Resuscitation, Trauma and Emergency Anesthesia
Resuscitation items combine ATLS sequencing, transfusion strategy and ACLS drug and energy accuracy. The exam penalises deviations from the algorithms.
Trauma
- Primary survey: catastrophic haemorrhage control before ABCDE; airway with cervical protection; tension pneumothorax decompressed clinically.
- Permissive hypotension (systolic 80–90 mmHg) in penetrating trauma until haemorrhage control; do not apply it in traumatic brain injury (target systolic at least 110 mmHg).
- Massive transfusion 1:1:1 red cells, plasma and platelets; tranexamic acid 1 g within 3 hours of injury, then 1 g over 8 hours.
- Burns: Parkland 4 mL/kg/%TBSA over 24 hours, half in the first 8 hours; titrate to urine output 0.5–1 mL/kg/h.
ACLS
- VF/pVT: biphasic 200 J, epinephrine 1 mg every 3–5 minutes, amiodarone 300 mg after the third shock.
- Asystole/PEA: epinephrine 1 mg and high-quality CPR; atropine is no longer recommended for asystole or PEA.
- Reversible causes: the four H's and four T's; capnography EtCO₂ above 10 mmHg suggests effective compressions and likely ROSC.
Worked example
A 70 kg patient with 40% TBSA burns. Parkland = 4 × 70 × 40 = 11,200 mL over 24 hours; first 8 hours = 5,600 mL, about 700 mL/h. The clock starts at the time of injury, not arrival - a 2-hour delay leaves 6 hours of the first phase, so recalculate the rate.
Traps
Large crystalloid boluses in haemorrhagic shock before blood; giving atropine in asystole; running the Parkland formula without titrating to urine output.