Emergency Medicine and Critical Care
Emergency Medicine and Critical Care tests rapid stabilization, shock, sepsis, anaphylaxis, arrhythmia, poisoning, and trauma. The exam rewards actions that prevent death in the next minutes.
Core rules
- ABCDE: airway, breathing, circulation, disability, exposure; reassess after every intervention.
- Sepsis: obtain cultures, give broad-spectrum antibiotics early, and give fluids for hypoperfusion; use vasopressors if mean arterial pressure remains low.
- Anaphylaxis: intramuscular epinephrine 0.5 mg of 1:1000 into the anterolateral thigh, repeat every 5 minutes as needed; oxygen and fluids are adjuncts.
- Shock: distinguish hypovolemic, cardiogenic, distributive, and obstructive causes by bedside findings.
Worked example
A patient develops stridor, urticaria, and hypotension minutes after a penicillin injection. This is anaphylaxis. Give IM epinephrine immediately, call for help, give oxygen, and start rapid IV fluids. Do not wait for antihistamines or steroids. Reasoning: epinephrine reverses bronchospasm and vasodilation; delayed epinephrine is associated with worse outcomes.
Traps
- Giving an IV bolus of undiluted 1:1000 epinephrine.
- Treating anaphylaxis with antihistamines first.
- Forgetting to reassess airway after epinephrine.
- Missing hypoglycemia or opioid toxicity as reversible causes of altered consciousness.