SLMC ERPM cheat sheet

Medical Knowledge and Clinical Practice - High-Yield Core

• Shock is defined by inadequate tissue perfusion, not by blood pressure alone; hypotension (SBP <90 mmHg or MAP <65 mmHg) is a late and insensitive sign, so use lactate, urine output, capillary refill, and mentation as perfusion markers.

• Anaphylaxis: intramuscular adrenaline 0.5 mg of 1:1000 solution into the anterolateral thigh, repeated every 5 minutes as needed; adjuncts (antihistamines, steroids) never replace adrenaline.

• Acute coronary syndrome: serial high-sensitivity troponin at 0–1 h or 0–3 h plus ECG within 10 minutes of arrival; ST elevation triggers immediate reperfusion, and aspirin 300 mg chewed is given unless contraindicated.

• Sepsis: infection plus organ dysfunction (SOFA rise of 2 or more); give broad-spectrum antibiotics within 1 hour of recognition and 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more.

• Stroke: thrombolysis window up to 4.5 hours from onset with CT excluding haemorrhage; mechanical thrombectomy up to 6 hours for large-vessel occlusion, extended to 24 hours with perfusion imaging in selected patients.

• Acute severe asthma: continuous nebulised salbutamol plus ipratropium, systemic steroids, and magnesium sulphate 1.5–2 g IV over 20 minutes for poor response; a silent chest or rising PaCO2 signals impending respiratory arrest.

• Diabetic ketoacidosis: 0.9% saline resuscitation, fixed-rate insulin infusion 0.1 units/kg/h, and potassium replacement once K+ is below 5.5 mmol/L; add 10% dextrose when glucose falls below 14 mmol/L to keep clearing ketones.

• Hyponatraemia correction limit: 8–10 mmol/L in the first 24 hours to avoid osmotic demyelination; use hypertonic 3% saline boluses only for severe symptoms such as seizures or reduced consciousness.

• Drug dosing adjustments: check renal function (eGFR/Cockcroft-Gault) for renally cleared drugs such as gentamicin, vancomycin, and DOACs, and check hepatic function for drugs metabolised by CYP450 before prescribing.