Clinical knowledge: emergency medicine and critical care
What the exam asks
This domain tests resuscitation priorities, team behaviour and the first ten minutes of a deteriorating patient, plus recognition of who needs critical care.
Core rules
- ABCDE with a NEWS2 score, calling for help early. Treat before you have a definitive diagnosis.
- Sepsis Six within one hour: cultures, lactate, urine output, oxygen (94-98%, or 88-92% if at risk of hypercapnia), IV antibiotics and fluids.
- Anaphylaxis: IM adrenaline 500 micrograms (1:1000) into the anterolateral thigh, repeated every 5 minutes, with high-flow oxygen and a fluid bolus. Antihistamines and steroids are secondary.
- Cardiac arrest: for VF/pVT defibrillate, give adrenaline 1 mg after the third shock and amiodarone 300 mg after the fourth.
- Major trauma: catastrophic haemorrhage control before airway, permissive hypotension, tranexamic acid within 3 hours, major haemorrhage protocol with balanced blood products.
- ARDS: lung-protective ventilation at 6 ml/kg ideal body weight and prone positioning in moderate-severe cases.
Worked example
A 24-year-old develops stridor, wheeze and a systolic of 80 after a wasp sting. This is anaphylaxis with airway compromise: give IM adrenaline 500 micrograms immediately into the thigh, oxygen, lie the patient flat with legs raised, give 500-1000 ml crystalloid and repeat adrenaline at 5 minutes. Observe for at least 6 hours because biphasic reactions occur.
Traps
Giving IV adrenaline on a general ward (arrhythmia risk); delaying adrenaline in order to give antihistamine; assuming a normal blood pressure excludes shock in a young patient; failing to reassess after every intervention.