Emergency Medicine and Critical Care
What Emergency Medicine and Critical Care tests
This section tests immediate recognition and treatment of time-critical conditions: cardiac arrest, shock, anaphylaxis, sepsis, airway obstruction, trauma and altered consciousness. Questions ask for the first action, the correct drug and dose, or the most likely reversible cause.
Core rules
- Universal approach: ABCDE with continuous reassessment; call for help early; treat before diagnosis when the patient is unstable.
- ACLS: for VF or pulseless VT give immediate defibrillation (biphasic 200 J) and CPR; for asystole or PEA give CPR, adrenaline 1 mg every 3–5 minutes, and hunt reversible causes (the 4 Hs and 4 Ts).
- Anaphylaxis: intramuscular adrenaline 1:1000, 0.5 mg (0.01 mg/kg in children, maximum 0.5 mg) into the anterolateral thigh, repeated every 5–15 minutes; oxygen, IV fluids, then antihistamines and steroids as adjuncts.
- Sepsis: measure lactate, take cultures, give broad-spectrum antibiotics within 1 hour for septic shock, 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more, and norepinephrine for persistent hypotension targeting a mean arterial pressure of 65 mmHg.
- Status epilepticus: a benzodiazepine first, then a second-line agent; always check glucose.
Worked example
A patient develops stridor, urticaria and hypotension minutes after an IV antibiotic. Reason: anaphylaxis. Stop the drug, call for help, give intramuscular adrenaline 0.5 mg immediately, lay the patient flat with legs raised, give high-flow oxygen and a rapid crystalloid bolus, and repeat adrenaline if there is no response. Antihistamines and corticosteroids are given after adrenaline, never instead of it.
Traps
Giving IV adrenaline instead of intramuscular in a non-arrested patient; delaying antibiotics to await cultures in septic shock; forgetting to check glucose in altered consciousness; prolonged pulse checks and interruptions in chest compressions.