e-UKCG cheat sheet

Acute upper GI bleeding: pre-endoscopy Glasgow-Blatchford score of 0-1 identifies very low-risk patients suitable for outpatient management; a score ≥7 predicts high risk of needing endoscopic or surgical intervention.

Sepsis (Sepsis-3): suspect when qSOFA ≥2 (RR ≥22, altered mentation, SBP ≤100); septic shock = persisting hypotension requiring vasopressors to keep MAP ≥65 mmHg plus lactate >2 mmol/L despite fluid resuscitation.

Acute coronary syndrome: high-sensitivity troponin rise/fall with at least one value above the 99th percentile upper reference limit defines MI; STEMI needs reperfusion (primary PCI within 120 min of first medical contact where achievable).

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, RR ≥30, SBP <90 or DBP ≤60, age ≥65) - 0-1 treat at home, 2 consider admission, ≥3 manage as severe.

Acute pancreatitis diagnosis needs 2 of 3: characteristic epigastric pain radiating to the back, amylase/lipase >3× upper limit of normal, or imaging findings; severity scored with modified Glasgow or APACHE II at 48 h.

Diabetic ketoacidosis: IV 0.9% saline resuscitation, fixed-rate insulin infusion 0.1 units/kg/h, and potassium replacement once K+ <5.5 mmol/L; add 10% glucose when capillary glucose <14 mmol/L to allow continued insulin.

Postoperative fever timing: day 1-2 atelectasis, day 3-5 urinary or wound infection, day 5-7 intra-abdominal abscess or anastomotic leak, day 7+ deep vein thrombosis or prosthetic material infection.

Thyroid storm is clinical (Burch-Wartoff score ≥45): treat with propylthiouracil or carbimazole, plus propranolol, iodine load at least 1 hour after thionamide, and hydrocortisone.

Pre-eclampsia: hypertension after 20 weeks plus proteinuria (protein:creatinine ratio ≥30 mg/mmol) or maternal organ dysfunction; delivery is the only cure, and magnesium sulfate is first line for eclamptic seizures and prophylaxis in severe disease.

Postpartum haemorrhage: blood loss >500 mL after vaginal or >1000 mL after caesarean delivery; first-line uterotonic is oxytocin 5 IU slow IV, with ergometrine contraindicated in hypertension and carboprost avoided in asthma.

Ectopic pregnancy: a negative pregnancy test excludes it; a discriminatory hCG of 1000-2000 IU/L with an empty uterus on transvaginal ultrasound is suspicious, and methotrexate requires hCG <5000 IU/L, no fetal cardiac activity, and haemodynamic stability.

Paediatric fluid resuscitation: 10-20 mL/kg crystalloid bolus for shock, and maintenance by Holliday-Segar (4 mL/kg/h for first 10 kg, 2 for next 10, 1 thereafter).

Paediatric basic life support: 5 rescue breaths first for asphyxial arrest, then 15:2 compressions to ventilations, compressing at least one third of the anterior-posterior chest diameter at 100-120/min.

Neonatal jaundice: phototherapy threshold depends on gestational age, postnatal hours and bilirubin level; conjugated jaundice beyond 14 days or pale stools requires urgent investigation for biliary atresia.

Depression: first-line treatment for moderate to severe episodes is a psychological therapy (CBT) or an SSRI; SSRIs carry a small increased risk of suicidal ideation in under-25s and require review within 1-2 weeks of starting.

Acute dystonia from antipsychotics responds to procyclidine or benzatropine; neuroleptic malignant syndrome (rigidity, hyperthermia, raised CK) requires stopping the drug, cooling, and dantrolene or bromocriptine.

Cardiovascular risk: QRISK3 estimates 10-year risk; offer statin (atorvastatin 20 mg) when risk ≥10%, and discuss when ≥10% with comorbidities or familial hypercholesterolaemia features.

Hypertension diagnosis: clinic BP ≥140/90 mmHg requires ambulatory or home monitoring; ABPM daytime average ≥135/85 mmHg confirms. Offer treatment for stage 1 (≥140/90) under 80 only after confirming and assessing risk.

Type 2 diabetes: HbA1c ≥48 mmol/mol (6.5%) on two occasions diagnoses; target 48 mmol/mol for most, 53 mmol/mol if on multiple drugs or at hypoglycaemia risk.

Antibiotic stewardship: delayed or back-up prescriptions are appropriate for uncomplicated URTI and otitis media; sore throat with Centor/FeverPAIN score 0-2 does not warrant antibiotics.

