Emergency Medicine and Acute Care
Emergency medicine and acute care tests systematic resuscitation, scene safety, triage and time-critical referral in primary care. The exam favours ABCDE, reversible causes and drugs that must not be delayed.
Core rules
- Start with airway, breathing, circulation, disability and exposure; call for help early.
- Anaphylaxis is treated with intramuscular adrenaline into the anterolateral thigh; antihistamines and steroids are adjuncts, not first-line.
- In sepsis, take cultures if possible, give broad-spectrum antibiotics within the first hour and fluids for hypotension.
- Suspected stroke needs immediate transfer for imaging and thrombolysis or thrombectomy assessment; note the time of onset.
- Acute asthma is assessed by speech, respiratory rate, heart rate, oxygen saturation and peak flow; give oxygen and repeated bronchodilators.
- Check capillary glucose in any altered conscious state.
Worked example
Ten minutes after an antibiotic injection, a patient has stridor, wheeze, hypotension and urticaria. The reasoning: this is anaphylaxis. Give adrenaline 0.5 mg IM (1 mg/mL) immediately, call for emergency transfer, give high-flow oxygen, lie the patient flat with legs raised, start IV fluids, and repeat adrenaline after 5 minutes if needed. Do not wait for antihistamines to work.
Traps
Delaying adrenaline for mild symptoms; giving subcutaneous adrenaline; missing hypoglycaemia as a cause of coma; and failing to document the time of stroke onset.