EBEEM cheat sheet

Primary survey sequence: catastrophic haemorrhage control, Airway with cervical spine protection, Breathing, Circulation, Disability (GCS/pupils/glucose), Exposure with temperature control; reassess after every intervention.

Shock index = heart rate / systolic blood pressure; a value above 0.9 in adults suggests occult hypoperfusion and predicts need for transfusion or critical care.

Anaphylaxis: intramuscular adrenaline 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh for adults, repeated every 5 minutes; adjuncts (antihistamine, steroid) never replace adrenaline.

Adult cardiac arrest: compressions 100-120/min, depth 5-6 cm, full recoil, ratio 30:2, minimise pauses below 10 seconds; non-shockable rhythms (asystole, PEA) get adrenaline 1 mg immediately and every 3-5 minutes.

Defibrillation energy for biphasic devices is per manufacturer (typically 150-200 J); use the maximum available if unknown. Refractory VF/pVT after three shocks: amiodarone 300 mg IV bolus.

Sepsis: qSOFA (respiratory rate 22/min or more, altered mentation, systolic BP 100 mmHg or less) flags risk; lactate above 2 mmol/L plus hypotension defines septic shock requiring immediate fluids and antibiotics.

Acute coronary syndrome: obtain 12-lead ECG within 10 minutes of first medical contact; ST-elevation triggers reperfusion (primary PCI within 120 minutes of diagnosis, or fibrinolysis if PCI unavailable).

Stroke: activate stroke pathway, non-contrast CT within 20 minutes of arrival where feasible; intravenous thrombolysis window up to 4.5 hours, mechanical thrombectomy up to 6 hours (selected cases to 24 hours).

Trauma: permissive hypotension (systolic 80-90 mmHg) until haemorrhage control in penetrating torso trauma without traumatic brain injury; tranexamic acid 1 g within 3 hours of injury, repeated once.

Airway: predict difficult intubation with LEMON or MACOCHA; a failed airway escalates supraglottic device, then surgical front-of-neck access; confirm tube position with waveform capnography.

Rapid sequence intubation checklist: preoxygenation, suction, drugs (induction plus neuromuscular blocker), positioning, monitor, and a declared plan for failure.

Breathing: for tension pneumothorax, immediate needle decompression in the 4th-5th intercostal space anterior axillary line, followed by chest drain; do not wait for imaging in the unstable patient.

Circulation: restrictive fluid strategy in cardiogenic pulmonary oedema; non-invasive ventilation plus nitrates reduces intubation rates; inotropes for hypotension with poor perfusion.

Tachycardia algorithm: unstable (hypotension, ischaemic chest pain, acute heart failure, altered mental state, shock) means synchronised cardioversion; stable narrow-complex uses vagal manoeuvres then adenosine 6 mg IV.

Bradycardia with adverse features: atropine 500 micrograms IV every 3-5 minutes to a maximum of 3 mg; if ineffective, transcutaneous pacing or chronotropic drugs.

Paediatric dosing: weight-based drug calculation with a length-based tape; adrenaline for paediatric anaphylaxis is 10 micrograms/kg intramuscularly (maximum 0.5 mg).

Toxicology: paracetamol overdose treated with N-acetylcysteine based on the Rumack-Matthew nomogram from 4 hours post-ingestion; activated charcoal is useful within 1 hour if airway is protected.

Environmental emergencies: in suspected hypothermia, continue resuscitation until rewarmed; in hyperthermic heat stroke, immediate evaporative cooling targeting core temperature below 39 degrees Celsius.

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

Acute headache red flags: thunderclap onset, fever with neck stiffness, focal deficit, papilloedema, age over 50 with new headache, and anticoagulation use.

Abdominal pain: systematic approach by quadrant and system; always consider and exclude abdominal aortic aneurysm in older patients with back or abdominal pain and hypotension.

Acute urinary retention: urethral catheterisation with documentation of residual volume; suspect cauda equina syndrome with saddle anaesthesia, bilateral sciatica, and bladder or bowel dysfunction, requiring urgent MRI.

Paediatric fever: use age-based risk stratification; infants under 3 months with fever of 38 degrees Celsius or more need full sepsis evaluation and empirical antibiotics.

Acute asthma severity: inability to complete sentences, respiratory rate above 25, heart rate above 110, peak flow 33-50 percent predicted indicates severe attack; silent chest and exhaustion signal life-threatening disease.

