Emergency, Critical Care and First Aid
Emergency questions test the first five minutes: recognise cardiac arrest, act, and treat life threats before making a diagnosis.
Primary survey
Airway with cervical spine protection, Breathing with oxygen and auscultation, Circulation with pulse, blood pressure and capillary refill, Disability with AVPU or the Glasgow Coma Scale, Exposure with temperature control. Treat each problem before moving on.
Cardiac arrest
Adults: compressions 100–120/min, depth 5–6 cm, full recoil, ratio 30:2, minimal interruptions, defibrillate as soon as an AED arrives. Children: 15:2 with two rescuers, depth one-third of chest diameter. Do not spend more than 10 seconds checking a pulse.
Worked example
A man collapses in the outpatient department and does not respond. Reasoning: check response and shout for help, open the airway and check breathing for no more than 10 seconds, call for the emergency trolley and AED, and begin compressions immediately. Continue until the AED arrives and follow its prompts. Establish intravenous access and give oxygen only when this does not interrupt compressions.
Key emergencies
Anaphylaxis: adrenaline 0.5 mg intramuscularly (1:1000) for adults, 0.01 mg/kg for children, repeated after 5 minutes. Severe malaria: intravenous artesunate. Snake bite: immobilise the limb; do not apply a tourniquet or cut the wound.
Traps
Leaning on the chest between compressions; hyperventilating the patient; giving oral fluids to a drowsy patient; delaying adrenaline while trying to find a vein.