Master Emergency Medicine & Trauma
for PLAB 1

What the PLAB 1 Tests in Emergency Medicine & Trauma

PLAB 1 tests your ability to recognise and manage acute undifferentiated presentations in Emergency Medicine & Trauma. You must demonstrate knowledge of immediate life-saving interventions, correct triage categories, and adherence to UK resuscitation council and NICE guidelines. Questions focus on decision-making: when to scan, when to operate, which drug at what dose, and which patient can be discharged. Common scenarios include major trauma, chest pain, dyspnoea, altered consciousness, anaphylaxis, and paediatric emergencies. You are expected to know specific criteria (e.g., SIRS, qSOFA, CURB-65, FAST-ED), first-line drugs (e.g., adrenaline for anaphylaxis, amiodarone for shockable rhythms), and critical thresholds (e.g., systolic BP <90 mmHg in sepsis, GCS ≤8 for intubation). The exam emphasises safe, guideline-based care within the first hour of presentation.

High-Yield Concepts

• Major Haemorrhage Protocol & Massive Transfusion: Activate major haemorrhage protocol if suspected bleeding with haemodynamic instability. Give tranexamic acid 1g IV over 10 minutes within 3 hours of injury (CRASH-2). Resuscitate with blood products 1:1:1 (PRBC:FFP:platelets). Target systolic BP 80-90 mmHg until surgical control (permissive hypotension).
• Chest Pain: STEMI vs NSTEMI vs Aortic Dissection: For STEMI (ST elevation >1mm in limb leads or >2mm in chest leads, new LBBB): immediate PCI or thrombolysis if PCI >120 min away. Give aspirin 300mg, ticagrelor 180mg, and heparin. For aortic dissection: severe tearing chest pain, BP differential, widened mediastinum on CXR; give labetalol or esmolol to reduce dP/dt, then urgent CT angiography.
• Sepsis Recognition & 1-Hour Bundle: Screen using qSOFA: altered mentation, RR ≥22, SBP ≤100. If positive, measure lactate, blood cultures, start IV broad-spectrum antibiotics (e.g., piperacillin-tazobactam 4.5g) within 1 hour, give 30mL/kg crystalloid if lactate ≥2 mmol/L or hypotension. Use NICE Sepsis NG51 for risk stratification.
• Anaphylaxis: Adrenaline Dosing and IM Route: First-line: adrenaline IM 0.5mg (0.5mL of 1:1000) into anterolateral thigh. Repeat every 5 minutes if no improvement. Give high-flow oxygen, IV fluids, chlorphenamine 10mg IV, and hydrocortisone 200mg IV. Do not use IV adrenaline unless in cardiac arrest or expert supervision.
• Major Trauma: C-spine, Pelvis, and Head Injury: Immobilise C-spine if any high-risk mechanism or GCS <15. For pelvic fracture with haemodynamic instability: apply pelvic binder. Head injury: CT head within 1 hour if GCS <13 at any point, or suspected open skull fracture, or coagulopathy. Use Canadian CT Head Rule for minor head injury.
• Cardiac Arrest Rhythms and ALS Algorithm: Shockable rhythms (VF/pVT): defibrillate 150-200J biphasic, then CPR 2 min, then adrenaline 1mg IV after 2nd shock, amiodarone 300mg after 3rd shock. Non-shockable (PEA/asystole): adrenaline 1mg IV every 3-5 min, treat reversible causes (4Hs and 4Ts).
• Diabetic Ketoacidosis (DKA) Management in Adults: Diagnosis: glucose >11 mmol/L, ketones ≥3 mmol/L, pH <7.3 or bicarbonate <15. Fluid: 1L 0.9% saline over 1 hour, then 500mL/hour. Fixed-rate insulin infusion 0.1 units/kg/hour. Monitor K+ and replace if <5.5 mmol/L. Give 10% glucose when glucose <14 mmol/L. Use DKA protocol from JBDS.
• Paediatric Fever: Sepsis and Meningitis Red Flags: In children <5 years: if non-blanching rash, neck stiffness, bulging fontanelle, or seizure — suspect meningitis. Give IV ceftriaxone 80mg/kg immediately. For sepsis: tachycardia, prolonged CRT >3s, hypotension, lethargy; give 20mL/kg bolus of 0.9% saline, repeat if needed, and IV antibiotics within 1 hour.

Common Traps in Emergency Medicine & Trauma Questions

• Giving IV adrenaline for anaphylaxis when IM is first-line and safer.
• Ordering CT head for every minor head injury without applying Canadian CT Head Rule criteria.
• Delaying antibiotics in sepsis while waiting for imaging or labs.
• Using crystalloid alone for massive haemorrhage instead of activating major haemorrhage protocol early.
• Forgetting to check glucose in all patients with altered consciousness before giving glucose or insulin.
• Administering amiodarone for a shockable rhythm before the 3rd shock in cardiac arrest.

How to Revise Emergency Medicine & Trauma for the PLAB 1

Prioritise memorising the UK-specific algorithms: ALS, sepsis 1-hour bundle, major haemorrhage protocol, and DKA management. Questions often present a brief scenario with a single critical decision point — e.g., 'what is the next step?' or 'which drug now?'. Practise applying triage categories (e.g., Manchester Triage) and interpreting ECGs for STEMI and hyperkalaemia. Focus on NICE guidelines for head injury, chest pain, and sepsis. Expect one or two paediatric emergency questions (fever, croup, anaphylaxis). Revise the 4Hs and 4Ts of cardiac arrest and the correct doses of adrenaline in different contexts (anaphylaxis vs cardiac arrest). Avoid overthinking; the correct answer is usually the safest, guideline-based intervention.

Practise it: MedLumen has 50 Emergency Medicine & Trauma questions for the PLAB 1, each with a full explanation and references.