COPD exacerbation: controlled oxygen targeting 88-92 percent saturation, nebulised bronchodilators, systemic corticosteroids, and non-invasive ventilation for persistent hypercapnic acidosis.

Psychiatric emergencies: assess suicide risk and capacity; acute agitation is managed with verbal de-escalation first, then rapid tranquillisation with benzodiazepine or antipsychotic, monitoring for sedation.

Wound and soft-tissue care: tetanus status review, irrigation, exploration for foreign bodies and tendon or nerve injury before closure; high-risk bites and contaminated wounds are left open.

ECG basics: rate (300 divided by number of large squares between R waves), rhythm regularity, P-QRS relationship, axis, and ST segment; compare with previous tracings where available.

Life-threatening ECG patterns: wide-complex tachycardia, pre-excited atrial fibrillation, Brugada pattern, Wellens syndrome, and hyperkalaemic sine wave all demand immediate action.

Point-of-care ultrasound uses in emergency care: focused cardiac assessment, lung sliding for pneumothorax, abdominal free fluid, and FAST for trauma; findings must be integrated with clinical assessment.

Arterial blood gas interpretation: check pH, then PaCO2 and bicarbonate to identify respiratory versus metabolic cause; calculate anion gap (Na minus [Cl plus HCO3]) and delta ratio in metabolic acidosis.

Hyperkalaemia with ECG changes: intravenous calcium chloride or gluconate for membrane stabilisation, then insulin-glucose and salbutamol to shift potassium intracellularly; dialysis for refractory cases.

Acute kidney injury: use KDIGO staging based on creatinine rise and urine output; emergency dialysis indications include refractory hyperkalaemia, pulmonary oedema, severe acidosis, and uraemic encephalopathy.

Electrolyte emergencies: correct sodium no faster than 8-10 mmol/L in 24 hours to avoid osmotic demyelination; rapid correction of severe hyponatraemia with seizures uses hypertonic saline.

Analgesia: multimodal approach with paracetamol, NSAIDs where not contraindicated, opioids titrated to effect, and regional blocks; reassess pain and sedation scores regularly.

Procedural sedation: pre-procedure risk assessment, fasting considerations, monitoring with capnography, and availability of airway rescue equipment and reversal agents.

Major incident triage: use a validated sieve and sort system (such as START or a national equivalent); priority categories P1 immediate, P2 urgent, P3 delayed, P4 expectant or deceased.

Mass casualty command: establish clear command structure with declared roles (medical commander, triage officer, treatment officer, transport officer) and communication channels.

Hazardous materials: approach from upwind, establish hot, warm and cold zones with decontamination before entry to the emergency department; personal protective equipment is mandatory.

Chemical incidents: specific antidotes include atropine and pralidoxime for organophosphate poisoning, hydroxocobalamin for cyanide, and oxygen plus methylene blue for methaemoglobinaemia.

Radiation incidents: time, distance, shielding; remove contaminated clothing and decontaminate before treatment; acute radiation syndrome presents with nausea, vomiting and lymphopenia.

Emergency department preparedness: surge capacity planning, isolation and cohorting capability, and stockpiles of antidotes, antibiotics and ventilators are core requirements.

Crisis resource management: closed-loop communication, explicit role allocation, and structured handover (such as SBAR) reduce error during resuscitation and major incidents.

Ethics and law: assess capacity, act in best interests for patients lacking capacity, document decisions, and know local rules on advance directives, restraint, and reporting of deaths.

Triage systems (such as Manchester, MTS, or ESI) assign acuity within minutes of arrival; target times from triage to clinician assessment depend on acuity level and department capacity.

Time-critical diagnoses and their targets: ST-elevation myocardial infarction, stroke, sepsis, major trauma, and ruptured aortic aneurysm require pathway activation at first recognition.

Patient safety: medication reconciliation at admission, allergy documentation, and double-checking of high-alert drugs (insulin, anticoagulants, opioids, concentrated potassium) are core practices.

Clinical governance: incident reporting, morbidity and mortality review, and audit of key performance indicators (door-to-needle time, time to antibiotics, unplanned reattendance) drive departmental improvement.

Handover and documentation: structured handover at shift change with identified unwell patients, pending results, and outstanding tasks; contemporaneous records support continuity and legal defensibility.

Research and evidence: understand levels of evidence, critical appraisal of trials, and the role of guidelines from bodies such as the European Resuscitation Council in standardising emergency care.

