Egyptian Board Emergency Medicine cheat sheet

Cardiac arrest with shockable rhythm (VF/pVT): defibrillate immediately, then CPR 2 min before rhythm recheck; epinephrine 1 mg IV/IO every 3-5 min and amiodarone 300 mg after the third shock.

Non-shockable arrest (asystole/PEA): epinephrine 1 mg IV/IO every 3-5 min as early as possible; no atropine, no routine sodium bicarbonate.

Reversible causes mnemonic (4H/4T): hypoxia, hypovolemia, hydrogen ion (acidosis), hypo/hyperkalemia; tension pneumothorax, tamponade, toxins, thrombosis (coronary/pulmonary).

STEMI reperfusion: primary PCI is preferred if achievable within 120 min of first medical contact; otherwise fibrinolysis within 30 min of arrival (door-to-needle).

Acute decompensated heart failure with hypotension and congestion: IV vasodilators are contraindicated; use inotropes and diuretics only after perfusion is supported.

Unstable tachyarrhythmia with a pulse: synchronized cardioversion; narrow regular 50-100 J, narrow irregular 120-200 J, wide regular 100 J, wide irregular defibrillation dose (unsynchronized).

Aortic dissection: sudden tearing chest/back pain with pulse or blood pressure differential >20 mmHg between arms; avoid thrombolysis, control heart rate with beta-blockade first, target SBP 100-120 mmHg.

Post-arrest care: target temperature 32-36 °C for at least 24 h in comatose survivors, avoid hyperthermia, maintain MAP ≥65 mmHg, and obtain 12-lead ECG and early coronary angiography if STEMI.

Hemorrhagic shock in trauma: permissive hypotension (SBP 80-90 mmHg) until hemorrhage control, except in traumatic brain injury where SBP ≥110 mmHg is targeted.

Massive transfusion protocol: balanced 1:1:1 ratio of packed RBCs, plasma, and platelets; give tranexamic acid 1 g within 3 h of injury, then 1 g over 8 h.

Tension pneumothorax is a clinical diagnosis: hypotension, distended neck veins, absent breath sounds, tracheal deviation; treat with immediate needle decompression before imaging.

Open fracture: antibiotics within 1 h, tetanus prophylaxis, and urgent irrigation and debridement; do not delay antibiotics for operative washout.

Compartment syndrome: pain out of proportion, pain on passive stretch, tense compartment; pulselessness and paralysis are late signs. Pressure within 30 mmHg of diastolic indicates fasciotomy.

Pelvic fracture with hemodynamic instability: apply pelvic binder at the level of the greater trochanters and consider REBOA or angioembolization; exclude urethral injury before catheterization.

Cervical spine clearance: NEXUS criteria (no midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, no distracting injury) allow clinical clearance without imaging.

Septic arthritis of a native joint: joint aspiration before antibiotics; gonococcal and staphylococcal organisms predominate; do not inject corticosteroids into a possibly infected joint.

Acute severe asthma: SABA plus ipratropium, systemic corticosteroids within 1 h, magnesium sulfate 2 g IV over 20 min for poor response; avoid routine antibiotics and chest radiography.

COPD exacerbation with hypercapnia: target SpO2 88-92% in at-risk patients; use noninvasive ventilation for pH 7.25-7.35 with hypercapnia, reducing intubation and mortality.

Post-intubation lung-protective ventilation: tidal volume 6 mL/kg predicted body weight, plateau pressure <30 cmH2O, driving pressure <15 cmH2O.

ARDS (Berlin definition): acute onset within 1 week, bilateral opacities, no cardiogenic cause, PaO2/FiO2 ≤300 mmHg on PEEP ≥5 cmH2O; prone positioning for ≥16 h/day if ratio <150.

Massive hemoptysis: secure airway with a large-bore endotracheal tube or double-lumen tube, place the bleeding side down, and arrange bronchoscopy or embolization.

Tension pneumothorax in a ventilated patient: sudden rise in peak airway pressure with hypotension and hypoxia; decompress immediately.

Sepsis-3: suspected infection plus SOFA increase ≥2; qSOFA (respiratory rate ≥22, altered mentation, SBP ≤100) is a screening prompt, not a diagnostic criterion.

Septic shock: vasopressors to target MAP ≥65 mmHg, crystalloid 30 mL/kg for initial resuscitation, and norepinephrine as the first-line vasopressor.

Acute ischemic stroke: IV alteplase within 4.5 h of last known well (0-4.5 h), with door-to-needle ≤60 min; tenecteplase 0.25 mg/kg is an accepted alternative.

Mechanical thrombectomy: large vessel occlusion with NIHSS ≥6 and ASPECTS ≥6, up to 24 h in selected patients with salvageable penumbra.

Blood pressure before thrombolysis: lower to <185/110 mmHg; after thrombolysis maintain <180/105 mmHg for 24 h.

