UKOM Sp.PD cheat sheet

ACS: STEMI diagnosis requires ST elevation ≥1 mm in two contiguous limb leads, ≥2 mm in V2–V3 (men ≥40 y), or new LBBB with ischemic symptoms; door-to-balloon target ≤90 min at PCI center, ≤120 min if transferred.

Acute heart failure: IV furosemide 20–40 mg bolus (or 2.5× home oral dose) for congestion; nitrates if SBP >110 mmHg; avoid negative inotropes in cardiogenic shock; NIV for respiratory distress with RR >25 and SpO2 <90%.

Atrial fibrillation: CHA2DS2-VASc ≥2 (men) or ≥3 (women) → anticoagulation; score 1 (men)/2 (women) → consider. DOAC preferred over warfarin except mechanical valve or moderate-severe mitral stenosis.

Hypertension grade: optimal <120/80, normal 120–129/80–84, high-normal 130–139/85–89, grade 1 140–159/90–99, grade 2 160–179/100–109, grade 3 ≥180/110 mmHg (ESC).

Infective endocarditis: obtain 3 sets of blood cultures from separate sites before antibiotics; TTE first, TEE if prosthetic valve, intracardiac device, or negative TTE with high suspicion; surgery for heart failure from valve dysfunction, uncontrolled infection, or large vegetation >10 mm with emboli.

Aortic stenosis: classic triad angina, syncope, dyspnea; severe if Vmax ≥4 m/s, mean gradient ≥40 mmHg, or AVA <1.0 cm² (ESC). Symptomatic severe AS warrants valve replacement (SAVR or TAVI).

Pericarditis: diagnostic criteria need ≥2 of chest pain, pericardial rub, new widespread ST elevation/PR depression, new or worsening effusion. First-line: NSAID + colchicine; avoid anticoagulation if large effusion.

Acute limb ischemia: 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia). Rutherford class IIb/III (sensory or motor deficit) requires urgent revascularization within hours; heparin bolus immediately.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms obstruction; GOLD ABE groups guide initial therapy - group A bronchodilator, B LABA+LAMA, E LABA+LAMA (add ICS if blood eosinophils ≥300).

Asthma control: assess daytime symptoms, night waking, reliever use, activity limitation (GINA). Step-up if uncontrolled; add ICS-formoterol as MART; never use LABA monotherapy in asthma.

Acute severe asthma: SABA nebulization + ipratropium + systemic corticosteroid (prednisone 40–50 mg or hydrocortisone 100 mg q6h); add magnesium sulfate 2 g IV over 20 min for poor response; target SpO2 93–95%.

CAP severity: CURB-65 (confusion, urea >7 mmol/L, RR ≥30, SBP <90 or DBP ≤60, age ≥65) - 0–1 outpatient, 2 short ward admission, ≥3 severe. IDSA/ATS major criteria: septic shock needing vasopressors or respiratory failure needing ventilation.

Pleural effusion: Light's criteria - exudate if pleural/serum protein >0.5, pleural/serum LDH >0.6, or pleural LDH >2/3 upper normal serum LDH.

Pulmonary embolism: Wells score plus age-adjusted D-dimer (age ×10 µg/L if >50 y) to rule out; high-risk PE (shock/hypotension) → systemic thrombolysis or embolectomy; sPESI 0 identifies low-risk patients for outpatient care.

Tuberculosis: sputum AFB and GeneXpert MTB/RIF as initial tests; standard regimen 2RHZE/4RH; isoniazid preventive therapy for household contacts <5 y and PLHIV after excluding active disease.

ARDS (Berlin): onset within 1 week, bilateral opacities, not fully explained by heart failure; PaO2/FiO2 ≤300 with PEEP ≥5 - mild 200–300, moderate 100–200, severe <100. Lung-protective ventilation 6 mL/kg predicted body weight.

Upper GI bleeding: Glasgow-Blatchford score ≤1 may allow outpatient management; pre-endoscopy PPI infusion; endoscopy within 24 h; variceal bleed → terlipressin/octreotide + prophylactic ceftriaxone + band ligation.