Teaching and supervision: near-peer teaching, simulation-based training, and direct observation of procedural skills are standard methods for competency development in emergency medicine.

Paediatric assessment triangle: appearance, work of breathing, and circulation to skin give an immediate impression of illness severity before vital signs are obtained.

Paediatric airway differences: larger head, smaller and more anterior larynx, larger tongue, and narrowest point at the cricoid ring; uncuffed tubes sized by age formula (age/4 plus 4).

Paediatric fluid resuscitation: 10-20 mL/kg crystalloid boluses in shock, reassessing after each bolus; maintenance fluids by Holliday-Segar formula (4-2-1 rule).

Paediatric trauma: children compensate well and deteriorate suddenly; hypotension is a late sign; head injury is the leading cause of death in paediatric trauma.

Obstetric emergencies: postpartum haemorrhage is managed with uterine massage, oxytocin, tranexamic acid, and escalation; pre-eclampsia with severe features needs magnesium sulphate for seizure prophylaxis.

Ectopic pregnancy: any woman of reproductive age with abdominal pain, syncope, or vaginal bleeding needs pregnancy testing and pelvic ultrasound; unstable patients go to theatre.

Elderly patients: atypical presentations of acute coronary syndrome, sepsis, and abdominal pathology are common; polypharmacy and falls require medication review and assessment for injury.

Frailty and falls: assess for occult fracture, head injury on anticoagulation, and social circumstances; early comprehensive geriatric assessment reduces readmission.

Vulnerable adults and children: recognise indicators of abuse and neglect and follow local safeguarding pathways with clear documentation and appropriate referral.

Advanced life support team roles: team leader, airway, compressions (rotating every 2 minutes), vascular access and drugs, monitor and defibrillator, and documentation; the leader should not be task-fixed.

Post-resuscitation care: targeted temperature management for comatose survivors of cardiac arrest, controlled oxygenation (target saturation 94-98 percent), and treatment of the precipitating cause.

Reversible causes of cardiac arrest (4 Hs and 4 Ts): hypoxia, hypovolaemia, hypo/hyperkalaemia and metabolic disorders, hypothermia; thrombosis, tension pneumothorax, tamponade, toxins.

Airway equipment check: bag-valve-mask, supraglottic device, laryngoscope and blades, suction, capnography, and front-of-neck access kit available before induction.

Vascular access: peripheral IV first; intraosseous access is the rescue route in arrest and shock, with sites at proximal tibia, distal femur, or proximal humerus.

Drug administration in arrest: adrenaline 1 mg IV/IO every 3-5 minutes; amiodarone 300 mg after third shock; atropine 3 mg total for asystole with bradycardia context is no longer routine.

Monitoring: continuous ECG, waveform capnography, pulse oximetry, and invasive or non-invasive blood pressure; capnography rise during CPR suggests return of spontaneous circulation.

Debriefing: structured team debrief after critical events improves performance and staff wellbeing; document learning points and follow-up actions.

Communication: breaking bad news using a structured framework (such as SPIKES); confirm understanding, allow silence, and document the discussion and decisions.

Consent: obtain informed consent for procedures where the patient has capacity; in emergencies, treat under necessity and record the rationale.

Capacity assessment: patient must understand, retain, weigh, and communicate a decision; if capacity is absent, act in best interests and consider least restrictive options.

Confidentiality: share information on a need-to-know basis for care; disclose without consent only where required by law or to prevent serious harm.

Medical error disclosure: explain the incident to the patient openly, apologise, document, and report through the incident system; this is an ethical and professional obligation.

Burnout prevention: recognise fatigue and stress in self and colleagues, use scheduled breaks, and access occupational health support; fatigue impairs decision-making.

Interprofessional teamwork: clarify roles, use closed-loop communication, and escalate concerns about patient safety through a graded assertiveness approach.

End-of-life decisions: discuss ceilings of treatment, resuscitation status, and palliative needs with patients and families; document decisions clearly in the record.

Evidence-based emergency medicine: formulate an answerable question (PICO), search efficiently, and appraise validity, effect size, and applicability to the individual patient.

Guideline use: European Resuscitation Council guidelines are updated on a five-year cycle; know the current version and local adaptations for drugs, doses, and sequences.

Quality indicators: door-to-balloon time, door-to-needle time for stroke, time to antibiotics in sepsis, and unplanned 72-hour reattendance are commonly audited emergency metrics.