Intracerebral hemorrhage: reverse anticoagulation immediately; target SBP 130-140 mmHg; do not give prophylactic anticonvulsants or corticosteroids.

Subarachnoid hemorrhage: thunderclap headache, CT within 6 h is highly sensitive; if CT negative and suspicion persists, perform lumbar puncture for xanthochromia after 12 h.

Status epilepticus: benzodiazepine first line (lorazepam 0.1 mg/kg IV, max 4 mg), repeated once; then levetiracetam, fosphenytoin, or valproate; refractory cases need anesthesia and intubation.

Bacterial meningitis: dexamethasone 10 mg IV before or with the first antibiotic dose in adults with suspected pneumococcal disease; do not delay antibiotics for lumbar puncture.

Raised intracranial pressure: head elevation 30°, avoid hypoxia and hypotension, hypertonic saline or mannitol for herniation, and short-term hyperventilation only as a bridge.

Acetaminophen toxicity: Rumack-Matthew nomogram applies from 4 h after a single acute ingestion; N-acetylcysteine is most effective within 8 h and is given for level at or above the treatment line.

Salicylate toxicity: give sodium bicarbonate to alkalinize urine and serum (target urine pH 7.5-8.0), correct hypoglycemia, and avoid intubation unless necessary because it removes the compensatory respiratory alkalosis.

Toxic alcohol ingestion (methanol, ethylene glycol): fomepizole is first line; ethanol is an alternative; hemodialysis for severe acidosis or visual/renal injury.

Carbon monoxide poisoning: treat with 100% oxygen; hyperbaric oxygen for loss of consciousness, severe neurologic findings, or carboxyhemoglobin >25% (lower threshold in pregnancy).

Organophosphate poisoning: atropine titrated to dry secretions (large doses may be needed), plus pralidoxime; avoid succinylcholine due to prolonged paralysis.

Beta-blocker overdose: glucagon is first line, high-dose insulin with glucose is second line, and calcium is used for calcium channel blocker overdose.

Serotonin syndrome: clonus, hyperreflexia, agitation, and hyperthermia; stop serotonergic drugs, give benzodiazepines, and avoid antipyretics for the hyperthermia.

Heat stroke: core temperature >40 °C with central nervous system dysfunction; cool rapidly by cold water immersion and do not use antipyretics.

Upper GI bleeding: resuscitate first, give a proton pump inhibitor, and perform endoscopy within 24 h; use a restrictive transfusion threshold of hemoglobin 7 g/dL.

Variceal bleeding: octreotide plus prophylactic antibiotics (ceftriaxone) reduce mortality and rebleeding; band ligation is preferred over sclerotherapy.

Acute pancreatitis: aggressive isotonic fluid resuscitation, analgesia, and early enteral feeding; do not give prophylactic antibiotics.

Hyperkalemia with ECG changes: IV calcium gluconate or chloride first, then insulin with glucose, beta-agonist, and sodium bicarbonate; dialysis for refractory cases.

Acute kidney injury: distinguish prerenal, intrinsic, and postrenal causes; urgent dialysis for refractory hyperkalemia, acidosis, pulmonary edema, uremic pericarditis, or toxin removal.

Renal colic: NSAIDs are first-line analgesia; noncontrast CT is the imaging standard; obstructed infected kidney requires urgent decompression.

Testicular torsion: immediate urologic consultation and detorsion; do not delay for ultrasound if clinical suspicion is high, since salvage declines after 6 h.

Urinary retention: urethral catheterization first; suprapubic catheterization for urethral obstruction or trauma with suspected urethral injury.

Pediatric bradycardia with poor perfusion: start CPR if heart rate <60/min despite oxygenation and ventilation; epinephrine 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000).

Pediatric defibrillation: 2 J/kg first shock, 4 J/kg second, then ≥4 J/kg up to 10 J/kg or adult dose.

Fluid bolus in children: 20 mL/kg isotonic crystalloid, reassess after each bolus; use 10 mL/kg aliquots in septic shock with cardiac dysfunction or malnutrition.

Croup: dexamethasone 0.15-0.6 mg/kg; nebulized epinephrine for stridor at rest, with observation for at least 2-4 h afterward.

Bronchiolitis: supportive care only; no routine bronchodilators, corticosteroids, or antibiotics; use high-flow nasal cannula for respiratory distress.

Kawasaki disease: IVIG 2 g/kg plus aspirin; IVIG-resistant cases may need corticosteroids or infliximab; obtain echocardiography for coronary aneurysms.

Febrile infant under 28 days: full sepsis evaluation and empiric antibiotics with admission; lumbar puncture is standard unless contraindicated.

Anaphylaxis in children: epinephrine 0.01 mg/kg IM (max 0.5 mg) into the anterolateral thigh; antihistamines and steroids are adjuncts only.

