CNA Emergency Nursing (ENC(C)) cheat sheet

ESI levels: 1 = immediate life-saving intervention; 2 = high-risk or severe pain/distress; 3 = two or more resources; 4 = one resource; 5 = no resources.

Resources counted at triage: labs, ECG, plain imaging, CT/MRI, IV fluids, IV or IM medications, specialty consultation. PO medications, tetanus, and simple wound care are not resources.

Primary survey order is airway with cervical spine protection, breathing, circulation with hemorrhage control, disability, exposure with temperature control.

Shock index = heart rate divided by systolic blood pressure; a value above 0.9 suggests occult hypoperfusion and need for escalation.

Mean arterial pressure = (systolic + 2 x diastolic) / 3; cerebral and renal perfusion generally require MAP of at least 65 mmHg.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15; score of 8 or less indicates need to secure the airway.

Triage tags in mass casualty: red immediate, yellow delayed, green minor, black expectant or deceased; reassessment occurs after each transport cycle.

Handoff uses SBAR: situation, background, assessment, recommendation; read-back confirms verbal and telephone orders.

Adult high-quality CPR: compression rate 100-120 per minute, depth 5-6 cm, full recoil, interruptions under 10 seconds, compression fraction above 60%, and a 30:2 ratio without an advanced airway.

Defibrillation for VF or pulseless VT is delivered as soon as available; resume compressions immediately after each shock and check rhythm every 2 minutes.

Epinephrine 1 mg IV/IO every 3-5 minutes during cardiac arrest; amiodarone 300 mg then 150 mg is given after the third shock for refractory VF/VT.

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

ST-elevation myocardial infarction: door-to-balloon goal of 90 minutes for primary PCI or door-to-needle within 30 minutes when fibrinolysis is chosen.

Acute decompensated heart failure: sit upright, oxygen for saturation below 90%, IV loop diuretic, and noninvasive ventilation for pulmonary edema with respiratory distress.

Unstable tachyarrhythmia with hypotension, altered mentation, shock, or ischemic chest pain is treated with synchronized cardioversion; unstable bradycardia with a pulse is treated with atropine 1 mg IV, then pacing.

Aortic dissection presents with abrupt tearing chest or back pain and a systolic pressure differential between arms; blood pressure control precedes definitive imaging.

Asthma severity markers: inability to speak in full sentences, accessory muscle use, silent chest, peak flow below 40% of predicted, and oxygen saturation below 90% indicate severe or life-threatening exacerbation.

Status asthmaticus treatment: inhaled short-acting beta agonist with ipratropium, early systemic corticosteroids, and magnesium sulfate for severe refractory cases.

Tension pneumothorax is a clinical diagnosis: unilateral absent breath sounds, tracheal deviation away from the affected side, distended neck veins, and hypotension; needle decompression precedes imaging.

Massive hemoptysis is more than 600 mL in 24 hours; priority is airway protection, positioning the bleeding side down, and securing a definitive airway.

Pulmonary embolism risk tools include Wells criteria and PERC; massive PE with hypotension is treated with systemic thrombolysis or embolectomy.

Acute respiratory distress syndrome uses low tidal volume ventilation of 6 mL/kg predicted body weight and plateau pressure of 30 cm H2O or less.

Noninvasive positive pressure ventilation is indicated for COPD exacerbation with pH below 7.35 and for cardiogenic pulmonary edema; contraindicated in altered mentation, vomiting, or facial trauma.

Oxygen targets: 94-98% for most acutely ill adults, 88-92% for those at risk of hypercapnic respiratory failure.

Stroke thrombolysis window is up to 4.5 hours from last known well; door-to-needle goal is 60 minutes or less, and door-to-CT goal is 25 minutes or less.

Alteplase dose for ischemic stroke is 0.9 mg/kg (maximum 90 mg), with 10% as a bolus and the remainder infused over 60 minutes.

Blood pressure must be below 185/110 mmHg before thrombolysis and maintained below 180/105 mmHg for 24 hours afterward.

Mechanical thrombectomy is considered up to 24 hours in selected large-vessel occlusion with favorable imaging; CT excludes hemorrhage before any reperfusion therapy.

Subarachnoid hemorrhage presents with thunderclap headache; CT is most sensitive within 6 hours, and xanthochromia in cerebrospinal fluid supports later presentation.

Increased intracranial pressure signs: declining level of consciousness, ipsilateral dilated pupil, contralateral hemiparesis, bradycardia with hypertension and irregular respirations (Cushing triad).

Seizure lasting more than 5 minutes or repeated without recovery is status epilepticus; first-line therapy is a benzodiazepine, followed by a second-line antiepileptic.

Spinal cord injury with neurogenic shock shows hypotension with bradycardia; treatment is cautious fluid resuscitation plus vasopressor support.

Hemorrhagic shock classes: class I up to 15% blood loss; class II 15-30% with tachycardia; class III 30-40% with hypotension and altered mentation; class IV above 40% with profound instability.

Permissive hypotension targets a systolic pressure of about 80-90 mmHg in penetrating trauma without traumatic brain injury; head-injured patients require systolic pressure of at least 110 mmHg.

Massive transfusion protocol ratio approximates 1:1:1 of packed red cells, plasma, and platelets; tranexamic acid is given within 3 hours of injury.

Pelvic fracture with hemodynamic instability is managed with a pelvic binder at the level of the greater trochanters and early angioembolization or preperitoneal packing.

