Shock

Hypoperfusion / circulatory failure

Sepsis

Sepsis Six within 1 hour

Septic Shock

Vasopressors + antibiotics + source control

Necrotising Fasciitis

Immediate surgical debridement

Toxic Shock Syndrome

Remove source + clindamycin + IVIG

Severe Malaria (Falciparum)

IV artesunate

Severe Dengue / Dengue Shock

Isotonic fluids — avoid over-hydration

Tetanus

Wound care + Ig + control spasms

Rabies Post-Exposure Prophylaxis

Wound + RIG + vaccine

Diabetic Ketoacidosis (DKA)

Insulin + fluids + K⁺

Hyperosmolar Hyperglycaemic State

Slow fluid resuscitation

Hypoglycaemia

BSL < 4 mmol/L

Myxoedema Coma

Severe hypothyroidism with decompensation

Addisonian Crisis

Hydrocortisone + fluids + glucose

Thyroid Storm

PTU → iodine → β-blocker + steroid

Phaeochromocytoma Crisis

α before β blockade

HHS Complications

Slow correction to prevent oedema

Severe Hypoglycaemia (Adult)

Glucose + address cause

STEMI

PPCI < 120 min

Acute Heart Failure / Pulmonary Oedema

LMNOP

Cardiogenic Shock

Pump failure

Cardiac Arrest

ALS algorithm

Ventricular Tachycardia

Pulseless = ALS, pulse = stable/unstable

Hypertensive Emergency

BP >180/120 + end-organ damage

Acute Pulmonary Oedema

LMNOP

Aortic Dissection

Type A / B — control BP, urgent CT

Cardiac Tamponade

Pericardiocentesis

Torsades de Pointes

Polymorphic VT — Mg + defib

AF with WPW (Pre-excited)

Avoid AV nodal blockers

Complete Heart Block

Atropine → pacing

Infective Endocarditis

Duke criteria — antibiotics + surgery

Digoxin Toxicity

DigiFab + correct K

Acute Pulmonary Oedema

Sit up, O₂, GTN, furosemide, NIV

Refractory Cardiogenic Shock

Escalate to MCS

Papillary Muscle Rupture

Post-MI mechanical complication

Post-MI VSR

Harsh pansystolic murmur + shock

Hypertensive Emergency — Neurological

SBP reduction 10–20% first hour

Stroke

Time is brain — FAST

Status Epilepticus

Seizure >5 min or recurrent

Subarachnoid Haemorrhage

Thunderclap headache — CT + LP + coiling

Intracerebral Haemorrhage

BP control + reverse anticoag

Bacterial Meningitis

Empirical Abx within 1 h

Viral Encephalitis

Acyclovir empirically

Myasthenic Crisis

PLEX or IVIG + intubate

Malignant Spinal Cord Compression

Dexamethasone + urgent MRI

Cauda Equina Syndrome

Urgent MRI + decompression <48 h

Brain Abscess

Antibiotics + drainage

Raised Intracranial Pressure

Head up, mannitol, osmotherapy

Hypertensive Encephalopathy

Controlled BP reduction

Anaphylaxis

Adrenaline first, every time

Acute Severe Asthma

OSHITME approach

Pulmonary Embolism

PESI / Wells

Tension Pneumothorax

Clinical diagnosis — decompress immediately

Acute Respiratory Failure

Type 1 vs 2 — oxygen + NIV/IMV

Acute Respiratory Distress Syndrome (ARDS)

Lung-protective ventilation

Massive Haemoptysis

Airway protection + bronchial artery embolisation

Upper GI Bleed

Blatchford / Rockall

Variceal Bleeding

Terlipressin + ceftriaxone + endoscopy

Acute Liver Failure

NAC + transplant assessment

Acute Cholangitis (Ascending)

Charcot triad — Abx + biliary decompression

Severe Acute Pancreatitis

Fluids, analgesia, ICU

Toxic Megacolon

Steroids + surgical review

Tumour Lysis Syndrome

Fluids + rasburicase + monitor K/PO₄

Hepatorenal Syndrome

Terlipressin + albumin

Hyperkalaemia

K⁺ > 5.5 mmol/L

Organophosphorus Poisoning

Cholinergic crisis — SLUDGE/DUMBELS

Snake Bite

ASV indication

Tricyclic Antidepressant Overdose

QRS widening = give bicarbonate

Opioid Overdose

Reverse, ventilate, monitor

β-blocker Overdose

Glucagon + high-dose insulin

Calcium Channel Blocker Overdose

Calcium + HIE + vasopressors

Salicylate Poisoning

Alkaline diuresis + dialysis

Iron Overdose

Deferoxamine + supportive

Carbon Monoxide Poisoning

100% O₂ ± HBO

Cyanide Poisoning

Hydroxocobalamin

Methanol / Ethylene Glycol Poisoning

Fomepizole + dialysis

Lithium Toxicity

Fluids + haemodialysis if severe

Serotonin Syndrome

Stop drugs + cyproheptadine

Neuroleptic Malignant Syndrome

Stop neuroleptic + dantrolene

Envenomation (General)