Simulation and skills maintenance: regular low-fidelity and high-fidelity simulation maintains rare procedural skills (surgical airway, thoracotomy, paediatric resuscitation).

Clinical decision rules: use validated tools (Ottawa ankle rules, Canadian CT head rules, PERC, HEART score) to reduce unnecessary investigation while recognising their limitations.

Ultrasound training: emergency ultrasound requires supervised practice and documented competency; findings are operator-dependent and should be interpreted in clinical context.

Digital health: electronic records, clinical decision support, and telemedicine support remote emergency care; verify data quality and maintain information governance.

Wound closure timing: clean wounds can be closed primarily; contaminated or bite wounds are left to heal by secondary intention or delayed closure; document neurovascular status before and after.

Burns: estimate surface area with the rule of nines (each arm 9 percent, each leg 18 percent, anterior trunk 18 percent, posterior trunk 18 percent, head 9 percent) and use Lund-Browder in children.

Burn fluid resuscitation: Parkland formula 4 mL/kg per percent burn of crystalloid in 24 hours, half in the first 8 hours from injury time; formula is a starting point only.

Fracture and dislocation: assess distal pulses and sensation, immobilise, and reduce dislocations promptly; open fractures need antibiotics and urgent orthopaedic referral.

Head injury: indications for CT include loss of consciousness, vomiting, focal deficit, seizure, anticoagulation, and age over 65; observe and reassess in mild injury.

Spinal injury: immobilise with manual in-line stabilisation and use validated clearance rules; do not remove collar until clinical and radiological clearance criteria are met.

Acute limb ischaemia: six Ps (pain, pallor, pulselessness, paraesthesia, paralysis, perishing cold); urgent vascular referral and anticoagulation; time-critical limb salvage.

Compartment syndrome: pain out of proportion, pain on passive stretch, tense compartment; pulselessness is a late sign; urgent fasciotomy is definitive treatment.

Emergency department design: resus bays, majors, minors, paediatric area, isolation rooms, and a secure area for mental health assessment support safe flow and infection control.

Patient flow: early senior review, point-of-care testing, and streaming of ambulatory patients reduce crowding; crowding correlates with adverse outcomes and increased mortality.

Infection control: hand hygiene, isolation of suspected infectious cases, and appropriate personal protective equipment are mandatory; know local protocols for high-consequence infections.

Medication safety: avoid abbreviations, verify allergy status, and check renal function before prescribing renally cleared drugs; review interactions in polypharmacy.

Blood transfusion: verify patient identity and compatibility, use a transfusion checklist, and monitor for reactions (fever, urticaria, haemolysis, TRALI); stop transfusion if reaction suspected.

Procedural documentation: record consent, indication, technique, findings, complications, and aftercare; this supports continuity and audit.

Leadership in the emergency department: allocate patients by acuity and skill mix, anticipate deterioration, and escalate early when capacity is exceeded.

Staff wellbeing: fatigue and stress management, peer support, and clear escalation routes for concerns contribute to safer care and retention.

Anaphylaxis criteria: acute onset with skin or mucosal involvement plus respiratory compromise or hypotension, or hypotension after exposure to a known allergen; adrenaline is first-line.

Sepsis and septic shock: use a screening tool, take cultures before antibiotics if no delay, give broad-spectrum antibiotics within 1 hour in shock, and measure lactate.

Acute heart failure: sit up, oxygen if hypoxaemic, intravenous diuretic, nitrates if hypertensive, and non-invasive ventilation for respiratory distress; identify precipitants.

Pulmonary embolism: use Wells score and D-dimer in low-probability patients; high-probability or haemodynamically unstable patients need imaging and consideration of thrombolysis.

Pneumonia: assess severity with CURB-65 (confusion, urea above 7 mmol/L, respiratory rate 30 or more, blood pressure low, age 65 or more); score 2 or more suggests hospital care.

Diabetic emergencies: DKA managed with fluids, insulin infusion, and potassium replacement; HHS has higher osmolality and greater fluid deficit; monitor potassium closely.

Alcohol and drug withdrawal: use a validated scale (CIWA-Ar) for alcohol withdrawal; benzodiazepines are first-line; thiamine before glucose in at-risk patients.

Acute behavioural disturbance: exclude hypoglycaemia, hypoxia, head injury, and intoxication before attributing to psychiatric illness; use de-escalation first.

