Arab Board EM Part 1 cheat sheet

Ventricular fibrillation/pulseless VT: defibrillate immediately at 120-200 J biphasic (or 360 J monophasic), then CPR for 2 minutes before rhythm recheck.

Asystole/PEA: epinephrine 1 mg IV/IO every 3-5 minutes; no defibrillation.

Acute STEMI: door-to-balloon <90 min at PCI center; fibrinolysis within 30 min if PCI unavailable and symptom onset <12 h without contraindications.

Unstable tachycardia with a pulse: synchronized cardioversion (narrow regular 50-100 J, narrow irregular 120-200 J, wide regular 100 J, wide irregular defibrillation dose).

Aortic dissection: avoid thrombolytics; target HR <60 and SBP 100-120 mmHg with IV beta-blocker first, then vasodilator.

Cardiac tamponade: Beck triad (hypotension, distended neck veins, muffled heart sounds); treat with IV fluids and pericardiocentesis.

Pulmonary embolism with hemodynamic instability: systemic thrombolysis (alteplase 100 mg over 2 h) or catheter-directed therapy.

Hypertensive emergency: reduce MAP by no more than 25% in first hour (except aortic dissection, eclampsia, or stroke).

Asthma severity: peak flow <40% predicted = severe; <25% = life-threatening; silent chest and altered consciousness are life-threatening signs.

Tension pneumothorax: immediate needle decompression (2nd intercostal space midclavicular line or 5th ICS anterior axillary line) before imaging.

COPD exacerbation: controlled oxygen to target SpO2 88-92%; noninvasive ventilation for pH <7.35 with hypercapnia.

Massive hemoptysis: >400 mL in 24 h or >100 mL/h; secure airway with endotracheal tube (consider double-lumen) and lateral decubitus positioning toward the bleeding side.

ARDS Berlin criteria: acute onset within 1 week, bilateral opacities, PaO2/FiO2 ≤300 mmHg with PEEP ≥5 cmH2O, not fully explained by cardiac failure.

Pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, RR ≥30, BP <90/60, age ≥65); score ≥2 consider admission, ≥3 ICU assessment.

Acute ischemic stroke: IV thrombolysis (alteplase 0.9 mg/kg, max 90 mg) within 4.5 h of onset; mechanical thrombectomy up to 24 h in selected large-vessel occlusion.

Stroke thrombolysis contraindications include BP >185/110 mmHg, recent intracranial surgery, active bleeding, and platelet count <100,000/µL.

Subarachnoid hemorrhage: CT within 6 h of onset has near 100% sensitivity; if negative and suspicion persists, perform lumbar puncture for xanthochromia.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg IV or midazolam 10 mg IM), then second-line (fosphenytoin, valproate, levetiracetam), then anesthetic infusion.

Bacterial meningitis: dexamethasone 10 mg IV before or with first antibiotic dose; do not delay antibiotics for lumbar puncture.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia; stop serotonergic agents and give benzodiazepines; cyproheptadine for severe cases.

Neuroleptic malignant syndrome: rigidity, hyperthermia, altered mental status, autonomic instability, elevated CK; treat with dantrolene or bromocriptine and supportive care.

Upper GI bleed: IV proton pump inhibitor after endoscopy; transfuse to hemoglobin 7-8 g/dL (restrictive strategy) unless massive bleeding or cardiac ischemia.

Acute pancreatitis: diagnosis requires 2 of 3 (characteristic pain, lipase >3× upper limit, imaging findings); aggressive IV fluids (lactated Ringer's) are cornerstone.

Hepatic encephalopathy: lactulose titrated to 2-3 soft stools/day; rifaximin as add-on; correct precipitating factors (infection, bleeding, constipation).

Spontaneous bacterial peritonitis: ascitic fluid PMN ≥250/µL; treat with third-generation cephalosporin and albumin 1.5 g/kg day 1 and 1 g/kg day 3.

