Arab Board Emergency Medicine Clinical Exam cheat sheet

Adult CPR: ratio 30:2, rate 100-120/min, depth 5-6 cm, full chest recoil; pauses for rhythm checks <10 s.

Biphasic defibrillation 120-200 J (manufacturer's recommended dose); monophasic 360 J; resume compressions immediately after shock.

Shockable rhythms are VF and pulseless VT; asystole and PEA are non-shockable and receive epinephrine 1 mg IV/IO every 3-5 min.

Amiodarone 300 mg IV/IO after the third shock for refractory VF/pVT, then 150 mg; lidocaine 1-1.5 mg/kg is an alternative.

Reversible causes: hypoxia, hypovolaemia, hypo/hyperkalaemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis.

Post-ROSC targets: SpO2 94-98%, PaCO2 35-45 mmHg, MAP >=65 mmHg; comatose patients receive targeted temperature management 32-36°C.

Paediatric CPR: 15:2 with two rescuers (30:2 single), rate 100-120/min, depth one-third AP chest; epinephrine 0.01 mg/kg IV/IO.

Symptomatic bradycardia: atropine 1 mg IV every 3-5 min (max 3 mg), transcutaneous pacing, dopamine 5-20 mcg/kg/min or epinephrine infusion.

Shock index = heart rate / systolic blood pressure; >0.9 suggests occult shock and >1.0 predicts increased transfusion need.

MAP = (SBP + 2 x DBP)/3; target >=65 mmHg in most shock states.

Lactate >2 mmol/L and base deficit <-4 mmol/L indicate hypoperfusion; serial lactate clearance guides resuscitation.

Septic shock: 30 mL/kg crystalloid within 3 h, broad-spectrum antibiotics within 1 h, norepinephrine for MAP <65 mmHg.

Norepinephrine is first-line vasopressor; add vasopressin 0.03 units/min and then epinephrine for refractory shock.

Anaphylaxis: IM epinephrine 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh; repeat every 5-15 min as needed.

DKA: 0.9% saline 15-20 mL/kg in the first hour; start insulin 0.1 units/kg/h only after potassium >=3.3 mmol/L.

ARDS ventilation: tidal volume 6 mL/kg predicted body weight, plateau pressure <30 cmH2O, PEEP >=5 cmH2O.

Post-intubation: confirm with continuous capnography, give sedation/analgesia, elevate head 30°, start DVT prophylaxis.

Primary survey ABCDE; in exsanguinating trauma, catastrophic hemorrhage control precedes airway (ABC).

Permissive hypotension: target SBP 80-90 mmHg in penetrating trauma without traumatic brain injury until hemorrhage control.

Massive transfusion 1:1:1 RBC:FFP:platelets; tranexamic acid 1 g IV within 3 h of injury, followed by 1 g over 8 h.

FAST examines pericardial, perihepatic, perisplenic, and pelvic windows; it is insensitive for retroperitoneal and hollow viscus injury.

Tension pneumothorax: immediate needle decompression (2nd intercostal space midclavicular or 5th space anterior axillary line), then chest tube.

Cardiac tamponade: Beck triad of hypotension, distended neck veins, muffled heart sounds; treat with pericardiocentesis or thoracotomy.

Severe TBI: intubate if GCS <=8; maintain SBP >=110 mmHg and avoid hypoxia; give mannitol 0.5-1 g/kg or hypertonic saline for herniation.

Pelvic fracture: apply binder at greater trochanters; avoid repeated log-roll; angiography for persistent instability.

Compartment syndrome: pain out of proportion and passive stretch pain; fasciotomy if pressure >30 mmHg or delta <30 mmHg.

Parkland formula: 4 mL/kg/%TBSA lactated Ringer's over 24 h; half in the first 8 h from burn time.

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

Paediatric rule of nines: head 18%, each leg 14%; Lund-Browder chart is more accurate for children.

Inhalation injury: stridor, hoarseness, soot, singed nares; intubate early; give 100% O2 for CO and hydroxocobalamin for suspected cyanide.

Circumferential burns require escharotomy when perfusion is impaired or compartment pressure rises.

Refer burns >10% TBSA, full-thickness, face/hands/feet/perineum, electrical, chemical, or inhalation injury to a burn centre.

Tetanus prophylaxis: contaminated wound with unknown or <3 doses -> toxoid plus immunoglobulin; clean wound and >10 y -> toxoid.

Wound closure timing: clean wounds within 6-12 h, face within 24 h; bites and contaminated wounds are left open or delayed.

Chemical burns: copious irrigation for 20-30 min; alkali burns penetrate deeper than acid; hydrofluoric acid needs calcium gluconate.

STEMI reperfusion: door-to-balloon <90 min at PCI centre, <120 min if transfer; fibrinolysis within 30 min when PCI unavailable and symptoms <12 h.

ACS: chewed aspirin 162-325 mg, P2Y12 inhibitor, anticoagulation; nitroglycerin contraindicated with RV infarct or recent sildenafil.

Atrial fibrillation: rate control with beta-blocker or diltiazem; synchronized cardioversion if unstable; CHA2DS2-VASc guides anticoagulation.