Acute pancreatitis: diagnosis needs 2 of 3 - characteristic pain, lipase/amylase >3× upper limit, imaging findings. Early aggressive fluid (lactated Ringer), enteral nutrition within 48–72 h; no prophylactic antibiotics.

Cirrhosis decompensation: ascites first-line spironolactone 100 mg + furosemide 40 mg; SBP diagnosed if ascitic PMN ≥250/mm³ → IV cefotaxime plus albumin 1.5 g/kg day 1 and 1 g/kg day 3.

Hepatorenal syndrome (HRS-AKI): creatinine rise, no response to volume, absence of shock, no nephrotoxins, no structural kidney disease; terlipressin + albumin; avoid NSAIDs and aminoglycosides.

Hepatitis B: treatment if HBV DNA >2000 IU/mL with elevated ALT or fibrosis; first-line tenofovir or entecavir; all HBsAg-positive patients screened for HCC with ultrasound ± AFP every 6 months.

Hepatitis C: pan-genotypic DAA (sofosbuvir/velpatasvir or glecaprevir/pibrentasvir) for 12 weeks; SVR12 = cure; check drug interactions with amiodarone, statins, anticonvulsants.

Nutrition screening: MUST or NRS-2002 on admission; refeeding syndrome risk if BMI <16, weight loss >15% in 3–6 months, low electrolytes - start feeding at 10–20 kcal/kg/day and supplement thiamine, phosphate, potassium, magnesium.

C. difficile infection: watery diarrhea ≥3/day plus positive stool test; first episode oral vancomycin 125 mg q6h or fidaxomicin; stop offending antibiotics; avoid antimotility drugs.

AKI KDIGO: stage 1 = creatinine rise ≥0.3 mg/dL in 48 h or 1.5–1.9× baseline; stage 2 = 2.0–2.9×; stage 3 = ≥3×, creatinine ≥4 mg/dL, or urine output <0.3 mL/kg/h for ≥24 h or anuria ≥12 h.

Hyperkalemia emergency: IV calcium gluconate for cardiac membrane stabilization, insulin 10 U + dextrose 25 g, salbutamol nebulization, sodium bicarbonate if acidosis; dialysis for refractory cases.

CKD staging by eGFR (G1 ≥90, G2 60–89, G3a 45–59, G3b 30–44, G4 15–29, G5 <15) plus albuminuria A1 <30, A2 30–300, A3 >300 mg/g.

Nephrotic syndrome: proteinuria >3.5 g/day, albumin <3.5 g/dL, edema, hyperlipidemia; biopsy indicated in adults except clear diabetic nephropathy.

Hypertension in CKD: target <130/80 mmHg when tolerated; ACEi/ARB preferred with albuminuria; monitor creatinine and potassium 1–2 weeks after initiation; stop ACEi/ARB if creatinine rises >30%.

Secondary hypertension clues: onset <30 y or >55 y, resistant hypertension, hypokalemia (primary aldosteronism - aldosterone/renin ratio), renal bruit, episodic headache with palpitations (pheochromocytoma).

Dialysis indications (AEIOU): Acidosis refractory, Electrolyte (hyperkalemia) refractory, Intoxication (methanol, ethylene glycol, lithium), Overload refractory, Uremia (pericarditis, encephalopathy, bleeding).

Contrast-induced AKI prevention: isotonic saline hydration, use lowest contrast volume, stop nephrotoxins; N-acetylcysteine not recommended routinely.

DKA: glucose >250 mg/dL, pH <7.3, bicarbonate <18, ketonemia/ketonuria, anion gap >10–12. Management: isotonic saline, IV insulin 0.1 U/kg/h after K ≥3.3 mmol/L, add dextrose when glucose <200–250 mg/dL, replace potassium.

