Critical Care and Emergency Nursing
What to master
The unifying skill is rapid, structured assessment: ABCDE, plus a mechanism-of-shock framework. There are four shock types - hypovolaemic, cardiogenic, distributive (septic, anaphylactic, neurogenic) and obstructive (tension pneumothorax, tamponade, PE) - and the treatment differs entirely. Recognise them by pattern: cold and clammy with narrow pulse pressure (cardiogenic/hypovolaemic), warm and vasodilated with wide pulse pressure early in sepsis or anaphylaxis.
Know the sepsis priorities (cultures, lactate, broad-spectrum antibiotics and fluids within the first hour), anaphylaxis (intramuscular epinephrine first-line, never antihistamine first), tension pneumothorax (needle decompression before imaging), and burns (rule of nines, parkland-type fluid formulae, inhalation injury signs).
Triage uses acuity, not arrival order. Deteriorating airway, uncontrolled bleeding, or altered consciousness always jumps the queue.
Traps in questions
- "Wait for the provider" in a true emergency - nurses act within protocol.
- Choosing vasopressors before fluid resuscitation in hypovolaemic or early septic shock.
- Forgetting that a sedated, intubated patient who desaturates needs suction and a DOPE check (Displacement, Obstruction, Pneumothorax, Equipment).
- Overlooking subtle early sepsis: new confusion, tachypnoea, and a normal blood pressure (still compensated).
Worked example
A trauma patient becomes acutely dyspnoeic, with absent left breath sounds, distended neck veins, and hypotension after a central line insertion. Options: chest X-ray, increase oxygen, needle decompression, dopamine infusion. Choose needle decompression - this is tension pneumothorax, and imaging would delay life-saving treatment.
Rule of thumb
Treat the cause of shock: the pump, the pipe, or the volume - then support the pressure.