Arab Board Anesthesia Final Clinical and Oral Exam cheat sheet

ASA physical status I–VI; suffix E denotes emergency; ASA IV = severe systemic disease that is a constant threat to life.

Revised cardiac risk index (RCRI) predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2 mg/dL, high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular).

Perioperative beta-blockade should be started days to weeks before surgery, not acutely on the day of surgery, to avoid stroke and hypotension.

NPO intervals (ASA): clear fluids 2 h, breast milk 4 h, infant formula/nonhuman milk 6 h, light meal 6 h, fatty meal 8 h.

Smoking cessation ≥4 weeks before surgery reduces pulmonary complications; shorter intervals may transiently increase airway reactivity.

Postoperative nausea and vomiting (PONV) risk factors: female sex, nonsmoker, history of PONV/motion sickness, postoperative opioids; each ~20% increase.

Enhanced recovery after surgery (ERAS) core elements: preoperative counseling, carbohydrate loading, multimodal analgesia, avoidance of prolonged fasting, early mobilization, opioid-sparing.

Perioperative mortality is increased with emergency surgery, age >70, ASA III–IV, and major intraperitoneal or intrathoracic procedures.

Maximum recommended single dose of bupivacaine is ~2–2.5 mg/kg (without epinephrine); with epinephrine ~3 mg/kg; ropivacaine ~3 mg/kg.

LAST treatment: stop injection, call for help, airway/100% O2, benzodiazepine for seizures, 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion.

Interscalene brachial plexus block reliably spares the ulnar nerve (C8–T1) and is associated with phrenic nerve palsy in most patients.

Supraclavicular block provides dense anesthesia of the entire upper extremity but carries pneumothorax risk (~0.5–1%).

Femoral nerve block spares the obturator and sciatic nerves; adductor canal block provides knee analgesia with less quadriceps weakness.

Transversus abdominis plane (TAP) block covers T6–L1 somatic abdominal wall; it does not cover visceral pain.

Epidural test dose: 3 mL of lidocaine 1.5% with 1:200,000 epinephrine; positive if HR rises >20 bpm or SBP rises >15–20 mmHg within 60 s.

Spinal anesthesia block height depends on baricity, patient position, and dose; hyperbaric bupivacaine in sitting position yields a saddle block.

Difficult mask ventilation predictors (MOANS): Mask seal, Obesity, Age >55, No teeth, Snores/Stiff lungs.

Difficult intubation predictors (LEMON): Look externally, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility.

Cormack–Lehane grades: I = full glottic view, II = partial vocal cords, III = epiglottis only, IV = no glottic structures visible.

Oxygen reserve index and safe apnea time depend on functional residual capacity and oxygen consumption (~250 mL/min in adults).

Rapid sequence intubation: preoxygenation, induction, neuromuscular blockade, cricoid pressure (optional), intubation without positive-pressure ventilation.

Cannot intubate, cannot oxygenate (CICO): emergency front-of-neck access (scalpel-bougie-tube or cannula technique) is indicated immediately.

Laryngeal mask airway (LMA) sits over the glottis; leak pressure typically 20–30 cm H2O; contraindicated in full stomach or high aspiration risk.

Hypoxemia during one-lung ventilation: apply CPAP to non-dependent lung, PEEP to dependent lung, and check tube position.

Cardiac output = heart rate × stroke volume; normal CO 4–8 L/min; cardiac index = CO/BSA, normal 2.5–4 L/min/m².

Mean arterial pressure ≈ DBP + 1/3 (SBP − DBP); cerebral perfusion pressure = MAP − ICP.

Pulmonary artery catheter: PCWP ≈ LVEDP; normal PCWP 6–12 mmHg; cardiogenic shock PCWP >18 mmHg with low CI.

Mixed venous oxygen saturation (SvO2) normal 65–75%; low SvO2 suggests inadequate cardiac output or increased oxygen consumption.

Stroke volume variation (SVV) >13% or pulse pressure variation >13% predicts fluid responsiveness in mechanically ventilated patients.

Aortic stenosis: maintain afterload, avoid tachycardia and hypotension; spinal anesthesia may cause severe hypotension.

Mitral stenosis: avoid tachycardia and fluid overload; atrial fibrillation is poorly tolerated.

Coronary perfusion pressure = DBP − LVEDP; tachycardia shortens diastole and reduces coronary perfusion.

