Emergency Medical Care and Intensive Care
This domain tests structured resuscitation: the ABCDE approach, basic and advanced life support, recognition of the four shock types, anaphylaxis, sepsis and airway management. Answers are judged on sequence and dose as much as on diagnosis.
Core rules
- Basic life support: compressions 100–120 per minute, depth 5–6 cm, full recoil, ratio 30:2, minimal interruptions, defibrillator as early as possible.
- Advanced life support: shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) are defibrillated; non-shockable rhythms (asystole, pulseless electrical activity) receive adrenaline 1 mg every 3–5 minutes. Always search for the four Hs and four Ts.
- Anaphylaxis: intramuscular adrenaline 0.01 mg/kg, maximum 0.5 mg, into the anterolateral thigh, repeated after 5 minutes; remove the trigger, give oxygen and intravenous crystalloid. Steroids and antihistamines are adjuncts only.
- Sepsis: infection plus organ dysfunction; take blood cultures before antibiotics but never delay them; broad-spectrum antibiotics within one hour; 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
- Airway: a Glasgow Coma Scale of 8 or less means intubation; preoxygenate and use a rapid sequence technique.
Worked example
A 45-year-old develops stridor, wheeze, urticaria and BP 80/50 after a wasp sting. Reasoning: this is anaphylaxis with airway compromise and distributive shock. The single action that changes outcome is immediate intramuscular adrenaline into the thigh, followed by oxygen, a fluid bolus, monitoring and repeat adrenaline if needed. Waiting for corticosteroids before adrenaline is a fatal error.
Traps
- Giving an intravenous adrenaline bolus to a patient who is not in cardiac arrest.
- Delaying adrenaline while giving antihistamines.
- Treating all shock with fluid - cardiogenic shock may worsen.
- Forgetting reversible causes during resuscitation.