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Egyptian Board Anesthesia study materials
Egyptian Board Anesthesia study resources

Egyptian Board Anesthesia: Resuscitation, Trauma, and Perioperative Emergency Management

Egyptian Board Anesthesia · Work through your exam, one topic at a time.

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Resuscitation, Trauma, and Perioperative Emergency Management

Resuscitation and trauma questions are time-critical: the exam wants the first action, the dose, and the reversible cause rather than a discussion. Trauma follows the ABCDE primary survey with simultaneous resuscitation, while cardiac arrest follows a shockable or non-shockable branch.

Core rules

  • Adult ALS for VF or pulseless VT: defibrillate immediately, continue CPR, give adrenaline 1 mg after the third shock and every 3 to 5 minutes, and amiodarone 300 mg after the third shock then 150 mg.
  • Reversible causes: 4 Hs (hypoxia, hypovolaemia, hypo or hyperkalaemia, hypothermia) and 4 Ts (tension pneumothorax, tamponade, toxins, thrombosis).
  • Trauma: catastrophic haemorrhage control precedes airway; permissive hypotension (systolic 80 to 90 mmHg) until haemorrhage is controlled in blunt injury without head injury; tranexamic acid 1 g within 3 hours then 1 g over 8 hours.
  • Massive haemorrhage: balanced 1:1:1 red cells, plasma, and platelets; avoid crystalloid overload.
  • Anaphylaxis: adrenaline 0.5 mg intramuscularly (0.5 mL of 1:1000), repeated every 5 minutes; refractory shock takes 50 microgram intravenous boluses.
  • Malignant hyperthermia: stop volatiles, give 100% oxygen, dantrolene 2.5 mg/kg repeated up to 10 mg/kg, and treat hyperkalaemia and arrhythmias.
  • Tension pneumothorax: needle decompression in the 5th intercostal space at the anterior axillary line, then a chest drain.

Worked example

A 40-year-old after a motorcycle crash has heart rate 120 and systolic pressure 100 mmHg. Shock index = 120/100 = 1.2, suggesting more than 1 L of blood loss even though the blood pressure looks acceptable; with a positive FAST, he needs immediate activation of the massive transfusion protocol and surgical review. Reasoning: the shock index detects occult hypoperfusion earlier than systolic pressure, and the trend after a fluid challenge matters more than a single reading.

Traps that cost marks

  • Giving antihistamines before adrenaline in anaphylaxis.
  • Delaying chest decompression while waiting for a chest radiograph.
  • Sending a shocked trauma patient for imaging before haemorrhage control.
  • Forgetting the 8-hour tranexamic acid infusion after the initial 1 g bolus.