Critical Care and Emergency Nursing
Critical Care and Emergency Nursing is tested through time-critical sequencing. The exam wants the first action within seconds, not a complete care plan, and it expects fluency with resuscitation numbers, sepsis bundles and arterial blood gas interpretation.
Resuscitation essentials
Compressions run at 100–120/min, 5–6 cm deep, with full recoil and interruptions under 10 seconds; the ratio is 30:2 without an advanced airway. Defibrillate ventricular fibrillation and pulseless ventricular tachycardia immediately. Epinephrine 1 mg IV every 3–5 minutes is given for non-shockable rhythms and after the third shock in shockable ones, with amiodarone 300 mg after the third shock. The pulse check must not exceed 10 seconds.
Sepsis and shock
The first-hour bundle is lactate measurement, blood cultures before antibiotics, broad-spectrum antibiotics, and 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more. Anaphylaxis is treated with intramuscular epinephrine 0.01 mg/kg (maximum 0.5 mg) into the anterolateral thigh, not intravenous epinephrine.
Worked example
Arterial blood gas: pH 7.28, PaCO2 30 mmHg, HCO3 14 mEq/L, Na 140, Cl 100. Reasoning: the low pH with low bicarbonate indicates metabolic acidosis; the low PaCO2 is respiratory compensation. Anion gap = 140 − (100 + 14) = 26, so this is a high anion gap acidosis from lactate or ketones. Treat the cause, not the number on the gas.
Traps that cost marks
- Delaying defibrillation in order to intubate.
- Giving sodium bicarbonate routinely in lactic acidosis.
- Reading a compensated gas as normal because the pH is nearly normal.