Cerebral blood flow (CBF) ~50 mL/100 g/min; autoregulation typically between MAP 60–150 mmHg; lost in ischemia and severe trauma.

Cerebral perfusion pressure = MAP − ICP; target CPP ≥60 mmHg in traumatic brain injury (Brain Trauma Foundation).

Monro–Kellie doctrine: intracranial volume = brain + blood + CSF; an increase in one compartment must be offset by a decrease in another.

Hyperventilation reduces PaCO2, causing cerebral vasoconstriction and decreased CBF (~3–4% per mmHg PaCO2 change); reserve for herniation.

Mannitol 0.25–1 g/kg IV or hypertonic saline 3% used for intracranial hypertension; monitor osmolality and renal function.

Glasgow Coma Scale: eye (1–4), verbal (1–5), motor (1–6); total 3–15; score ≤8 indicates severe injury and consideration for airway protection.

Volatile anesthetics increase CBF and ICP; total intravenous anesthesia with propofol reduces CBF and ICP.

Subarachnoid hemorrhage: nimodipine 60 mg PO q4h for 21 days reduces delayed cerebral ischemia; target euvolemia and avoid hypotension.

Aortocaval compression occurs from ~20 weeks gestation; left uterine displacement is mandatory during resuscitation and anesthesia.

Neuraxial anesthesia is preferred for cesarean delivery; spinal anesthesia is faster and denser than epidural.

Epidural test dose and incremental dosing reduce the risk of unrecognized intrathecal or intravascular injection.

Magnesium sulfate (4–6 g loading, 1–2 g/h) for preeclampsia/eclampsia; monitor for loss of deep tendon reflexes, respiratory depression, and oliguria.

Preeclampsia: avoid sudden hypotension; neuraxial anesthesia is preferred when platelets >70–100 × 10⁹/L and coagulation is normal.

Postpartum hemorrhage: uterine atony is the most common cause; treat with uterotonics (oxytocin, carboprost, misoprostol, methylergonovine).

Difficult airway is more common in pregnancy due to edema, weight gain, and breast enlargement; preoxygenation and smaller ETT (6.0–7.0 mm) recommended.

Fetal heart rate categories: category I (normal), II (indeterminate), III (abnormal, e.g., absent variability with recurrent decelerations).

Pediatric airway: large head, short neck, large tongue, anterior larynx; straight (Miller) blade often preferred.

Endotracheal tube size (uncuffed) ≈ (age/4) + 4 mm; cuffed ≈ (age/4) + 3.5 mm.

Pediatric fluid maintenance (4-2-1 rule): 4 mL/kg/h for first 10 kg, 2 mL/kg/h for next 10 kg, 1 mL/kg/h for each kg above 20.

Pediatric blood volume: neonates ~85–90 mL/kg, infants ~80 mL/kg, children ~70–75 mL/kg.

Infants have higher oxygen consumption (~6–8 mL/kg/min) and lower functional residual capacity, predisposing to rapid desaturation.

Laryngospasm is common in children; treat with 100% O2, jaw thrust, CPAP, and small-dose propofol or succinylcholine if needed.

Pyloric stenosis: correct hypochloremic, hypokalemic metabolic alkalosis and dehydration before anesthesia.

Emergence delirium is common in preschool children after sevoflurane; consider propofol or dexmedetomidine for prevention.

Sepsis-3: sepsis = life-threatening organ dysfunction from dysregulated host response; qSOFA ≥2 of SBP ≤100, RR ≥22, altered mentation.

Septic shock: persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite fluid resuscitation.

ARDS Berlin criteria: acute onset within 1 week, bilateral opacities, not explained by cardiac failure, PaO2/FiO2 ≤300 with PEEP ≥5 cm H2O.

Lung-protective ventilation in ARDS: tidal volume 6 mL/kg predicted body weight, plateau pressure ≤30 cm H2O, permissive hypercapnia.

Vasopressors: norepinephrine first-line in septic shock; add vasopressin or epinephrine as needed; target MAP ≥65 mmHg.

Acute kidney injury KDIGO stages based on creatinine rise and urine output (<0.5 mL/kg/h for ≥6 h = stage 1).

Delirium prevention: identify and treat pain, agitation, and delirium (PADIS); early mobilization and sleep hygiene reduce incidence.

Stress ulcer prophylaxis indicated in mechanically ventilated patients and those with coagulopathy.