Spirometry: FEV1/FVC ratio <0.7 after bronchodilator confirms airflow obstruction; grade severity by FEV1 percent predicted (mild ≥80%, moderate 50-79%, severe 30-49%).

Contraception: combined oral contraceptive is contraindicated with migraine with aura, BP ≥160/100, smoking over 35 with ≥15 cigarettes/day, and within 6 weeks postpartum if breastfeeding.

Safeguarding in primary care: a child with unexplained injury, delayed presentation, or inconsistent history triggers referral to the local authority safeguarding team; consent is not required for a child protection referral.

Sick day rules: patients on ACE inhibitors, diuretics, NSAIDs or metformin should temporarily stop these during acute dehydrating illness to reduce acute kidney injury risk.

Adult cardiac arrest: high-quality compressions at 100-120/min, depth 5-6 cm, full recoil, minimal interruptions; shockable rhythms (VF/pulseless VT) get immediate defibrillation and adrenaline 1 mg after the third shock.

Anaphylaxis: intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh, repeated after 5 minutes; give oxygen, IV fluid bolus, and remove the trigger.

Acute asthma: life-threatening features include silent chest, cyanosis, exhaustion, bradycardia and SpO2 <92%; treat with oxygen, nebulised salbutamol plus ipratropium, and IV magnesium sulfate 1.2-2 g over 20 min.

Trauma: catastrophic haemorrhage control precedes airway in ABCDE; permissive hypotension (SBP ~90 mmHg) applies to penetrating trauma without head injury.

Burns: estimate area with Wallace rule of nines (head 9%, each arm 9%, each leg 18%, front trunk 18%, back trunk 18%, perineum 1%); fluid resuscitation with Parkland formula 4 mL/kg/% burn over 24 h, half in first 8 h.

Sepsis bundle: measure lactate, take blood cultures before antibiotics, give broad-spectrum antibiotics within 1 hour of recognition in septic shock, and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Opioid overdose: titrate naloxone 400 micrograms IV/IM, repeated every 2-3 minutes; its half-life is shorter than most opioids, so observe for at least 4-6 hours for respiratory depression recurrence.

Raised intracranial pressure: head-up 30 degrees, avoid hypoxia and hypotension, maintain normocapnia (PaCO2 4.5-5.0 kPa); hypertonic saline or mannitol and short-term hyperventilation are rescue measures only.

Prescription legibility and safety: write generic drug names, avoid abbreviations (e.g. 'U' for units, 'OD' for once daily), and state the indication, dose, route, frequency and duration explicitly.

High-risk medicines: insulin, anticoagulants, opioids, methotrexate and concentrated potassium are on the NHS never-events/ high-risk list; potassium chloride ampoules must never be given undiluted by IV push.

Warfarin: initiate with a loading regimen and check INR; target INR 2-3 for AF and venous thromboembolism, 2.5-3.5 for mechanical mitral valves; major bleeding is reversed with prothrombin complex plus IV vitamin K.

Renal dosing: calculate eGFR or Cockcroft-Gault creatinine clearance; avoid NSAIDs and metformin in significant renal impairment; adjust gentamicin, vancomycin and DOACs to renal function.

Allergy documentation: record the drug, reaction type (true allergy vs intolerance) and severity; penicillin allergy labels should be verified and de-labelled where possible to reduce broad-spectrum use.

Medication reconciliation at admission and discharge reduces errors; include over-the-counter drugs, herbal remedies, and confirm the patient's own supply before prescribing new charts.

Reporting: any patient safety incident, near miss or never event is reported through the local incident system (e.g. Datix); duty of candour requires an apology and explanation to the patient when harm occurs.

Anticoagulant bridging: heparin bridging is generally not indicated for most AF patients undergoing procedures; follow local protocols and use CHA2DS2-VASc and HAS-BLED to guide decisions.

Consultation models: Calgary-Cambridge structures the consultation into initiating the session, gathering information, physical examination, explanation and planning, and closing the session.

Open-to-closed questioning: begin with open questions ('What brings you in today?'), use closed questions to clarify facts, and avoid leading or multiple questions in one turn.

ICE: elicit the patient's Ideas, Concerns and Expectations early; addressing these improves adherence and satisfaction and is assessed in UK consultations.

Chunking and checking: give information in small chunks, avoid jargon, use the teach-back method ('Can you tell me how you'll take the tablets?') to confirm understanding.

Breaking bad news: SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/summary) is a structured framework; allow silence and respond to emotion before giving more information.

Shared decision making: discuss options with risks and benefits, explore patient values, and record the agreed plan; use decision aids where available for preference-sensitive choices.

Consent: valid consent requires capacity, sufficient information and voluntariness; for children, assess Gillick competence and involve those with parental responsibility.

