Emergency Medicine
Emergency medicine questions are resuscitation-focused: cardiac arrest, shock, sepsis, anaphylaxis, trauma and poisoning.
Cardiac arrest
- Shockable rhythms (VF and pulseless VT): defibrillate, start CPR for 2 minutes, then adrenaline 1 mg every 3–5 minutes, with amiodarone 300 mg after the third shock.
- Non-shockable rhythms (asystole and PEA): adrenaline, high-quality CPR, and search for reversible causes (4 Hs and 4 Ts).
Sepsis and anaphylaxis
- Sepsis: cultures, lactate, broad-spectrum antibiotics within 1 hour, and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
- Anaphylaxis: intramuscular adrenaline 0.5 mg of 1:1000 into the anterolateral thigh, repeated every 5 minutes as needed; give oxygen and fluids.
Trauma
Primary survey ABCDE. Tension pneumothorax is a clinical diagnosis - needle decompression before imaging. Control external haemorrhage and activate massive transfusion when indicated.
Toxicology
- Paracetamol: N-acetylcysteine, guided by the nomogram.
- Opioids: naloxone.
- Tricyclic overdose: sodium bicarbonate for wide QRS.
Worked example
A 24-year-old develops stridor, urticaria and hypotension minutes after a penicillin injection. This is anaphylaxis with airway compromise: give IM adrenaline immediately, call for airway support, and add fluids and antihistamines only as adjuncts. Delaying adrenaline to give steroids is the classic error.
Traps
Shocking asystole, giving adrenaline before defibrillation in VF, and waiting for a chest X-ray in tension pneumothorax all cost marks.