Anaesthetics Knowledge Library
Scenario-by-scenario guides with a management focus — the decisions and the evidence behind them, mapped to the CT1 clinical judgement station.
Perioperative Emergencies
Airway
Critical Care
Professionalism
Acute medicine on the ward
Acute Asthma: BTS/SIGN Severity and Escalation
Life-threatening asthma is an SpO2 below 92 per cent plus any one of altered conscious level, exhaustion, arrhythmia, hypotension, cyanosis, silent chest, poor respiratory effort, PEF below 33 per cent, PaO2 below 8 kPa or a normal PaCO2; a raised PaCO2 is near-fatal asthma and needs an anaesthetist now (BTS/SIGN 158, amended May 2025).
Acute Coronary Syndrome and Chest Pain
Every suspected acute coronary syndrome gets a single 300 mg loading dose of aspirin as soon as possible; a STEMI presenting within 12 hours of symptom onset goes for primary PCI if it can be delivered within 120 minutes of the time fibrinolysis could have been given, otherwise fibrinolysis with an antithrombin; an NSTEMI gets fondaparinux and a GRACE score, with angiography within 72 hours if predicted 6-month mortality is above 3 per cent (NICE NG185).
Acute Kidney Injury
AKI is a creatinine rise of 26 micromol/L or more in 48 hours, a rise of 50% or more in 7 days, or urine output under 0.5 ml/kg/hour for over 6 hours (NICE NG148). Manage volume, stop the drugs that caused it, scan within 24 hours if the cause is unclear, and refer for renal replacement on the whole patient.
Anaphylaxis on the Ward
Ward anaphylaxis is treated with intramuscular adrenaline 500 micrograms into the anterolateral thigh, repeated after 5 minutes if there is no improvement, with the patient kept lying flat; the Resuscitation Council UK 2021 guideline calls it refractory once two doses have not worked.
COPD Exacerbation and Controlled Oxygen
In a COPD exacerbation, give oxygen to an SpO2 of 88 to 92 per cent until the blood gas is back, nebulise with air if the patient is hypercapnic or acidotic, give prednisolone 30 mg daily for five days, and use NIV as the treatment of choice for persistent hypercapnic ventilatory failure despite optimal medical therapy (NICE NG115; BTS 2017).
Diabetic Ketoacidosis
DKA is glucose above 11 mmol/L or known diabetes, ketones above 3 mmol/L, and venous pH below 7.3 or bicarbonate below 15 mmol/L. Fluid first, then fixed rate insulin at 0.1 units/kg/hour with potassium guided by the serum level, per JBDS 2023.
Lower Respiratory Tract Infection and CURB-65
CURB-65 scores one point each for confusion, urea over 7 mmol/L, respiratory rate 30 or more, systolic blood pressure under 90 or diastolic 60 or less, and age 65 or over: 0 to 1 is low risk, 2 intermediate, 3 to 5 high, and NICE NG250 (September 2025) wants antibiotics within 4 hours of presentation and critical care referral considered at 3 or more.
Meningitis: Recognition and the First Hour
NICE NG240 asks you to strongly suspect bacterial meningitis when fever, headache, neck stiffness and altered consciousness or cognition are all present, and to give intravenous antibiotics within 1 hour of arrival in hospital, with dexamethasone given with or before the first dose where possible.
New Atrial Fibrillation
New-onset atrial fibrillation with life-threatening haemodynamic instability gets emergency electrical cardioversion without waiting for anticoagulation; if the patient is stable, NICE NG196 offers rate or rhythm control when onset is under 48 hours and rate control alone when it is over 48 hours or uncertain, with a beta-blocker or diltiazem or verapamil first line and a CHA2DS2-VASc score to decide anticoagulation.
Pneumothorax: the BTS 2023 Pathway
The BTS 2023 pneumothorax pathway asks three questions in order: is the patient symptomatic, do they have a high-risk characteristic (haemodynamic compromise, significant hypoxia, bilateral pneumothorax, underlying lung disease, age 50 or over with a significant smoking history, or haemopneumothorax), and is it safe to intervene, usually 2 cm or more on the chest X-ray; high-risk patients get a chest drain, the rest choose between conservative care, an ambulatory device and needle aspiration.
