ENP-BC cheat sheet

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP). A highly sensitive test is best for ruling out disease when negative (SnNout); a highly specific test is best for ruling in disease when positive (SpPin).

Positive predictive value = TP/(TP+FP) and depends on prevalence; negative predictive value = TN/(TN+FN). Likelihood ratio positive = sensitivity/(1 − specificity); likelihood ratio negative = (1 − sensitivity)/specificity.

Number needed to screen = 1/(prevalence × mortality reduction × adherence); number needed to treat = 1/absolute risk reduction.

CAGE (Cut down, Annoyed, Guilty, Eye-opener) ≥2 positive screens for alcohol use disorder; AUDIT-C ≥4 in men or ≥3 in women is a positive screen.

PHQ-9 scores: 5–9 mild, 10–14 moderate, 15–19 moderately severe, ≥20 severe depression; a score ≥10 has ~88% sensitivity and ~88% specificity for major depression.

GAD-7 scores: 5–9 mild, 10–14 moderate, ≥15 severe anxiety; a score ≥10 has ~89% sensitivity and ~82% specificity for generalized anxiety disorder.

Mini-Mental State Examination score ≤23 (adjusted for education) suggests cognitive impairment; Montreal Cognitive Assessment <26 is abnormal.

Centor/McIsaac criteria for streptococcal pharyngitis: fever >38°C, tonsillar exudates, tender anterior cervical adenopathy, absence of cough (1 point each); age 3–14 adds 1, age ≥45 subtracts 1.

Wells score for pulmonary embolism: clinical signs of DVT 3, PE most likely diagnosis 3, heart rate >100 1.5, immobilization/surgery 1.5, previous DVT/PE 1.5, hemoptysis 1, malignancy 1; >4 indicates likely PE.

Hypertension in adults: initiate pharmacotherapy for confirmed BP ≥140/90 mmHg; target <130/80 mmHg for most adults, including those with diabetes or chronic kidney disease.

Type 2 diabetes: metformin is first-line unless contraindicated; add an SGLT2 inhibitor or GLP-1 receptor agonist when atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease is present.

Heart failure with reduced ejection fraction: guideline-directed therapy includes an ARNI/ACE inhibitor/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Asthma: step-up therapy when symptoms are not controlled; inhaled corticosteroid is the preferred controller at every step; short-acting beta-agonist alone is no longer recommended for persistent asthma.

Community-acquired pneumonia in outpatients without comorbidities: amoxicillin 1 g three times daily or doxycycline 100 mg twice daily; with comorbidities use a beta-lactam plus macrolide or doxycycline, or a respiratory fluoroquinolone.

Uncomplicated cystitis: nitrofurantoin 100 mg twice daily for 5 days, trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days (if local resistance <20%), or fosfomycin 3 g single dose.

Acute gout flare: NSAIDs, colchicine, or glucocorticoids; do not initiate or adjust urate-lowering therapy during a flare unless already established.

Opioid prescribing: check the prescription drug monitoring program, offer naloxone when risk factors are present (≥50 morphine milligram equivalents/day, concurrent benzodiazepine, substance use history), and use shared decision-making.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, understanding, voluntariness, and documentation; a signed form alone does not establish informed consent.

Universal precautions: treat all blood and body fluids as infectious; perform hand hygiene before and after every patient contact and after glove removal.

Surgical scrub: scrub hands and forearms to 2 inches above the elbow for the manufacturer-specified duration (typically 3–5 minutes for first scrub); keep hands above elbows throughout.

Venipuncture order of draw: blood cultures, coagulation tube (light blue), serum tube (red/gold), heparin tube (green), EDTA tube (lavender), glycolytic inhibitor tube (gray).

Lumbar puncture: position lateral decubitus with knees to chest; estimate opening pressure in cm H2O; normal opening pressure is 10–20 cm H2O (100–200 mm H2O).

Intubation: confirm placement with continuous waveform capnography plus auscultation; a colorimetric detector alone is insufficient in cardiac arrest.

Central line insertion: use ultrasound guidance for internal jugular access, full barrier precautions, chlorhexidine skin antisepsis, and a checklist; confirm tip position on chest radiograph before use.

Urinary catheterization: use the smallest appropriate catheter, maintain a closed drainage system, and remove promptly; each day of catheterization increases CAUTI risk by approximately 3–7%.

Warfarin: monitor INR; target 2.0–3.0 for most indications (2.5–3.5 for mechanical mitral valves); vitamin K reverses warfarin; fresh frozen plasma or prothrombin complex concentrate for major bleeding.

Heparin-induced thrombocytopenia: suspect when platelets fall >50% from baseline 5–10 days after heparin start; stop heparin and start a non-heparin anticoagulant (argatroban, bivalirudin, fondaparinux).

Acetaminophen maximum: 4 g/day in healthy adults; reduce to ≤2 g/day in chronic liver disease or chronic alcohol use; 3 g/day is a common conservative limit.

Vancomycin: target trough 15–20 mg/L for serious infections; AUC-guided dosing (AUC/MIC 400–600) is preferred; monitor renal function and audiometry with prolonged use.

Aminoglycosides: peak and trough monitoring; trough should be below 2 mg/L for gentamicin/tobramycin; risk of nephrotoxicity and ototoxicity increases with elevated troughs.

Digoxin: narrow therapeutic index (0.5–0.9 ng/mL for heart failure); toxicity signs include nausea, visual changes (yellow-green halos), and arrhythmias; hypokalemia increases toxicity risk.

SSRIs: onset of antidepressant effect typically 2–4 weeks; warn about serotonin syndrome (clonus, hyperthermia, agitation) when combined with MAOIs, tramadol, triptans, or linezolid.