SVT: vagal maneuvers then adenosine 6 mg IV push, followed by 12 mg if needed; synchronized cardioversion 50-100 J if unstable.

Stable ventricular tachycardia: amiodarone 150 mg IV over 10 min or synchronized cardioversion; pulseless VT -> defibrillation.

Aortic dissection: sudden tearing pain, pulse deficit, BP differential; target HR <60 and SBP 100-120 with beta-blocker first.

Hypertensive emergency: reduce MAP 20-25% in the first hour; exceptions include aortic dissection and ischemic stroke.

Acute cardiogenic pulmonary oedema: CPAP/NIV, nitrates, furosemide 40 mg IV; treat precipitants and avoid fluid loading.

Pericarditis: diffuse ST elevation with PR depression; NSAIDs plus colchicine; avoid anticoagulation.

Acute asthma: nebulized salbutamol, ipratropium, systemic corticosteroids; magnesium sulfate 2 g IV for severe exacerbation.

COPD exacerbation: target SpO2 88-92%; bronchodilators, steroids, antibiotics for purulent sputum; NIV for pH <7.35 with hypercapnia.

Pulmonary embolism: Wells score, D-dimer for low/intermediate probability, CT pulmonary angiography for high probability.

Massive PE with hypotension: systemic thrombolysis (alteplase 100 mg over 2 h) or catheter/surgical embolectomy.

Tension pneumothorax needs immediate needle decompression; small primary spontaneous pneumothorax may be observed.

ARDS Berlin criteria: onset within 1 week, bilateral opacities, PaO2/FiO2 <=300 with PEEP >=5 cmH2O.

Type 1 respiratory failure: PaO2 <60 mmHg with normal/low PaCO2; type 2: PaCO2 >50 mmHg.

Flail chest or >=3 rib fractures with age >65: admit, multimodal analgesia, incentive spirometry; intubate for respiratory failure.

Massive hemoptysis >600 mL/24 h: secure airway, position bleeding side down, bronchoscopy and embolization.

Ischemic stroke: CT within 20 min; IV thrombolysis within 4.5 h; thrombectomy within 6-24 h for large vessel occlusion.

BP before thrombolysis must be <185/110 mmHg; otherwise permissive <220/120 mmHg unless another indication exists.

Subarachnoid hemorrhage: thunderclap headache; CT within 6 h is highly sensitive; LP if CT negative; nimodipine 60 mg every 4 h.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg or midazolam 10 mg IM), then levetiracetam 60 mg/kg or fosphenytoin 20 mg PE/kg.

Bacterial meningitis: dexamethasone 10 mg with or before antibiotics; ceftriaxone 2 g plus vancomycin, add ampicillin if age >50.

GCS <=8 mandates intubation; GCS eye 4, verbal 5, motor 6.

Raised ICP: head up 30°, avoid hypoxia and hypotension, short-term hyperventilation to PaCO2 30-35 mmHg, mannitol or hypertonic saline.

Neurogenic shock: hypotension with bradycardia after spinal cord injury; fluids plus norepinephrine; methylprednisolone is not routine.

Anticholinergic toxidrome: dry skin, flushing, mydriasis, delirium, urinary retention; physostigmine only for severe cases without conduction delay.

Opioid toxidrome: pinpoint pupils, respiratory depression, decreased consciousness; naloxone 0.04-0.4 mg IV titrated to breathing.

Acetaminophen: N-acetylcysteine; Rumack-Matthew nomogram at 4 h; treat if level above line or unknown ingestion with hepatotoxicity.

Salicylate toxicity: sodium bicarbonate for alkaline diuresis; hemodialysis for severe acidosis, seizures, or level >100 mg/dL.

Organophosphate: atropine until secretions dry, pralidoxime, decontamination; avoid succinylcholine.

Carbon monoxide: 100% O2; hyperbaric oxygen for syncope, neurological symptoms, COHb >25%, or pregnancy with COHb >15%.

Alcohol withdrawal: benzodiazepines guided by CIWA; give thiamine before glucose in malnourished patients.

Beta-blocker/calcium-channel blocker overdose: glucagon, high-dose insulin euglycemia, calcium salts, pacing for refractory bradycardia.

Snake envenomation: immobilize limb, avoid tourniquet and incision; give antivenom for systemic or progressive local effects.

Paediatric assessment triangle: appearance, work of breathing, circulation to skin.

Weight estimate: (age in years + 4) x 2 kg; length-based tape is preferred in emergencies.

Fluid bolus 20 mL/kg isotonic crystalloid; maintenance 4-2-1 rule (4 mL/kg/h first 10 kg, 2 next 10, 1 thereafter).

Croup: dexamethasone 0.15-0.6 mg/kg; nebulized epinephrine for stridor at rest; avoid throat examination.

Epiglottitis: drooling, tripod position, muffled voice; do not examine throat, prepare for controlled intubation.

Bronchiolitis: supportive care, supplemental O2, high-flow nasal cannula; no routine bronchodilators or corticosteroids.

Febrile seizure: age 6 months-5 years, simple <15 min; LP only if meningism, incomplete immunization, or <6 months.