Interpreters: use professional interpreters, not family members, for discussions of diagnosis or consent; document the language and interpreter used.

GMC four pillars of good medical practice: knowledge, skills and performance; safety and quality; communication, partnership and teamwork; maintaining trust.

Mental Capacity Act 2005: presume capacity, support the person to decide, and act in their best interests if they lack capacity; a capacitous adult may refuse treatment even if it will lead to death.

Deprivation of Liberty Safeguards / Liberty Protection Safeguards: restraint or restriction of a person lacking capacity requires legal authorisation; the least restrictive option must be chosen.

Confidentiality: disclose information only with consent or where required by law (e.g. notifiable diseases, terrorism, serious crime) or in the public interest; anonymise where possible.

Consent for adults: capacity is decision-specific and time-specific; for a patient lacking capacity, treatment can be given in their best interests under the MCA, with advance decisions respected if valid and applicable.

Children: under-16s may consent if Gillick competent; refusal of life-saving treatment by a competent child can be overridden by the court, and parental consent suffices for younger children.

Fitness to practise: the GMC can suspend or erase registration for misconduct, deficient professional performance, conviction, or adverse physical/mental health; doctors must declare relevant convictions and regulatory actions.

Research ethics: research involving human participants requires Research Ethics Committee approval, informed consent, and compliance with the UK GDPR and Human Medicines Regulations.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); a highly sensitive test is useful for ruling out disease when negative.

Positive predictive value depends on prevalence: PPV = TP/(TP+FP); likelihood ratio positive = sensitivity/(1 - specificity), and LR negative = (1 - sensitivity)/specificity.

Number needed to treat = 1/absolute risk reduction; absolute risk reduction = control event rate minus intervention event rate; relative risk reduction can be large while ARR is small.

Confidence intervals: a 95% CI excluding 1 for a ratio (RR, OR, HR) or excluding 0 for a difference indicates statistical significance at p<0.05; wide intervals imply imprecision.

Hierarchy of evidence: systematic reviews and RCTs sit above cohort, case-control and case series; GRADE rates certainty as high, moderate, low or very low based on risk of bias, inconsistency, indirectness, imprecision and publication bias.

Diagnostic study quality: compare against a reference standard, blind assessors, and avoid spectrum bias by recruiting consecutive patients; STARD reporting standards apply.

Quality improvement: use the Model for Improvement (what are we trying to accomplish, how will we know change is an improvement, what changes can we make) with PDSA cycles and run charts or SPC charts to detect special-cause variation.

Audit vs research: audit measures practice against an existing standard and closes the loop with re-audit; research generates new generalisable knowledge and requires ethical approval.

Hyponatraemia: assess volume status and urine osmolality; treat symptomatic or severe cases with hypertonic saline and limit correction to 10 mmol/L in 24 h to avoid osmotic demyelination.

Hyperkalaemia with ECG changes: give IV calcium chloride or gluconate first to stabilise the myocardium, then insulin-dextrose and salbutamol to shift potassium, and consider dialysis or potassium binders for removal.

Pulmonary embolism: use Wells score then D-dimer (age-adjusted); a negative age-adjusted D-dimer with low/intermediate probability safely excludes PE in many pathways; high-risk PE with haemodynamic instability gets thrombolysis.

Acute kidney injury staging (KDIGO): stage 1 creatinine rise ≥26 micromol/L in 48 h or 1.5-1.9× baseline; stage 2 2.0-2.9×; stage 3 ≥3× or creatinine ≥354 micromol/L or urine output <0.3 mL/kg/h for 24 h.

Stroke: thrombolysis within 4.5 h of symptom onset and thrombectomy for large vessel occlusion up to 6 h (selected patients to 24 h); give aspirin 300 mg after 24 h once haemorrhage excluded.

Atrial fibrillation anticoagulation: CHA2DS2-VASc ≥2 in men or ≥3 in women indicates anticoagulation; DOACs are preferred over warfarin except in mechanical valves or moderate-severe mitral stenosis.

Bowel obstruction: initial management is nil by mouth, IV fluids, nasogastric decompression, analgesia and monitoring; urgent surgery for strangulation, perforation, closed-loop obstruction or peritonitis.

Diabetic foot: assess with probe-to-bone, pulses, neuropathy and ankle-brachial pressure index; refer within 24 h for spreading infection, ischaemia, or suspected osteomyelitis.

Ovarian torsion: sudden unilateral pelvic pain with nausea and an enlarged ovary on ultrasound is a surgical emergency; detorsion and ovarian preservation are preferred to oophorectomy.