Acute kidney injury: KDIGO criteria = creatinine rise ≥0.3 mg/dL in 48 h or ≥1.5× baseline in 7 days, or urine output <0.5 mL/kg/h for 6 h.

Hyperkalemia with ECG changes: IV calcium gluconate first for membrane stabilization, then insulin/glucose, beta-agonist, and dialysis for refractory cases.

Rhabdomyolysis: CK >5× normal; aggressive IV fluids to maintain urine output 200-300 mL/h; monitor for compartment syndrome and AKI.

ATLS primary survey: Airway with cervical spine protection, Breathing, Circulation with hemorrhage control, Disability, Exposure/Environment.

Hemorrhagic shock: class I <15% blood loss, class II 15-30% (tachycardia, narrowed pulse pressure), class III 30-40% (hypotension), class IV >40% (lethargy).

Massive transfusion protocol: 1:1:1 ratio of packed RBCs, plasma, and platelets; give tranexamic acid 1 g within 3 h of injury.

Pelvic fracture: apply pelvic binder at level of greater trochanters; avoid repeated pelvic examination; consider angioembolization for arterial bleeding.

Open fracture: antibiotic within 1 h (cefazolin ± gentamicin for contaminated wounds), tetanus prophylaxis, and surgical debridement.

Compartment syndrome: pain out of proportion, pain with passive stretch, paresthesia; pressure >30 mmHg or within 30 mmHg of diastolic requires fasciotomy.

Head trauma: GCS ≤8 requires intubation; avoid hypotension (SBP <90) and hypoxia; maintain normocapnia unless signs of herniation.

Acetaminophen toxicity: Rumack-Matthew nomogram at 4 h postingestion; N-acetylcysteine is antidote and most effective within 8 h.

Salicylate toxicity: mixed respiratory alkalosis and metabolic acidosis, tinnitus; treat with sodium bicarbonate to alkalinize urine and enhance elimination.

Organophosphate poisoning: SLUDGE/ DUMBELS; atropine until secretions dry and pralidoxime early.

Beta-blocker overdose: glucagon 3-5 mg IV, high-dose insulin euglycemia, and calcium; avoid calcium channel blockers.

Carbon monoxide poisoning: carboxyhemoglobin level does not correlate with severity; 100% oxygen; hyperbaric oxygen for severe poisoning, pregnancy, or syncope.

Tricyclic antidepressant overdose: sodium bicarbonate for QRS >100 ms or ventricular arrhythmia; avoid class IA and IC antiarrhythmics.

Digoxin toxicity: hyperkalemia, bradycardia, visual changes; digoxin-specific Fab fragments for life-threatening arrhythmia or hyperkalemia.

Pediatric assessment triangle: appearance, work of breathing, circulation to skin; used for rapid initial impression.

Weight estimation: (age in years × 2) + 8 kg for children 1-10 years; use length-based tape if available.

Pediatric defibrillation: 2 J/kg first shock, 4 J/kg subsequent; epinephrine 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000).

Croup: barking cough, stridor; treat with dexamethasone 0.15-0.6 mg/kg and nebulized epinephrine for moderate-severe cases.

Bronchiolitis: supportive care; no routine bronchodilators or corticosteroids; high-flow nasal cannula for respiratory distress.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria (rash, conjunctivitis, oral changes, extremity changes, lymphadenopathy); treat with IVIG 2 g/kg and aspirin.

Intussusception: colicky pain, currant-jelly stool, sausage-shaped mass; air or contrast enema is diagnostic and therapeutic.

Ectopic pregnancy: hemodynamically unstable → immediate surgery; stable with unruptured mass <4 cm and no fetal cardiac activity → methotrexate if hCG <5000 mIU/mL.

Preeclampsia with severe features: BP ≥160/110 mmHg, platelets <100,000, elevated liver enzymes, pulmonary edema, or visual/cerebral symptoms; treat with magnesium sulfate and antihypertensives.

Postpartum hemorrhage: uterine atony most common cause; treat with uterine massage, oxytocin, then methylergonovine, carboprost, misoprostol, and tranexamic acid.

