Emergency, acute, and critical care situations
Domain 5 - Emergency, acute, and critical care situations
This domain tests rapid recognition and stabilization using a structured approach, with time-critical decisions and early escalation.
Core rules
- Use ABCDE and early warning scores, and reassess after every intervention.
- In sepsis, obtain cultures and give broad-spectrum antibiotics within 1 hour, measure lactate, and give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
- Start norepinephrine if MAP remains below 65 mmHg after fluids; do not delay vasopressors for central access.
- Treat reversible causes: hypoglycaemia, hypoxia, tension pneumothorax, tamponade, and toxins.
- Escalate early: call for help and plan ICU transfer.
Worked example
A 70-year-old with urosepsis has BP 82/50, heart rate 120, and lactate 5.2 mmol/L. Give oxygen if hypoxic, secure two large-bore IVs, take blood cultures, give ceftriaxone plus gentamicin per local protocol, and give 30 mL/kg crystalloid. Reassess perfusion; if MAP is below 65 mmHg, start norepinephrine. Insert a urinary catheter and monitor urine output. Avoid repeated blind fluid boluses if the patient has heart failure; use dynamic measures of fluid responsiveness.
Traps
- Delaying antibiotics to obtain cultures or imaging.
- Giving repeated fluid boluses without reassessment.
- Missing hypoglycaemia or anaphylaxis.
- Failing to document time-critical decisions.