Menorrhagia: first-line is a levonorgestrel intrauterine system; tranexamic acid and NSAIDs are alternatives; investigate with full blood count and pelvic ultrasound, and consider endometrial biopsy if over 45 or risk factors.

Antenatal screening: combined test at 11+0 to 14+1 weeks (nuchal translucency plus beta-hCG and PAPP-A); quadruple test at 14+2 to 20+0 weeks if too late for combined screening.

Gestational diabetes: 75 g OGTT at 24-28 weeks; diagnostic thresholds are fasting ≥5.6 mmol/L or 2-hour ≥7.8 mmol/L; first-line treatment is diet and metformin if needed, with insulin if targets not met.

Paediatric febrile convulsion: simple if generalised, under 15 minutes, once in 24 h in a child 6 months to 5 years; no routine investigations or long-term anticonvulsants are required.

Kawasaki disease: fever ≥5 days plus 4 of 5 features (conjunctivitis, rash, mucosal changes, cervical lymphadenopathy, extremity changes); treat with IV immunoglobulin and aspirin to reduce coronary artery risk.

Anorexia nervosa: highest mortality of psychiatric disorders; medical risk markers include BMI <13, rapid weight loss, bradycardia, hypothermia and electrolyte disturbance, which warrant urgent paediatric or medical admission.

Postnatal depression: Edinburgh Postnatal Depression Scale ≥13 suggests probable depression; SSRIs such as sertraline are preferred in breastfeeding, alongside psychological therapy.

Asthma: diagnosis supported by bronchodilator reversibility of FEV1 ≥12% and ≥200 mL, or peak flow variability >20%; all patients should be on inhaled corticosteroid-containing therapy.

COPD: offer smoking cessation and vaccination; LAMA/LABA combination for persistent breathlessness; pulmonary rehabilitation for MRC dyspnoea scale ≥3; long-term oxygen if PaO2 <7.3 kPa.

Atrial fibrillation: rate control with beta-blocker or rate-limiting calcium channel blocker; consider rhythm control if symptomatic or first episode; anticoagulate by CHA2DS2-VASc.

Erectile dysfunction: consider cardiovascular risk assessment as a marker of vascular disease; PDE5 inhibitors are contraindicated with nitrates.

Suspected cancer referral: use NICE NG12 criteria, e.g. unexplained weight loss with abdominal pain over 40, postmenopausal bleeding, or dysphagia, for urgent two-week-wait referral.

Childhood immunisation schedule (UK): 8, 12 and 16 weeks for primary course, 1 year for MMR and Hib/MenC, 3 years 4 months for pre-school boosters, and HPV at 12-13 years.

Hypothyroidism: levothyroxine titrated to TSH; check TSH 6-8 weeks after dose change; in pregnancy, levothyroxine requirements usually increase and TSH should be checked each trimester.

Anticoagulation in AF with falls: falls risk alone is not a reason to withhold anticoagulation; assess and address modifiable bleeding risks instead.

Tension pneumothorax: immediate needle decompression in the second intercostal space mid-clavicular line (or fifth space anterior axillary line) followed by chest drain; do not wait for imaging.

Diabetic emergencies: check capillary glucose and ketones; DKA has ketonaemia ≥3 mmol/L with acidosis (pH <7.3 or bicarbonate <18); HHS has osmolality >320 mOsm/kg with minimal ketosis.

Poisoning: activated charcoal within 1 hour of ingestion if airway protected; paracetamol overdose uses the Rumack-Matthew nomogram and N-acetylcysteine; salicylate toxicity causes tinnitus and mixed acidosis.

Major haemorrhage: activate the major haemorrhage protocol, give tranexamic acid within 3 h of trauma, and use a balanced ratio of red cells to plasma and platelets.

Status epilepticus: benzodiazepine first (IV lorazepam or buccal/intramuscular midazolam), then a second dose, then IV phenytoin, levetiracetam or sodium valproate; anaesthesia if refractory.

Acute heart failure with pulmonary oedema: sit up, oxygen if hypoxic, IV loop diuretic, and non-invasive ventilation for respiratory distress; treat the precipitant (e.g. ACS, arrhythmia, infection).

ICU sedation and delirium: target light sedation with a validated scale (RASS), use the CAM-ICU to screen for delirium, and prioritise non-pharmacological measures and early mobilisation.

Sepsis in neutropenic patients: give empirical antipseudomonal beta-lactam within 1 hour if febrile ≥38°C; do not delay for cultures in unstable patients.

Methotrexate: prescribed weekly, never daily; co-prescribe folic acid, monitor full blood count, renal and liver function, and avoid trimethoprim and NSAIDs where possible.

