ABEM EM cheat sheet

Acute coronary syndrome: serial high-sensitivity troponin with delta criteria; a single undetectable troponin at least 3 hours after symptom onset plus non-ischemic ECG identifies low-risk chest pain suitable for accelerated rule-out.

Acute ischemic stroke: IV thrombolysis window 0–4.5 hours from last known well; mechanical thrombectomy up to 24 hours in selected large-vessel occlusion by DAWN/DEFUSE-3 imaging criteria.

Sepsis: qSOFA (RR ≥22, SBP ≤100, altered mentation) is a prompt for further assessment, not a stand-alone diagnosis; septic shock = vasopressor need to keep MAP ≥65 plus lactate >2 mmol/L despite fluids.

Anaphylaxis: IM epinephrine 0.01 mg/kg of 1:1000 (max 0.5 mg) anterolateral thigh; antihistamines and steroids are adjuncts and do not treat airway or shock.

Pediatric weight estimate: (age in years + 4) × 2 kg; use length-based tape when available for dosing and equipment sizing.

Hyperkalemia with ECG changes: IV calcium first for membrane stabilization, then insulin/glucose and beta-agonist to shift, plus removal (diuretics, binder, dialysis).

Trauma: permissive hypotension (SBP ~90) until hemorrhage control in penetrating trauma; tranexamic acid within 3 hours of injury reduces mortality in bleeding trauma patients.

Wells/Geneva and PERC stratify PE pretest probability; PERC-negative low-risk patients need no D-dimer, and age-adjusted D-dimer (age × 10 in patients >50) improves specificity.

MyEMCert is the continuing-certification pathway: a set of focused online modules plus attestations, replacing the single high-stakes recertifying exam for most diplomates.

Module content is organized by clinical topic (e.g., cardiovascular, trauma, pediatrics, critical care); each module is completed within a defined window and scored against a passing standard.

Module items are typically answered with immediate feedback and references, and incorrect responses may require a short learning activity before the module closes.

Diplomates must complete all required modules and the Improvement in Medical Practice and professionalism attestations within each certification cycle to remain certified.

The Advanced Practice Provider (APP) pathway allows eligible PAs and NPs to sit a focused examination and hold a defined, distinct credential.

MyEMCert modules are open-book by design; the assessment emphasizes applied clinical judgment and current guideline-concordant management rather than recall.

Cycle length is 5 years with an annual distribution of modules; failure to complete required activities by the deadline can lapse certification.

Content is developed through peer item writing and psychometric review, with each item mapped to a clinical topic and a model of clinical reasoning.

PDSA cycle: Plan (state aim, predict, plan data collection) → Do (small-scale test) → Study (compare results to prediction) → Act (adopt, adapt, or abandon).

AIM statement format: a clear, measurable aim naming the population, the metric, the direction of change, and the time frame.

Run charts and statistical process control charts distinguish common-cause from special-cause variation; a shift of 6+ consecutive points or a defined trend signals special cause.

Measure types: structure (resources), process (what is done), outcome (patient result); process measures are most sensitive to improvement work.

Balancing measures detect unintended effects of a change on other parts of the system and are reported alongside the primary measure.

Root cause analysis uses a causal (fishbone) diagram and the 5 Whys; it is applied to system failures, not to assign individual blame.

MOC Part IV (Improvement in Medical Practice) requires a documented, data-driven quality activity relevant to the diplomate's practice with a measured outcome.

Clinical practice guidelines are graded by strength of recommendation and quality of evidence; local protocols should be adapted to local resources and measured for effect.

The physician–patient relationship rests on fiduciary duty, autonomy, beneficence, nonmaleficence, and justice; informed consent requires capacity, disclosure, understanding, and voluntariness.

Emergency exception to consent applies when immediate treatment is needed to prevent serious harm and the patient lacks capacity with no available surrogate.

EMTALA: a medical screening examination and stabilizing treatment are required regardless of ability to pay; transfer only for medical benefit with an accepting facility and qualified transport.

Mandatory reporting duties include suspected child abuse/neglect, elder and dependent-adult abuse, and specified communicable diseases and injuries (e.g., gunshot wounds in many jurisdictions).

Impairment and fitness for duty: a colleague who is impaired should be reported to the appropriate physician health program or authority; patient safety takes precedence over collegiality.

Conflicts of interest must be disclosed and managed; gifts and industry relationships that could bias clinical judgment are avoided or transparently disclosed.

Professional standing requires an unrestricted license, current certification, and compliance with CME, licensure, and institutional credentialing requirements.

Boundary violations (sexual misconduct, inappropriate dual relationships) are reportable and are distinct from boundary crossings, which may be benign and context-dependent.