Emergency Medicine and Critical Care
Emergency medicine tests rapid prioritization; critical care tests recognition of organ failure and physiology.
Core rules
- ABCDE with simultaneous resuscitation; in trauma, control catastrophic hemorrhage first.
- Sepsis: qSOFA (RR ≥22, altered mentation, SBP ≤100) flags risk. Septic shock is persistent hypotension requiring vasopressors plus lactate >2 despite fluids. Give broad-spectrum antibiotics within 1 hour and 30 mL/kg crystalloid.
- Shock types: hypovolemic, cardiogenic, distributive, obstructive - distinguish with bedside ultrasound, lactate, and response to fluid.
- ACLS: shockable rhythms (VF/pVT) get immediate defibrillation, 2 minutes of CPR, then adrenaline after the second shock.
- Airway: predict difficulty and call for help early rather than after failure.
Worked example
A 70-year-old with pneumonia, BP 78/40, lactate 4.2, mottled skin. Start 30 mL/kg balanced crystalloid, antibiotics within 1 hour, and norepinephrine if MAP stays <65 after fluids. Norepinephrine is first-line; vasopressin may be added. Avoid dopamine as a first agent.
Traps
- Delaying antibiotics to obtain cultures.
- Giving fluid boluses to cardiogenic pulmonary edema.
- Forgetting a glucose check in altered consciousness.
- Intubating without preoxygenation or a failed-airway plan.