Sepsis: the Sepsis Six and Source Control
NICE NG51 was replaced in November 2025 by NG253 for people aged 16 or over, which grades risk on NEWS2, gives broad-spectrum intravenous antibiotics within 1 hour at high risk, and resuscitates with 250 ml crystalloid boluses to a maximum of 1,000 ml before a senior clinical decision maker is involved.
Stroke and the FAST Pathway
NICE NG128 asks for a validated tool such as FAST outside hospital, hypoglycaemia excluded, and immediate non-enhanced CT when thrombolysis or thrombectomy is possible, the patient is anticoagulated, or the Glasgow Coma Scale score is below 13.
Upper GI Bleeding
Resuscitate, score with Blatchford at first assessment and full Rockall after endoscopy, and get the scope: immediately after resuscitation if unstable, within 24 hours for everyone else (NICE CG141). No PPI before endoscopy for suspected non-variceal bleeding; terlipressin and antibiotics at presentation if varices are suspected.
VTE and Pulmonary Embolism
Use the two-level Wells score: more than 4 points is PE likely and goes straight to CTPA, 4 or less gets a D-dimer within 4 hours, and interim anticoagulation covers any delay (NICE NG158). Haemodynamic instability means unfractionated heparin and consideration of systemic thrombolysis.
Electrolytes, perioperative and special groups
Calcium: Hypercalcaemia and Hypocalcaemia
Adjusted calcium above 3.5 mmol/L needs urgent correction with 4 to 6 litres of 0.9% saline over 24 hours and then an intravenous bisphosphonate; below 1.9 mmol/L, or symptomatic at any low level, needs 10 to 20 ml of 10% calcium gluconate over 10 minutes with ECG monitoring (Society for Endocrinology emergency guidance).
Obstetric Anaesthesia Emergencies: Collapse on the Labour Ward
A collapsed woman on the labour ward is managed as a cardiac arrest with three pregnancy changes: declare 'obstetric cardiac arrest', displace the uterus to the left from 20 weeks, and prepare for resuscitative hysterotomy from the start.
Potassium: Hyperkalaemia and Hypokalaemia
Hyperkalaemia is mild at 5.5 to 5.9, moderate at 6.0 to 6.4 and severe at 6.5 mmol/L or above. With ECG changes give 30 ml of 10% calcium gluconate over 10 minutes, then 10 units of insulin in 25 g of glucose, nebulised salbutamol and a potassium binder, per the UK Kidney Association guideline updated July 2026.
Pre-operative Assessment and ASA Grading
ASA physical status runs from I, a normal healthy patient, to VI, a declared brain-dead organ donor, with E added for emergencies; it describes comorbidity, not risk on its own. NICE NG45 decides the tests by surgery grade and ASA grade, and GPAS chapter 2 sets what a pre-assessment service must do.
Sodium: Hyponatraemia and Safe Correction
Treat symptoms, not the number: severe or moderately severe symptoms get 150 ml of 3% saline over 20 minutes, repeated to a 5 mmol/L rise in the first hour, then a ceiling of 10 mmol/L in the first 24 hours and 8 mmol/L per day after (Society for Endocrinology 2022).
The Sick Child: Recognition and Paediatric Differences
A sick child is recognised by colour, activity, breathing and circulation before any single number, graded red, amber or green by NICE NG143, with antibiotics within 1 hour and a 10 ml/kg fluid bolus capped at 250 ml when NG254's high risk sepsis criteria are met.
The Trauma Call: The Anaesthetist's Role
At a trauma call the anaesthetist owns the airway and shares the resuscitation, and the Royal College of Anaesthetists says the role extends beyond intubation to the recognition and management of physiological derangement, haemorrhage and shock.
Professional and the application
Audit vs Research vs QI in Anaesthetics
Audit measures practice against an existing standard, research generates new knowledge where none exists, and quality improvement changes a process and measures whether the change worked. Comparing the three is a named Stage 1 capability in the Royal College of Anaesthetists 2021 curriculum.
