Respiratory and Thoracic Emergencies
Core concepts
Understand the spectrum of respiratory failure: type 1 (hypoxemic) versus type 2 (hypercapnic). Know asthma and COPD exacerbation management - inhaled bronchodilators, systemic steroids, and when to add magnesium or escalate to noninvasive ventilation. Recognize the "can't miss" thoracic emergencies: tension pneumothorax (clinical diagnosis, immediate needle decompression), massive hemoptysis, and pulmonary embolism.
For PE, know the risk stratification tools (Wells, PERC) and that hemodynamically unstable PE warrants thrombolysis or embolectomy, while stable PE gets anticoagulation. Understand pneumonia severity scoring (CURB-65) and when to admit. In airway emergencies, know the difficult airway algorithm, rapid sequence intubation, and the difference between cricothyrotomy and tracheostomy.
Traps
Tension pneumothorax is a clinical diagnosis - do not wait for a chest X-ray. Another trap: treating wheeze as always asthma when it may be anaphylaxis, foreign body, or cardiac asthma. Questions often test whether you recognize impending respiratory failure (silent chest, rising CO2, exhaustion) and act before arrest.
Worked example / rule of thumb
A trauma patient with unilateral absent breath sounds, distended neck veins, and hypotension: needle decompression before imaging. Rule of thumb: "If the chest is silent and the patient is tiring, the next step is the airway, not another nebulizer."