Emergency Medicine Revision Guide✅

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🚨 Emergency Medicine is prioritisation under uncertainty. The first diagnosis is not “pneumonia” or “MI” — it is whether the patient has an immediate threat to airway, breathing, circulation, disability or exposure. For exams and ED work, think: resuscitate first, treat time-critical threats early, diagnose in parallel, reassess repeatedly, and give clear safety-netting when discharging.

✅ 1. ED Mindset and Initial Assessment

🚨 1.1 Priorities in Emergency Medicine

• Recognise sick patients early: abnormal physiology usually matters more than a neat diagnosis.
• Use ABCDE: identify and treat threats in order, then reassess.
• Call for help early: senior ED, anaesthetics, ICU, trauma, stroke, cardiology, surgery or paediatrics.
• Investigate in parallel: ECG, glucose, VBG/ABG, bloods, imaging and cultures while stabilising.
• Use time-critical pathways: STEMI, stroke, sepsis, major trauma, DKA, anaphylaxis, meningitis.
• Think disposition: resus, majors, observation, admission, ambulatory care, discharge or transfer.

🧭 1.2 Triage Red Flags

🧠 Exam pearl: In ED, “stable” means stable after reassessment, not just stable at the door. A patient can compensate well until they suddenly crash.

🔤 2. ABCDE Assessment

🗣️ 2.1 Airway

• Look for obstruction: snoring, gurgling, stridor, hoarse voice, drooling, burns, facial trauma, swelling.
• A talking patient has a patent airway at that moment, but it can deteriorate quickly.
• Basic manoeuvres: head tilt-chin lift, jaw thrust if C-spine concern, suction, airway adjuncts.
• High-risk airway: anaphylaxis, epiglottitis/deep neck infection, facial burns, reduced GCS, expanding neck haematoma.
• Call anaesthetics/ENT/ICU early if airway may be lost.

🫁 2.2 Breathing

• Assess respiratory rate, oxygen saturations, work of breathing, chest expansion, percussion and auscultation.
• Look for cyanosis, exhaustion, inability to speak, accessory muscle use, tracheal deviation and chest trauma.
• Give oxygen if hypoxic or critically ill; choose target saturation based on risk of hypercapnic respiratory failure.
• Consider CXR, VBG/ABG, ECG, ultrasound and capnography depending on severity.
• Life threats: tension pneumothorax, severe asthma, pulmonary oedema, massive PE, anaphylaxis, pneumonia/sepsis.

❤️ 2.3 Circulation

• Assess pulse, BP, capillary refill, skin temperature, JVP, bleeding, urine output and mental state.
• Insert IV/IO access, take bloods and consider fluid/blood resuscitation.
• Shock categories: hypovolaemic, distributive, cardiogenic and obstructive.
• Control bleeding early: direct pressure, tourniquet, pelvic binder, blood products, surgery/IR.
• Check ECG early in chest pain, collapse, electrolyte disturbance, overdose and shock.

🧠 2.4 Disability

• Assess GCS/AVPU, pupils, limb movement, seizures and blood glucose.
• Hypoglycaemia is a reversible cause of coma, seizure and stroke-like symptoms.
• Consider stroke, sepsis, head injury, intoxication, metabolic disturbance, meningitis and post-ictal state.
• Protect airway if GCS is low or vomiting/aspiration risk is high.

🌡️ 2.5 Exposure

• Expose enough to examine properly while preventing hypothermia.
• Look for rash, trauma, bleeding, surgical scars, abdomen, back, pressure areas and signs of injection/drug use.
• Measure temperature.
• Consider safeguarding, neglect, non-accidental injury and domestic abuse.

🚨 Safety pearl: ABCDE is not a checklist to complete once. It is a loop: assess, treat, reassess, escalate.

❤️ 3. Cardiac Arrest and Peri-Arrest

Resuscitation Council UK 2025 adult ALS guidance states there are no major changes from 2021, continuing emphasis on early recognition, high-quality CPR, defibrillation for shockable rhythms and treating reversible causes.