Propofol: induction dose 1.5–2.5 mg/kg IV; rapid onset, antiemetic, causes hypotension and apnea; no analgesia.

Ketamine: 1–2 mg/kg IV; dissociative; preserves airway reflexes and sympathetic tone; bronchodilator; may increase secretions and ICP.

Etomidate: 0.2–0.3 mg/kg IV; hemodynamically stable; transient adrenal suppression; myoclonus common.

Succinylcholine: 1–1.5 mg/kg IV; depolarizing; onset 45–60 s; contraindicated in hyperkalemia, burns >24 h, denervation, malignant hyperthermia.

Rocuronium: 0.6–1.2 mg/kg IV; nondepolarizing; reversed by sugammadex 2–4 mg/kg (16 mg/kg for immediate reversal).

Neostigmine 0.03–0.07 mg/kg with glycopyrrolate 0.2 mg per 1 mg neostigmine reverses residual block; ensure train-of-four ratio ≥0.9.

Volatile agents: MAC of sevoflurane ~2%, isoflurane ~1.15%, desflurane ~6%; MAC reduced by age, hypothermia, pregnancy, opioids, and propofol.

Local anesthetics: pKa determines onset; lipid solubility determines potency; protein binding determines duration.

Standard ASA monitors: pulse oximetry, capnography, ECG, noninvasive blood pressure, temperature, and inspired oxygen analyzer.

Capnography waveform: normal end-tidal CO2 35–45 mmHg; sudden loss suggests disconnection, obstruction, or cardiac arrest.

Pulse oximetry: normal SpO2 95–100%; methemoglobinemia causes SpO2 ~85% with normal PaO2; carboxyhemoglobin falsely elevates SpO2.

Anesthesia machine leak test: pressure the circuit to 30 cm H2O with a closed APL valve; leak should be <200 mL/min.

Difficult airway trolley should include video laryngoscope, fiberoptic scope, supraglottic devices, cricothyrotomy kit, and bougie.

Malignant hyperthermia: dantrolene 2.5 mg/kg IV, stop volatile agents, hyperventilate with 100% O2, cool patient, treat hyperkalemia.

WHO surgical safety checklist: sign in, time out, sign out; reduces morbidity and mortality.

Critical incident reporting and root cause analysis improve patient safety; just culture encourages reporting without blame.

Informed consent requires capacity, adequate disclosure, comprehension, and voluntariness; emergency exception applies when life-threatening.

Four principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Do-not-resuscitate orders are suspended during surgery unless explicitly discussed; clarify preferences preoperatively.

Confidentiality is protected by law; disclosure is permitted with patient consent or legal/statutory requirement.

Advance directives and durable power of attorney for healthcare should guide decisions when the patient lacks capacity.

Conflict of interest must be disclosed; gifts of more than nominal value should be declined or reported.

Error disclosure: honest, prompt, and empathetic communication reduces litigation and supports patient trust.

Cultural competence and interpreter services improve communication and reduce disparities in perioperative care.

Adult BLS: compressions at 100–120/min, depth 5–6 cm, full recoil, 30:2 compression-to-ventilation ratio; minimize interruptions.

Adult ACLS shockable rhythms: VF/pulseless VT - defibrillate 120–200 J biphasic (or 360 J monophasic), CPR 2 min, epinephrine 1 mg q3–5 min, amiodarone 300 mg after third shock.

Non-shockable rhythms (asystole/PEA): CPR, epinephrine 1 mg q3–5 min, treat reversible causes (Hs and Ts).

Reversible causes (Hs and Ts): hypoxia, hypovolemia, hypothermia, hypo/hyperkalemia, hydrogen ion (acidosis), tension pneumothorax, tamponade, toxins, thrombosis, thromboembolism.

Anaphylaxis: epinephrine 0.5 mg IM (1:1000) in adults, repeat q5–15 min; IV fluids; adjuncts include antihistamines and steroids.

Malignant hyperthermia: dantrolene 2.5 mg/kg IV, stop triggering agents, 100% O2, cooling, treat hyperkalemia and acidosis.

Local anesthetic systemic toxicity: 20% lipid emulsion 1.5 mL/kg bolus, then 0.25 mL/kg/min; continue CPR and consider cardiopulmonary bypass.

Massive transfusion protocol: 1:1:1 ratio of RBCs:FFP:platelets; permissive hypotension in trauma until hemorrhage control.

