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ENP-BC: Emergency and Critical Care

ENP-BC · Work through your exam, one topic at a time.

All guide sections

Emergency and Critical Care

Emergency and Critical Care covers resuscitation, airway management, shock recognition, and post-arrest care. Items ask what you do in the next 30 seconds and what you stop doing. Prioritization and closed-loop team behavior are scored as heavily as knowledge.

Resuscitation essentials

  • High-quality cardiopulmonary resuscitation: rate 100–120/min, depth 5–6 cm, full recoil, pauses under 10 seconds, compressor rotation every 2 minutes.
  • Epinephrine 1 mg every 3–5 minutes during cardiac arrest; amiodarone or lidocaine for refractory ventricular fibrillation or pulseless ventricular tachycardia.
  • Reversible causes: hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis.
  • Post-arrest care: targeted temperature management 32–37.5 °C, avoid fever, target SpO2 92–98%, PaCO2 35–45 mmHg, MAP ≥65 mmHg.

Shock and airway

  • Classify shock with bedside ultrasound and exam: distributive, hypovolemic, cardiogenic, obstructive. Obstructive shock (tamponade, tension pneumothorax, massive pulmonary embolism) needs a procedure, not more fluid.
  • Rapid sequence intubation: preoxygenation, hemodynamic optimization before induction, suction, backup plan, and immediate post-intubation sedation.
  • Status epilepticus: benzodiazepine first, then a second-line anticonvulsant such as levetiracetam, fosphenytoin, or valproate.
  • Trauma hemorrhage: balanced 1:1:1 resuscitation, tranexamic acid within 3 hours of injury, and permissive hypotension until hemorrhage control.

Worked example

A 34-year-old in pulseless electrical arrest after a motor vehicle crash has distended neck veins, muffled heart sounds, and a positive FAST scan. Reasoning: this is obstructive shock from tamponade. The intervention is immediate pericardiocentesis or thoracotomy, not another fluid bolus. After return of circulation, targeted temperature and pressure targets apply.

Traps that cost marks

  • Interrupting compressions for rhythm checks or pulse checks longer than 10 seconds.
  • Giving more fluids in obstructive shock.
  • Inducing a hypotensive patient without optimizing preload first, then blaming the sedative.
  • Forgetting sedation after paralysis in the intubated patient.
  • Treating seizure with a second-line agent before an adequate benzodiazepine dose.