⚡ 3.1 Adult ALS Overview

• Confirm unresponsive and not breathing normally.
• Call resuscitation team and start CPR 30:2 if no advanced airway.
• Attach defibrillator and identify rhythm: shockable or non-shockable.
• Shockable: VF/pulseless VT — defibrillate and continue CPR.
• Non-shockable: PEA/asystole — CPR, adrenaline and reversible causes.
• Minimise interruptions to chest compressions.
• Use waveform capnography if intubated to confirm tube position and monitor CPR quality/ROSC.

🔁 3.2 Reversible Causes: 4 Hs and 4 Ts

🚨 3.3 Peri-Arrest Clues

• Severe bradycardia with shock, syncope, myocardial ischaemia or heart failure.
• Broad-complex tachycardia with hypotension, chest pain, heart failure or reduced consciousness.
• Severe hypoxia, exhaustion, silent chest or altered mental state in asthma/COPD.
• Hyperkalaemia ECG changes: peaked T waves, PR prolongation, QRS widening, sine wave.
• Shock with rising lactate, mottling, oliguria or confusion.

🧠 Exam pearl: In cardiac arrest, compressions and defibrillation save lives; drugs are secondary. Do not let cannulation or airway attempts interrupt CPR.

❤️ 4. Chest Pain

NICE CG95 covers assessment and diagnosis of recent-onset chest pain of suspected cardiac origin in adults. In the ED, the immediate priority is identifying acute coronary syndrome and other life-threatening mimics.

🚨 4.1 Life-Threatening Chest Pain Differentials

🫀 4.2 Acute Coronary Syndrome

• ACS includes STEMI, NSTEMI and unstable angina.
• Get ECG rapidly and repeat if symptoms continue or initial ECG non-diagnostic.
• Troponin supports diagnosis but must be interpreted with timing, symptoms and ECG.
• Do not wait for troponin if STEMI criteria and clinical picture require immediate reperfusion pathway.
• Initial management may include antiplatelet/anticoagulant strategies, nitrates, analgesia and oxygen only if hypoxic, according to local pathway.
• Atypical presentations are common in older adults, women, diabetes and CKD: dyspnoea, nausea, collapse, delirium.

🫁 4.3 Pulmonary Embolism

• Symptoms: pleuritic chest pain, dyspnoea, haemoptysis, syncope, tachycardia.
• Risk factors: recent surgery, immobility, cancer, pregnancy/postpartum, oestrogen therapy, previous VTE, thrombophilia.
• Use clinical probability scoring and D-dimer in appropriate low/intermediate-risk patients.
• CTPA is common diagnostic imaging; V/Q scan may be used in selected patients.
• Massive PE causes hypotension/shock and may need thrombolysis/embolectomy pathway.

🩸 4.4 Aortic Dissection

• Severe abrupt chest/back pain, often tearing or ripping.
• Pulse deficit, BP difference, new aortic regurgitation, stroke symptoms, syncope or limb ischaemia may occur.
• Risk factors: hypertension, connective tissue disease, bicuspid aortic valve, pregnancy, cocaine, known aneurysm.
• Type A dissection involves ascending aorta and is a surgical emergency.
• Manage pain and BP/heart rate with senior input; urgent CT angiography if stable enough.

🚨 Safety pearl: Chest pain plus neurological deficit, pulse deficit or syncope should make you think aortic dissection, not just ACS.

🫁 5. Breathlessness

🔍 5.1 Initial Breathlessness Assessment

• Assess work of breathing, ability to speak, respiratory rate, oxygen saturation, wheeze, crackles and chest symmetry.
• Check ECG, CXR, VBG/ABG, FBC, U&E, CRP, troponin/BNP/D-dimer selectively.
• Consider point-of-care ultrasound if trained: lung sliding, B-lines, effusion, cardiac function, IVC.
• Look for immediate threats: anaphylaxis, tension pneumothorax, severe asthma, pulmonary oedema, massive PE, sepsis.

