Emergency Medicine and Critical Care
Emergency Medicine and Critical Care tests the ABCDE approach, shock, sepsis, anaphylaxis, airway, and arrhythmia management. The exam rewards the first correct action, not a complete differential.
Core rules
- Anaphylaxis: intramuscular epinephrine 0.5 mg (1:1000) into the anterolateral thigh; repeat every 5 minutes if needed; oxygen and IV fluids.
- Sepsis: recognize infection plus organ dysfunction; give broad-spectrum antibiotics within 1 hour and fluids.
- Do not sit a hypotensive patient upright; lay them flat and raise legs if appropriate.
- Check glucose in any altered consciousness.
Worked example
A patient develops stridor, urticaria, and hypotension minutes after ceftriaxone. This is anaphylaxis. Give IM epinephrine immediately, call for help, give high-flow oxygen, start IV crystalloid, and monitor. Antihistamines and steroids are adjuncts, not first-line. Do not give an IV bolus of undiluted epinephrine.
Traps
- Giving antihistamines before epinephrine in anaphylaxis.
- Delaying antibiotics in septic shock to wait for cultures when cultures cannot be obtained quickly.
- Forgetting to check glucose in coma.
- Using the wrong epinephrine concentration or route.