CENP cheat sheet

Primary survey (ABCDE) precedes focused history and secondary survey; life threats are treated as they are found.

Glasgow Coma Scale = Eye (1-4) + Verbal (1-5) + Motor (1-6), range 3-15; a score of 8 or less warrants airway assessment.

Shock index = heart rate / systolic blood pressure; a value above 0.9 in an adult suggests occult shock despite a normal blood pressure.

qSOFA assigns 1 point each for respiratory rate ≥22, systolic BP ≤100 mmHg, and GCS <15; 2 or more points predicts higher mortality in suspected infection.

Cushing triad (hypertension with widened pulse pressure, bradycardia, irregular respirations) is a late sign of rising intracranial pressure.

Anion gap = Na − (Cl + HCO3); normal is approximately 8-12 mEq/L.

Corrected sodium = measured Na + 1.6 × [(glucose − 100) / 100] for hyperglycemia.

HEART score components: History, ECG, Age, Risk factors, Troponin (total 0-10).

Ottawa ankle rules: imaging indicated if there is malleolar or navicular tenderness, base-of-5th-metatarsal tenderness, or inability to bear weight for 4 steps.

Anaphylaxis: IM epinephrine 0.3-0.5 mg of 1:1000 into the anterolateral thigh, repeated every 5-15 minutes as needed.

STEMI reperfusion: PCI within 90 minutes of first medical contact at a PCI-capable center; fibrinolysis within 30 minutes if PCI is more than 120 minutes away.

SVT: vagal maneuvers first, then adenosine 6 mg rapid IV push, then 12 mg if unresolved.

Status epilepticus: benzodiazepine first line, followed by levetiracetam, fosphenytoin, or valproate.

DKA: isotonic fluids, insulin infusion 0.1 units/kg/hour, potassium repletion when K <5.2 mEq/L with urine output; add dextrose when glucose falls below 200-250 mg/dL.

Hyperkalemia with ECG changes: IV calcium salts first to stabilize myocardium, then insulin with glucose, then inhaled beta-agonist; dialysis for refractory cases.

Sepsis-3: suspected infection plus SOFA increase ≥2; septic shock adds vasopressor requirement for MAP ≥65 mmHg and lactate >2 mmol/L despite fluids.

Tension pneumothorax: immediate needle decompression before any imaging.

Opioid overdose: naloxone titrated to adequate spontaneous respirations, not to full arousal.

Catastrophic external hemorrhage is controlled before airway assessment (XABCDE sequence).

Permissive hypotension in hemorrhagic shock targets systolic BP near 90 mmHg until bleeding control; traumatic brain injury is the exception, requiring systolic BP ≥110 mmHg.

Massive transfusion approximates 1:1:1 PRBC to FFP to platelets; tranexamic acid 1 g is given within 3 hours of injury when bleeding is suspected.

Parkland formula: 4 mL/kg per %TBSA lactated Ringer's over 24 hours, half in the first 8 hours from the time of injury.

Adult Rule of Nines: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.

Pelvic binder is placed at the level of the greater trochanters.

Needle decompression: 5th intercostal space at the anterior axillary line, or alternatively 2nd intercostal space at the midclavicular line.

Cerebral perfusion pressure = MAP − ICP; ICP above 20 mmHg is treated, with CPP targeted at 60-70 mmHg.

The spleen is the most commonly injured organ in blunt abdominal trauma.

Informed consent elements: indication, risks, benefits, alternatives (including no treatment), and confirmation of patient understanding.

Seldinger technique sequence: needle access, guidewire, needle removal, tract dilation, catheter over wire, position confirmation.

Thoracentesis: enter just above the superior margin of the rib to avoid the intercostal neurovascular bundle; limit removal to roughly 1-1.5 L per session.

Paracentesis: avoid surgical scars and visible vessels; consider albumin infusion when more than 5 L is removed.

Lumbar puncture: L3-L4 or L4-L5 interspace at or below the iliac crest line; normal opening pressure is 10-20 cm H2O.

Chest tube: 4th-5th intercostal space anterior to the midaxillary line, within the safe triangle.

Rapid sequence intubation: preoxygenation/optimization, induction with etomidate or ketamine, paralysis with rocuronium 1.2 mg/kg or succinylcholine 1.5 mg/kg.

Biphasic defibrillation for VF/pulseless VT is typically 120-200 J; synchronized cardioversion is used for unstable tachyarrhythmia with a pulse.

Central venous catheter tip terminates at the cavoatrial junction; ultrasound guidance reduces mechanical complications.

Pediatric hypotension threshold for ages 1-10 years: systolic BP <70 + (2 × age in years); hypotension is a late finding in pediatric shock.

Rapid pediatric weight estimate (1-10 years) = (2 × age) + 8 kg.

Pediatric defibrillation: 2 J/kg for the first shock and 4 J/kg for subsequent shocks.

Neonatal CPR uses a 3:1 compression-to-ventilation ratio (90 compressions : 30 breaths); post-pubertal patients use 30:2.

Pediatric shock fluid bolus is 20 mL/kg of isotonic crystalloid with reassessment after each bolus.

After 20 weeks gestation, left uterine displacement of 15-30 degrees relieves inferior vena cava compression during resuscitation.

Perimortem cesarean delivery is considered within 4-5 minutes of maternal arrest when the uterine fundus is at or above the umbilicus.

Older adults with acute coronary syndrome more often present with dyspnea, fatigue, or syncope rather than classic chest pain.

Beers criteria identify potentially inappropriate medications for older adults.

EMTALA requires a medical screening examination and stabilizing treatment for any emergency condition regardless of insurance status or ability to pay.

HIPAA minimum necessary standard applies to disclosures; treatment, payment, and operations do not require patient authorization.

Capacity is a bedside clinical determination (understand, appreciate, reason, express a choice); competence is a legal status decided by courts.

Mandatory reporting includes suspected abuse or neglect, specified communicable diseases, and (state-dependent) gunshot wounds.

Minors require parent or guardian consent; the emergency exception and emancipated minor status are recognized exceptions.

Against-medical-advice departure requires documented capacity assessment, explained risks and alternatives, and the patient's stated reason.

SBAR (Situation, Background, Assessment, Recommendation) and I-PASS structure handoffs to reduce omissions.

Just culture distinguishes human error from at-risk and reckless behavior; sentinel events are reviewed through root cause analysis.

Emergency department boarding of admitted patients correlates with crowding, delayed treatment, and worse outcomes.

Number needed to treat = 1 / absolute risk reduction; number needed to harm = 1 / absolute risk increase.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); predictive values change with disease prevalence.

A likelihood ratio above 10 or below 0.1 substantially shifts post-test probability; a ratio near 1 does not.

Evidence hierarchy: systematic reviews/meta-analyses of RCTs, then RCTs, cohort studies, case-control studies, case series, expert opinion.

Teach-back asks patients to restate instructions in their own words to verify comprehension.

Patient education materials should target roughly a 5th-6th grade reading level using plain language.

The 5 A's of tobacco cessation: Ask, Advise, Assess, Assist, Arrange.

SBIRT for alcohol use: Screening, Brief Intervention, Referral to Treatment.

Tdap vaccination is recommended during each pregnancy at 27-36 weeks gestation.