🌬️ 5.2 Asthma Exacerbation

• Features of life-threatening asthma: silent chest, cyanosis, poor respiratory effort, exhaustion, confusion, hypotension, arrhythmia.
• Severe asthma: inability to complete sentences, high respiratory/heart rate, low peak flow.
• Management: oxygen if hypoxic, nebulised salbutamol, ipratropium in severe/life-threatening cases, steroids, magnesium sulfate if poor response, escalation to ICU/anaesthetics if tiring.
• Normal or rising CO₂ in a severe asthma attack is dangerous — it suggests ventilatory failure.

🫁 5.3 COPD Exacerbation

• Symptoms: increased dyspnoea, cough, sputum volume/purulence, wheeze.
• Controlled oxygen target is often 88–92% if at risk of hypercapnic respiratory failure.
• Check VBG/ABG for hypercapnia/acidosis.
• Treatment: bronchodilators, steroids, antibiotics if infective features, NIV if persistent acidotic hypercapnic respiratory failure.
• Exclude pneumonia, PE, pneumothorax, heart failure and ACS.

🫀 5.4 Acute Pulmonary Oedema

• Features: severe breathlessness, orthopnoea, crackles, hypoxia, pink frothy sputum, hypertension or shock.
• Causes: ACS, arrhythmia, valve disease, fluid overload, renal failure, hypertensive crisis.
• Management: sit upright, oxygen/CPAP if hypoxic, nitrates if hypertensive and safe, diuretics if overloaded, treat cause.
• Hypotensive pulmonary oedema suggests cardiogenic shock and needs urgent senior/cardiology/ICU input.

🫧 5.5 Pneumothorax

• Symptoms: sudden pleuritic chest pain and breathlessness.
• Tension pneumothorax: shock, severe respiratory distress, unilateral absent breath sounds, distended neck veins, tracheal deviation late.
• Tension pneumothorax is a clinical diagnosis — do not wait for CXR if unstable.
• Management depends on size, symptoms, primary vs secondary, and tension physiology.

🧠 Exam pearl: Breathlessness is not always lung disease. PE, ACS, anaemia, metabolic acidosis and sepsis can present mainly as “short of breath”.

🦠 6. Sepsis and Infection in ED

NICE NG253 covers recognition, assessment and early management of suspected sepsis in people aged 16 or over who are not and have not recently been pregnant. It recommends broad-spectrum IV antibiotics within 1 hour of calculating NEWS2 in high-risk ED/ward patients who have not already received antibiotics for that episode.

🚨 6.1 Sepsis Recognition

• Sepsis is life-threatening organ dysfunction due to infection.
• Sources: pneumonia, UTI/pyelonephritis, abdominal sepsis, cellulitis, meningitis, line infection, endocarditis.
• High-risk signs: new confusion, mottled/ashen skin, hypotension, hypoxia, tachypnoea, oliguria, non-blanching rash, high lactate.
• Older adults may present with falls, delirium, reduced intake or functional decline.
• Immunosuppressed patients may not mount fever or high inflammatory markers.

🧯 6.2 Initial Sepsis Management

• ABCDE, oxygen if hypoxic and senior help.
• Blood cultures and site cultures if this does not delay urgent antibiotics.
• Broad-spectrum antibiotics according to local policy when high risk/severely unwell.
• IV fluids if hypoperfusion or shock, with reassessment after boluses.
• Check lactate, FBC, U&E, LFT, clotting, glucose, VBG/ABG and urine output.
• Find source and control it: drain abscess, remove infected line, decompress obstruction, operate if perforation.

🧠 6.3 Meningitis and Meningococcaemia

• Features: fever, headache, neck stiffness, photophobia, vomiting, confusion, seizures, non-blanching rash.
• Do not delay antibiotics for CT or lumbar puncture in a seriously unwell patient.
• Non-blanching rash with fever/shock is meningococcaemia until proven otherwise.
• Give dexamethasone according to local pathway when bacterial meningitis suspected.
• Consider aciclovir if encephalitis features: altered behaviour, seizures, focal neurology.

