Emergency and Acute Care
Core concepts
Prioritise the ABCDE approach, recognition of life-threatening conditions, and safe disposition. Know anaphylaxis, acute coronary syndrome, stroke, sepsis, asthma exacerbation, and diabetic emergencies.
Question traps
- Anaphylaxis. Intramuscular adrenaline is the first-line treatment; antihistamines and steroids are adjuncts only. Do not delay adrenaline for investigations.
- Acute coronary syndrome. Aspirin and urgent ECG are immediate priorities; thrombolysis or PCI depends on timing and availability. Do not give nitrates in hypotension or right ventricular infarction.
- Stroke. Time is brain; urgent imaging distinguishes ischaemic from haemorrhagic stroke before thrombolysis. Know the thrombolysis window.
- Sepsis. Recognise the signs (fever or hypothermia, tachycardia, tachypnoea, altered mentation, hypotension) and act with early antibiotics and fluids.
- Diabetic emergencies. DKA (ketotic, acidotic, hyperglycaemic) versus HHS (hyperosmolar, minimal ketosis). Both need fluids, insulin, and electrolyte monitoring; potassium must be checked before insulin in DKA.
Worked rule of thumb
Use ABCDE as the mental scaffold. In any emergency stem, the correct answer is the intervention that addresses the most immediate threat to life, not the most definitive diagnostic test.
Safety
Always consider disposition - admission, observation, or safe discharge with safety-netting - as part of the answer.