CT1 vs ACCS: Choosing and Explaining Your Route
Core anaesthetics is three indicative years of Stage 1 at CT1 to CT3, while ACCS anaesthetics is a four-year programme with two years of six-month rotations in emergency medicine, internal medicine, anaesthetics and intensive care before two years of anaesthesia. One Oriel application and one interview cover both.
Commitment to Anaesthetics: The Evidence the Panel Credits
ANRO's Commitment to Specialty descriptor names what it credits: undergraduate placements in anaesthesia or intensive care, taster sessions, career open days, student selected components, projects, quality improvement, knowledge of the training scheme and a career development plan.
Reflective Practice in an Interview Answer
Reflective Practice is a scored domain at the CT1 anaesthetics interview, and ANRO's descriptor asks for a real example, what you did with feedback, what changed in your practice, and awareness of GMC guidance on being a reflective practitioner.
Structuring a Spoken Answer for the Anaesthetics Interview
A spoken clinical judgement answer at the CT1 anaesthetics interview has four moves in order: a one-sentence headline, an A to E assessment said aloud, a named escalation, and a reflection, because ANRO's assessors score structure, prioritisation and a contingency plan explicitly.
Working Under Pressure: The Human Factors Answer
Working Under Pressure is a named domain worth 5 marks per assessor at the CT1 anaesthetics interview, and ANRO's own descriptor scores calm, clear decisions, task prioritisation, insight into your own limitations and a flexible response to being challenged.
The approach and the airway
ABCDE for the Anaesthetic CT1: What 'Stabilise, then Call' Means in Practice
Stabilise, then call means treating each life-threatening ABCDE problem as you find it while help is already on its way: the Resuscitation Council UK ABCDE guidance says to treat before moving on, reassess after every intervention, and call for appropriate help early.
Oxygen Therapy, CPAP and When to Intubate: Type 1 vs Type 2 Failure
Type 1 respiratory failure is a PaO2 below 8 kPa with a normal or low PaCO2 and type 2 is a PaCO2 above 6.1 kPa whatever the saturation; the British Thoracic Society targets 94 to 98% saturation, or 88 to 92% in those at risk of hypercapnic failure, and non-invasive ventilation starts at a pH below 7.35 with a PaCO2 above 6.5 kPa.
Rapid Sequence Induction: Indications and the Standard Drugs
Rapid sequence induction is the technique for a patient at risk of aspiration: preoxygenation with a tight-fitting mask at 10 to 15 L/min for 3 minutes, a predetermined dose of induction agent and a neuromuscular blocker given together, cricoid force applied at 10 N awake and 30 N once unconscious, and a maximum of three intubation attempts before declaring failure, as the 2018 DAS critically-ill guideline sets out.
Reduced Consciousness and the GCS
The Glasgow Coma Scale runs from 3 to 15 across eye opening, verbal and motor responses, and NICE NG232 defines severe traumatic brain injury as 8 or less, which is also the score at which an appropriately trained clinician is needed for advanced airway management.
Shock: Recognition and Management by Type
Shock is inadequate tissue perfusion, and the Resuscitation Council UK ABCDE guidance says to consider hypovolaemia the primary cause in almost all medical and surgical emergencies until proven otherwise, giving 500 ml of crystalloid over less than 15 minutes to a hypotensive adult and reassessing every 5 minutes.
The Crash Call: ALS 2021 in the Anaesthetic Context
At a crash call the Resuscitation Council UK adult ALS guideline, republished in October 2025 with no major changes from 2021, gives adrenaline 1 mg as soon as possible in a non-shockable rhythm and after the third shock in a shockable one, repeated every 3 to 5 minutes, with amiodarone 300 mg after three shocks; the anaesthetist's job is the airway, waveform capnography and the reversible causes.
FAQ
What is the Anaesthetics Knowledge Library?
Free scenario-by-scenario guides for the CT1 anaesthetics interview's clinical judgement station: the decisions and the evidence behind them. No account is needed.
How does it help with the CT1 interview?
The guides cover the reasoning the clinical judgement station tests. The question bank turns the same scenarios into full practice stations with model answers.