Emergency and Critical Care Response
Emergency and Critical Care Response
This domain tests time-critical recognition and action: cardiac arrest, choking, anaphylaxis, shock, sepsis, and rapid response. The exam expects the correct sequence and the role of the responding nurse.
Core rules
- Cardiac arrest: recognize, call for help, start high-quality CPR (rate 100–120/min, depth 5–6 cm), attach defibrillator, shock VF/pVT, and follow ACLS algorithm.
- Defibrillation is unsynchronized for VF/pVT; synchronized cardioversion is for unstable tachyarrhythmias with a pulse.
- Anaphylaxis: stop the trigger, call for help, give IM epinephrine into the anterolateral thigh, oxygen, IV fluids, and adjuncts; repeat epinephrine every 5–15 minutes if needed.
- Sepsis: recognize infection plus organ dysfunction, obtain cultures before antibiotics if no delay, give broad-spectrum antibiotics and fluids per protocol.
- Code team roles should be assigned clearly: compressor, airway, monitor/defibrillator, medications, recorder, team leader.
- Post-resuscitation care includes targeted temperature management per protocol, hemodynamic support, and glucose/electrolyte monitoring.
Worked example
A patient receiving IV antibiotics develops stridor, hives, and hypotension within minutes. The nurse stops the infusion, calls the rapid response team, gives IM epinephrine 0.3 mg (1:1000) in the anterolateral thigh, applies oxygen, starts a rapid crystalloid bolus, and prepares adjuncts. The reasoning is that epinephrine is first-line and delay increases mortality; antihistamines and steroids are secondary and do not replace epinephrine.
Traps
- Waiting for antihistamines before giving epinephrine in anaphylaxis.
- Using an unsynchronized shock on a patient with a pulse and unstable VT.
- Interrupting CPR for prolonged rhythm checks or intubation.
- Giving undiluted IV epinephrine outside cardiac arrest protocols.