Postpartum hemorrhage: uterine atony is the most common cause; give oxytocin, then tranexamic acid 1 g within 3 h, and use uterine massage and balloon tamponade.

Ectopic pregnancy: hemodynamically unstable patients go to surgery; methotrexate is for stable patients with small unruptured masses and no fetal cardiac activity.

Preeclampsia with severe features: magnesium sulfate 4-6 g loading dose then 1-2 g/h; delivery is definitive treatment.

Magnesium toxicity: loss of deep tendon reflexes, respiratory depression, and cardiac arrest; antidote is calcium gluconate 1 g IV.

Shoulder dystocia: McRoberts maneuver plus suprapubic pressure first; avoid fundal pressure; consider internal rotational maneuvers and the all-fours position.

Ovarian torsion: sudden unilateral pelvic pain with nausea; urgent laparoscopy for detorsion, with ovarian preservation attempted whenever feasible.

Perimortem cesarean delivery: begin within 4 min of maternal cardiac arrest and deliver by 5 min when the uterus is at or above the umbilicus.

Placenta previa: painless vaginal bleeding in late pregnancy; avoid digital vaginal examination until previa is excluded by ultrasound.

FAST examination: views of Morison's pouch, splenorenal recess, pelvic windows, and subxiphoid pericardial window; a positive scan in unstable trauma prompts laparotomy.

eFAST adds bilateral anterior lung windows for pneumothorax (loss of lung sliding) and hemothorax.

Focused cardiac ultrasound: subxiphoid view for pericardial effusion and tamponade; parasternal and apical views for global function and right ventricular strain.

Ocular ultrasound: optic nerve sheath diameter >5 mm suggests raised intracranial pressure; look for retinal detachment and vitreous hemorrhage.

Ultrasound-guided central venous access: use real-time needle visualization and confirm with a bubble study or manometry; do not rely on the color flash alone.

Lumbar puncture: use ultrasound to mark the level; avoid in coagulopathy or suspected raised intracranial pressure; measure opening pressure in the lateral decubitus position.

Intraosseous access: proximal tibia or proximal humerus; confirm by aspiration of marrow and free flow without extravasation.

Difficult airway: preoxygenate, use video laryngoscopy, and have a supraglottic airway and surgical airway plan ready; limit attempts to avoid airway trauma.

START triage: green (walking), yellow (delayed), red (immediate), black (deceased or expectant); use RPM (respiration, perfusion, mental status) for non-ambulatory patients.

Crisis standards of care prioritize saving the most lives with available resources; document resource allocation decisions and use transparent, consistent criteria.

Emergency department crowding: use input-throughput-output measures; boarding time and length of stay are key quality indicators.

Triage systems: Emergency Severity Index levels 1-5 based on acuity and resource needs; level 1 requires immediate life-saving intervention.

Prehospital trauma destination: major trauma centers for prolonged extrication, hypotension, or penetrating torso injury; use the field triage decision scheme.

Mass casualty incident: establish incident command, designate triage and treatment areas, and track patients with unique identifiers.

Surge capacity: expand space, staff, supplies, and systems; the hospital emergency operations plan is activated by the incident commander.

Informed consent requires capacity, disclosure of risks and alternatives, understanding, and voluntariness; document the discussion.

Emergency exception: treat without consent when immediate intervention is needed to prevent serious harm and the patient lacks capacity and no surrogate is available.

Capacity assessment: patient communicates a choice, understands the information, appreciates consequences, and reasons; capacity is decision-specific.

Advance directives and durable power of attorney for health care take effect when the patient lacks capacity; do not override a valid directive.

Mandatory reporting: suspected child abuse, elder abuse, and certain communicable diseases must be reported to designated authorities.

Breaking bad news: use a structured approach (SPIKES), gather the patient's perspective, give warning, and allow silence and questions.

Medical errors: disclose harm to the patient in a timely, factual manner and report through the institution's incident reporting system.

Confidentiality: exceptions include imminent danger to self or others, mandated reporting, and court order; disclose only the minimum necessary.

Randomized controlled trial: randomization reduces selection bias; intention-to-treat analysis preserves the effect of assignment.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive predictive value depends on prevalence.

Likelihood ratio positive = sensitivity/(1 − specificity); LR negative = (1 − sensitivity)/specificity; LRs are less affected by prevalence.

Number needed to treat = 1/absolute risk reduction; absolute risk reduction = control event rate minus treatment event rate.

Diagnostic study design: avoid case-control designs and spectrum bias; use consecutive enrollment and a reference standard with blinding.

Confidence intervals: a 95% CI excluding the null value corresponds to a statistically significant result at p < 0.05.

Systematic review: assess heterogeneity with I², publication bias with funnel plots, and risk of bias with validated tools.

Levels of evidence: systematic reviews and RCTs rank above cohort and case-control studies; guidelines grade recommendations by evidence quality and strength.