SNB Medical Emergencies and Critical Care: What to Do First

Scope and time budget

Six questions is six minutes, and emergency stems are usually short. A patient collapses, a result comes back, a monitor alarms. The test is whether you can recognise the problem, do the first thing and call for help in the right way. The SNB test plan lists medical emergencies as its own category, and emergencies also touch critical thinking, client safety and delegation. Because wrong answers here are the most dangerous in real life, examiners tend to set strong distractors: actions that are sensible but not first.

What is tested

• Cardiac arrest and basic life support. Recognition, calling for help, compressions, airway and breathing, early defibrillation, and handover to the team.
• Anaphylaxis. Remove the trigger, call for help, give the first-line medicine by the correct route, position, give oxygen and monitor.
• Sepsis. Recognise early signs, escalate using the early warning score, and expect cultures, fluids and antibiotics within the time set by local protocol.
• Shock and haemorrhage. Direct pressure, positioning, access, fluids or blood as ordered and monitoring of response.
• Acute myocardial infarction and chest pain. Rest, oxygen if indicated, electrocardiogram, medicines per protocol and rapid escalation.
• Acute stroke. The FAST approach, time of onset, blood glucose, swallow precautions and rapid referral.
• Seizures. Protect from injury, time the event, do not restrain or put anything in the mouth, then position and observe after the seizure and call for help if prolonged.
• Trauma and triage. Airway with spine protection, breathing, circulation, disability, exposure. Prioritise life-threatening injuries first.
• Burns and smoke inhalation. Stop the burning, cool, assess airway risk, estimate the extent, give fluids and pain relief.
• Poisoning and overdose. Identify the substance, protect the airway, seek poison advice and know the antidote principle.
• Choking and airway obstruction. Encourage coughing, back blows and abdominal thrusts as appropriate, and start resuscitation if the patient becomes unresponsive.
• Rapid response and SBAR. Situation, background, assessment, recommendation, with the numbers.
• Disaster and fire safety. Mass casualty triage categories and the fire response sequence in a ward.
• Hypoglycaemic and hypertensive crises. Recognition and first-line management.

Singapore points to anchor your answers

• Resuscitation guidelines. Hospitals follow international resuscitation guidance, as adopted by local resuscitation committees. Confirm the current sequence and numbers from the guideline your institution uses.
• Escalation. Hospitals use early warning scores and rapid response teams, so the right answer is usually to escalate promptly using SBAR, not to wait and re-check for a long time.
• Disaster planning. Hospitals have mass-casualty and fire plans. Expect questions on triage categories and on the order of actions in a ward fire: rescue, alarm, contain and extinguish or evacuate.
• Advance directives. Check for a documented resuscitation status or advance medical directive, but never delay an emergency while searching, and follow your institution's policy.

Three typical traps

1. Doing a good action in the wrong order. In an emergency the first action is the one that restores or protects airway, breathing and circulation. Taking a full history or contacting the family comes later.
2. Delaying escalation. Choosing to "reassess in 30 minutes" when the early warning score is high is rarely right. Call for help, then continue care.
3. Misreading the triage question. In multiple trauma, the priority is the injury that threatens life soonest, not the one that looks worst or makes the most noise.

How to revise it

1. Write the first three actions for each of the 14 subtopics on a single sheet.
2. Practise ABCDE as a spoken routine with numbers.
3. Learn the stroke and chest pain pathways and what you do before the doctor arrives.
4. Practise SBAR aloud for three deteriorating-patient scenarios, in 30 seconds each.
5. Make a triage chart of categories and example patients.
6. Do timed blocks of ten emergency questions and note which first action you picked and why.

Pair this domain with assessment and wound care for early warning, medication for anaphylaxis and collaboration and delegation for escalation.

Worked reasoning patterns

The ABCDE spine

Whatever the emergency, a nurse who works from airway to exposure will rarely be far wrong. Airway first, with spinal protection if trauma is possible. Breathing next, with oxygen and ventilation support. Circulation, with bleeding control and access. Disability, including consciousness and glucose. Exposure, including temperature and injuries. Most answer sets contain one option that follows this order.

Recognise, call, act

Many stems end with a question about the next step. If the patient is deteriorating, recognising and calling for help comes before collecting more data. Then act within your role while help arrives, and hand over using SBAR.

Triage is relative

In mass-casualty questions, the highest priority goes to patients who are in immediate danger and likely to survive with prompt treatment. Those who are walking and stable wait. Learn your institution's category names and colours from a local source.

Revision targets

Use short, frequent practice rather than long reading. Emergency knowledge is mostly recall under pressure, and recall improves with repetition.