Emergency and Critical Care Basics
Key Takeaways
- ABCDE primary survey: airway, breathing, circulation, disability, exposure—with C-spine precautions in trauma.
- Sepsis: early lactate, cultures, antibiotics, fluids, and vasopressors per hour-1 bundle concepts.
- Anaphylaxis first line: IM epinephrine in anterolateral thigh without delay.
- Heat stroke in Saudi climate: CNS changes and hyperthermia need aggressive cooling and ICU care.
- High-quality CPR: 100–120 compressions/min, minimize interruptions, defibrillate shockable rhythms rapidly.
Quick Answer: SNLE emergency-critical items test primary survey (ABCDE), shock types, sepsis bundles, basic arrhythmia response, ventilator alarms, and rapid triage—mirroring MOH emergency departments and ICU entry competencies for Saudi registered nurses.
Emergency and Critical Care Basics
Critical care questions appear throughout Adult Nursing forty-percent weight. Prometric scenarios include MVA trauma, heat stroke, sepsis, and cardiac arrest—you must choose the first stabilizing action consistent with ACLS and trauma nursing principles adapted to hospital policy.
ABCDE Primary Survey
| Step | Focus |
|---|---|
| Airway | Patent, cervical spine precaution in trauma |
| Breathing | Rate, effort, bilateral breath sounds |
| Circulation | Pulse, bleeding control, perfusion |
| Disability | GCS, pupils, glucose |
| Exposure | Temperature, full exam while preventing hypothermia |
Shock Classification
| Type | Cause | Clues |
|---|---|---|
| Hypovolemic | Blood/fluid loss | Tachycardia, hypotension, cool skin |
| Cardiogenic | Pump failure | JVD, crackles |
| Distributive | Sepsis, anaphylaxis | Warm skin early sepsis, wheeze in anaphylaxis |
| Obstructive | PE, tamponade | Muffled heart sounds, JVD |
Fluid resuscitation first line in hypovolemic and septic shock per protocol; cardiogenic needs cautious fluids.
Sepsis Recognition and Bundle
Suspect infection plus organ dysfunction. Hour-1 bundle concepts: lactate, cultures before antibiotics if no delay, broad antibiotics, fluids if hypotensive, vasopressors if fluid refractory. Nurse initiates monitoring, labs, oxygen, notifies rapid response.
Cardiac Arrest
CPR high-quality: rate 100–120, depth 2+ inches, full recoil, minimize interruptions. Defibrillate VF/pVT ASAP. Epinephrine per ACLS timing. SNLE may test compression-to-ventilation ratio 30:2 single rescuer.
Anaphylaxis
Epinephrine IM vastus lateralis first—do not delay for IV antihistamines alone. Airway swelling, hypotension, remove trigger.
Heat-Related Illness (Saudi Relevance)
Heat exhaustion: cool environment, fluids, rest. Heat stroke: CNS dysfunction, hot dry or sweaty skin, core temp >40°C—aggressive cooling, IV fluids, ICU—cooling before transport if field care.
Ventilator Basics
High pressure alarm: secretions, biting tube, pneumothorax, patient fighting vent—suction, calm, notify RT/provider. Low exhaled volume: disconnect check, leak, apnea.
Sedation vacation and spontaneous breathing trials are ICU liberation concepts—know nurse role in monitoring during weaning trials.
Triage
ESI or similar: immediate life threat first. SNLE may ask who to see first among four patients—apply ABC instability ranking.
Worked Scenario
ED: septic patient BP 82/48, lactate 4.5, temp 39.2. Oxygen, two large-bore IVs, fluid bolus per sepsis protocol, blood cultures, antibiotics within hour, frequent reassessment—document time stamps.
Traps
- Epinephrine delayed in anaphylaxis
- Cooling heat stroke patient with oral fluids if unconscious
- Ignoring tension pneumothorax decompression need when trachea deviated
Final Check
Recite ABCDE, name four shock types, and state first drug for anaphylaxis route and site.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
In the primary trauma survey, which step immediately follows establishment of a patent airway when cervical spine injury is possible?
A patient with suspected anaphylaxis after bee sting has wheezing and hypotension. What is the first medication route and priority?
Which patient should the triage nurse see first among these four?