Trauma team activation: mechanism, physiology, and anatomic criteria determine team activation; senior emergency physician leads the primary survey and coordinates specialist input.

Damage control resuscitation: haemostatic resuscitation with balanced blood products, tranexamic acid within 3 hours, prevention of hypothermia, and permissive hypotension until control.

FAST examination: free fluid in pericardium, perihepatic, perisplenic, and pelvic views; a positive FAST in an unstable patient prompts immediate surgical intervention.

Chest trauma: tension pneumothorax, massive haemothorax, cardiac tamponade, flail chest, and aortic injury are immediately life-threatening; treat before imaging in unstable patients.

Abdominal trauma: blunt vs penetrating mechanism changes management; unstable patients with positive FAST go to theatre; stable patients may have CT.

Pelvic fracture: apply a binder at the level of the greater trochanters, consider early blood transfusion, and involve interventional radiology or orthopaedics for haemorrhage control.

Head injury in trauma: prevent secondary injury by maintaining oxygenation, blood pressure, and normocapnia; urgent neurosurgical referral for expanding mass lesions.

Paediatric trauma: use age-appropriate equipment and dosing; a child's large surface area increases hypothermia risk; non-accidental injury must be considered.

Acute coronary syndrome: serial troponin testing and ECG; aspirin 300 mg plus P2Y12 inhibitor and anticoagulation per pathway; avoid NSAIDs.

Arrhythmias: atrial fibrillation with rapid ventricular response and instability needs synchronised cardioversion; stable patients are rate-controlled and assessed for stroke risk.

Hypertensive emergency: target a controlled reduction in blood pressure (typically 20-25 percent in the first hour) in the presence of end-organ damage; avoid rapid drops in ischaemic stroke.

Aortic dissection: sudden tearing chest or back pain with pulse deficit or blood pressure differential; urgent CT angiography and blood pressure control; analgesia and heart rate control first.

Acute abdomen: serial examination and appropriate imaging; analgesia does not mask surgical pathology and should be given.

Upper gastrointestinal bleeding: resuscitate, risk-stratify (Glasgow-Blatchford score), and arrange urgent endoscopy; transfuse to a restrictive threshold in most patients.

Acute pancreatitis: diagnosis requires two of typical pain, raised lipase or amylase (three times upper limit), and imaging; early fluids and analgesia are mainstays.

Renal colic: NSAIDs are first-line analgesia; urgent decompression for infected obstructed kidney; CT is the reference standard for stone detection.

Paediatric resuscitation: start CPR with 5 rescue breaths then 15:2 compressions to ventilations for two rescuers; adrenaline dose is 10 micrograms/kg IV/IO.

Neonatal resuscitation: dry, stimulate, assess tone, breathing, and heart rate; inflate lungs with air if not breathing; chest compressions at 3:1 ratio with 90 per minute.

Paediatric sepsis: recognise tachycardia, prolonged capillary refill, and altered mental state; give antibiotics within 1 hour and fluid boluses of 10-20 mL/kg with reassessment.

Paediatric asthma: use oxygen, inhaled beta-agonist with spacer or nebuliser, ipratropium, and systemic steroids; consider magnesium sulphate in severe cases.

Croup and epiglottitis: croup has barking cough and stridor responsive to dexamethasone and nebulised adrenaline; epiglottitis has drooling, tripod posture, and needs senior airway management.

Bronchiolitis: supportive care with oxygen and hydration; bronchodilators and steroids are not routinely indicated; monitor for apnoea in young infants.

Febrile seizures: most are self-limiting; investigate if focal, prolonged, or recurrent; parental reassurance and safety advice are important.

Child safeguarding: unexplained injuries, delay in presentation, and inconsistent history should prompt referral; document carefully and follow local pathways.

Prehospital care: chain of survival, bystander CPR, and early defibrillation improve outcomes; emergency physicians may work in retrieval or medical support roles.

Major incident triage: use a validated system; expectant category is used where resources are overwhelmed and survival is unlikely; document triage category and time.

Chemical, biological, radiological, nuclear incidents: recognise syndromes (cholinergic crisis, radiation sickness), decontaminate, and use specific antidotes where available.

Emergency preparedness: personal protective equipment, isolation facilities, and stockpiles of antibiotics and antidotes should be planned and exercised regularly.

Communication in incidents: use a declared command structure and interoperable communication; avoid overwhelming channels with non-essential traffic.

