Emergency Medicine and Acute Care
This domain tests recognition and immediate management of time-critical presentations in a setting where the family physician may be the first responder. Marks are won by correct sequencing and correct doses.
Core rules
- Use ABCDE with reassessment after every intervention. Treat the airway and breathing before taking a detailed history.
- Anaphylaxis: intramuscular adrenaline into the anterolateral thigh - 0.5 mg (0.5 mL of 1:1000) for adults, 0.01 mg/kg up to 0.5 mg for children - repeated every 5 minutes as needed, with high-flow oxygen, intravenous fluids and removal of the trigger. Antihistamines and steroids are adjuncts only; observation for 6-12 hours is required because of biphasic reactions.
- Acute coronary syndrome: 12-lead ECG within 10 minutes, aspirin 300 mg chewed, troponin, and immediate transfer for ST elevation.
- Stroke: exclude hypoglycaemia, do CT to exclude haemorrhage, and thrombolyse within 4.5 hours of onset where eligible; thrombectomy for selected large-vessel occlusion up to 24 hours.
- Sepsis: cultures, lactate and broad-spectrum antibiotics within 1 hour when there is septic shock.
- Diabetic ketoacidosis: isotonic fluids, fixed-rate insulin infusion, potassium replacement, and no routine bicarbonate.
- Acute asthma: oxygen to target saturations, repeated salbutamol with ipratropium, systemic steroids, magnesium for severe or life-threatening features.
Worked example
A 25-year-old develops stridor, wheeze and hypotension minutes after an antibiotic injection. Reasoning: airway compromise plus shock equals anaphylaxis. Give IM adrenaline 0.5 mg immediately into the thigh, oxygen, lie flat with legs raised, fluids, and repeat adrenaline at 5 minutes if no improvement.
Traps that cost marks
Waiting for antihistamines before adrenaline; giving intravenous adrenaline boluses outside cardiac arrest; discharging after a single dose; failing to document the trigger.