ASA physical status I–VI; suffix E denotes emergency; ASA IV = severe systemic disease that is a constant threat to life.

Revised cardiac risk index (RCRI) predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2 mg/dL, high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular).

Perioperative beta-blockade should be started days to weeks before surgery, not acutely on the day of surgery, to avoid stroke and hypotension.

NPO intervals (ASA): clear fluids 2 h, breast milk 4 h, infant formula/nonhuman milk 6 h, light meal 6 h, fatty meal 8 h.

Smoking cessation ≥4 weeks before surgery reduces pulmonary complications; shorter intervals may transiently increase airway reactivity.

Postoperative nausea and vomiting (PONV) risk factors: female sex, nonsmoker, history of PONV/motion sickness, postoperative opioids; each ~20% increase.

Enhanced recovery after surgery (ERAS) core elements: preoperative counseling, carbohydrate loading, multimodal analgesia, avoidance of prolonged fasting, early mobilization, opioid-sparing.

Perioperative mortality is increased with emergency surgery, age >70, ASA III–IV, and major intraperitoneal or intrathoracic procedures.

Maximum recommended single dose of bupivacaine is ~2–2.5 mg/kg (without epinephrine); with epinephrine ~3 mg/kg; ropivacaine ~3 mg/kg.

LAST treatment: stop injection, call for help, airway/100% O2, benzodiazepine for seizures, 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion.

Interscalene brachial plexus block reliably spares the ulnar nerve (C8–T1) and is associated with phrenic nerve palsy in most patients.

Supraclavicular block provides dense anesthesia of the entire upper extremity but carries pneumothorax risk (~0.5–1%).

Femoral nerve block spares the obturator and sciatic nerves; adductor canal block provides knee analgesia with less quadriceps weakness.

Transversus abdominis plane (TAP) block covers T6–L1 somatic abdominal wall; it does not cover visceral pain.

Epidural test dose: 3 mL of lidocaine 1.5% with 1:200,000 epinephrine; positive if HR rises >20 bpm or SBP rises >15–20 mmHg within 60 s.

Spinal anesthesia block height depends on baricity, patient position, and dose; hyperbaric bupivacaine in sitting position yields a saddle block.

Difficult mask ventilation predictors (MOANS): Mask seal, Obesity, Age >55, No teeth, Snores/Stiff lungs.

Difficult intubation predictors (LEMON): Look externally, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility.

Cormack–Lehane grades: I = full glottic view, II = partial vocal cords, III = epiglottis only, IV = no glottic structures visible.

Oxygen reserve index and safe apnea time depend on functional residual capacity and oxygen consumption (~250 mL/min in adults).

Rapid sequence intubation: preoxygenation, induction, neuromuscular blockade, cricoid pressure (optional), intubation without positive-pressure ventilation.

Cannot intubate, cannot oxygenate (CICO): emergency front-of-neck access (scalpel-bougie-tube or cannula technique) is indicated immediately.

Laryngeal mask airway (LMA) sits over the glottis; leak pressure typically 20–30 cm H2O; contraindicated in full stomach or high aspiration risk.

Hypoxemia during one-lung ventilation: apply CPAP to non-dependent lung, PEEP to dependent lung, and check tube position.

Cardiac output = heart rate × stroke volume; normal CO 4–8 L/min; cardiac index = CO/BSA, normal 2.5–4 L/min/m².

Mean arterial pressure ≈ DBP + 1/3 (SBP − DBP); cerebral perfusion pressure = MAP − ICP.

Pulmonary artery catheter: PCWP ≈ LVEDP; normal PCWP 6–12 mmHg; cardiogenic shock PCWP >18 mmHg with low CI.

Mixed venous oxygen saturation (SvO2) normal 65–75%; low SvO2 suggests inadequate cardiac output or increased oxygen consumption.

Stroke volume variation (SVV) >13% or pulse pressure variation >13% predicts fluid responsiveness in mechanically ventilated patients.

Aortic stenosis: maintain afterload, avoid tachycardia and hypotension; spinal anesthesia may cause severe hypotension.

Mitral stenosis: avoid tachycardia and fluid overload; atrial fibrillation is poorly tolerated.

Coronary perfusion pressure = DBP − LVEDP; tachycardia shortens diastole and reduces coronary perfusion.