Hyperosmolar hyperglycemic state: glucose >600 mg/dL, effective osmolality >320 mOsm/kg, minimal ketosis; fluid deficit often 8–10 L; mortality higher than DKA.

Type 2 diabetes first-line: metformin unless contraindicated (eGFR <30); add SGLT2 inhibitor if ASCVD, heart failure, or CKD; GLP-1 receptor agonist if ASCVD or obesity predominant.

Thyroid: overt hypothyroidism TSH high with low FT4 → levothyroxine 1.6 µg/kg/day; overt hyperthyroidism TSH low with high FT4 → methimazole (PTU in first trimester and thyroid storm).

Thyroid storm: Burch-Wartofsky score ≥45; treat with PTU, beta-blocker, iodine after thionamide, hydrocortisone, supportive care.

Adrenal crisis: hypotension, hyponatremia, hyperkalemia, hypoglycemia; draw cortisol/ACTH then give hydrocortisone 100 mg IV immediately, followed by 50 mg q6h; do not delay for results.

Osteoporosis: DXA T-score ≤−2.5 defines osteoporosis; FRAX guides treatment; bisphosphonate first-line; ensure calcium 1000–1200 mg/day and vitamin D 800–1000 IU/day.

Metabolic syndrome (IDF): central obesity plus ≥2 of raised triglycerides, low HDL, elevated BP, elevated fasting glucose; waist thresholds differ by ethnicity (Asian men ≥90 cm, women ≥80 cm).

Anemia workup: MCV <80 microcytic (iron deficiency, thalassemia, chronic disease), 80–100 normocytic, >100 macrocytic (B12/folate, alcohol, hypothyroidism, MDS). Ferritin <30 ng/mL confirms iron deficiency; <100 with inflammation is suggestive.

Iron deficiency anemia: oral ferrous sulfate 200 mg daily or alternate-day dosing improves absorption; continue 3 months after hemoglobin normalizes to replenish stores.

Transfusion threshold: restrictive strategy (Hb <7 g/dL) for most stable patients; <8 g/dL in cardiac surgery or stable cardiovascular disease; <9–10 g/dL if symptomatic.

Neutropenic fever: ANC <500/µL plus fever ≥38.3 °C once or ≥38.0 °C sustained 1 h; take cultures and start empiric antipseudomonal beta-lactam (piperacillin-tazobactam or cefepime) within 60 min.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; prevention with IV hydration and allopurinol (rasburicase if high risk); Cairo-Bishop criteria for diagnosis.

Hodgkin lymphoma: Reed-Sternberg cells (CD15+, CD30+); staging with PET-CT; ABVD regimen; B symptoms = fever >38 °C, drenching night sweats, weight loss >10% in 6 months.

Multiple myeloma CRAB criteria: hyperCalcemia, Renal insufficiency, Anemia, Bone lesions; plus SLiM criteria (≥60% plasma cells, light chain ratio ≥100, >1 MRI lesion).

Oncologic emergencies: superior vena cava syndrome, spinal cord compression (dexamethasone + urgent MRI), febrile neutropenia, hypercalcemia (IV fluids + bisphosphonate), tumor lysis.

SLE: ACR/EULAR 2019 classification requires ANA ≥1:80 plus ≥10 points across domains; hydroxychloroquine for all patients unless contraindicated; monitor with CBC, creatinine, eye exam.

Rheumatoid arthritis: 2010 ACR/EULAR criteria - score ≥6/10; symmetric small joint involvement, morning stiffness >1 h; first-line methotrexate plus folic acid; treat-to-target remission.

Anaphylaxis: epinephrine 0.3–0.5 mg IM (1:1000) in the anterolateral thigh, repeat every 5–15 min; adjuncts (antihistamine, steroid) do not replace epinephrine; observe 4–8 h for biphasic reaction.

Gout: acute flare treated with NSAID, colchicine, or corticosteroid; do not start or stop urate-lowering therapy during a flare; target urate <6 mg/dL (<5 mg/dL with tophi).

