Emergency and Critical Care Fundamentals
What this domain tests
This domain tests the ABCDE approach, basic life support, shock, sepsis, anaphylaxis, triage and time-critical handover. Questions reward priority setting and immediate action over exhaustive diagnosis.
Core rules
- Primary survey: airway with cervical-spine caution, breathing and ventilation, circulation with haemorrhage control, disability with neurological assessment, and exposure with temperature control.
- Adult basic life support uses 30 compressions to 2 breaths, a compression depth of 5-6 cm, a rate of 100-120 per minute, full recoil and minimal interruption. Attach an automated external defibrillator as soon as available.
- Shock is inadequate tissue perfusion. Types include hypovolaemic, cardiogenic, distributive such as septic and anaphylactic, and obstructive such as tension pneumothorax and cardiac tamponade.
- Sepsis is life-threatening organ dysfunction caused by a dysregulated response to infection. Obtain cultures, measure lactate, give broad-spectrum antibiotics and fluids promptly according to local protocol.
- Anaphylaxis is treated with intramuscular adrenaline into the anterolateral thigh, removing the trigger, giving high-flow oxygen and intravenous fluids, and calling for help.
- Use a structured handover such as ISBAR and state time-critical findings first.
Worked example
A patient develops stridor, widespread urticaria and hypotension minutes after an intravenous antibiotic. Recognise anaphylaxis, stop the infusion, call for help, give intramuscular adrenaline 0.5 mg of 1:1,000 solution into the anterolateral thigh, give high-flow oxygen, lie the patient flat with legs elevated if tolerated, and start rapid intravenous crystalloid. The reasoning is that airway compromise and hypotension are life-threatening, and intramuscular adrenaline is the first-line drug because it reverses vasodilatation and bronchospasm quickly.
Traps that cost marks
- Giving intravenous adrenaline to a non-arresting patient instead of intramuscular adrenaline.
- Delaying adrenaline while giving antihistamines first.
- Checking the pulse for too long before starting compressions.
- Missing the significance of a rising respiratory rate in a patient who still looks well.
- Giving uncontrolled high-flow oxygen without a target range in a patient at risk of carbon dioxide retention.