Emergency Medicine and Critical Care
Core concepts
Emergency questions prioritize the ABCDE approach, rapid recognition, and time-critical interventions. Know ACLS rhythms (shockable: ventricular fibrillation and pulseless ventricular tachycardia; non-shockable: asystole and pulseless electrical activity), the reversible causes (Hs and Ts), and the sepsis bundle (fluids, cultures, antibiotics, lactate, vasopressors). Understand anaphylaxis (epinephrine first), acute asthma exacerbation, status epilepticus, stroke thrombolysis windows, and trauma primary survey. In critical care, know mechanical ventilation basics, shock management, and the recognition of acute respiratory distress syndrome.
Common traps
Questions often test what comes first. In anaphylaxis, epinephrine intramuscular is first-line - antihistamines and steroids are adjuncts. In stroke, confirm the time of onset and exclude hemorrhage with imaging before thrombolysis. Do not delay defibrillation for medication in shockable rhythms. In sepsis, antibiotics should be given early, but cultures should be drawn first when feasible without delaying treatment. Watch for the trap of treating hypertension aggressively in ischemic stroke.
Worked example
A patient with sudden collapse, no pulse, and a monitor showing ventricular fibrillation. Rule of thumb: immediate defibrillation and CPR; epinephrine after the second shock in shockable rhythms - early defibrillation is the single most important intervention.
Rule of thumb
In emergencies, sequence matters: ABCDE, then definitive therapy; never delay a life-saving intervention for a confirmatory test.