Today’s acute-care material begins with mechanism-based prehospital pharmacology. Medicines used during transfer or emergency care should be selected according to the immediate physiological problem rather than treated as interchangeable options. Naloxone is titrated to restore adequate ventilation after opioid exposure, not necessarily to produce full wakefulness. Rocuronium causes paralysis without analgesia, anxiolysis or amnesia, and sodium bicarbonate generates carbon dioxide that must be cleared through adequate ventilation. Medication handover should therefore include the indication, dose, route, timing, response, adverse effects and ongoing monitoring requirements.

Preschool wheeze provides the paediatric and antimicrobial-stewardship thread. Severity assessment should focus on oxygen saturation, work of breathing, air entry, wheeze and response to treatment, with the PRAM score offering a structured bedside measure. Acute care centres on bronchodilators, systemic corticosteroids when indicated, oxygen for hypoxaemia and repeated clinical reassessment. Azithromycin does not provide meaningful improvement in wheeze-related symptoms, length of stay or early return visits when there is no separate bacterial indication. Detection of bacteria in the nasopharynx may represent colonisation and should not be mistaken for proof of lower respiratory infection.

The critical-care episode shifts attention from ICU survival to recovery. Post-intensive care syndrome may involve new or worsened weakness, reduced mobility, memory or executive difficulties, anxiety, depression, intrusive memories, sleep disturbance and persistent pain. Establishing pre-admission function is essential because trauma, traumatic brain injury and chronic health problems may also explain later impairment. Patients who spend at least 48 hours in intensive care can be screened across physical, cognitive and psychological domains at ICU and hospital discharge, with follow-up adapted to symptoms and local services.

Multidisciplinary post-ICU care may involve physiotherapy, occupational therapy, cognitive or speech support, pharmacy review and mental-health services. Practical assessments include the Montreal Cognitive Assessment, timed up and go, walking tests or grip strength when lower-limb injury makes mobility testing unreliable. Recovery conversations should acknowledge that improvement may be prolonged or incomplete and that discharge marks the beginning of survivorship care rather than the end of clinical responsibility.