Emergency and Critical Care
Domain focus
Emergency and Critical Care tests triage, cardiopulmonary resuscitation, shock recognition, fluid resuscitation, emergency drug calculations, and continuous monitoring. The exam rewards a systematic ABC approach.
Core rules and concepts
- Triage by airway, breathing, and circulation. Treat life threats before obtaining a full history.
- Use the RECOVER-style CPR approach: chest compressions at 100–120 per minute, ventilations at 10 per minute with a 30:2 compression-to-ventilation ratio if no advanced airway, and early defibrillation when indicated.
- Recognize hypovolemic shock by tachycardia, pale mucous membranes, weak pulses, prolonged capillary refill, and altered mentation. Start isotonic crystalloid boluses and reassess.
- Emergency drugs must be calculated and double-checked. Epinephrine for CPR is 0.01 mg/kg IV.
- Monitor blood pressure, ECG, lactate, urine output, and mentation. Reassess after every intervention.
Worked example
A 20 kg dog in cardiac arrest needs epinephrine 0.01 mg/kg IV. Dose = 20 × 0.01 = 0.2 mg. The vial is 1:1000, or 1 mg/mL, so the volume is 0.2 mL. If the team dilutes 1 mL of 1:1000 epinephrine with 9 mL of saline to make 1:10,000 (0.1 mg/mL), the same 0.2 mg dose is 2 mL. Label the syringe and state the concentration aloud.
Traps that cost marks
Giving 1:1000 epinephrine IV without dilution when the protocol calls for 1:10,000; delaying compressions to place a catheter; and stopping CPR too early.