Emergency Medicine and Critical Care
What OMRSE tests
Emergency Medicine and Critical Care tests resuscitation, shock, sepsis, trauma, airway management, and safe disposition. The exam rewards ABCDE priorities and early source control over exhaustive investigation.
Core rules
- In sepsis, obtain cultures but do not delay antibiotics; give broad-spectrum antibiotics within 1 hour for septic shock.
- Give 30 mL/kg crystalloid for sepsis-induced hypoperfusion, then reassess; start norepinephrine if MAP remains below 65 mmHg.
- Use point-of-care ultrasound and lactate to guide resuscitation, not as substitutes for clinical reassessment.
- In trauma, treat tension pneumothorax clinically with immediate decompression before imaging.
Worked example
A 72-year-old nursing-home resident has fever, confusion, BP 82/50, and lactate 4.2 mmol/L. This is septic shock, probably from urinary or respiratory infection. Start oxygen, obtain blood cultures and urine culture, give broad-spectrum antibiotics within 1 hour, and give 30 mL/kg crystalloid. Reassess perfusion and jugular venous pressure; if MAP stays below 65 after fluids, start norepinephrine. Arrange source control. Avoid fluid overload in heart failure; use smaller boluses and early vasopressors.
Traps that cost marks
- Waiting for cultures before giving antibiotics.
- Using qSOFA alone to rule out sepsis.
- Giving repeated fluid boluses without reassessment.
- Missing a tension pneumothorax because the chest X-ray is pending.