🚨 6.4 Neutropenic Sepsis

• Fever or sepsis after chemotherapy is neutropenic sepsis until proven otherwise.
• Patients may appear deceptively well and have few localising signs.
• Do not wait for neutrophil count if clinical suspicion is high.
• Urgent IV antibiotics according to local neutropenic sepsis protocol.
• Look for line infection, mucositis, pneumonia, skin, perianal and urinary sources.

🚨 Safety pearl: Cultures are important, but antibiotics should not be delayed in high-risk sepsis, meningitis or neutropenic sepsis.

🧠 7. Collapse, Syncope and Reduced Consciousness

⚡ 7.1 Collapse Approach

• Clarify whether this was syncope, seizure, mechanical fall, intoxication or cardiac arrest with spontaneous recovery.
• Ask witnesses about posture, prodrome, colour, movements, duration, breathing, injury and recovery.
• Check ECG, glucose, lying/standing BP, FBC, U&E and pregnancy test where relevant.
• High-risk collapse: exertional syncope, chest pain, palpitations, family sudden death, abnormal ECG, structural heart disease, older age with injury.

🫀 7.2 Syncope Types

⚡ 7.3 Seizure vs Syncope

🧠 7.4 Reduced Consciousness

• Check glucose immediately.
• ABCDE and protect airway if vomiting, low GCS or aspiration risk.
• Consider: hypoxia, hypercapnia, sepsis, stroke, seizure/post-ictal, head injury, intoxication, metabolic disturbance, meningitis/encephalitis.
• Investigations: glucose, VBG/ABG, ECG, bloods, toxicology where relevant, CT head if indicated, infection work-up.
• Naloxone may reverse opioid toxicity; titrate to restore ventilation.

🧠 Exam pearl: Convulsive movements do not automatically mean epilepsy. Syncope can cause brief jerking due to cerebral hypoperfusion.

🧠 8. Stroke, Headache and Neurological Emergencies

⚡ 8.1 Stroke/TIA

• Sudden focal neurological deficit is stroke until proven otherwise.
• Check glucose early because hypoglycaemia can mimic stroke.
• FAST signs: face, arm, speech, time.
• Posterior circulation stroke: vertigo, diplopia, dysarthria, ataxia, vomiting, reduced consciousness.
• Urgent imaging determines haemorrhage vs infarct and reperfusion eligibility.
• Assess swallow before oral intake.

🤕 8.2 Headache Red Flags

• Thunderclap onset — subarachnoid haemorrhage until proven otherwise.
• Fever, meningism, rash, immunosuppression.
• New neurological deficit, seizure or confusion.
• New headache after age 50, especially with jaw claudication/scalp tenderness.
• Pregnancy/postpartum headache.
• Headache after trauma or with anticoagulation.
• Progressive headache with morning vomiting or papilloedema.

⚡ 8.3 Status Epilepticus

• Seizure lasting more than 5 minutes or recurrent seizures without recovery is an emergency.
• ABCDE, protect from injury, oxygen if needed, glucose check, IV access.
• Give benzodiazepine according to local pathway.
• Escalate to second-line antiseizure medication and anaesthetics/ICU if ongoing.
• Look for cause: missed medication, alcohol withdrawal, infection, stroke, tumour, drugs, metabolic disturbance.

🚨 8.4 Cauda Equina Syndrome

• Red flags: urinary retention, reduced urinary sensation, saddle anaesthesia, faecal incontinence, bilateral sciatica, progressive leg weakness.
• Requires emergency MRI and spinal surgical referral.
• Do not rely on normal anal tone alone to exclude it.

🍽️ 9. Acute Abdominal Pain

🔍 9.1 ED Abdominal Pain Approach

• Assess haemodynamic stability first.
• Ask onset, site, migration, character, vomiting, bowel habit, urinary symptoms, bleeding, pregnancy possibility.
• Examine for peritonism, hernias, pulsatile mass, testicular/ovarian pathology and sepsis.
• Pregnancy test in reproductive-age abdominal pain, collapse or bleeding.
• Check FBC, U&E, LFT, CRP, amylase/lipase, VBG/lactate, urinalysis and imaging as appropriate.

