Sample Cases

1. Anaphylactic Shock

A 25-year-old man arrives with an acute onset of breathlessness, facial swelling, and generalised urticaria following an insect sting. Primary survey shows impending airway obstruction and severe circulatory compromise (BP 80/60 mmHg). Critical actions: immediate IM epinephrine, airway preparation/intubation if necessary, IV fluids, antihistamines, and steroids. Adjuncts include continuous ECG and pulse oximetry monitoring. SAMPLE history confirms insect allergy. Differential: anaphylaxis requiring urgent ICU admission for monitoring.

2. Cardiac Arrest (Ventricular Fibrillation)

A 50-year-old male collapses at home and is brought in by bystanders receiving CPR en route. Primary survey shows pulselessness, apnea, and cardiac monitor reveals VF. Critical actions immediately initiated: rapid defibrillation, high-quality CPR, IV/IO access, administration of epinephrine and antiarrhythmic medications per ACLS guidelines. Adjuncts include continuous cardiac rhythm monitoring, ABG, bedside ultrasound (cardiac activity), and monitoring of CPR quality (waveform capnography). SAMPLE history limited, but notes chest discomfort prior to collapse. Immediate Cath lab transfer after return of spontaneous circulation (ROSC).

 3. Acute Stroke

A 68-year-old female arrives with a sudden onset of right-sided weakness and aphasia. Primary survey: stable airway, mild hypertension (BP 160/90 mmHg), normal SpO₂. Immediate critical actions include rapid neurological assessment (NIH Stroke Scale), IV access, bedside glucose assessment, and stroke code activation. Urgent adjunct imaging: non-contrast CT brain. SAMPLE history indicates hypertension and atrial fibrillation. Differential includes acute ischemic stroke. Patient is rapidly prepared for thrombolysis/thrombectomy with neurology consultation, followed by ICU admission (for BP monitoring every 15 minutes for the first 2 hours, then every 30 minutes for the next 6 hours, and maintain BP 180/105).

4. Intracranial Haemorrhage

An 80-year-old hypertensive patient presents in an altered state (GCS 6), after a sudden headache and collapse. Primary survey identifies a compromised airway requiring emergent intubation, hypertension (BP 200/110 mmHg), and an irregular breathing pattern. Critical interventions: airway stabilisation via intubation, IV antihypertensive therapy, seizure prophylaxis, and rapid neuroimaging (CT brain). SAMPLE history highlights poorly controlled hypertension. Provisional Diagnosis is intracranial haemorrhage. Neurosurgical consultation and transfer to the neurosurgical ICU are arranged.

5. Septic Shock (1-hour Bundle)

A 70-year-old diabetic female presents with fever, altered mental status. Primary survey reveals airway maintainable, tachycardic (HR 130 bpm), tachypnea (RR 28 breaths/min), hypotensive (BP 80 systolic) and hypoxia (SpO₂ 88%). Critical actions include high-flow oxygen via NRBM mask, IV fluid resuscitation, broad-spectrum antibiotics, and vasopressor support. Adjunct diagnostics include ABG, ECG, lactate measurement, cultures, and bedside ultrasound for fluid responsiveness. SAMPLE history significant for recent UTI symptoms. Differential diagnosis is septic shock from suspected urosepsis. Immediate ICU transfer is planned.

6. Acute Anterior STEMI

A 55-year-old man arrives with sudden-onset crushing chest pain radiating to the left arm, accompanied by nausea and diaphoresis. Primary survey: stable airway, hypotensive (BP 90/60 mmHg), SpO₂ 94%. Immediate critical actions include O₂ therapy, IV access, cardiac monitoring, analgesia, and antiplatelet administration (aspirin). ECG promptly identifies anterior STEMI. SAMPLE history significant for smoking and hypertension. Cath-lab activation for PCI.

