Ukom Kolegium Dokter cheat sheet

Primary survey (ABCDE): Airway with cervical spine protection, Breathing (rate, saturation, auscultation), Circulation (pulse, CRT, blood pressure), Disability (GCS, pupils, glucose), Exposure/environment.

Anaphylaxis: IM epinephrine 0.01 mg/kg (max 0.5 mg) of 1:1000 solution into the anterolateral thigh; repeat every 5–15 minutes if needed; adjuncts (antihistamine, corticosteroid) never replace epinephrine.

Acute asthma severity: inability to speak in sentences, silent chest, bradycardia, or exhaustion indicate life-threatening asthma; give oxygen to target SpO2 93–95%, repeated inhaled salbutamol, ipratropium, and early systemic corticosteroid.

Community-acquired pneumonia: CURB-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30, Blood pressure systolic <90 or diastolic ≤60, Age ≥65); score 0–1 outpatient, 2 short inpatient, ≥3 consider ICU.

Sepsis: qSOFA (respiratory rate ≥22, altered mentation, systolic blood pressure ≤100) is a bedside screen; sepsis with hypotension despite fluids = septic shock; start broad-spectrum antibiotics within 1 hour of recognition.

Acute coronary syndrome: ST-elevation myocardial infarction requires reperfusion (primary PCI within 120 minutes of first medical contact, or fibrinolysis if PCI unavailable within 120 minutes and symptom onset <12 hours).

Stroke: non-contrast head CT excludes hemorrhage; IV thrombolysis (alteplase 0.9 mg/kg, max 90 mg, 10% bolus) within 4.5 hours of onset if no contraindications; mechanical thrombectomy up to 24 hours in selected large-vessel occlusion.

Diabetic ketoacidosis: diagnostic triad of hyperglycemia (>250 mg/dL), ketonemia/ketonuria, and metabolic acidosis (pH <7.3, bicarbonate <18 mEq/L); treat with isotonic saline, IV insulin infusion (0.1 U/kg/h) after potassium ≥3.3 mEq/L, and potassium replacement.

Hypertensive emergency: severe blood pressure elevation with target-organ damage (encephalopathy, aortic dissection, pulmonary edema, acute kidney injury); reduce mean arterial pressure by no more than 25% in the first hour, then to 160/100 mmHg over 2–6 hours, using titratable IV agents.

Pediatric dehydration: WHO ORS plan A (no dehydration, home ORS), plan B (some dehydration, ORS 75 mL/kg over 4 hours), plan C (severe dehydration, IV Ringer's lactate 100 mL/kg: 30 mL/kg in first hour then 70 mL/kg over 5 hours for infants; 30 mL/kg in 30 minutes then 70 mL/kg over 2.5 hours for older children).

Neonatal resuscitation: initial steps (warm, dry, stimulate, position airway) for 30 seconds; if heart rate <100/min or apnea, start positive pressure ventilation with room air; chest compressions if heart rate <60/min after effective ventilation; consider 3:1 compression-to-ventilation ratio.

Preeclampsia with severe features: blood pressure ≥160/110 mmHg or symptoms (headache, visual changes, epigastric pain, pulmonary edema, thrombocytopenia, elevated liver enzymes); give magnesium sulfate 4–6 g IV loading dose then 1–2 g/h maintenance, and antihypertensives (labetalol, hydralazine, nifedipine).

Postpartum hemorrhage: uterine atony is the most common cause; first-line uterotonics include oxytocin (10 IU IM or IV infusion), then ergometrine (contraindicated in hypertension), carboprost (contraindicated in asthma), and misoprostol.

Tuberculosis treatment: new cases receive 2 months of isoniazid, rifampicin, pyrazinamide, ethambutol (HRZE) followed by 4 months of isoniazid and rifampicin (HR); fixed-dose combination improves adherence.

Dengue: warning signs include abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement >2 cm, and rising hematocrit with falling platelets; give isotonic crystalloid 5–10 mL/kg/h for 1–2 hours in warning-sign dengue, then titrate.

Antimicrobial stewardship: obtain cultures before starting antibiotics when feasible; review antibiotics at 48–72 hours based on culture results and clinical response; de-escalate to narrowest effective agent and shortest effective duration.

Surgical safety checklist: sign in (before induction of anesthesia), time out (before skin incision, confirming patient, site, procedure, allergies, and imaging), sign out (before patient leaves operating room, confirming counts and specimen labeling).

Ethics and medicolegal: informed consent requires capacity, disclosure of material risks and alternatives, and voluntariness; emergency exception applies when immediate treatment is needed to prevent serious harm and the patient cannot consent.