Arab Board Emergency & Disaster Nursing Part 1 cheat sheet

Emergency Severity Index (ESI) has five levels: 1 = immediate life-saving intervention; 2 = high-risk or emergent (target wait about 10 minutes); 3, 4, 5 = estimated resource need of two or more, one, or zero resources.

ESI danger-zone vital signs that force up-triage to level 2 in adults include heart rate above 100/min, respiratory rate above 20/min, SpO2 below 92%, and systolic BP below 90 mmHg.

NEWS2 scoring: a total of 5 or more, or any single parameter scoring 3, mandates urgent clinician review and continuous monitoring.

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

Primary survey is ABCDE: Airway with cervical spine protection, Breathing, Circulation with hemorrhage control, Disability (GCS, pupils, glucose), Exposure with temperature control - each life threat is treated before advancing.

START mass-casualty triage uses the 30-2-can-do rule: respiratory rate above 30/min, capillary refill above 2 seconds or absent radial pulse, and inability to follow simple commands each move a casualty to the immediate category.

Time-critical benchmarks: 12-lead ECG within 10 minutes of chest pain arrival; CT within 25 minutes of suspected stroke arrival; thrombolysis door-to-needle within 60 minutes.

Absolute airway triggers: GCS 8 or below, absent gag, stridor at rest, or inability to maintain SpO2 above 90% despite high-flow oxygen.

Triage is a continuous process - patients must be re-triaged at defined intervals in the waiting room and after every intervention, not only at first contact.

Disaster cycle phases: mitigation (reduce hazard impact), preparedness (plans, drills, stockpiles), response (immediate life-saving action), and recovery (restoration of infrastructure, health, and psychological function).

Hospital Incident Command System (HICS) functions are Command, Operations, Planning, Logistics, and Finance/Administration; a single Incident Commander sets objectives and approves one Incident Action Plan per operational period.

Span of control in ICS is approximately 1:5 (acceptable range 3–7); exceeding it requires creating additional branches, divisions, or groups.

Surge capacity escalates through conventional (usual resources), contingency (adaptive use of staff, space, and equipment), and crisis (standards of care formally altered, allocation by expected survival benefit) levels.

START categories: Red = immediate, Yellow = delayed, Green = walking wounded/minor, Black = deceased or expectant; JumpSTART assigns children five rescue breaths before deciding.

Decontamination sequence: remove and double-bag clothing (removes roughly 80–90% of contaminant), then wash with soap and water, then reassess; reusing outer clothing or jewelry is contraindicated.

PPE levels: A = fully encapsulating with supplied air (unknown vapor/oxygen-deficient); B = splash protection with supplied air; C = splash protection with air-purifying respirator; D = uniform with minimal splash protection.

Recovery-phase interventions include Psychological First Aid, crisis counseling referral, community health surveillance, and a formal after-action review (HSEEP) to correct identified gaps.

Triage in disasters may use the expectant category - patients are designated when resources cannot meet survival needs, requiring reassessment if resources improve; decisions must be documented.

Primary survey in trauma follows XABCDE: eXsanguinating hemorrhage control (direct pressure, wound packing, tourniquet) precedes airway, breathing, circulation, disability, and exposure.

Rule of Nines (adult): head 9%, each upper limb 9%, anterior trunk 18%, posterior trunk 18%, each lower limb 18%, perineum 1%; the palmar surface of the patient's hand is about 1%; superficial partial-thickness burns are excluded.

Parkland formula: 4 mL × body weight (kg) × %TBSA, with half given in the first 8 hours from the time of injury - not from hospital arrival - and the remainder over 16 hours; titrate to urine output 0.5–1 mL/kg/h (30–50 mL/h in adults).

Tension pneumothorax: unilateral absent breath sounds, distended neck veins, hypotension, tracheal deviation; treat immediately with needle decompression at the 2nd intercostal space midclavicular line or 4th–5th space anterior axillary line, then tube thoracostomy.

Hemorrhagic shock resuscitation: permissive hypotension (systolic 80–90 mmHg) until surgical hemorrhage control, except traumatic brain injury or pregnancy where systolic must stay ≥110 mmHg; massive transfusion ratio 1:1:1 (plasma:platelets:RBC).

Trauma lethal triad: hypothermia, metabolic acidosis, and coagulopathy are mutually reinforcing; prevent with warmed rooms and fluids, hemorrhage control, and balanced blood products.

Traumatic brain injury: cerebral perfusion pressure = mean arterial pressure − intracranial pressure, target CPP 60–70 mmHg; maintain PaCO2 35–40 mmHg (short hyperventilation to 30–35 mmHg only for impending herniation).

Inhalation injury signals - singed nasal hairs, soot in oropharynx, hoarseness, stridor, carbonaceous sputum - indicate early intubation before edema obliterates the airway; give 100% oxygen for carbon monoxide and hydroxocobalamin for suspected cyanide.

Circumferential full-thickness burns and deep electrical burns require escharotomy for compartment compromise; chemical burns need copious irrigation (dry elemental metals and dry lime are exceptions).

