brain damage begins within minutes of no perfusion, so your response must be immediate and organized.
CPR quality matters. The American Heart Association (AHA) emphasizes several measurable targets for high-quality CPR: compression rate within the recommended range (currently 100–120 compressions per minute), adequate compression depth (at least 2 inches in adults, avoiding more than 2.4 inches), full chest recoil between compressions, and minimizing interruptions. Interruptions should be kept to fewer than 10 seconds whenever possible. A CPR quality-feedback device gives real-time data so you can correct rate and depth immediately.
In a three-person team, roles rotate: compressor, ventilator (BVM), and AED operator. Ventilations are delivered at a ratio of 30 compressions to 2 breaths for a single or two-rescuer BLS scenario before an advanced airway is placed. Avoid over-ventilating — excessive ventilations increase intrathoracic pressure and reduce cardiac output.
AED use. Power on the device, attach pads to bare dry skin (anterior-lateral or anterior-posterior placement), and follow voice prompts. Clear the patient during analysis and before shock delivery — announce "Clear!" and visually confirm no one is in contact. Resume CPR immediately after the shock without waiting to recheck a pulse. Safety rule: never use an AED near pooled water or on a patient lying on a conductive surface without moving them first.
Acute Coronary Syndrome (ACS) includes unstable angina and myocardial infarction (MI). Classic presentation is chest pain or pressure radiating to the jaw, left arm, or back; diaphoresis; nausea; and shortness of breath. Women, diabetics, and older adults may present atypically (fatigue, nausea, or mild discomfort only). BLS management: position of comfort (usually sitting up), supplemental oxygen if SpO₂ is below protocol threshold, and rapid transport. Aspirin administration follows local medical direction and protocol — never administer without authorization.
Respiratory Distress
Six common causes appear on skill stations and exams. Distinguishing them guides your interventions.
- Asthma: wheezing, prolonged expiration, accessory muscle use. Assist with prescribed inhaler per protocol.
- COPD exacerbation: history of chronic lung disease, barrel chest, pursed-lip breathing. Administer oxygen cautiously per protocol.
- Congestive heart failure / pulmonary edema: pink frothy sputum, crackles bilaterally, dependent edema, hypertension. Position upright (legs dependent), high-flow O₂.
- Anaphylaxis: hives, angioedema, stridor or wheezing, hypotension after allergen exposure. Epinephrine auto-injector is the priority intervention per protocol; rapid transport.
- Pneumothorax: absent or decreased breath sounds on one side, tracheal deviation (tension), hypotension. Oxygen and rapid transport; do not delay for a suspected tension pneumothorax.
- Hyperventilation: rapid deep breathing, carpopedal spasm, tingling; often anxiety-driven. Rule out serious causes first, then reassure and guide breathing.
Safety note: Always don appropriate PPE (gloves, mask, eye protection) before any patient contact. With respiratory patients, an N95 or surgical mask may be required depending on your system's infection-control protocol.
Stroke Recognition and Transport Decisions
Stroke is a time-critical emergency — brain tissue is lost rapidly when blood flow is interrupted. The Cincinnati Prehospital Stroke Scale (CPSS) evaluates three findings:
1. Facial droop — ask the patient to smile; asymmetry is abnormal.
2. Arm drift — ask the patient to close eyes and hold both arms out for 10 seconds; one arm drifting or falling is abnormal.
3. Abnormal speech — ask the patient to repeat a simple phrase; slurred, wrong words, or inability to speak is abnormal.
A single abnormal finding on the CPSS is considered a positive screen. When the screen is positive, establish last-known-well (LKW) time immediately — this information drives hospital treatment decisions. Notify the receiving hospital early (stroke alert) and transport without unnecessary delay to a stroke-capable facility per local protocol. Do not give anything by mouth to a stroke patient (aspiration risk).
Altered Mental Status
AMS has many causes remembered with the mnemonic AEIOU-TIPS: Alcohol, Epilepsy/Environment, Insulin (glucose problems), Opiates/Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke/Seizure. Check blood glucose if your scope and equipment allow. Manage the airway as the priority — an unconscious patient cannot protect their own airway. Use a recovery position if no spinal injury is suspected. Gather a thorough history from bystanders and look for medical-alert jewelry or medication containers.
Lab Safety
- Treat all simulation scenarios with the same seriousness as real events to build reliable habits.
- Keep work areas clear of tripping hazards during manikin drills.
- AED trainers are marked with bright labels — confirm you are using training equipment, never a live AED, during practice.
- Disinfect manikin faces between each user with the disinfectant specified by the manufacturer.
Key terms8
Materials: CPR manikins with quality-feedback devices, AED trainers, BVM devices, oxygen equipment, Cincinnati Prehospital Stroke Scale laminated cards, scenario cards, epinephrine auto-injector trainer, Brady textbook, current AHA BLS guidelines
Check: CPR quality-feedback device report: student must achieve compression rate within AHA-recommended range and adequate depth on at least 80% of compressions during a 2-minute cycle; AED skill sheet must show zero critical failures; stroke scenario: 4 of 5 correct identification required.
Practice check8
Answer each question, then check it. Nothing is recorded; this is your own practice.
