Critical Care and Emergency Medicine
Core concepts
Understand the ABCDE approach, shock classification (hypovolaemic, cardiogenic, distributive, obstructive), and the use of fluids versus vasopressors. Know sepsis bundles, early goal-directed principles, and the interpretation of lactate. Be confident with airway management, oxygen delivery, and non-invasive versus invasive ventilation. Recognise the reversible causes of cardiac arrest (4 Hs and 4 Ts) and the management of anaphylaxis (adrenaline IM, fluids, airway). Understand trauma primary survey and the principles of damage control.
Traps
Questions test fluid overload in cardiogenic shock - give inotropes and vasopressors rather than large fluid boluses. Do not give adrenaline IV in anaphylaxis outside of cardiac arrest or specialist settings - use IM into the anterolateral thigh. Distinguish septic from cardiogenic shock by clinical signs and echocardiography. In trauma, do not remove impaled objects or delay definitive haemorrhage control.
Rule of thumb
In undifferentiated shock, start with focused history, examination, ECG, and bedside ultrasound (cardiac, lung, IVC, aorta) to classify the shock before committing to fluids or vasopressors.
Worked example
A patient with anaphylaxis after a bee sting: give IM adrenaline 0.5 mg to the thigh, high-flow oxygen, IV fluids, and monitor for biphasic reaction.