Pyloric stenosis: projectile nonbilious vomiting at 3-6 weeks, hypochloremic hypokalemic metabolic alkalosis.

Intussusception: colicky pain, red currant jelly stool, target sign on ultrasound; air enema reduction.

Neonatal resuscitation: 21% O2 at term, initial steps 30-60 s, 3:1 compressions if HR <60 after ventilation.

Ectopic pregnancy: beta-hCG and transvaginal ultrasound; methotrexate if stable and unruptured, surgery if ruptured or unstable.

Preeclampsia: BP >=140/90 after 20 weeks plus proteinuria or organ dysfunction; magnesium sulfate 4-6 g IV for eclampsia or severe features.

Postpartum hemorrhage: uterine atony most common; fundal massage, oxytocin 10 units IM, tranexamic acid 1 g IV, balloon tamponade.

Placenta previa: painless vaginal bleeding; avoid digital examination; deliver by caesarean section.

Abruptio placentae: painful bleeding, uterine tenderness, fetal distress; resuscitate and deliver.

Shoulder dystocia: McRoberts maneuver, suprapubic pressure, then internal rotation; avoid fundal pressure.

Cord prolapse: knee-chest or Trendelenburg position, elevate presenting part, immediate delivery.

Perimortem caesarean section: perform within 4-5 min of maternal arrest if no ROSC; left uterine displacement during CPR.

Ottawa ankle rules: malleolar pain plus bone tenderness or inability to bear weight -> X-ray.

Ottawa knee rules: age >55, isolated patella tenderness, fibular head tenderness, inability to flex 90°, inability to bear weight.

Compartment syndrome: pain out of proportion, passive stretch pain; fasciotomy if pressure >30 mmHg or delta <30 mmHg.

Hip fracture: shortened, externally rotated leg; analgesia, traction, early surgery.

Septic arthritis: fever, hot swollen joint; arthrocentesis with cell count >50,000/mm3 and IV antibiotics.

Cauda equina syndrome: saddle anaesthesia, bowel/bladder dysfunction, bilateral leg weakness; urgent MRI.

Back pain red flags: age >50, trauma, cancer, fever, neurological deficit, night pain, weight loss.

Joint dislocation: check neurovascular status before and after reduction under procedural sedation.

Upper GI bleed: two large-bore IVs, PPI, endoscopy within 24 h; variceal bleed -> octreotide plus ceftriaxone.

Acute pancreatitis: lipase >3x upper limit of normal with typical pain; aggressive isotonic fluids, analgesia, early enteral feeding.

AKI KDIGO: creatinine rise >=0.3 mg/dL in 48 h, >=1.5x baseline in 7 days, or urine output <0.5 mL/kg/h for 6 h.

Hyperkalemia: calcium gluconate for ECG changes, insulin 10 units with glucose, salbutamol, bicarbonate, dialysis for refractory.

Hyponatremia: correct <=8-10 mmol/L per 24 h; 3% saline for seizures or severe symptoms.

DKA: glucose >250 mg/dL, ketosis, pH <7.3; HHS: glucose >600 mg/dL, osmolality >320 mOsm/kg, minimal ketosis.

Variceal bleeding: restrictive transfusion target Hgb 7-8 g/dL; avoid over-transfusion.

Mesenteric ischemia: pain out of proportion, atrial fibrillation; CT angiography and early surgery.

GI bleed risk: Glasgow-Blatchford score <=1 may allow outpatient management.

Ultrasound-guided peripheral IV: visualize vein longitudinally, in-plane needle approach, confirm flash and catheter in vessel.

Central venous line: Trendelenburg, ultrasound guidance, confirm tip with ultrasound or chest radiograph; avoid infected sites.

Lumbar puncture: L3-L4 or L4-L5 interspace; contraindicated with raised ICP, local infection, or coagulopathy.

Thoracentesis: posterior approach below the 9th rib, avoid intercostal neurovascular bundle; ultrasound guidance.

Paracentesis: lateral to rectus sheath, avoid varices; SAAG >=1.1 g/dL indicates portal hypertension.

Endotracheal intubation: preoxygenation, rapid sequence induction, confirm with continuous capnography and ultrasound.

FAST: four windows (RUQ, LUQ, pelvis, subxiphoid); cardiac standstill on POCUS predicts poor arrest outcome.

Arthrocentesis: avoid overlying cellulitis; send cell count, crystals, Gram stain, culture.

START triage: green (minor), yellow (delayed), red (immediate), black (deceased/expectant); 30-2-can-do.

Mass casualty: establish incident command, ensure scene safety, triage, treatment, transport.

Disaster surge: activate surge capacity, PPE, decontamination, and hospital incident command.

EMS: scene safety first, selective spinal immobilization, prehospital 12-lead ECG for chest pain.

Hospital diversion: use when emergency department capacity is exceeded; notify EMS.

Chain of evidence: label, seal, document, and hand over forensic specimens.

Quality metrics: door-to-antibiotic time for sepsis, door-to-balloon for STEMI, time to CT for stroke.

Crisis standards: allocate resources by objective triage scores when demand exceeds supply.