Resuscitation, Trauma and Emergency Management
Core content
Resuscitation questions test ALS and ATLS principles. Know the adult cardiac arrest algorithm: high-quality CPR, early defibrillation for shockable rhythms (VF/pVT), adrenaline for non-shockable and after shocks, and reversible causes (4 Hs and 4 Ts). Understand defibrillation energy, compression depth and rate, and the importance of minimising interruptions. Trauma: primary survey (ABCDE), catastrophic haemorrhage control, permissive hypotension in uncontrolled bleeding, massive transfusion, and damage-control resuscitation. Know the signs of tension pneumothorax and its immediate needle decompression, and the management of anaphylaxis (adrenaline IM, fluids, airway).
Traps
- Delaying defibrillation to give drugs in VF - shocks come first.
- Forgetting that in trauma, hypotension is due to bleeding until proven otherwise.
- Confusing tension pneumothorax (decompression needed) with simple pneumothorax.
- Giving IM adrenaline late in anaphylaxis - it is first-line and early.
Rule of thumb
For arrest, follow the algorithm: shock shockable rhythms, compress well, and hunt reversible causes. For trauma, follow ABCDE and stop the bleeding.
Worked example
A trauma patient with absent breath sounds and hypotension after a chest injury has tension pneumothorax: needle decompress immediately, then chest drain, before further imaging.
Professionalism, Ethics, Patient Safety and Quality Improvement
What is tested
This domain tests judgement as much as knowledge. Understand consent (capacity, information, voluntariness; emergency exception), confidentiality and its limits, and the principles of biomedical ethics (autonomy, beneficence, non-maleficence, justice). Know the duty of candour after harm, incident reporting, and the difference between a root cause analysis and a morbidity and mortality meeting. Understand human factors: fatigue, hierarchy, communication (SBAR), checklists, and the Swiss cheese model of error. Quality improvement: PDSA cycles, audit vs research, and the importance of measuring outcomes.
Traps
- Confusing audit (measures against a standard) with research (generates new knowledge) - consent and ethics differ.
- Assuming a competent adult's refusal can be overridden by family - it cannot.
- Forgetting that duty of candour requires openness with the patient after harm, not just internal reporting.
- Missing that a checklist improves reliability only if used correctly, not as a tick-box.
Rule of thumb
For ethics stems, apply the four principles and ask who has capacity and what the patient would want. For safety stems, ask what system failed, not who to blame.
Worked example
A competent patient refuses a blood transfusion before surgery. Respect the refusal, document the discussion, and plan alternatives; do not proceed against their wishes even if the family disagrees.