Compartment syndrome: pain out of proportion, pain on passive stretch, paresthesia, pallor, paralysis, and pulselessness (a late finding); pressure above 30 mmHg or delta pressure below 30 mmHg warrants fasciotomy.

Open fracture care includes gross contamination removal, sterile dressing, splinting, tetanus status assessment, and antibiotics within 1 hour.

Fat embolism syndrome after long bone fracture: hypoxemia, petechiae, and confusion typically 24-72 hours after injury.

Traumatic brain injury anticoagulation reversal and avoidance of hypotension and hypoxia are priorities; a single episode of systolic pressure below 90 mmHg doubles mortality.

Diabetic ketoacidosis: glucose above 250 mg/dL, pH below 7.30, bicarbonate below 18 mEq/L, anion gap above 10, and ketonemia; treatment is isotonic fluids, insulin infusion, and potassium replacement once potassium is below 5.2 mEq/L.

Hyperosmolar hyperglycemic state shows glucose above 600 mg/dL, serum osmolality above 320 mOsm/kg, and minimal ketosis; fluid deficit may exceed 8 liters.

Hypoglycemia is glucose below 70 mg/dL; symptomatic or below 54 mg/dL is treated with oral glucose if able to swallow or IV dextrose or glucagon if not.

Upper gastrointestinal bleeding: IV proton pump inhibitor, two large-bore IVs, type and crossmatch, and urgent endoscopy within 24 hours; variceal bleeding adds octreotide and prophylactic antibiotics.

Acute pancreatitis diagnosis requires two of three: characteristic pain, lipase above three times the upper limit of normal, and imaging findings.

Hyperkalemia with ECG changes is treated with IV calcium for membrane stabilization, insulin with glucose, beta agonist, and dialysis for refractory cases.

Renal colic with suspected obstruction and fever requires urgent decompression by stent or nephrostomy plus antibiotics.

Sepsis bundle: measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics and 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or greater.

Postpartum hemorrhage is blood loss above 500 mL after vaginal delivery or 1000 mL after cesarean; uterine atony is the most common cause and is treated with fundal massage and uterotonics.

Causes of postpartum hemorrhage: tone, trauma, tissue, thrombin; medications include oxytocin, methylergonovine (avoided in hypertension), carboprost (avoided in asthma), and misoprostol.

Preeclampsia is blood pressure of 140/90 mmHg or higher after 20 weeks with proteinuria or organ dysfunction; severe features include pressure of 160/110 mmHg, platelets below 100,000, and elevated liver enzymes.

Eclampsia treatment is magnesium sulfate with a loading dose of 4-6 g IV followed by 1-2 g per hour; monitor reflexes, respiration, and urine output for toxicity.

Emergent delivery in pregnancy occurs for maternal cardiac arrest with fundal displacement and CPR, and perimortem cesarean is considered within 4-5 minutes.

Pediatric weight estimate for ages 1-10 years is (age + 4) x 2 kg; epinephrine for pediatric arrest is 0.01 mg/kg of the 0.1 mg/mL concentration.

Pediatric hypotension: systolic pressure below 70 + (2 x age in years) for ages 1-10; hypotension is a late sign of shock in children.

Neonatal resuscitation begins with warmth, drying, stimulation, and airway positioning; compressions begin if heart rate stays below 60 per minute after effective ventilation.

Toxidromes: anticholinergic (dry, flushed, mydriasis, delirium), cholinergic (salivation, lacrimation, urination, diarrhea, bronchospasm), opioid (miosis, respiratory depression), sympathomimetic (tachycardia, hypertension, agitation).

Acetaminophen toxicity is treated with N-acetylcysteine; the Rumack-Matthew nomogram guides treatment from 4 hours after ingestion.

Salicylate toxicity causes mixed respiratory alkalosis and metabolic acidosis; treatment includes urinary alkalinization with sodium bicarbonate and hemodialysis for severe cases.

Carbon monoxide poisoning: carboxyhemoglobin does not reliably correlate with severity; 100% oxygen is given, and hyperbaric oxygen is considered for syncope, neurologic deficit, or pregnancy.

Organophosphate poisoning is treated with atropine titrated to secretions and pralidoxime; bradycardia and bronchorrhea guide dosing.

Hypothermia treatment: passive and active external rewarming for mild cases; severe hypothermia with instability may require extracorporeal rewarming.

Heat stroke is core temperature above 40 degrees Celsius with altered mentation; cold water immersion is the preferred cooling method.

Suicide risk assessment documents ideation, plan, intent, means access, and protective factors; patients requiring involuntary hold need continuous observation and removal of ligature risks.

Emergency Medical Treatment and Labor Act requires a medical screening examination and stabilizing treatment regardless of ability to pay, with transfer only after stabilization or a certified appropriate transfer.

Consent exceptions include emergency situations with imminent harm, implied consent, and legally authorized surrogates; minors require guardian consent except for emancipated minors and specified public health situations.

Chain of evidence for forensic specimens includes labeling, sealed packaging, documented transfer of custody, and secure storage.

Violence risk reduction: limit exit access, remove weapons, use metal detection, and apply behavioral emergency response teams for escalating patients.

Medication safety targets include independent double checks for high-alert drugs, weight-based pediatric dosing, and reconciliation at transitions of care.

Documentation elements include time-stamped arrival, triage level, reassessment intervals, vital signs, interventions, response, and discharge instructions.

Surge capacity uses the Hospital Incident Command System, bed tracking, and reverse triage of inpatients to create capacity.

Mandatory reporting includes suspected abuse or neglect, certain communicable diseases, and gunshot wounds in many jurisdictions.