Emergency, Intensive Care and Critical Care Nursing
This domain tests triage, resuscitation, shock, sepsis, airway and ventilation management, hemodynamic monitoring, and critical-care communication.
Core rules
- Use ABCDE and a structured triage system to prioritize immediate threats to airway, breathing, and circulation.
- In sepsis, obtain cultures, give broad-spectrum antibiotics promptly, measure lactate, and give fluids according to protocol; start vasopressors if hypotension persists.
- In shock, distinguish hypovolemic, cardiogenic, distributive, and obstructive causes; treat the cause, not only the blood pressure.
- Use lung-protective ventilation with low tidal volumes in acute respiratory distress syndrome.
- Monitor sedation, delirium, glucose, nutrition, pressure injuries, and ventilator-associated pneumonia prevention.
- Communicate clearly with families and document goals of care.
Worked example
A patient with pneumonia has blood pressure 82/48 after 30 mL/kg crystalloid, lactate 4 mmol/L, and mottled skin. Do not simply give more fluid indefinitely. Confirm the diagnosis, start norepinephrine per protocol, ensure antibiotics were given promptly, and reassess perfusion. Reason: this is septic shock with persistent hypotension after fluids; vasopressors are needed to maintain perfusion while the source is treated.
Traps
- Delaying antibiotics while waiting for all test results.
- Giving large fluid volumes to a patient with cardiogenic pulmonary edema.
- Missing tension pneumothorax: sudden deterioration, absent breath sounds, distended neck veins.
- Using high tidal volumes in ARDS.