Ethical allocation of scarce resources: use transparent, consistent criteria and document decisions; avoid discrimination and review decisions as resources change.

Recovery phase: staff debriefing, psychological support, and review of lessons learned are part of the incident cycle.

Clinical reasoning: generate a differential diagnosis early, use hypothetico-deductive reasoning, and actively look for disconfirming evidence to avoid premature closure.

Diagnostic error: cognitive biases (anchoring, availability, confirmation) contribute; use checklists, second opinions, and reflection to mitigate.

Test interpretation: sensitivity and specificity describe test performance; predictive values depend on prevalence; likelihood ratios update pre-test probability.

Shared decision-making: discuss benefits, harms, and alternatives with patients; document the discussion and the patient's preference.

Learning in the emergency department: case-based learning, morbidity and mortality meetings, and reflective practice support development of clinical judgement.

Guideline adherence: follow local protocols while recognising when individual patient factors justify deviation; document reasoning.

Quality improvement: use plan-do-study-act cycles to test changes; measure outcomes and balance measures to avoid unintended harm.

Toxicology: identify toxidromes (opioid, sympathomimetic, anticholinergic, cholinergic, sedative-hypnotic) to guide treatment before laboratory confirmation.

Poisoning antidotes: naloxone for opioids, flumazenil for benzodiazepines (cautious use), N-acetylcysteine for paracetamol, fomepizole or ethanol for methanol and ethylene glycol.

Carbon monoxide poisoning: give high-flow oxygen; consider hyperbaric oxygen for severe poisoning, neurological features, or pregnancy; pulse oximetry may be falsely normal.

Tricyclic overdose: sodium bicarbonate for QRS widening; avoid class IA and IC antiarrhythmics; monitor for arrhythmia.

Beta-blocker and calcium channel blocker overdose: high-dose insulin with glucose, calcium salts, and vasopressors; glucagon for beta-blocker toxicity.

Salicylate toxicity: alkaline diuresis with sodium bicarbonate; dialysis for severe cases; avoid intubation unless necessary as it may worsen acidosis.

Organophosphate poisoning: atropine titrated to secretions and pralidoxime; decontaminate and protect staff.

Withdrawal syndromes: alcohol, benzodiazepine, and opioid withdrawal require protocolised management; never abruptly stop long-term benzodiazepines.

Airway assessment: look for stridor, voice change, drooling, and swelling; predict difficulty with mouth opening, thyromental distance, and cervical mobility.

Rapid sequence intubation: preoxygenate, give induction agent and neuromuscular blocker, intubate, confirm with capnography, and secure the tube.

Failed intubation: use a supraglottic airway, then surgical front-of-neck access; declare failure early and call for help.

Surgical airway: identify cricothyroid membrane, make a vertical incision, insert a tube; this is a life-saving procedure in cannot-intubate cannot-oxygenate situations.

Ventilation: use lung-protective tidal volumes (6-8 mL/kg predicted body weight) and monitor peak pressures; avoid hyperoxia and hypocapnia in brain injury.

Sedation and analgesia in the ventilated patient: titrate to a validated sedation scale; assess for delirium and pain regularly.

Weaning and extubation: assess readiness with spontaneous breathing trials and ensure airway protection and adequate cough before extubation.

Tracheostomy care: know indications, complications (bleeding, infection, displacement), and emergency management of a blocked or displaced tube.

Fluid resuscitation: crystalloids are first-line; balanced solutions may reduce hyperchloraemia; reassess after each bolus and avoid over-resuscitation.

Vasopressors: noradrenaline is first-line for septic shock; start early via peripheral or central access if needed; target mean arterial pressure of at least 65 mmHg.

Inotropes: dobutamine for cardiogenic shock with low output; monitor for arrhythmia and hypotension.

Blood products: use a massive transfusion protocol with balanced ratios; tranexamic acid within 3 hours in trauma and postpartum haemorrhage.

Electrolyte correction: correct potassium and magnesium together; monitor ECG in severe hyperkalaemia; avoid rapid sodium correction.

Acid-base: treat the cause; sodium bicarbonate is reserved for severe acidaemia or specific poisonings (tricyclic, salicylate).

Renal replacement therapy: urgent indications include refractory hyperkalaemia, pulmonary oedema, severe acidosis, and uraemic complications.

Endocrine emergencies: adrenal crisis needs immediate hydrocortisone and fluids; thyroid storm needs beta-blockade, thionamide, and supportive care.