Corticosteroids: chronic use requires taper to avoid adrenal insufficiency; monitor bone density, glucose, and blood pressure; stress dosing may be needed during acute illness.

Adult basic life support: compression rate 100–120/min, depth 5–6 cm, full chest recoil, minimize interruptions to <10 seconds, and switch compressor every 2 minutes.

Defibrillation: biphasic shock 120–200 J (manufacturer recommendation) for ventricular fibrillation/pulseless ventricular tachycardia; resume compressions immediately after shock.

Anaphylaxis: epinephrine 0.3–0.5 mg intramuscularly (1 mg/mL) into the anterolateral thigh; repeat every 5–15 minutes as needed; adjuncts include oxygen, IV fluids, and antihistamines.

Sepsis: obtain blood cultures before antibiotics, administer broad-spectrum antibiotics within 1 hour for septic shock, and give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute coronary syndrome: aspirin 162–325 mg chewed, nitroglycerin if no contraindication, and reperfusion within 90 minutes of first medical contact for ST-elevation myocardial infarction.

Stroke: activate stroke team, obtain noncontrast head CT, and administer intravenous alteplase within 4.5 hours of symptom onset if criteria are met; door-to-needle target ≤60 minutes.

Diabetic ketoacidosis: isotonic saline resuscitation, insulin infusion after potassium is ≥3.3 mmol/L, and add dextrose when glucose <200–250 mg/dL; monitor potassium and anion gap.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg IV or midazolam IM), then a second-line antiepileptic (levetiracetam, fosphenytoin, or valproate); intubate if refractory.

Teach-back method: ask the patient to explain the plan in their own words; it improves recall and identifies gaps better than asking "Do you understand?"

Health literacy: use plain language at a 5th–6th grade reading level, limit to 3–5 key messages per session, and supplement with pictures or diagrams.

Motivational interviewing: use open questions, affirmations, reflections, and summaries (OARS); avoid confrontation; elicit change talk rather than arguing.

Shared decision-making: present options, discuss benefits and harms, explore patient values and preferences, and reach a decision together; document the discussion.

Medication adherence: simplify regimens, use pill organizers, link doses to daily routines, and address cost barriers; ask about side effects at every visit.

Smoking cessation: brief intervention (Ask, Advise, Assess, Assist, Arrange); combine behavioral counseling with pharmacotherapy (varenicline, bupropion, or nicotine replacement).

Vaccine counseling: address specific concerns, explain the risk of disease versus vaccine risk, and use presumptive announcements ("You are due for a tetanus booster today").

Advance care planning: discuss goals of care, health care proxy, and code status before a crisis; document in the medical record and provide copies to the patient and family.

Situational leadership: adapt style (directing, coaching, supporting, delegating) to the follower's competence and commitment for the task.

TeamSTEPPS: use SBAR (Situation, Background, Assessment, Recommendation) for handoffs, briefs, huddles, and debriefs to improve communication and safety.

Conflict resolution: address the behavior, not the person; use "I" statements, active listening, and focus on patient safety and shared goals.

Delegation: the delegating clinician retains accountability; verify the delegate's scope of practice, competence, and the task's predictability.

Just culture: distinguish human error (console), at-risk behavior (coach), and reckless behavior (remediate or discipline); encourage reporting without fear.

Change management: use Kotter's steps (create urgency, form a guiding coalition, communicate vision, remove barriers, anchor in culture) or PDSA cycles for improvement.

Professional boundaries: avoid dual relationships, self-disclosure that shifts focus to the clinician, and accepting gifts that could influence judgment.

Peer review and credentialing: verify licensure, certifications, and training; participate in ongoing professional practice evaluation and focused professional practice evaluation.

Institute for Healthcare Improvement Model for Improvement: three questions (aim, measures, changes) plus Plan-Do-Study-Act cycles for testing changes.

Root cause analysis: retrospective, systems-focused review of a sentinel event; identifies contributing factors and actions to prevent recurrence.

Failure mode and effects analysis: prospective risk assessment that scores severity, occurrence, and detection to prioritize high-risk processes.

Medication reconciliation: compare the patient's current medications with the new regimen at admission, transfer, and discharge; discrepancies are a leading cause of adverse drug events.

Hand hygiene: the WHO 5 Moments (before patient contact, before aseptic task, after body fluid exposure, after patient contact, after touching surroundings) reduce health care–associated infections.

Central line–associated bloodstream infection prevention bundle: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal site selection, and daily review of line necessity.

Surgical safety checklist: sign-in (before induction), time-out (before incision), and sign-out (before leaving the operating room) reduce surgical complications.

Quality measures: structure, process, and outcome; balancing measures detect unintended consequences of improvement efforts.

Informed consent: the patient must have decision-making capacity; capacity requires understanding, appreciation, reasoning, and expressing a choice.

Mandatory reporting: report suspected child abuse, elder abuse, and certain communicable diseases to the designated authority; reporting is required even without proof.

HIPAA: disclose protected health information only for treatment, payment, or health care operations, or with authorization, unless an exception (e.g., serious threat, required by law) applies.

Emergency exception: treat without consent when the patient lacks capacity and delay would risk serious harm; document the emergency and the treatment provided.

Advance directives: a living will states treatment preferences; a durable power of attorney for health care designates a surrogate; a POLST/DNR order is a medical order.

Confidentiality: minors may consent to certain services (e.g., sexually transmitted infection testing, contraception) depending on state law; verify jurisdiction-specific rules.

Negligence elements: duty, breach, causation, and damages; documentation should be contemporaneous, objective, and complete.

Conflict of interest: disclose financial relationships with industry; recuse from decisions that could be influenced by personal gain.