Critical Care and Emergency Nursing
Emergency and critical care questions reward a structured, prioritised approach. Use primary survey ABCDE (Airway, Breathing, Circulation, Disability, Exposure) and reassess after every intervention.
Airway: Look for obstruction (stridor, inability to speak). Head-tilt/chin-lift or jaw thrust (trauma), suction, airway adjuncts. Breathing: oxygen, auscultation, treat tension pneumothorax (tracheal deviation, absent breath sounds, hypotension - needle decompression is emergent). Circulation: control bleeding, IV access, fluids/blood, monitor for shock. Disability: GCS, pupils, glucose. Exposure: undress to find injuries while preventing hypothermia.
Recognition: Know the reversible causes of cardiac arrest (Hs and Ts) at a conceptual level, and the difference between shockable (VF/pulseless VT) and non-shockable rhythms. In an arrest, high-quality chest compressions, early defibrillation and minimal interruptions are priorities.
Monitoring: Interpret arterial blood gases (acidosis, alkalosis, oxygenation). Recognise sepsis (infection plus organ dysfunction) and act within the "golden hour" - cultures, antibiotics, fluids. Monitor for deterioration using early-warning scores.
Crisis resource management: closed-loop communication, clear roles, and speaking up for safety.
Traps
- Completing a secondary survey before securing the airway.
- Choosing a diagnostic test before a life-saving intervention.
- Forgetting to reassess after giving oxygen or fluids.
- Delaying defibrillation to give medications.
Rule of thumb
In any emergency, treat the greatest threat to life first: airway before breathing, breathing before circulation, and reassess. If the patient is deteriorating, escalate and call for help early.