7. Asthma Exacerbation

A 20-year-old female presents with an acute onset of severe breathlessness, accessory muscle use, and audible wheezing. Vital signs show HR 120 bpm, RR 32 breaths/min, SpO₂ 85%. Critical interventions include high-flow oxygen, nebulised bronchodilators, IV corticosteroids, and IV magnesium sulfate. Essential adjuncts: ABG, ECG, and bedside lung ultrasound (POCUS). SAMPLE history indicates known asthma with medication non-adherence. Differential includes severe asthma exacerbation confirmed clinically. Management includes admission to the ED ICU.

8. Acute Pulmonary Oedema

A 60-year-old patient arrives with severe breathlessness, frothy sputum, and agitation. Primary survey identifies maintainable airway but in respiratory distress (RR 34 breaths/min, SpO₂ 80%), hypertension (BP 190/110 mmHg), and tachycardia (HR 130 bpm). Critical actions include immediate O₂ via non-invasive ventilation (BiPAP), IV diuretics (furosemide), nitrate therapy, and cardiac monitoring. Adjunct diagnostics: ECG, ABG, chest X-ray (showing bilateral infiltrates), and bedside lung ultrasound. SAMPLE history reveals CHF, medication non-adherence. Diagnosis confirmed as cardiogenic pulmonary oedema. Immediate ICU admission and cardiology consult arranged.

9. Febrile Seizure

An 18-month-old child presents after a generalized tonic-clonic seizure lasting approximately 2 minutes, associated with fever (39.5°C). Primary survey: maintainable airway, normal breathing (SpO₂ 98%), postictal but arousable. Immediate actions include IV access, tepid sponging, antipyretic administration, seizure precautions (lorazepam), and cardiac monitoring. Adjunct diagnostics: blood glucose, CBC, blood cultures, and lumbar puncture if indicated by clinical suspicion of CNS infection. SAMPLE history indicates recent viral illness, no seizure history. Differential includes simple febrile seizure versus underlying CNS infection. Pediatric consultation and observation for 24 hours are recommended.

10. Postpartum Haemorrhage (PPH)

A 32-year-old woman, 2 hours postpartum, arrives with profuse vaginal bleeding, delayed CRT, hypotension (BP 80/50 mmHg), tachycardia (HR 125 bpm), and pallor. Primary survey: patent airway, severe circulatory compromise. Immediate critical actions include aggressive IV crystalloid resuscitation, massive blood transfusion initiation, uterine massage, and administration of uterotonic medications (oxytocin, tranexamic acid). Adjuncts: CBC, coagulation profile, blood typing and crossmatch, bedside ultrasound assessing uterine tone and retained products. SAMPLE history: recent normal vaginal delivery. Diagnosis of PPH. Immediate obstetrics and OT preparation are required.

11. Pulmonary Embolism (PE)

A 40-year-old woman presents with an acute onset of shortness of breath, pleuritic chest pain, tachypnea (RR 28 breaths/min), tachycardia (HR 120 bpm), and hypoxia (SpO₂ 88%). Primary survey reveals a stable airway but compromised breathing and circulation. Immediate critical actions include high-flow O₂, IV access, cardiac monitoring, and initiation of anticoagulation therapy (heparin). Adjunct diagnostics: ECG, ABG, D-dimer, and bedside echocardiogram showing RV strain. SAMPLE history notable for recent orthopaedic surgery. Diagnosis: acute PE. CTPA is required to confirm. Admission to the ICU for thrombolysis.

12. Acute Psychosis

A 25-year-old male arrives agitated, delusional, and hallucinating, posing a safety risk to staff and himself. Primary survey: airway patent, agitated but breathing normally, normal vitals (HR 105 bpm, BP 130/80 mmHg, SpO₂ 98%). Critical actions include immediate de-escalation techniques, safe restraint if necessary, IV access, administration of sedative medications (benzodiazepines, antipsychotics), and continuous monitoring for sedation and safety. Adjuncts include bedside glucose, drug toxicology screening, and ECG (due to antipsychotic use). SAMPLE history reveals no psychiatric history, but recent suspected illicit substance use. Diagnosis: substance-induced psychosis vs. first-episode psychosis. modified SAD PERSON Score assessment & Psychiatric consultation are required