Emergency, Critical Care and Perioperative Nursing
Domain 10 - Emergency, Critical Care and Perioperative Nursing
This domain tests rapid assessment, prioritisation and time-critical intervention, plus safe perioperative care and the recognition of deterioration in critically ill or recovering patients. Questions frequently use 'first action' wording - the answer is usually the one that secures airway, breathing or circulation.
Core rules
- Use ABCDE with a call for help and continuous reassessment. Treat the biggest threat first, regardless of the order problems were reported.
- Triage sorts by urgency, not by arrival. The most urgent patients are those with airway compromise, severe respiratory distress, shock, altered consciousness, uncontrolled bleeding or chest pain.
- Basic life support for adults: compressions at 100–120 per minute, depth 5–6 cm, full recoil, ratio 30:2, minimal interruptions, and early defibrillation for shockable rhythms.
- Anaphylaxis: remove the trigger, call for help, lie the patient flat with legs raised, give IM adrenaline 0.5 mg of 1:1000 into the anterolateral thigh (0.01 mg/kg for children, maximum 0.5 mg), repeat every five minutes as needed, high-flow oxygen, IV fluids, then antihistamine and steroid as adjuncts only.
- Shock types: hypovolaemic, cardiogenic, distributive (septic, anaphylactic, neurogenic) and obstructive. Fluid resuscitation is not appropriate for cardiogenic shock.
- Perioperative: verify identity, site and side, consent, fasting status and allergies; complete the WHO surgical safety checklist; maintain counts of swabs, instruments and needles. In recovery, airway and breathing come before everything else, with Aldrete-style scoring before discharge.
- Critical care monitoring: interpret trends in blood pressure, urine output, lactate, central venous pressure and conscious state as a whole.
Worked example
Ten minutes after an IV antibiotic, a patient develops stridor, widespread urticaria, a pulse of 130 and BP 80/40. Reasoning: this is anaphylaxis with airway and circulatory compromise. Actions in order: call for help and the resuscitation team, stop the infusion, lie the patient flat with legs elevated, give IM adrenaline 0.5 mg into the thigh, give high-flow oxygen, start a rapid IV fluid bolus, prepare airway equipment, and repeat adrenaline after five minutes if there is no improvement. Antihistamines are given only after adrenaline.
Traps
- Giving IV adrenaline instead of IM in anaphylaxis.
- Sitting a hypotensive anaphylaxis patient upright.
- Delaying defibrillation to give more drugs.
- Giving large fluid boluses in cardiogenic shock.
- Starting recovery monitoring with the wound instead of the airway.