Immobilise + specific antivenom

Bee / Wasp Sting Anaphylaxis

Remove sting + IM adrenaline

Aluminium Phosphide Poisoning

Coconut oil + supportive

Paraquat Poisoning

Fuller's earth + immunosuppression

Carbon Monoxide Poisoning

100% O₂ + consider HBO

Heat Stroke

Core temp >40°C + CNS

Severe Hypothermia (<28 °C)

Slow rewarming + ECLS if arrest

High-Altitude Illness (HACE/HAPE)

Descend + O₂ + drugs

Hypothermic Cardiac Arrest

Prolonged CPR + rewarm to >32 °C

Polytrauma

ATLS — Primary + secondary survey

Severe Head Injury (GCS ≤8)

Intubate + osmotherapy + neurosurgery

Spinal Cord Injury (Acute)

Immobilise + MAP support + neurosurgery

Flail Chest / Pulmonary Contusion

Analgesia + selective IMV

Haemothorax

Chest drain 28–32 Fr

Pelvic Fracture (Unstable)

Binder + haemorrhage control

Blunt Abdominal Trauma

FAST + CT / laparotomy

Major Burns

Parkland + airway + escharotomy

Electrical Injury

ECG + rhabdo + burns

Drowning / Immersion

Ventilate + rewarm + oxygen

Compartment Syndrome

Fasciotomy within hours

Massive Pulmonary Embolism

Haemodynamic instability + suspected PE

VF / Pulseless VT Arrest

Shockable rhythm — defib every 2 min

PEA / Asystole

Non-shockable — reversible causes

Cardiac Arrest in Pregnancy

Left uterine displacement + PMCS at 4 min

PEA Cardiac Arrest

Non-shockable — reversible causes

Asystole

Confirm leads, adrenaline, reversibles

Refractory VF / pVT

≥3 shocks without ROSC

Post-ROSC Care Bundle

Neuro-protect + reperfuse

Cardiac Arrest — Suspected PE

Thrombolyse + prolonged CPR

Hyperkalaemic Cardiac Arrest

Calcium + insulin/dextrose + dialysis

Foreign Body Airway Obstruction

Back blows + abdominal thrusts

Angioedema (Non-allergic / ACE-i)

Airway + icatibant/C1-INH

Acute Mesenteric Ischaemia

Pain out of proportion — urgent CTA

GI Perforation

Resuscitate + broad Abx + surgery

Obstructive Uropathy / Anuria

Decompress + urology

Testicular Torsion

Surgery within 6 h

Acute Scrotum

Rule out torsion — urology <6 h

Massive Haemorrhage / MTP

1:1:1 packed cells:FFP:platelets

TTP

Plasma exchange + steroids

Acute Chest Syndrome (Sickle)

Transfuse + antibiotics

Neutropenic Sepsis

Piperacillin-tazobactam ≤1 h

Hyperviscosity Syndrome

Plasmapheresis / leukapheresis

Eclampsia

Magnesium sulphate + delivery

Severe Pre-eclampsia

BP + Mg + delivery timing

Postpartum Haemorrhage

4 Ts — Tone/Trauma/Tissue/Thrombin

Amniotic Fluid Embolism

ALS + massive transfusion

Shoulder Dystocia

HELPERR mnemonic

Umbilical Cord Prolapse

Elevate presenting part + emergency delivery

Ruptured Ectopic Pregnancy

Resuscitate + emergency salpingectomy

Placental Abruption

Resuscitate + urgent delivery

Placenta Praevia (Bleed)

Do not PV examine — LSCS

Septic Abortion

Antibiotics + evacuation

Severe HTN in Pregnancy / Eclampsia

Labetalol / hydralazine + MgSO4

Ovarian Torsion

Urgent laparoscopy

Paediatric Sepsis

Bundle within 1 h

Acute Epiglottitis

Airway + IV ceftriaxone

Kawasaki Disease

IVIG + aspirin within 10 days

Intussusception

Air enema reduction

Meningococcal Septicaemia (Paediatric)

Ceftriaxone ASAP + fluid + inotropes

Paediatric DKA

Cautious fluids — cerebral oedema risk

Neonatal Resuscitation

Dry, warm, stimulate, ventilate

Non-Accidental Injury (Suspected)

Safeguarding + document + admit

Suicidal Ideation / Attempt

Safety + risk assessment + admission

Acute Limb Ischaemia

6 Ps — heparin + revascularisation <6 h

Ruptured AAA

Permissive hypotension + emergency EVAR/open

Ruptured AAA

Permissive hypotension + surgery

ENT Airway Foreign Body

ENT airway plan

Acute Angle-Closure Glaucoma

Rapid IOP reduction

Chemical Eye Injury

Irrigate immediately >30 min

Central Retinal Artery Occlusion

Ocular massage + urgent ophthalmology

Unstable Narrow-Complex Tachycardia

Synchronised DC cardioversion

Unstable Wide-Complex Tachycardia

Treat as VT — synchronised shock

Torsades de Pointes

Mg + correct QT drivers