Emergency Medicine - Resuscitation, Prioritisation and Disposition
The Emergency Medicine domain of the OMSB Emergency Medicine (OEEM) examination tests whether you can prioritise, resuscitate and disposition undifferentiated patients safely. Items are case-based: they reward the correct sequence of actions and the physiological reasoning behind each step, not isolated recall.
Core rules
- Primary survey before any secondary detail: catastrophic haemorrhage control, Airway with cervical spine protection, Breathing, Circulation, Disability, Exposure. Reassess after every intervention.
- Shock in trauma is a diagnosis of exclusion: head injury does not cause hypotension - hunt the bleeding (chest, abdomen, pelvis, long bones, external).
- Permissive hypotension (SBP around 90 mmHg) until haemorrhage control in penetrating trauma; damage-control resuscitation with balanced blood products, plus tranexamic acid 1 g IV over 10 minutes within 3 hours of injury, then 1 g over 8 hours.
- Cardiac arrest: compressions 100–120/min, 5–6 cm depth, minimal interruption; adrenaline 1 mg IV every 3–5 minutes; shockable rhythms get immediate defibrillation before drugs.
- Sepsis: recognise with qSOFA/NEWS, take cultures before antibiotics, give broad-spectrum antibiotics within 1 hour in septic shock, and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
Worked example
A 28-year-old motorcyclist: HR 128, BP 86/50, RR 28, GCS 14, distended abdomen with positive FAST. Reasoning: class III haemorrhagic shock. The GCS of 14 cannot be blamed on hypotension alone, so reassess after resuscitation and look for head injury, hypoxia or intoxication. Actions: activate massive transfusion, give TXA, restrict crystalloid to 250–500 mL boluses while blood arrives, and proceed to urgent laparotomy. Do not send an unstable patient for CT.
Traps
- Chasing a normal blood pressure with crystalloid instead of blood products.
- Missing a tension pneumothorax because breath sounds seem equal, or sedating before airway assessment.
- Attributing altered mentation to intoxication without excluding hypoglycaemia, hypoxia and head injury.
- Omitting analgesia, tetanus prophylaxis and reassessment after every intervention.