Emergency and Critical Care
The Emergency and Critical Care domain tests triage, shock recognition, CPR, fluid therapy, transfusion, and continuous reassessment. Questions present a deteriorating patient and ask for the first action.
Core rules
- Triage ABC: airway, breathing, circulation; then disability and exposure.
- Shock: assess mentation, heart rate, pulse quality, mucous membranes, CRT, and lactate. Give isotonic crystalloid boluses, typically 20 mL/kg over 15–20 minutes in dogs, and reassess after each bolus.
- CPR: follow RECOVER-style basic life support-chest compressions at 100–120/min, one-third chest depth, minimize interruptions, and ventilate at 10 breaths/min with a bag.
- Transfusion: crossmatch when possible, use a filter, start slowly, and monitor for reactions.
- Reassess perfusion, urine output, and mentation continuously.
Worked example
A 15 kg dog presents weak, tachycardic, with pale gums and CRT greater than 2 seconds. A shock bolus is 20 mL/kg = 300 mL over 15–20 minutes. Reassess perfusion; repeat if still poor, and investigate hemorrhage or sepsis. Do not give the entire daily fluid requirement as a single rapid bolus.
Traps
Giving a full shock bolus to a patient with cardiogenic shock or pulmonary contusions, using dextrose as a resuscitation fluid, and forgetting to reassess after each bolus.