Iraqi Board Emergency Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Defibrillation energy in paediatric arrest

First shock 2 J/kg, subsequent shocks 4 J/kg. Use the largest paddles that fit the chest without touching, and resume compressions immediately after the shock.

Parkland burn formula

4 mL/kg per percent total body surface area of lactated Ringer's in 24 hours from injury, half in the first 8 hours. Target urine output 0.5-1 mL/kg/h in adults.

CURB-65 score

One point each for confusion, urea above 7 mmol/L, respiratory rate 30 or more, blood pressure below 90/60, and age 65 or older. Score 3 or more indicates severe pneumonia.

Septic shock definition

Sepsis with persisting hypotension requiring vasopressors to keep mean arterial pressure at 65 mmHg or above, and lactate above 2 mmol/L despite adequate fluid resuscitation.

Rumack-Matthew nomogram

A plot of serum paracetamol concentration against time after a single acute ingestion. Levels above the treatment line at 4 hours indicate N-acetylcysteine, given as a full course.

Status epilepticus first line

A benzodiazepine given promptly: IV lorazepam 0.1 mg/kg or IM midazolam 10 mg. Repeat once if seizures persist, then give second-line IV levetiracetam, valproate or phenytoin.

Alteplase dose in stroke

0.9 mg/kg total, maximum 90 mg, with 10% as an IV bolus and the remainder infused over 60 minutes. Exclude haemorrhage on CT and control blood pressure before giving.

Magnesium sulfate in eclampsia

Loading dose 4-6 g IV over 20 minutes, then 1-2 g per hour. Monitor deep tendon reflexes, respiratory rate and urine output; calcium gluconate reverses toxicity.

Hyperkalaemia with ECG changes

Give IV calcium gluconate first to stabilise the myocardium, then shift potassium intracellularly with insulin-dextrose and salbutamol, and arrange definitive removal by dialysis or binders.

DKA potassium rule

If potassium is below 5.5 mmol/L and urine output is adequate, start replacement with insulin. Insulin shifts potassium into cells, so hypokalaemia can worsen rapidly during treatment.

Tension pneumothorax management

A clinical diagnosis requiring immediate needle decompression without waiting for imaging, followed by a definitive chest drain. Signs include hypotension, absent breath sounds and tracheal deviation.

Massive transfusion ratio

A balanced approach approximating 1:1:1 of packed red cells, fresh frozen plasma and platelets, with tranexamic acid 1 g within 3 hours of traumatic haemorrhage.

FAST examination windows

Four views: subxiphoid for pericardial fluid, right upper quadrant for Morison's pouch, left upper quadrant for splenorenal space, and suprapubic for pelvic free fluid.

Lung point sign

The transition between lung sliding and absent sliding seen on ultrasound, which confirms pneumothorax. Absent sliding alone can also occur with pleurodesis or intubation.

RSI rocuronium dose

1 to 1.2 mg/kg IV provides intubating conditions within about 60 seconds and lasts roughly 45 minutes. Sugammadex 16 mg/kg can reverse it if intubation fails.

Cannot intubate cannot oxygenate

After failed intubation and failed supraglottic rescue with falling saturations, perform an immediate front-of-neck airway. Do not persist with further intubation attempts.

Ottawa ankle rule

Ankle radiography is indicated if there is pain in the malleolar zone plus bone tenderness at the posterior malleolar edge or inability to bear weight for four steps.

Compartment syndrome earliest sign

Pain out of proportion to injury and pain on passive stretch of the compartment muscles. Pulselessness and paralysis are late and unreliable signs and should not be awaited.

Necrotising fasciitis treatment

Immediate surgical debridement is the priority, combined with broad-spectrum antibiotics including clindamycin to suppress toxin production. Imaging must not delay surgery.

Cauda equina syndrome

Saddle anaesthesia, bladder or bowel dysfunction and bilateral leg weakness demand urgent MRI and neurosurgical referral. Delayed decompression risks permanent deficit.

Ectopic pregnancy discriminatory zone

A serum beta-hCG between 1500 and 3500 mIU/mL should show an intrauterine gestational sac on transvaginal ultrasound. Absence suggests ectopic or non-viable pregnancy.

Postpartum haemorrhage sequence

Uterine massage and oxytocin first, then ergometrine, carboprost or misoprostol. Give tranexamic acid 1 g within 3 hours, and escalate to balloon tamponade or surgery.

Sepsis antibiotic timing

Give antibiotics within 1 hour for septic shock and within 3 hours for possible sepsis without shock. Blood cultures should be taken before antibiotics if no delay results.

qSOFA criteria

Respiratory rate 22 or more, altered mentation with Glasgow Coma Scale below 15, and systolic blood pressure 100 mmHg or less. Two or more prompt assessment for organ dysfunction.

Hyperbaric oxygen indications

Carbon monoxide poisoning with loss of consciousness, neurological signs, pregnancy or carboxyhaemoglobin above 25 percent. Also used for decompression illness and gas gangrene.

Tricyclic overdose antidote

Sodium bicarbonate for QRS widening beyond 100 ms or ventricular arrhythmia. Avoid class IA and IC antiarrhythmics, and physostigmine is contraindicated because it worsens conduction.

Berlin ARDS criteria

Onset within one week, bilateral opacities not explained by cardiac failure, and PaO2/FiO2 of 300 mmHg or less with PEEP of at least 5 cmH2O.

Disaster triage categories

Red for immediate, yellow for delayed, green for minor and black for expectant or deceased. Resources are directed to those most likely to benefit from intervention.

Capacity assessment elements

The patient must understand, retain, weigh and communicate the decision. If any element is absent, treat in the patient's best interests and document the reasoning.

ESI triage level one

Emergency Severity Index level 1 requires an immediate life-saving intervention such as intubation, defibrillation or emergency blood. These patients are seen without delay.

Door-to-needle time

The interval from ED arrival to thrombolytic administration in acute ischaemic stroke. Guidelines target 60 minutes or less, with many centres achieving under 45 minutes.

Norepinephrine first-line shock

The preferred vasopressor in septic shock, titrated to mean arterial pressure of 65 mmHg or above. Vasopressin or epinephrine may be added for refractory hypotension.