ABPS Emergency Medicine (BCEM) flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Defibrillation for VF/pVT

Deliver an unsynchronized shock immediately for ventricular fibrillation or pulseless ventricular tachycardia, then resume CPR; epinephrine 1 mg every 3–5 minutes and amiodarone 300 mg after the third shock.

STEMI reperfusion time targets

Primary PCI door-to-balloon time should be ≤90 minutes at PCI-capable centers; fibrinolysis should begin within 30 minutes of arrival when PCI is unavailable and no contraindication exists.

Septic shock initial bundle

Give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, obtain blood cultures before antibiotics, and administer broad-spectrum antibiotics within one hour of recognition.

Anaphylaxis first-line treatment

Intramuscular epinephrine 0.3–0.5 mg of 1 mg/mL solution into the anterolateral thigh, repeated every 5–15 minutes; antihistamines and steroids are adjuncts and never replace epinephrine.

Ischemic stroke thrombolysis window

Intravenous alteplase may be given within 4.5 hours of last known well after CT excludes intracranial hemorrhage; target door-to-needle time is ≤60 minutes.

Hyperkalemia with ECG changes

Give intravenous calcium (gluconate or chloride) first to stabilize the myocardium, then shift potassium intracellularly with insulin/glucose and a beta-agonist; dialysis for refractory cases.

Tension pneumothorax decompression

A clinical diagnosis requiring immediate needle decompression at the second intercostal space midclavicular line or fourth to fifth intercostal space anterior axillary line, before any imaging.

Naloxone titration principle

Titrate naloxone to restore adequate ventilation rather than full arousal, and observe for renarcotization because naloxone's half-life is shorter than that of many opioids.

PERC rule purpose

The PERC rule excludes pulmonary embolism in low pretest probability patients when all eight criteria are negative, avoiding unnecessary D-dimer testing and imaging.

Aortic dissection blood pressure goal

In acute aortic dissection, reduce heart rate and blood pressure with a beta-blocker first (target heart rate about 60/min), then add a vasodilator if needed.

Pediatric weight-based epinephrine dose

For pediatric cardiac arrest, give epinephrine 0.01 mg/kg IV/IO of 0.1 mg/mL solution every 3–5 minutes; the maximum single dose is 1 mg.

Croup treatment

Give a single dose of dexamethasone (0.15–0.6 mg/kg) to all children with croup; add nebulized epinephrine for moderate to severe stridor or retractions.

Diabetic ketoacidosis fluid first

Begin with isotonic crystalloid bolus before insulin; start an insulin infusion only after potassium is confirmed above 3.3 mEq/L, and add dextrose when glucose falls below about 200–250 mg/dL.

Torsades de pointes treatment

Give intravenous magnesium sulfate, correct electrolyte deficiencies, and consider overdrive pacing or isoproterenol; avoid QT-prolonging drugs.

Boerhaave syndrome presentation

Spontaneous esophageal rupture presents with severe chest pain, subcutaneous emphysema, and mediastinal air after vomiting; it requires urgent surgical consultation and broad-spectrum antibiotics.

Oral case presentation structure

Present unstable findings first, then the primary survey, resuscitation priorities, differential diagnosis, investigations, and disposition; examiners score structured reasoning over recall speed.

Definitive airway indication

Escalate to a definitive airway when the patient cannot maintain oxygenation or ventilation, cannot protect the airway, or has an anticipated deteriorating course.

Shock category naming

For any shock case, explicitly name the category (hypovolemic, distributive, cardiogenic, or obstructive) and state the immediate intervention specific to that category.

Toxicology case components

State the toxidrome, the specific antidote if one exists, the decontamination decision, and the observation or disposition rationale explicitly.

Trauma primary survey verbalization

Verbalize the ABCDE primary survey with findings and interventions at each step before moving to adjuncts, the secondary survey, and definitive disposition.

Pediatric dosing in oral exam

State weight-based doses and age-specific normal ranges aloud, and address caregiver communication and child-protection concerns when the scenario raises them.

Disposition justification

State the disposition (admit, observe, discharge with follow-up, or transfer) with explicit criteria and a reassessment interval, rather than a vague plan.

Safe default when uncertain

When uncertain, verbalize a safe default: stabilize the patient, obtain consultation, and document reasoning, rather than guessing an unsupported answer.

Closed-loop communication

In resuscitation scenarios, direct orders to a named individual and require verbal confirmation of task completion to demonstrate team leadership.

Handover structure

Use a structured handover (identify patient, situation, background, assessment, recommendation) when transferring care during an oral station.

Breaking bad news framework

Use a structured framework (setting, perception, invitation, knowledge, empathy, strategy) and explicitly address the patient's emotional response and next steps.

Ethical dilemma response

Identify the competing principles (autonomy, beneficence, nonmaleficence, justice), state the legal framework for capacity or consent, and propose a consultative resolution.

Resource-limited triage

Apply a mass-casualty triage system, prioritize immediate life-saving interventions, and justify allocation decisions using expected survival benefit.

Error disclosure in oral exam

Acknowledge the error, disclose it to the patient or family, document it, and describe system-level reporting and prevention steps.

Airway assessment verbalization

Describe the airway assessment (mouth opening, Mallampati, thyromental distance, neck mobility) and state the backup plan for a failed airway.

Discharge safety discussion

State return precautions, follow-up arrangements, medication reconciliation, and social barriers to safe discharge, then confirm patient understanding.

Consultation request structure

State the clinical question, urgency, relevant findings, and what you need from the consultant, then confirm agreement on the plan and timeframe.