Cerebral blood flow (CBF) ~50 mL/100 g/min; autoregulation typically between MAP 60–150 mmHg; lost in ischemia and severe trauma.

Cerebral perfusion pressure = MAP − ICP; target CPP ≥60 mmHg in traumatic brain injury (Brain Trauma Foundation).

Monro–Kellie doctrine: intracranial volume = brain + blood + CSF; an increase in one compartment must be offset by a decrease in another.

Hyperventilation reduces PaCO2, causing cerebral vasoconstriction and decreased CBF (~3–4% per mmHg PaCO2 change); reserve for herniation.

Mannitol 0.25–1 g/kg IV or hypertonic saline 3% used for intracranial hypertension; monitor osmolality and renal function.

Glasgow Coma Scale: eye (1–4), verbal (1–5), motor (1–6); total 3–15; score ≤8 indicates severe injury and consideration for airway protection.

Volatile anesthetics increase CBF and ICP; total intravenous anesthesia with propofol reduces CBF and ICP.

Subarachnoid hemorrhage: nimodipine 60 mg PO q4h for 21 days reduces delayed cerebral ischemia; target euvolemia and avoid hypotension.

Aortocaval compression occurs from ~20 weeks gestation; left uterine displacement is mandatory during resuscitation and anesthesia.

Neuraxial anesthesia is preferred for cesarean delivery; spinal anesthesia is faster and denser than epidural.

Epidural test dose and incremental dosing reduce the risk of unrecognized intrathecal or intravascular injection.

Magnesium sulfate (4–6 g loading, 1–2 g/h) for preeclampsia/eclampsia; monitor for loss of deep tendon reflexes, respiratory depression, and oliguria.

Preeclampsia: avoid sudden hypotension; neuraxial anesthesia is preferred when platelets >70–100 × 10⁹/L and coagulation is normal.

Postpartum hemorrhage: uterine atony is the most common cause; treat with uterotonics (oxytocin, carboprost, misoprostol, methylergonovine).

Difficult airway is more common in pregnancy due to edema, weight gain, and breast enlargement; preoxygenation and smaller ETT (6.0–7.0 mm) recommended.

Fetal heart rate categories: category I (normal), II (indeterminate), III (abnormal, e.g., absent variability with recurrent decelerations).

Pediatric airway: large head, short neck, large tongue, anterior larynx; straight (Miller) blade often preferred.

Endotracheal tube size (uncuffed) ≈ (age/4) + 4 mm; cuffed ≈ (age/4) + 3.5 mm.

Pediatric fluid maintenance (4-2-1 rule): 4 mL/kg/h for first 10 kg, 2 mL/kg/h for next 10 kg, 1 mL/kg/h for each kg above 20.

Pediatric blood volume: neonates ~85–90 mL/kg, infants ~80 mL/kg, children ~70–75 mL/kg.

Infants have higher oxygen consumption (~6–8 mL/kg/min) and lower functional residual capacity, predisposing to rapid desaturation.

Laryngospasm is common in children; treat with 100% O2, jaw thrust, CPAP, and small-dose propofol or succinylcholine if needed.

Pyloric stenosis: correct hypochloremic, hypokalemic metabolic alkalosis and dehydration before anesthesia.

Emergence delirium is common in preschool children after sevoflurane; consider propofol or dexmedetomidine for prevention.

Sepsis-3: sepsis = life-threatening organ dysfunction from dysregulated host response; qSOFA ≥2 of SBP ≤100, RR ≥22, altered mentation.

Septic shock: persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite fluid resuscitation.

ARDS Berlin criteria: acute onset within 1 week, bilateral opacities, not explained by cardiac failure, PaO2/FiO2 ≤300 with PEEP ≥5 cm H2O.

Lung-protective ventilation in ARDS: tidal volume 6 mL/kg predicted body weight, plateau pressure ≤30 cm H2O, permissive hypercapnia.

Vasopressors: norepinephrine first-line in septic shock; add vasopressin or epinephrine as needed; target MAP ≥65 mmHg.

Acute kidney injury KDIGO stages based on creatinine rise and urine output (<0.5 mL/kg/h for ≥6 h = stage 1).

Delirium prevention: identify and treat pain, agitation, and delirium (PADIS); early mobilization and sleep hygiene reduce incidence.

Stress ulcer prophylaxis indicated in mechanically ventilated patients and those with coagulopathy.