Giant cell arteritis: age >50, new headache, jaw claudication, elevated ESR; start prednisone 40–60 mg immediately and obtain temporal artery biopsy within 2 weeks.

Antiphospholipid syndrome: thrombosis or pregnancy morbidity plus persistent antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-β2 glycoprotein I) ≥12 weeks apart; anticoagulation with warfarin for thrombosis.

Drug allergy: type I immediate (IgE, minutes), type II cytotoxic, type III immune complex, type IV delayed (T-cell, maculopapular rash, SJS/TEN). Penicillin skin testing before desensitization.

Systemic sclerosis: limited (CREST, anti-centromere) vs diffuse (anti-Scl-70); screen annually for pulmonary hypertension and interstitial lung disease with PFT and echocardiography.

Sepsis-3: suspected infection plus SOFA increase ≥2; septic shock = vasopressor requirement to maintain MAP ≥65 mmHg plus lactate >2 mmol/L despite adequate fluid resuscitation.

Sepsis bundle (Surviving Sepsis 2021): measure lactate, obtain blood cultures before antibiotics, broad-spectrum antibiotics within 1 h for septic shock, 30 mL/kg crystalloid for hypotension or lactate ≥4.

Dengue: warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement >2 cm, rising hematocrit with falling platelets); avoid NSAIDs and IM injections.

Malaria: thick and thin blood smear or rapid diagnostic test; severe malaria (parasitemia >5%, cerebral, acidosis, hypoglycemia, renal failure) → IV artesunate; uncomplicated falciparum → artemisinin-based combination therapy.

Typhoid fever: blood culture in first week, stool/urine culture later; ceftriaxone or azithromycin; watch for intestinal perforation in the third week.

HIV: start ART regardless of CD4 count; first-line TDF + 3TC + DTG; screen for TB, hepatitis B/C, syphilis before starting; monitor viral load at 6 and 12 months.

Tetanus prophylaxis: clean minor wound - vaccine if >10 years since last dose; contaminated or deep wound - vaccine plus tetanus immunoglobulin if >5 years or unknown status.

Leptospirosis: exposure to contaminated water, fever, myalgia, conjunctival suffusion, jaundice with renal failure (Weil disease); treat with penicillin G or doxycycline.

Acute ischemic stroke: IV alteplase within 4.5 h of onset (0.9 mg/kg, max 90 mg); mechanical thrombectomy within 6 h for large vessel occlusion, up to 24 h with favorable perfusion imaging.

Stroke: NIHSS quantifies severity; check glucose and CT first; do not lower BP below 185/110 before thrombolysis or 220/120 without thrombolysis; give aspirin after 24 h post-thrombolysis.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg IV or midazolam IM), then second-line (levetiracetam, valproate, or phenytoin), then anesthetic agents (propofol, midazolam, thiopental) for refractory cases.

Meningitis: do not delay antibiotics for CT or LP in suspected bacterial meningitis; dexamethasone 10 mg before or with first antibiotic dose in pneumococcal disease; empiric ceftriaxone plus vancomycin (plus ampicillin if >50 y).

Glasgow Coma Scale: eye 1–4, verbal 1–5, motor 1–6; score ≤8 indicates need for airway protection; motor response is the strongest prognostic component.

Increased intracranial pressure: head elevation 30°, normocapnia (PaCO2 35–40 mmHg), hypertonic saline or mannitol, short-term hyperventilation only for herniation; avoid hypotonic fluids.

Myasthenic crisis vs cholinergic crisis: both cause weakness; cholinergic crisis has SLUDGE signs; treat myasthenic crisis with plasma exchange or IVIG plus respiratory monitoring (vital capacity <20 mL/kg indicates intubation).

Guillain-Barré syndrome: ascending symmetric weakness, areflexia, albuminocytologic dissociation in CSF; monitor vital capacity; IVIG or plasma exchange; avoid corticosteroids alone.

Frailty: Fried phenotype (weight loss, exhaustion, low activity, slow gait, weakness) - ≥3 criteria = frail, 1–2 = prefrail; Clinical Frailty Scale 1–9 predicts outcomes.

