Critical Care and Emergency Nursing
Critical care and emergency nursing tests rapid recognition, resuscitation, and escalation for unstable patients across emergency departments and intensive care units. Items often use a deteriorating patient vignette and ask for the first action, safest drug, or most likely shock type.
Core rules
- Use ABCDE and treat immediately life-threatening problems before diagnosis: airway obstruction, tension pneumothorax, massive hemorrhage, anaphylaxis, and cardiac arrest.
- In cardiac arrest, start high-quality CPR at 100–120 compressions/min, depth 5–6 cm, full recoil, and minimize interruptions. Defibrillate shockable rhythms (VF/pulseless VT) as soon as possible; do not delay for drugs or IV access.
- Sepsis: obtain cultures, give broad-spectrum antibiotics and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L within the first hour, and measure lactate. Use vasopressors if MAP remains <65 mmHg after fluids.
- Shock types: hypovolemic (bleeding, dehydration), cardiogenic (pump failure), distributive (sepsis, anaphylaxis), obstructive (tension pneumothorax, tamponade, PE). Fluid boluses help hypovolemic and distributive shock, not cardiogenic or obstructive shock.
- Triage uses acuity, not arrival order; reassess after every intervention.
Worked example
A trauma patient becomes hypotensive, with absent left breath sounds, distended neck veins, and tracheal deviation to the right. Reasoning: this is tension pneumothorax, an obstructive shock. The first action is immediate needle decompression, not a fluid bolus or chest X-ray. Fluid may transiently help but does not relieve the pressure; definitive chest tube follows.
Traps
Do not give large fluid volumes in cardiogenic shock; assess for pulmonary edema. Do not delay defibrillation to obtain a 12-lead ECG. Do not miss hypoglycemia, opioid toxicity, or beta-blocker overdose as reversible causes. Avoid relying on a single BP reading; trends and perfusion matter.