Wound assessment: determine mechanism, time since injury, contamination, and neurovascular status; examine for foreign bodies and tendon injury.

Local anaesthetic: calculate maximum safe dose (lidocaine 3 mg/kg without adrenaline, 7 mg/kg with adrenaline); use buffered solutions to reduce pain.

Suturing: choose technique and material by wound site and tension; face uses fine non-absorbable sutures; remove at appropriate intervals by site.

Bite wounds: irrigate thoroughly, consider antibiotics (amoxicillin-clavulanate), assess tetanus and rabies risk, and avoid primary closure in high-risk wounds.

Abscess: incision and drainage is the primary treatment; pack if large; antibiotics for systemic features or high-risk patients.

Burns: cool with running water for 20 minutes within 3 hours; avoid ice; cover with cling film; assess for inhalation injury and circumferential burns.

Nail and soft-tissue injuries: trephine or remove nail for subungual haematoma; repair nail bed injuries meticulously.

Documentation: record wound dimensions, neurovascular status before and after, materials used, and follow-up arrangements.

Pain assessment: use validated scales (numeric rating, faces for children); reassess after intervention and document.

Multimodal analgesia: combine paracetamol, NSAIDs, opioids, and regional techniques to reduce opioid requirements and side effects.

Opioid safety: titrate intravenously, monitor sedation and respiratory rate, and have naloxone available; avoid in uncontrolled airway or severe respiratory depression.

Regional anaesthesia: femoral nerve block for hip fracture, fascia iliaca block, and haematoma block for distal radius fracture reduce pain and opioid use.

Procedural sedation: use a checklist, fasting where feasible, monitoring with capnography, and reversal agents; document vital signs throughout.

Ketamine: dissociative sedation at 1-2 mg/kg IV or 4-6 mg/kg IM; monitor for emergence reactions and laryngospasm.

Head injury analgesia: avoid drugs that obscure neurological assessment; paracetamol is preferred; opioids with caution and monitoring.

Chronic pain in the emergency department: avoid long-term opioid initiation; refer to specialist services and address psychosocial factors.

Elderly falls: assess for injury, review medications (anticoagulants, antihypertensives, sedatives), and screen for syncope and frailty.

Delirium: acute onset, fluctuating course, inattention; identify and treat precipitants (infection, pain, constipation, drugs, hypoxia); avoid antipsychotics unless needed for safety.

Polypharmacy: review medication lists, check renal function, and consider deprescribing; adverse drug reactions are common in older patients.

Fractures in older adults: hip fracture needs analgesia, early surgery, and orthogeriatric input; osteoporosis assessment follows.

Safeguarding: recognise neglect and financial or physical abuse; follow local safeguarding procedures and document.

End-of-life care: discuss treatment escalation plans and palliative needs; involve family and specialist teams.

Social care: assess home circumstances and carer support; arrange safe discharge with community services.

Clinical audit: define standards, collect data, compare practice, implement change, and re-audit; this is a core competency for emergency physicians.

Morbidity and mortality meetings: review adverse events and near misses, identify system factors, and implement learning actions.

Incident reporting: report patient safety incidents promptly; a no-blame culture encourages reporting and learning.

Guideline development: use evidence grading and multidisciplinary consensus; local adaptation should consider resources and patient population.

Teaching: use structured methods (e.g., one-minute preceptor, simulation debrief) and assess competence with validated tools.

Research participation: understand ethical approval, consent, and data protection; contribute to recruitment and dissemination.

Wellbeing: recognise burnout, fatigue, and moral injury; use peer support and occupational health services.

Triage: assign acuity using a validated system; reassess patients waiting and escalate if deterioration.

Patient flow: senior early review, point-of-care testing, and streaming reduce crowding; crowding is associated with increased mortality.

Infection control: hand hygiene, isolation, and personal protective equipment are mandatory; know local protocols for high-consequence infections.

Medication safety: verify allergy status, check renal function, and double-check high-alert drugs (insulin, anticoagulants, opioids, concentrated potassium).

Blood transfusion: verify identity and compatibility, use a checklist, and monitor for reactions; stop transfusion if reaction suspected.

Documentation: record consent, indication, technique, findings, complications, and aftercare for procedures.

Leadership: allocate patients by acuity and skill mix, anticipate deterioration, and escalate early when capacity is exceeded.

Staff wellbeing: fatigue and stress management, peer support, and clear escalation routes contribute to safer care and retention.