Procedures and Airway Management
Core concepts
Understand the airway assessment (Mallampati, mouth opening, thyromental distance, cervical mobility) and the difficult airway algorithm. Master rapid sequence intubation with pre-oxygenation, induction agent, and neuromuscular blocker, and the recognition of a failed airway: cannot intubate, cannot oxygenate. Learn rescue techniques: supraglottic airway, surgical airway, and the role of video laryngoscopy. Cover procedural sedation principles, central venous access, chest drain insertion, and lumbar puncture. Understand the complications of each procedure and how to avoid them.
Traps
Examiners test that a failed intubation with adequate oxygenation is not an emergency - keep oxygenating. Beware the patient with a raised intracranial pressure or cardiovascular instability where induction agents can cause collapse. In chest drain insertion, the safe triangle and avoiding the intercostal bundle are high-yield. In procedural sedation, never forget monitoring and the reversal agents.
Rule of thumb
In a failed airway, prioritise oxygenation over intubation: supraglottic airway, then surgical airway if you cannot oxygenate. Always pre-oxygenate and optimise the patient before induction.
Worked example
A patient with a predicted difficult airway and a rapidly expanding neck haematoma: this is a cannot-intubate, cannot-oxygenate scenario - proceed to a surgical airway without delay.
Emergency Department Administration, Quality, Patient Safety and Disaster Medicine
Core concepts
Understand ED flow and crowding, triage systems, and the concept of access block. Learn quality improvement methods (PDSA cycles, audit, and key performance indicators such as door-to-doctor time and left-without-being-seen rates). Cover patient safety principles: human factors, the Swiss cheese model, incident reporting, and the SBAR communication tool. Understand disaster medicine: triage (START and jumpSTART), surge capacity, and the incident command system. Learn the principles of mass casualty management and the difference between conventional and catastrophic incidents.
Traps
Examiners test that incident reporting is about system learning, not individual blame. In disaster triage, the goal is to do the greatest good for the greatest number - not to treat the sickest first. Beware confusing audit (measuring against a standard) with research (generating new knowledge).
Rule of thumb
In mass casualty triage, prioritise those who can be saved with limited resources; the expectant category exists in some systems but is ethically complex. Use SBAR for every critical handover.
Worked example
A multi-vehicle collision with 20 casualties and two available resuscitation bays: apply START triage, treat immediate casualties first, and allocate resources to maximise survival rather than to the most severely injured.
Research Methods, Evidence-Based Medicine and Professionalism/Ethics
Core concepts
Understand study designs (RCT, cohort, case-control, cross-sectional) and their strengths and weaknesses. Learn measures of effect: sensitivity, specificity, predictive values, likelihood ratios, relative risk, odds ratio, absolute risk reduction, number needed to treat, and confidence intervals. Recognise bias (selection, information, confounding) and the hierarchy of evidence. Understand critical appraisal of a paper: validity, results, and applicability. For ethics, cover consent and capacity, confidentiality, resource allocation, and the four principles (autonomy, beneficence, non-maleficence, justice). Understand professionalism in the ED, including duty of care and whistleblowing.
Traps
Examiners test that predictive values depend on prevalence, while sensitivity and specificity do not. Beware confusing relative risk reduction with absolute risk reduction - the NNT derives from the ARR. In ethics questions, the "best" answer is often the one that respects autonomy while protecting the patient. Do not confuse statistical significance with clinical importance.
Rule of thumb
To assess a diagnostic test, use likelihood ratios; to assess a treatment, use ARR and NNT. A confidence interval that crosses 1 (for ratios) or 0 (for differences) is not statistically significant.
Worked example
A trial reports a mortality reduction from 10% to 8%: the ARR is 2%, so the NNT is 50 - clinically meaningful only if the intervention is safe and affordable.