Critical Care and Emergency Medicine
Core framework
Prioritise airway, breathing, circulation, disability and exposure, and treat the immediately life-threatening problem before completing the diagnosis. Use a systematic approach to shock (distributive, cardiogenic, hypovolaemic, obstructive) and match it to bedside findings and bedside ultrasound where available. Understand the sepsis bundle, early goal-directed principles, and the indications for intubation and vasopressors.
Concepts examiners test
Shock classification and initial fluid and vasopressor strategy; respiratory failure and non-invasive ventilation indications and contraindications; acute coronary syndrome and arrhythmia emergencies; anaphylaxis management (adrenaline intramuscularly, fluids, airway); poisoning and antidotes (paracetamol, organophosphates, opioids, benzodiazepines, carbon monoxide); trauma primary survey; burns resuscitation; and rapid sequence intubation. Also know the criteria for intensive care admission and prognostication.
Traps
- Adrenaline in anaphylaxis is intramuscular into the anterolateral thigh, not intravenous in the ward setting.
- Non-invasive ventilation is contraindicated in impaired consciousness, vomiting, or facial trauma; it is not a substitute for intubation when airway protection is needed.
- In shock, do not give large fluid boluses blindly in cardiogenic shock; assess for overload and use vasopressors early in septic shock.
- Paracetamol toxicity antidote timing depends on the nomogram and the acetylcysteine protocol.
- Do not delay defibrillation in shockable rhythms.
Worked rule of thumb
A patient with hypotension, tachycardia, warm peripheries and a raised lactate after infection: this is distributive (septic) shock. Give balanced crystalloid, start broad-spectrum antibiotics early, measure lactate, and add noradrenaline if mean arterial pressure remains low despite fluids. Reassess fluid responsiveness rather than repeating boluses blindly.