Emergency, Critical Care and Infection Prevention
This domain tests rapid prioritisation, resuscitation, and infection control practice in emergency and intensive care settings. Mongolian-specific content includes hypothermia, carbon monoxide poisoning from coal stoves in ger districts, and trauma from road traffic crashes.
Core rules
- Primary survey: catastrophic haemorrhage control, airway with cervical spine protection, breathing, circulation, disability (Glasgow Coma Scale, pupils, glucose), exposure with temperature control.
- CPR: compressions 100-120 per minute, 5-6 cm deep, full recoil, 30:2 without an advanced airway, minimal interruptions, defibrillate ventricular fibrillation and pulseless ventricular tachycardia as early as possible.
- Sepsis: measure lactate, take cultures before antibiotics, give broad-spectrum antibiotics within one hour in septic shock, give 30 mL/kg crystalloid, start vasopressors if mean arterial pressure stays below 65.
- Anaphylaxis: adrenaline 0.5 mg (0.01 mg/kg, maximum 0.5 mg) intramuscularly into the vastus lateralis, repeated after five minutes; oxygen, fluids and airway support; antihistamines are adjuncts only.
- WHO five moments of hand hygiene; correct PPE doffing; after a needlestick, wash without squeezing, report immediately and start post-exposure assessment.
Worked example
A family in a ger with a burning coal stove presents with headache, nausea and confusion; one child has cherry-red lips. Reasoning: carbon monoxide poisoning. Move everyone to fresh air, give 100% oxygen by non-rebreather mask, measure carboxyhaemoglobin with co-oximetry, and consider hyperbaric oxygen for severe neurological signs or pregnancy. Standard pulse oximetry looks falsely normal because it cannot distinguish carboxyhaemoglobin from oxyhaemoglobin.
Traps
Intubating before defibrillating in ventricular fibrillation; giving adrenaline intravenously instead of intramuscularly in anaphylaxis; trusting a normal SpO2 in carbon monoxide exposure; squeezing a needlestick site; forgetting to rewarm before pronouncing death in hypothermia.