ACEM Fellowship Written flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Adrenaline in cardiac arrest

Give 1 mg of 1:10,000 adrenaline IV or IO every 3-5 cycles in cardiac arrest. For shockable rhythms, give after the second or third shock; for non-shockable rhythms, give immediately.

Anaphylaxis first-line treatment

Give adrenaline 0.5 mg IM of 1:1000 into the anterolateral thigh, repeat every 5 minutes as needed, and give a 500-1000 mL crystalloid bolus for hypotension.

Tension pneumothorax management

Tension pneumothorax is a clinical diagnosis requiring immediate decompression by finger thoracostomy or needle decompression, followed by intercostal catheter insertion. Do not delay for imaging in an unstable patient.

Hyperkalaemia emergency treatment

Give IV calcium for cardiac protection, then insulin with glucose and nebulised salbutamol to shift potassium intracellularly. Consider sodium bicarbonate if acidotic and arrange definitive removal if refractory.

Sepsis bundle essentials

Measure lactate, take blood cultures, give broad-spectrum antibiotics within one hour for septic shock, and give 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more.

Post-ROSC oxygen and carbon dioxide targets

After return of spontaneous circulation, target SpO2 of 94-98% and normocapnia with PaCO2 of 35-45 mmHg. Avoid hypotension and fever, and obtain a 12-lead ECG.

Paracetamol overdose antidote timing

Use the Rumack-Matthew nomogram from four hours post-ingestion. N-acetylcysteine is most effective within eight hours; treat if the level is at or above the treatment line or ingestion time is unknown with significant ingestion.

Tricyclic overdose treatment

Tricyclic overdose causes sodium channel blockade with QRS widening and arrhythmia. Give sodium bicarbonate boluses to narrow the QRS and avoid class IA antiarrhythmics.

Salicylate toxicity features

Salicylate toxicity causes mixed respiratory alkalosis and metabolic acidosis, tinnitus and altered mental state. Treat with sodium bicarbonate to alkalinise serum and urine, plus glucose and haemodialysis for severe cases.

Carbon monoxide poisoning

Measure carboxyhaemoglobin and give high-flow oxygen. Consider hyperbaric oxygen for loss of consciousness, neurological signs, ischaemia, or pregnancy with significant exposure.

Heat stroke management

Heat stroke is core temperature above 40 C with CNS dysfunction. Cool immediately with cold-water immersion or evaporative methods and monitor for rhabdomyolysis, DIC and hepatic injury.

STEMI reperfusion targets

Obtain a 12-lead ECG within 10 minutes. For ST-elevation MI, activate primary PCI with a target of 90 minutes from first medical contact where available, and give aspirin plus a P2Y12 inhibitor.

Acute pulmonary oedema treatment

Sit the patient upright, give high-flow oxygen or non-invasive ventilation, IV nitrates if systolic BP is above 100 mmHg, and a loop diuretic. Treat precipitants such as arrhythmia, ischaemia and hypertension.

Aortic dissection blood pressure control

Aortic dissection presents with tearing chest or back pain and pulse deficit. CT angiography is diagnostic, and analgesia plus heart-rate control targeting systolic BP of 100-120 mmHg precede definitive repair.

Acute severe asthma adjunct

Give continuous nebulised salbutamol with ipratropium, systemic corticosteroids, and IV magnesium sulfate 2 g over 20 minutes for poor response. Consider IV salbutamol and ketamine in life-threatening attacks.

COPD exacerbation oxygen target

In COPD exacerbation, titrate oxygen to target SpO2 of 88-92%, give nebulised bronchodilators and systemic steroids, and use non-invasive ventilation for respiratory acidosis with pH under 7.35 and hypercapnia.

Pulmonary embolism thrombolysis indication

Consider thrombolysis for pulmonary embolism with haemodynamic instability, such as systolic BP under 90 mmHg. Use Wells score and D-dimer in low or intermediate probability, and CT pulmonary angiography for diagnosis.

Acute ischaemic stroke thrombolysis

Non-contrast CT excludes haemorrhage. Give IV alteplase or tenecteplase within 4.5 hours of onset for eligible patients, and consider endovascular thrombectomy for large vessel occlusion up to 24 hours in selected cases.

Status epilepticus sequence

Give a benzodiazepine first-line, such as IV lorazepam 4 mg or IM midazolam 10 mg, and repeat once. Then give second-line IV levetiracetam, valproate or phenytoin; refractory cases need intubation and anaesthetic agents.

Diabetic ketoacidosis insulin and glucose

Give IV crystalloid, start an insulin infusion at 0.1 units/kg/hour, replace potassium once K is under 5.5 mmol/L, and add 10% glucose when glucose falls below 15 mmol/L. Continue insulin until ketones clear.

Hyponatraemia correction limit

Symptomatic or severe hyponatraemia needs hypertonic saline with correction limited to about 8-10 mmol/L in 24 hours to avoid osmotic demyelination. Treat seizures with 3% saline boluses.

Rapid sequence intubation confirmation

Pre-oxygenate, optimise haemodynamics, give an induction agent plus neuromuscular blocker, and confirm tube position with waveform capnography. Have a failed airway plan ready, including front-of-neck access.

Massive transfusion ratio

Give balanced blood product ratios approximating 1:1:1 of packed cells, plasma and platelets, limit crystalloid, and give tranexamic acid 1 g IV within three hours of trauma with ongoing bleeding.

TBI cerebral perfusion targets

Avoid hypoxia and hypotension with systolic BP at least 110 mmHg in adults, keep PaCO2 at 35-40 mmHg, elevate the head 30 degrees, and use hypertonic saline or mannitol for signs of herniation.

Paediatric fluid bolus volume

In paediatric resuscitation, give crystalloid boluses of 10-20 mL/kg with reassessment after each bolus. In septic shock, consider early inotropes if the child remains fluid-refractory.

Croup treatment

Give single-dose dexamethasone 0.15-0.6 mg/kg and nebulised adrenaline for stridor at rest. Observe after adrenaline because rebound symptoms can occur.

Postpartum haemorrhage treatment

Postpartum haemorrhage requires uterotonics, tranexamic acid 1 g IV, and blood products as needed. Eclampsia is treated with a magnesium sulfate loading dose and infusion.

Neonatal resuscitation heart rate threshold

Dry and stimulate the newborn, then assess tone, breathing and heart rate. Give positive pressure ventilation for apnoea or heart rate under 100, and start chest compressions if heart rate remains under 60 after effective ventilation.

Chemical eye injury irrigation

Irrigate a chemical eye injury immediately with copious saline or water for at least 20-30 minutes, check the pH, and refer urgently to ophthalmology.

Acute angle-closure glaucoma

Acute angle-closure glaucoma presents with severe eye pain, headache, halos, a mid-dilated pupil and corneal haze. Refer urgently to ophthalmology and give topical and systemic agents to lower intraocular pressure.

Necrotising fasciitis management

Necrotising fasciitis causes pain out of proportion, rapidly spreading erythema, crepitus and systemic toxicity. It requires urgent surgical debridement and broad-spectrum antibiotics including clindamycin.

Stevens-Johnson syndrome management

Stevens-Johnson syndrome and toxic epidermal necrolysis require stopping the culprit drug, fluid and electrolyte management, wound care, and referral to a burn unit or intensive care.