Phase 1: Core Clinical Sciences
Scenario-Based Learning - 80% Weightage in NORCET
Module Overview
This module covers critical care scenarios, pharmacology essentials, and midwifery topics. Focus on prioritization using Airway → Breathing → Circulation.
1Critical Care & MSN Scenarios
Focus: Prioritization (Airway > Breathing > Circulation)
Scenario A: Mechanical Ventilation Alarms
The Situation: You are caring for a patient on Volume Control Ventilation. The 'High Pressure Limit' alarm sounds.
Immediate Assessment (DOPE Mnemonic):
Displacement
Check ETT position
Obstruction - TOP PRIORITY
Bite block? Mucus plug? Kinked tubing? (Suction immediately)
Pneumothorax
Listen for absent breath sounds on one side
Equipment
Ventilator malfunction
Exam Tip
Low Pressure Alarm = Disconnection or Cuff Leak
Scenario B: Myocardial Infarction (MI) Management
The Situation: Patient arrives with crushing chest pain radiating to the left arm.
The 'MONA' Protocol (Updated Priority):
| Priority | Intervention | Notes |
|---|---|---|
| 1 | Oxygen | Only if SpO₂ < 94% |
| 2 | Aspirin 325mg Chewable | PRIORITY DRUG - Antiplatelet |
| 3 | Nitroglycerin (Sublingual) | Contraindicated: RV Infarction, Sildenafil use |
| 4 | Morphine | For pain/anxiety (Use cautiously in hypotension) |
2Dedicated Pharmacology
High-Yield Drug List for NORCET:
1. Adenosine
Drug of choice for SVT. Administer Rapid IV Push (1-2 sec) followed by saline flush. Lift arm.
2. Digoxin
Cardiac Glycoside. HOLD if HR < 60.
Watch for toxicity: Halo vision, Nausea, Vomiting. Therapeutic range: 0.5–2.0 ng/mL
3. Lithium
For Bipolar Disorder. TOXIC > 1.5 mEq/L. Causes tremors, polyuria.
Diet: Maintain normal Sodium intake (Low Na+ = High Lithium toxicity)
4. Magnesium Sulfate
Drug of choice for Eclampsia. Antidote: Calcium Gluconate
5. Heparin
Anticoagulant. Monitor: PTT (Partial Thromboplastin Time). Antidote: Protamine Sulfate
6. Warfarin
Anticoagulant. Monitor: PT/INR. Antidote: Vitamin K
3Midwifery & OBG
Topic: Post-Partum Hemorrhage (PPH)
Definition:
>500ml (Vaginal) or >1000ml (C-Section)
| Step | Intervention | Important Notes |
|---|---|---|
| 1 | Fundal Massage | FIRST intervention for uterine atony |
| 2 | Oxytocin (IV/IM) | Stimulates uterine contraction |
| 3 | Methergine | CONTRAINDICATED in Hypertension |
| 4 | Carboprost | CONTRAINDICATED in Asthma |
Exam Tip
Remember '4 Ts' of PPH - Tone, Trauma, Tissue, Thrombin
Key Takeaways
- Use DOPE for ventilator alarms (Displacement, Obstruction, Pneumothorax, Equipment)
- MONA for MI - Aspirin is the priority drug!
- Know drug antidotes: Heparin → Protamine, Warfarin → Vitamin K, MgSO₄ → Calcium Gluconate
- PPH first intervention: Fundal Massage