Propofol: induction dose 1.5–2.5 mg/kg IV; rapid onset, antiemetic, causes hypotension and apnea; no analgesia.

Ketamine: 1–2 mg/kg IV; dissociative; preserves airway reflexes and sympathetic tone; bronchodilator; may increase secretions and ICP.

Etomidate: 0.2–0.3 mg/kg IV; hemodynamically stable; transient adrenal suppression; myoclonus common.

Succinylcholine: 1–1.5 mg/kg IV; depolarizing; onset 45–60 s; contraindicated in hyperkalemia, burns >24 h, denervation, malignant hyperthermia.

Rocuronium: 0.6–1.2 mg/kg IV; nondepolarizing; reversed by sugammadex 2–4 mg/kg (16 mg/kg for immediate reversal).

Neostigmine 0.03–0.07 mg/kg with glycopyrrolate 0.2 mg per 1 mg neostigmine reverses residual block; ensure train-of-four ratio ≥0.9.

Volatile agents: MAC of sevoflurane ~2%, isoflurane ~1.15%, desflurane ~6%; MAC reduced by age, hypothermia, pregnancy, opioids, and propofol.

Local anesthetics: pKa determines onset; lipid solubility determines potency; protein binding determines duration.

Standard ASA monitors: pulse oximetry, capnography, ECG, noninvasive blood pressure, temperature, and inspired oxygen analyzer.

Capnography waveform: normal end-tidal CO2 35–45 mmHg; sudden loss suggests disconnection, obstruction, or cardiac arrest.

Pulse oximetry: normal SpO2 95–100%; methemoglobinemia causes SpO2 ~85% with normal PaO2; carboxyhemoglobin falsely elevates SpO2.

Anesthesia machine leak test: pressure the circuit to 30 cm H2O with a closed APL valve; leak should be <200 mL/min.

Difficult airway trolley should include video laryngoscope, fiberoptic scope, supraglottic devices, cricothyrotomy kit, and bougie.

Malignant hyperthermia: dantrolene 2.5 mg/kg IV, stop volatile agents, hyperventilate with 100% O2, cool patient, treat hyperkalemia.

WHO surgical safety checklist: sign in, time out, sign out; reduces morbidity and mortality.

Critical incident reporting and root cause analysis improve patient safety; just culture encourages reporting without blame.

Informed consent requires capacity, adequate disclosure, comprehension, and voluntariness; emergency exception applies when life-threatening.

Four principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Do-not-resuscitate orders are suspended during surgery unless explicitly discussed; clarify preferences preoperatively.

Confidentiality is protected by law; disclosure is permitted with patient consent or legal/statutory requirement.

Advance directives and durable power of attorney for healthcare should guide decisions when the patient lacks capacity.

Conflict of interest must be disclosed; gifts of more than nominal value should be declined or reported.

Error disclosure: honest, prompt, and empathetic communication reduces litigation and supports patient trust.

Cultural competence and interpreter services improve communication and reduce disparities in perioperative care.

Adult BLS: compressions at 100–120/min, depth 5–6 cm, full recoil, 30:2 compression-to-ventilation ratio; minimize interruptions.

Adult ACLS shockable rhythms: VF/pulseless VT - defibrillate 120–200 J biphasic (or 360 J monophasic), CPR 2 min, epinephrine 1 mg q3–5 min, amiodarone 300 mg after third shock.

Non-shockable rhythms (asystole/PEA): CPR, epinephrine 1 mg q3–5 min, treat reversible causes (Hs and Ts).

Reversible causes (Hs and Ts): hypoxia, hypovolemia, hypothermia, hypo/hyperkalemia, hydrogen ion (acidosis), tension pneumothorax, tamponade, toxins, thrombosis, thromboembolism.

Anaphylaxis: epinephrine 0.5 mg IM (1:1000) in adults, repeat q5–15 min; IV fluids; adjuncts include antihistamines and steroids.

Malignant hyperthermia: dantrolene 2.5 mg/kg IV, stop triggering agents, 100% O2, cooling, treat hyperkalemia and acidosis.

Local anesthetic systemic toxicity: 20% lipid emulsion 1.5 mL/kg bolus, then 0.25 mL/kg/min; continue CPR and consider cardiopulmonary bypass.

Massive transfusion protocol: 1:1:1 ratio of RBCs:FFP:platelets; permissive hypotension in trauma until hemorrhage control.