🚨 9.2 Life-Threatening Abdominal Diagnoses

🟡 9.3 Biliary Sepsis and Cholangitis

• Charcot triad: fever, jaundice, right upper quadrant pain.
• Severe cholangitis causes hypotension and confusion.
• Management: ABCDE, blood cultures, antibiotics and urgent biliary drainage, often ERCP.

🚨 Safety pearl: Pain out of proportion in abdominal pain is mesenteric ischaemia until proven otherwise, especially in AF or vascular disease.

🚑 10. Trauma and Major Trauma

NICE NG39 covers rapid identification and early management of major trauma in pre-hospital and hospital settings. It includes haemorrhage control principles such as direct pressure for external haemorrhage and restrictive volume resuscitation in active bleeding until definitive control.

🚨 10.1 Trauma Primary Survey

• C-spine: protect cervical spine when mechanism/risk suggests injury.
• Airway: obstruction, facial trauma, blood/vomit, low GCS.
• Breathing: tension pneumothorax, open pneumothorax, massive haemothorax, flail chest.
• Circulation: haemorrhage control, pelvic binder, tourniquet/pressure, blood products.
• Disability: GCS, pupils, glucose, limb movement.
• Exposure: fully expose, logroll when safe, prevent hypothermia.

🩸 10.2 Haemorrhagic Shock

• In trauma, shock is haemorrhage until proven otherwise.
• Bleeding sites: chest, abdomen, pelvis, long bones, external bleeding and floor.
• Apply direct pressure/tourniquet for external bleeding.
• Use pelvic binder for suspected pelvic fracture with haemodynamic instability.
• Activate major haemorrhage protocol early for significant bleeding.
• Avoid excessive crystalloid; use blood products and source control.
• Prevent hypothermia, acidosis and coagulopathy.

🫁 10.3 Life-Threatening Chest Trauma

🧠 10.4 Head Injury

• Record mechanism, GCS, pupils, vomiting, seizure, amnesia, anticoagulants, intoxication and safeguarding concerns.
• Red flags: falling GCS, unequal pupils, focal deficit, seizure, repeated vomiting, skull fracture signs.
• Check glucose if reduced consciousness.
• Prevent secondary brain injury: avoid hypoxia and hypotension.
• Follow NICE head injury imaging and observation pathways.

🦴 10.5 Limb Trauma

• Assess open vs closed fracture, deformity, skin compromise, neurovascular status and compartment signs.
• Immobilise, elevate where appropriate and provide analgesia.
• Open fractures need antibiotics, tetanus assessment, sterile dressing and urgent orthopaedics.
• Compartment syndrome: pain out of proportion, pain on passive stretch, tense compartment — urgent fasciotomy pathway.

🚨 Exam pearl: Pelvic binders go at the level of the greater trochanters, not around the waist.

💊 11. Toxicology and Overdose

🧪 11.1 Overdose Approach

• ABCDE and treat immediate threats.
• Ask what, how much, when, co-ingestants, alcohol/drugs, intent and access to remaining tablets.
• Check ECG, glucose, paracetamol level, salicylate level if possible, VBG/ABG, U&E, LFT, pregnancy test where relevant.
• Contact TOXBASE/NPIS according to local practice.
• Assess mental health and safeguarding after medical stabilisation.

💊 11.2 High-Yield Toxic Syndromes

🧯 11.3 Key Antidotes and Treatments

• Paracetamol: N-acetylcysteine according to level/timing and guidance.
• Opioids: naloxone titrated to restore ventilation.
• Carbon monoxide: high-flow oxygen; hyperbaric oxygen in selected cases.
• Beta-blocker/CCB: glucagon, high-dose insulin euglycaemic therapy and vasopressors in specialist settings.
• TCA: sodium bicarbonate for broad QRS/arrhythmias/severe toxicity.
• Organophosphates: atropine and pralidoxime according to specialist advice.
• Iron/lithium/salicylate: may require specific chelation, alkalinisation or dialysis pathways.

⚠️ Safety pearl: Every deliberate overdose needs psychosocial assessment. Medical clearance is not the same as safe discharge.

