Emergency Medicine and Intensive Care
Emergency Medicine and Intensive Care tests rapid recognition, resuscitation, and safe transfer. The exam prioritises reversible threats before diagnosis.
Core rules
- Use ABCDE with continuous reassessment; airway before breathing before circulation.
- Sepsis: infection plus organ dysfunction; give antibiotics within one hour and fluids, then vasopressors if mean arterial pressure remains low.
- Anaphylaxis: intramuscular adrenaline into the lateral thigh is first-line; remove trigger, give oxygen and fluids.
- Shock is classified by cause; cold, clammy skin suggests cardiogenic or hypovolaemic, warm skin suggests distributive.
- ICU triage considers benefit, frailty, and patient wishes; document ceilings of care.
Worked example
A patient develops stridor, wheeze, and hypotension minutes after penicillin. The reasoning: anaphylaxis. Give IM adrenaline 0.5 mg (0.01 mg/kg in children) immediately, call for help, lie flat with legs raised, give high-flow oxygen and IV fluids. Antihistamines and steroids are adjuncts, not first-line.
Traps
Do not delay adrenaline for steroids; do not give large fluid boluses in cardiogenic shock; do not intubate without a plan for failed airway.