Acute coronary syndrome bundle: 12-lead ECG within 10 minutes, chewed aspirin 162–325 mg, continuous monitoring, and nitroglycerin withheld if systolic BP below 90 mmHg or a phosphodiesterase-5 inhibitor was taken in the previous 24–48 hours.

STEMI reperfusion targets: primary PCI with door-to-balloon ≤90 minutes; fibrinolysis given within 30 minutes of arrival when PCI cannot be achieved within 120 minutes; fibrinolysis is contraindicated with recent stroke, active bleeding, or suspected aortic dissection.

High-quality CPR: rate 100–120/min, depth 5–6 cm in adults, full chest recoil, interruptions under 10 seconds, and a compression fraction above 60–80%.

VF/pulseless VT: defibrillate immediately (biphasic 120–200 J or monophasic 360 J), resume compressions immediately, epinephrine 1 mg IV/IO every 3–5 minutes, amiodarone 300 mg IV after the third shock for refractory VF.

Symptomatic bradycardia: atropine 1 mg IV every 3–5 minutes to a maximum of 3 mg; if unresponsive, transcutaneous pacing or a dopamine/epinephrine infusion.

Unstable tachycardia with a pulse and adequate QRS width → synchronized cardioversion; pulseless → unsynchronized defibrillation; unstable polymorphic VT → defibrillation.

Severe acute asthma: inhaled short-acting beta-2 agonist plus ipratropium, systemic corticosteroid within 1 hour, magnesium sulfate 2 g IV for severe or refractory cases; a silent chest and rising PaCO2 herald impending respiratory arrest.

COPD exacerbation: titrate oxygen to SpO2 88–92% when carbon dioxide retention is a concern; noninvasive ventilation reduces intubation and mortality in acidotic exacerbations (pH 7.25–7.35).

ARDS (Berlin): onset within 1 week, bilateral opacities, no cardiogenic cause, PaO2/FiO2 ≤300 with PEEP ≥5; lung-protective ventilation uses tidal volume about 6 mL/kg predicted body weight and plateau pressure below 30 cm H2O.

Massive pulmonary embolism with hypotension: systemic thrombolysis or catheter/surgical embolectomy; hemodynamically stable patients are evaluated with Wells score, age-adjusted D-dimer, and CT pulmonary angiography.

Glasgow Coma Scale: eye opening 4, verbal 5, motor 6 (total 3–15); motor score of 5 or below in a deteriorating patient, or total GCS ≤8, mandates airway protection.

Acute stroke pathway: glucose check and non-contrast CT first, door-to-CT ≤25 minutes, door-to-needle ≤60 minutes; intravenous thrombolysis window 4.5 hours with BP below 185/110 mmHg and no hemorrhage on imaging.

Status epilepticus (>5 minutes of seizure or recurrent seizures without recovery): benzodiazepine first-line (lorazepam 0.1 mg/kg, max 4 mg), then second-line levetiracetam 60 mg/kg, valproate 40 mg/kg, or fosphenytoin 20 mg PE/kg.

Raised intracranial pressure: head of bed 30°, head midline, avoid hypoxia and hypercapnia, maintain PaCO2 35–40 mmHg, keep normothermia and normoglycemia, use osmotherapy (mannitol 0.25–1 g/kg or hypertonic saline) for deterioration.

Diabetic ketoacidosis: glucose above 250 mg/dL, arterial pH below 7.30, bicarbonate below 18 mEq/L, ketonemia/ketonuria with anion gap; correct volume with isotonic crystalloid first, start insulin only when potassium is ≥3.3 mEq/L, add dextrose when glucose falls below 200–250 mg/dL.

Hyperosmolar hyperglycemic state: glucose above 600 mg/dL, serum osmolality above 320 mOsm/kg, minimal ketosis, more profound dehydration and higher mortality than DKA; fluid replacement precedes insulin.

Hypoglycemia (<70 mg/dL): if conscious give 15 g fast-acting carbohydrate and recheck in 15 minutes (15-15 rule); if unconscious give dextrose 25 g IV or glucagon 1 mg IM/SC and recheck in 10–15 minutes.

Hyperkalemia with ECG changes: give IV calcium gluconate or chloride first for membrane stabilization, then insulin with dextrose, inhaled beta-2 agonist, and definitive removal by dialysis or a potassium binder.

Acute kidney injury staging uses serum creatinine rise and urine output (<0.5 mL/kg/h for 6 hours = stage 1); emergent dialysis indications are refractory hyperkalemia, severe acidosis, pulmonary edema, and uremic pericarditis or encephalopathy.

Maternal cardiac arrest: continuous manual left uterine displacement (or left lateral tilt), airway management with smaller tube, and perimortem cesarean delivery within about 4–5 minutes of arrest for a uterus at or above the umbilicus.