Comprehensive geriatric assessment domains: medical, functional (ADL/IADL, Barthel, Lawton), cognitive (MMSE, MoCA), psychological, nutritional, social, and advance care planning.

Delirium: acute onset, fluctuating attention, altered consciousness; use 4AT or CAM; treat underlying cause; avoid antipsychotics unless severe agitation or danger; haloperidol lowest dose short term.

Falls: multifactorial assessment including orthostatic BP, vision, gait/balance, medications (sedatives, antihypertensives, anticholinergics), home hazards; vitamin D and exercise programs reduce risk.

Polypharmacy: STOPP/START criteria and Beers criteria identify potentially inappropriate medications in older adults; deprescribe anticholinergics, benzodiazepines, sulfonylureas with long action, and NSAIDs.

Pain management in palliative care: WHO ladder; opioids are first-line for moderate-severe cancer pain; add laxatives prophylactically; titrate to effect; assess total pain (physical, psychological, social, spiritual).

Palliative prognosis: Palliative Performance Scale and ECOG status guide goals; Karnofsky <50% indicates limited function; discuss advance directives and family support.

Pressure ulcers: Braden scale for risk; stage by depth and tissue involvement; reposition every 2 h, pressure-relieving surfaces, nutrition, wound care.

Adult BLS: check responsiveness and breathing, call for help, start chest compressions 100–120/min at 5–6 cm depth, minimize interruptions, use AED as soon as available; ratio 30:2 without advanced airway.

ACLS: shockable rhythms (VF/pVT) → defibrillate immediately, then CPR 2 min, epinephrine 1 mg q3–5 min, amiodarone 300 mg after third shock; non-shockable (asystole/PEA) → epinephrine and treat reversible causes.

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

Anaphylaxis and shock: epinephrine IM first-line; IV fluids 1–2 L bolus for hypovolemic or distributive shock; vasopressors (norepinephrine first-line) if MAP <65 despite fluids.

Trauma: ATLS primary survey ABCDE, cervical spine immobilization, FAST for hemoperitoneum, massive transfusion protocol (1:1:1) for hemorrhagic shock; permissive hypotension until control.

Burns: Parkland formula 4 mL × weight (kg) × %TBSA lactated Ringer in first 24 h, half in first 8 h; rule of nines for adults; intubate if inhalation injury or stridor.

Poisoning: activated charcoal within 1 h if airway protected; specific antidotes - N-acetylcysteine for paracetamol, naloxone for opioids, flumazenil for benzodiazepines (caution), fomepizole for methanol/ethylene glycol.

Clinical reasoning: pretest probability and likelihood ratios guide testing; sensitivity rules out when negative (SnNout), specificity rules in when positive (SpPin).

Informed consent: must include diagnosis, proposed treatment, alternatives, risks and benefits, and prognosis; obtain from competent adults; use guardian or surrogate for incompetent patients; document in the record.

Confidentiality: medical information may be disclosed only with patient consent or legal mandate; exceptions include mandatory reporting of certain infectious diseases, suspected abuse, and court order.

Medical record: complete, accurate, timely, legible; entries include date, time, signature; do not alter retrospectively; retain per local regulation; serves legal and clinical purposes.

Medical error disclosure: duty to disclose harm to patient, apologize, explain, and document; report through incident reporting systems; open disclosure is an ethical and professional obligation.

Professional boundaries: avoid conflicts of interest, dual relationships, and accepting gifts that could influence care; declare conflicts in research and presentations.

Resource allocation: triage by medical urgency and benefit, not by ability to pay or social status; document decisions; follow institutional and national guidelines.

Referral and consultation: refer when beyond competence; provide adequate information; maintain responsibility until handover is complete; use structured handover (SBAR).

Research ethics: IRB approval, informed consent, risk-benefit assessment, confidentiality, and publication integrity; the Declaration of Helsinki and local regulations apply.