Shoulder dystocia: McRoberts maneuver and suprapubic pressure first; avoid fundal pressure; consider episiotomy and internal maneuvers.

Ovarian torsion: sudden severe unilateral pelvic pain with nausea; Doppler may be normal; definitive treatment is laparoscopic detorsion.

Magnesium sulfate toxicity: loss of deep tendon reflexes, respiratory depression, cardiac arrest; antidote is calcium gluconate 1 g IV.

Diabetic ketoacidosis: IV fluids, insulin infusion 0.1 U/kg/h after initial bolus, and potassium replacement when K <5.2 mEq/L; add dextrose when glucose <200-250 mg/dL.

Hyperosmolar hyperglycemic state: profound dehydration, glucose often >600 mg/dL, minimal ketosis; treat with aggressive fluids and insulin.

Thyroid storm: Burch-Wartofsky score; treat with beta-blocker, thionamide (PTU), iodine load after thionamide, and glucocorticoid.

Adrenal crisis: hypotension unresponsive to fluids, hyponatremia, hyperkalemia; give hydrocortisone 100 mg IV immediately.

Sickle cell vaso-occlusive crisis: aggressive hydration, opioids, and incentive spirometry; transfuse for acute chest syndrome or stroke.

Severe thrombocytopenia: platelet transfusion for counts <10,000/µL or <20,000/µL with bleeding; avoid in TTP unless life-threatening hemorrhage.

Sepsis-3: suspected infection plus SOFA score increase ≥2; septic shock = sepsis with vasopressor requirement to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite fluids.

Sepsis bundle: measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics within 1 h for septic shock, and 30 mL/kg crystalloid for hypotension or lactate ≥4.

Necrotizing fasciitis: pain out of proportion, bullae, crepitus, systemic toxicity; immediate surgical debridement plus broad-spectrum antibiotics including clindamycin.

Meningococcal meningitis prophylaxis: rifampin, ciprofloxacin, or ceftriaxone for close contacts.

Tetanus prophylaxis: clean minor wound → vaccine if >10 years; contaminated wound → vaccine plus tetanus immunoglobulin if >5 years or unknown.

Infective endocarditis: obtain 3 sets of blood cultures before antibiotics; surgery for heart failure, uncontrolled infection, or large vegetations.

FAST exam: evaluate pericardial, perihepatic, perisplenic, and pelvic windows; sensitivity for free fluid increases with repeat examination.

Ultrasound-guided central line: use real-time needle visualization, confirm venous placement with manometry or ultrasound, and confirm lung sliding to exclude pneumothorax.

Thoracentesis: perform at posterior axillary line with patient sitting; avoid intercostal vessels by entering superior to the rib; limit drainage to 1-1.5 L to prevent reexpansion pulmonary edema.

Arthrocentesis: knee lateral approach; synovial fluid analysis includes cell count, crystals, Gram stain, and culture.

Lumbar puncture: L3-L4 or L4-L5 interspace; opening pressure measured in lateral decubitus; contraindicated with signs of raised intracranial pressure or coagulopathy.

Pericardiocentesis: subxiphoid approach with ultrasound guidance; monitor for arrhythmia and pneumothorax.

Triage: Emergency Severity Index (ESI) levels 1-5 based on acuity and resource needs; level 1 requires immediate life-saving intervention.

Informed consent: requires capacity, disclosure of risks/benefits/alternatives, and voluntariness; emergency exception applies when immediate treatment is necessary and patient cannot consent.

HIPAA: permitted disclosures include treatment, payment, operations, and required reporting (e.g., communicable diseases, abuse); minimum necessary standard applies.

Clinical decision rules: validate in external populations; pretest probability affects predictive value; a highly sensitive rule is best for ruling out.

Number needed to treat (NNT) = 1 / absolute risk reduction; number needed to harm (NNH) = 1 / absolute risk increase.

Cohort study: measures relative risk; case-control study: measures odds ratio; randomized controlled trial: best for causality but may have limited generalizability.