Preeclampsia = BP ≥140/90 mmHg after 20 weeks plus proteinuria or organ dysfunction; severe features (≥160/110 mmHg, platelets <100,000, transaminases doubled, pulmonary edema, visual or cerebral symptoms) require magnesium sulfate and antihypertensives.

Eclampsia magnesium sulfate: 4–6 g IV loading dose over 20 minutes, then 1–2 g/hour; monitor respiratory rate ≥12/min, patellar reflexes present, and urine output ≥30 mL/h; antidote is calcium gluconate 1 g IV.

Postpartum hemorrhage: the four T's - tone (atony, most common), tissue (retained placenta), trauma (laceration, rupture, inversion), thrombin (coagulopathy); uterine massage and oxytocin first, tranexamic acid 1 g IV within 3 hours.

Shoulder dystocia: call for help and first perform McRoberts maneuver with suprapubic pressure; secondary maneuvers include internal rotation, posterior arm delivery, and the Gaskin all-fours position; never apply fundal pressure or traction on the head.

Pediatric resuscitation: defibrillation 2 J/kg (first shock), 4 J/kg (second), ≥4 J/kg thereafter; epinephrine 0.01 mg/kg IV/IO of 1:10,000 (0.1 mL/kg); fluid bolus 10–20 mL/kg isotonic crystalloid.

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

Pediatric assessment triangle screens Appearance, Work of Breathing, and Circulation to Skin; grunting, nasal flaring, retractions, and head bobbing indicate impending respiratory failure.

Behavioral emergencies: conduct risk assessment for suicide or violence, remove ligature and weapon risks, place on 1:1 observation, de-escalate verbally before restraint; restraints require a practitioner order and face-to-face evaluation within 1 hour with 15-minute monitoring.

Heat stroke: core temperature above 40 °C with central nervous system dysfunction; principle is cool first, transport second - ice-water immersion or cold-water dousing, stopping active cooling at 38–39 °C.

Accidental hypothermia: severe (<28 °C) patients are handled gently because of ventricular fibrillation risk; use active external and internal rewarming; a single defibrillation attempt is reasonable, then continue CPR and rewarming.

Drowning: the primary insult is hypoxic brain injury - start with two rescue breaths before compressions in bystander resuscitation of a drowning victim; routine abdominal thrusts and cervical collars (absent trauma mechanism) are not indicated.

Carbon monoxide: give 100% oxygen until carboxyhemoglobin is below 5–10%; consider hyperbaric oxygen for loss of consciousness, neurological deficits, cardiac ischemia, pregnancy, or COHb above 25%.

Toxidromes: anticholinergic (hot, dry, flushed, dilated pupils, delirium), cholinergic (SLUDGE/DUMBELS), sympathomimetic (hypertensive, tachycardic, diaphoretic, agitated), opioid (miosis, respiratory depression), sedative-hypnotic (depressed consciousness, normal pupils).

Organophosphate poisoning: atropine titrated until pulmonary secretions dry (doses may be very large), plus pralidoxime and thorough decontamination of skin and clothing with staff in PPE.

Acetaminophen overdose: N-acetylcysteine is indicated when the timed serum level is above the Rumack-Matthew nomogram treatment line at 4 hours or later, or empirically for massive ingestion, unknown timing, or liver injury.

Sepsis bundle: measure lactate, obtain cultures before antibiotics, give broad-spectrum antibiotics within 1 hour for septic shock, and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L; qSOFA (RR ≥22, SBP ≤100, altered mentation) flags risk.

Isolation precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcus), airborne (tuberculosis, measles, varicella - negative-pressure room with fit-tested N95 respirator).

EMTALA obligations: perform a medical screening examination, provide stabilizing treatment, and arrange appropriate transfer for any emergency condition regardless of insurance, citizenship, or ability to pay; inquiries about payment must not delay screening.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness; the emergency exception applies when delay would risk serious harm and no surrogate decision-maker is available.

Mandatory reporting commonly covers suspected child, elder, or intimate-partner abuse, certain wounds (gunshot, stab per jurisdiction), impaired colleagues, and specified communicable diseases.

Restraint (CMS/Joint Commission): order by a licensed independent practitioner, face-to-face evaluation within 1 hour for violent/self-destructive restraints, monitoring every 15 minutes, and discontinuation at the earliest possible time.

Just culture distinguishes human error (console), at-risk behavior (coach and remove incentives), and reckless behavior (sanction); it protects reporting of near misses.

Quality benchmarks: door-to-ECG ≤10 minutes, door-to-needle ≤60 minutes for stroke thrombolysis, antibiotics within 60 minutes for septic shock, and left-without-being-seen rate as an access indicator.

Improvement cycle: root cause analysis for sentinel events, PDSA (Plan-Do-Study-Act) for rapid-cycle change, and clinical audits against evidence-based indicators.

Handoff and safety tools: SBAR (Situation, Background, Assessment, Recommendation), two patient identifiers, read-back of verbal orders, and a pre-procedure time-out.

Documentation standards: contemporaneous, objective, factual, and attributable entries; late entries are labeled as such and never altered, deleted, or backdated.