Emergency and Critical Care: Prioritization and Resuscitation
Emergency questions test rapid, structured thinking. Use ABCDE: airway, breathing, circulation, disability, exposure. Recognize reversible causes of cardiac arrest (the Hs and Ts) and follow advanced life support rhythms: shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) get defibrillation; non-shockable rhythms (asystole, pulseless electrical activity) get epinephrine and a search for causes. In anaphylaxis, intramuscular epinephrine is first line, given early, with fluids and airway support.
Shock and sepsis
Classify shock as hypovolemic, cardiogenic, distributive, or obstructive, and match treatment: fluids for hypovolemic and distributive, inotropes for cardiogenic, and decompression for obstructive (tension pneumothorax, cardiac tamponade). In sepsis, obtain cultures and give broad-spectrum antibiotics within the first hour, alongside fluid resuscitation.
Airway and trauma
Know indications for definitive airway and the steps of rapid sequence intubation. In trauma, follow the primary survey and address life threats as found.
Traps
Questions often test the first intervention in a deteriorating patient. Oxygen and airway before diagnostics; defibrillation before drugs in shockable arrest. Beware of giving too much fluid in cardiogenic shock.
Rule of thumb
In any unstable patient, treat the greatest immediate threat first: airway obstruction, then tension pneumothorax, then hemorrhage. Reassess after every intervention.