Lithium: narrow therapeutic index (target 0.6-0.8 mmol/L); monitor levels 12 h post-dose, check renal and thyroid function, and beware toxicity with dehydration, NSAIDs, ACE inhibitors and thiazides.

Digoxin: target 0.5-0.9 ng/mL in heart failure; toxicity risk increases with hypokalaemia, renal impairment and amiodarone; monitor levels and electrolytes.

Aminoglycosides: once-daily dosing, monitor trough levels and renal function; avoid in myasthenia gravis and during pregnancy; risk of ototoxicity and nephrotoxicity.

Insulin safety: use 'units' in full, never 'U'; use a standard insulin syringe or pen, and double-check the type (short vs long acting) and dose before administration.

Adverse drug reactions: report serious or unusual reactions to the MHRA Yellow Card scheme; report all suspected reactions to black triangle (newly licensed) medicines.

Antimicrobial stewardship: review IV antibiotics at 48-72 h for switch to oral; document indication and duration, and follow local guidelines based on resistance patterns.

Consent and capacity in prescribing: for patients lacking capacity, prescribe in their best interests, record the reasoning, and involve family or an independent mental capacity advocate where appropriate.

Signposting: summarise and state the direction of the consultation ('Now I'd like to ask about your medications'); this improves patient recall and reduces misunderstanding.

Empathy statements: name the emotion and acknowledge it ('It sounds as though this has been frightening for you') before moving to explanation or planning.

Safety netting: state what to do if symptoms worsen, when to seek help, and what to expect; this is a core component of safe consultations for undifferentiated illness.

Telephone consultation: confirm identity, location and safety; use structured frameworks, and escalate to face-to-face assessment when red flags are present.

Motivational interviewing: use open questions, affirmations, reflections and summaries (OARS); explore ambivalence rather than lecturing, to support behaviour change.

Complaints and second opinions: acknowledge the patient's concern, explain the process, and avoid defensiveness; a second opinion can be requested without prejudice.

Written information: provide in plain language at reading level appropriate to the patient, with large print or translated versions where needed; check understanding.

Colleague communication: use SBAR (Situation, Background, Assessment, Recommendation) for handover and escalation, and document clearly in the notes.

GMC consent guidance: doctors must be satisfied the patient has capacity, has been given information about risks and alternatives, and is acting voluntarily; document the discussion.

Advance decisions to refuse treatment: valid and applicable if made by a capacitous adult, covers the specific treatment and circumstances, and is not withdrawn; they do not apply to life-sustaining treatment unless in writing and signed.

Public interest disclosure: balance the risk of harm against confidentiality; disclose only the minimum necessary information to the appropriate person.

Driving and medical conditions: advise patients to inform the DVLA of relevant conditions (e.g. epilepsy, sudden arrhythmia, dementia, insulin-treated diabetes); doctors may breach confidentiality if a patient refuses to inform the DVLA and poses a risk.

Coroner referrals: refer deaths that are unexpected, violent, unnatural, or where the cause is unknown; also report deaths within 28 days of birth or related to surgery.

Conflicts of interest: declare financial and non-financial interests to patients, employers and the GMC; do not accept gifts that could influence clinical decisions.

Whistleblowing: doctors have a professional duty to raise concerns about patient safety, first internally and then with external bodies such as the Care Quality Commission or GMC if unresolved.

Documentation: records must be contemporaneous, accurate, legible, signed and dated; record decisions, discussions, and any refusal of treatment, and store securely under data protection law.

Randomised controlled trial designs: superiority, non-inferiority and equivalence trials have different sample size and analysis assumptions; non-inferiority requires a pre-specified margin.

Intention-to-treat analysis includes all randomised participants in their allocated group; per-protocol analysis can overestimate treatment effect by excluding non-adherent participants.

Odds ratio vs relative risk: OR approximates RR only when the outcome is rare; OR is always further from 1 than RR for common outcomes.

Hazard ratio: from Cox proportional hazards models, it compares instantaneous risk over time; the proportional hazards assumption must be checked.

Meta-analysis: heterogeneity measured by I² (low <25%, moderate 25-75%, high >75%); a funnel plot assesses publication bias.

Numbers needed to harm = 1/absolute risk increase; used alongside NNT to weigh benefits and harms.

Statistical significance vs clinical significance: p-values indicate evidence against the null hypothesis, not the size or importance of an effect; report effect sizes with confidence intervals.

Quality improvement measurement: use run charts or statistical process control to distinguish common-cause from special-cause variation; avoid reacting to random variation (tampering).