🌡️ 12. Environmental Emergencies

🔥 12.1 Burns

• Assess airway risk: facial burns, soot, hoarse voice, enclosed-space fire, stridor.
• Cool running water for 20 minutes if within appropriate timeframe; avoid hypothermia.
• Estimate burn size with Lund and Browder chart or rule of nines in adults.
• Consider fluid resuscitation for significant burns.
• Refer to burns service for complex, deep, circumferential, electrical, chemical, inhalation, face/hands/genitals/joints or large burns.

🧊 12.2 Hypothermia

• Causes: exposure, sepsis, endocrine disease, intoxication, older age, trauma.
• Handle gently due to arrhythmia risk.
• Check glucose and ECG.
• Rewarm according to severity: passive, active external, active internal.
• Cardiac arrest in hypothermia has modified resuscitation principles; follow specialist guidance.

☀️ 12.3 Heat Illness

• Heat exhaustion: sweating, weakness, dizziness, nausea, normal mental state.
• Heat stroke: core hyperthermia with CNS dysfunction — emergency.
• Management: rapid cooling, ABCDE, fluids, check CK/U&E/LFT/clotting, monitor rhabdomyolysis and organ failure.

💨 12.4 Carbon Monoxide Poisoning

• Symptoms: headache, dizziness, nausea, confusion, collapse; multiple household members may be affected.
• Pulse oximetry can be falsely normal.
• Check carboxyhaemoglobin on blood gas.
• Treat with high-flow oxygen and involve specialist advice for severe exposure/pregnancy/neurological features.

🚸 13. Paediatric Emergency Medicine

👶 13.1 Recognising the Sick Child

• Assess appearance, work of breathing and circulation to skin.
• Parental concern is important.
• Children compensate then deteriorate quickly; hypotension is a late sign.
• Red flags: poor feeding, reduced wet nappies, lethargy, grunting, apnoea, non-blanching rash, seizures, inconsolable cry.

🌡️ 13.2 Feverish Child

• Use age-appropriate risk assessment and NICE fever/sepsis pathways.
• Under 3 months with fever requires lower threshold for urgent paediatric assessment.
• Consider UTI, pneumonia, meningitis, sepsis, Kawasaki disease, viral infection.
• Non-blanching rash, grunting, reduced responsiveness or poor perfusion are high risk.

🫧 13.3 Bronchiolitis and Wheeze

• Bronchiolitis: infant with coryza, cough, poor feeding, crackles/wheeze, increased work of breathing.
• Management is supportive: oxygen if hypoxic, feeding/fluids support, monitoring.
• Acute asthma/wheeze: salbutamol, oxygen if hypoxic, steroids and escalation if severe.
• Silent chest, exhaustion or reduced consciousness are life-threatening signs.

🚨 13.4 Paediatric Emergencies

🧠 Exam pearl: A child who is not feeding, not interacting or not passing urine is high risk, even if one observation looks acceptable.

🤰 14. Obstetric and Gynaecological Emergencies in ED

🚨 14.1 Early Pregnancy

• Pregnancy test is essential in reproductive-age abdominal pain, collapse or bleeding.
• Ectopic pregnancy: pain, bleeding, shoulder tip pain, syncope, shock.
• Ruptured ectopic is a surgical emergency: ABCDE, IV access, crossmatch, urgent gynae.
• Miscarriage: bleeding and cramping; assess haemodynamic status, pain, infection and rhesus status according to pathway.

🩸 14.2 Late Pregnancy Emergencies

• Antepartum haemorrhage: placenta praevia, abruption, vasa praevia, labour.
• Do not perform digital vaginal examination in late pregnancy bleeding until placenta praevia excluded.
• Pre-eclampsia: headache, visual symptoms, epigastric pain, hypertension, proteinuria, reduced fetal movements.
• Eclampsia: seizure in pregnancy/postpartum — magnesium sulfate and urgent obstetric care.

