ABEM EM key terms

A physiologic state in which blood pressure, perfusion, or cardiac output is inadequate to meet tissue oxygen demand, often signaled by hypotension, altered mentation, cool skin, or rising lactate. It changes urgency and disposition decisions in emergency care.

Heart rate divided by systolic blood pressure. A value above roughly 0.9 to 1.0 suggests occult hypoperfusion even when blood pressure appears normal, making it useful for triage and transfusion triggers in trauma and hemorrhage.

The percentage decline in serum lactate over time, typically measured over two hours. Failure to clear lactate indicates ongoing hypoperfusion and predicts worse outcome in sepsis and other shock states.

A time-targeted set of actions for suspected sepsis, including cultures, broad-spectrum antibiotics, fluid resuscitation, and lactate measurement. Bundle completion within specified hours is linked to improved survival and is used as a quality measure.

Procedures that physically remove or drain the origin of infection, such as abscess drainage, debridement of necrotic tissue, or relief of an obstructed viscus. Antibiotics alone often fail without it.

A preplanned, balanced delivery of packed red cells, plasma, and platelets with limited crystalloid for severe hemorrhage. It reduces dilutional coagulopathy and is activated by clinical triggers rather than laboratory confirmation.

Deliberately accepting a lower-than-normal blood pressure during active hemorrhage, usually before surgical control, to avoid dislodging clots. It is generally avoided in traumatic brain injury, where cerebral perfusion pressure must be preserved.

A strategy for severely injured patients emphasizing hemorrhage control, limited crystalloid, balanced blood products, and correction of hypothermia, acidosis, and coagulopathy before definitive repair.

The self-reinforcing combination of hypothermia, metabolic acidosis, and coagulopathy that worsens bleeding and mortality after major trauma. Prevention and active correction are core resuscitation goals.

A clinical decision rule clearing cervical spine imaging in blunt trauma when there is no midline tenderness, no neurologic deficit, normal alertness, no intoxication, and no distracting injury. High sensitivity supports selective imaging.

A validated rule for cervical spine imaging after blunt trauma that uses age, mechanism, ability to rotate the neck, and examination findings. It is more selective than NEXUS in some populations and requires an alert, stable patient.

A decision rule limiting ankle or foot radiography to patients with bone tenderness at specified sites or inability to bear weight. It safely reduces imaging in adults with acute ankle injury.

A structured pretest probability tool for pulmonary embolism using clinical signs, risk factors, and the likelihood of an alternative diagnosis. It guides whether to use D-dimer testing or proceed to imaging.

The Pulmonary Embolism Rule-out Criteria: eight low-risk features that, when all present in a patient judged to have low pretest probability, allow pulmonary embolism to be excluded without further testing.

Raising the D-dimer positivity threshold with advancing age, commonly age times ten in patients over 50, to improve specificity for pulmonary embolism while preserving sensitivity.

A risk stratification tool for chest pain in the emergency department scoring history, electrocardiogram, age, risk factors, and troponin. Low scores identify patients suitable for early discharge or observation.

A collaborative process in which clinicians present options, benefits, and harms and patients contribute values and preferences before a plan is chosen. It supports informed consent and defensible documentation.

A patient's voluntary agreement to a proposed intervention after receiving information about its nature, risks, benefits, and alternatives, and after demonstrating understanding. Emergency exceptions exist when the patient lacks capacity and delay would cause harm.

A patient's clinical ability to understand relevant information, appreciate the consequences, reason about options, and communicate a choice. It is assessed for a specific decision rather than assigned globally.

Documented departure from care before the recommended plan is complete, initiated by a patient with capacity. The record should capture risks explained, alternatives offered, and the patient's stated reasoning.

The federal Emergency Medical Treatment and Labor Act requiring a medical screening examination and stabilizing treatment for anyone presenting to a Medicare-participating emergency department, regardless of ability to pay, before transfer or discharge.

The evaluation required under EMTALA to determine whether an emergency medical condition exists. It must be performed by a qualified provider and cannot be delayed to inquire about insurance or payment.

An EMTALA-compliant transfer of an unstable patient in which the receiving facility accepts, the benefit outweighs risk, the patient consents, and records and stabilizing treatment accompany the patient.

A legal duty to notify authorities of specified conditions such as suspected child or elder abuse, certain communicable diseases, and some injuries. Scope and thresholds vary by jurisdiction.

The professional obligation to report a colleague whose impairment or incompetence endangers patients, usually through defined institutional channels. It is a patient-safety duty, not a discretionary courtesy.

A framework distinguishing human error, at-risk behavior, and reckless conduct when responding to adverse events. It encourages error reporting while holding reckless behavior accountable.

A structured, systems-focused review of a serious adverse event that identifies contributing factors and produces corrective actions. Its purpose is prevention rather than assigning individual blame.

A rapid improvement method in which a small change is planned, tested, studied for results, and then adopted, adapted, or abandoned. Repeated cycles support iterative quality improvement.

A time-ordered plot of a measure used to detect nonrandom change, such as a shift of several consecutive points or a trend. It helps teams judge whether an improvement intervention had an effect.

Telling a patient or family about a harmful error or adverse event, explaining what happened, expressing regret, and describing steps to prevent recurrence. It is an ethical and often institutional expectation.

Systematically developed statements that assist decisions about care for specific circumstances. Guidelines are advisory and must be integrated with patient values and local resources.

A campaign producing specialty-specific lists of tests and treatments that are commonly overused and may offer little benefit. It supports stewardship and shared decision-making conversations.

The interval from emergency department arrival to reperfusion by primary percutaneous coronary intervention in ST-elevation myocardial infarction. It is a tracked performance measure because shorter times improve outcomes.

A patient who leaves before completing an emergency department evaluation. It is a core throughput and access metric reflecting crowding, wait times, and risk of adverse outcomes.

Holding admitted patients in the emergency department because inpatient beds are unavailable. Prolonged boarding is associated with crowding, delayed treatment, and worse outcomes.