🔥 14.3 Acute Pelvic Pain

• Differentials: ectopic pregnancy, ovarian torsion, ruptured cyst, PID, appendicitis, renal colic.
• Ovarian torsion: sudden unilateral pain, vomiting, adnexal mass; urgent gynae, normal Doppler does not fully exclude.
• PID: lower abdominal pain, cervical excitation, discharge, fever; pregnancy test and STI testing.

🧯 15. Common ED Procedures and Practical Skills

🩸 15.1 Vascular Access and Bloods

• Use large-bore IV access for shock, trauma, major bleeding or sepsis.
• IO access is appropriate in emergencies when IV access fails.
• Blood cultures should be taken before antibiotics where safe, but treatment should not be delayed in high-risk sepsis.

🫁 15.2 Chest Drain / Needle Decompression Principles

• Tension pneumothorax requires immediate decompression.
• Chest drain indications include pneumothorax, haemothorax and empyema depending on case.
• Use asepsis, analgesia, safe triangle/ultrasound where appropriate and post-procedure imaging.

🦴 15.3 Splinting and Reduction

• Check neurovascular status before and after.
• Provide adequate analgesia/sedation and monitoring.
• Reduce gross deformity or vascular compromise urgently.
• Give compartment syndrome and cast safety advice.

🧠 15.4 Lumbar Puncture

• Indications: meningitis, SAH after negative CT in some pathways, inflammatory/infective CNS disease.
• Contraindications/cautions: signs of raised ICP, focal neurology, reduced consciousness, coagulopathy, local infection, unstable patient.
• Do not delay antibiotics in suspected bacterial meningitis to perform LP.

💤 15.5 Procedural Sedation

• Used for reductions, cardioversion, painful procedures and imaging in selected patients.
• Requires fasting/risk assessment, monitoring, trained staff, airway equipment and recovery plan.
• Complications: airway obstruction, hypoventilation, aspiration, hypotension, emergence reactions.

🚨 16. Emergency Medicine Critical Diagnoses Table

📚 17. OSCE / Exam Pearls

• ABCDE first — then focused history and examination.
• Check glucose in collapse, seizure, confusion, focal neurology and reduced consciousness.
• ECG early for chest pain, collapse, palpitations, overdose and electrolyte disturbance.
• Pregnancy test in reproductive-age abdominal pain, collapse or bleeding.
• Do not delay antibiotics in high-risk sepsis, meningitis or neutropenic sepsis.
• Tension pneumothorax is a clinical diagnosis if unstable.
• Thunderclap headache is SAH until proven otherwise.
• Pain out of proportion suggests ischaemia, necrotising fasciitis or compartment syndrome.
• Discharge safety-netting should include what to watch for, what to do and when to return.
• A normal first troponin or ECG does not always exclude early ACS if timing is short.
• Do not call a fall “mechanical” until syncope, sepsis, stroke and medication causes are considered.
• Every deliberate self-poisoning needs psychosocial assessment after medical stabilisation.

📌 18. Quick Differentials Table

📚 References

• NICE. Suspected sepsis in people aged 16 or over: recognition, diagnosis and early management. NG253.
• NICE. Major trauma: assessment and initial management. NG39.
• NICE. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. CG95.
• Resuscitation Council UK. Adult advanced life support guidelines 2025.
• NICE. Head injury: assessment and early management. NG232.
• NICE. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NG128.
• NICE. Fever in under 5s: assessment and initial management. NG143.
• TOXBASE / National Poisons Information Service should be used for poisoning and overdose decisions.
• Local ED, ambulance, trauma, stroke, STEMI, sepsis, paediatric, safeguarding, mental health and major haemorrhage pathways should always be followed.

⚠️ Disclaimer

This article is for medical education and exam revision. Clinical decisions should follow current local emergency department, resuscitation, trauma, paediatric, sepsis, stroke, cardiology, toxicology, obstetric, surgical, safeguarding and mental health pathways, formularies, senior advice and national guidance. Emergency presentations such as cardiac arrest, sepsis, major trauma, ACS, stroke, anaphylaxis, meningitis, DKA, severe asthma, PE, ruptured AAA, ectopic pregnancy and serious overdose require urgent senior input.