CAQ-EM cheat sheet

Primary survey (ABCDE): Airway with cervical spine protection, Breathing with ventilation/oxygenation, Circulation with hemorrhage control, Disability (GCS, pupils, glucose), Exposure with temperature control.

Tension pneumothorax is a clinical diagnosis: unilateral absent breath sounds, tracheal deviation away, hypotension, distended neck veins. Immediate needle decompression (2nd intercostal space midclavicular line or 5th ICS anterior axillary line) precedes imaging.

Anaphylaxis: epinephrine 0.3–0.5 mg IM (1 mg/mL) in the mid-anterolateral thigh; repeat every 5–15 minutes. Adjuncts (antihistamines, steroids) are secondary and never delay epinephrine.

STEMI: activate reperfusion within 90 minutes door-to-balloon for PCI or 30 minutes door-to-needle for fibrinolysis. Aspirin 162–325 mg chewed plus P2Y12 inhibitor and anticoagulation per protocol.

Acute ischemic stroke: noncontrast CT excludes hemorrhage before thrombolysis. IV alteplase within 4.5 hours of last known well; mechanical thrombectomy up to 24 hours in selected large-vessel occlusion.

Sepsis: recognize via qSOFA (RR ≥22, altered mentation, SBP ≤100) or NEWS. Obtain cultures before antibiotics, give broad-spectrum antibiotics within 1 hour for septic shock, and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

DKA management: isotonic saline resuscitation, insulin infusion 0.1 units/kg/h after potassium is ≥3.3 mEq/L, add dextrose when glucose <200–250 mg/dL, and replace potassium as needed.

Opioid overdose: naloxone 0.04–2 mg IV/IM/IN titrated to respiratory effort, not full arousal; observe for renarcotization because naloxone half-life is shorter than most opioids.

Trauma transfusion: massive transfusion protocol with balanced 1:1:1 ratio of plasma:platelets:packed RBCs; permissive hypotension (SBP ~90 mmHg) until hemorrhage control in penetrating trauma without TBI.

FAST exam detects free intraperitoneal fluid in four windows: perihepatic (Morison's pouch), perisplenic, pelvic, and subxiphoid/pericardial. Sensitivity for hemoperitoneum is high but repeat or CT is needed in stable patients.

Acute coronary syndrome risk: HEART score (History, ECG, Age, Risk factors, Troponin) stratifies 0–3 low, 4–6 intermediate, 7–10 high risk for 6-week MACE.

Pediatric resuscitation: weight-based dosing; use length-based tape or formula (weight kg ≈ (age in years × 2) + 8 for 1–10 years). Defibrillation 2 J/kg first shock, 4 J/kg subsequent.

Status epilepticus: benzodiazepine first-line (lorazepam 0.1 mg/kg IV up to 4 mg, or IM midazolam 10 mg if no IV access), then second-line fosphenytoin/valproate/levetiracetam.

Hyperkalemia with ECG changes: IV calcium gluconate 10% 10–30 mL to stabilize myocardium, insulin with glucose to shift potassium intracellularly, and sodium bicarbonate if acidotic; dialysis for refractory cases.

Acute asthma: salbutamol/albuterol nebulized plus ipratropium, systemic corticosteroids within 1 hour, magnesium sulfate 2 g IV for severe exacerbations, and early NIV consideration.

Cervical spine clearance: NEXUS criteria (no posterior midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, no distracting injury) or Canadian C-Spine Rule to avoid unnecessary imaging.

Toxicology antidotes: acetaminophen - N-acetylcysteine; organophosphate - atropine plus pralidoxime; methanol/ethylene glycol - fomepizole; benzodiazepine - flumazenil (caution); beta-blocker - glucagon; digoxin - Fab fragments.

Rapid sequence intubation: preoxygenation, pretreatment as indicated, induction (etomidate 0.3 mg/kg or ketamine 1–2 mg/kg), neuromuscular blockade (rocuronium 1.2 mg/kg or succinylcholine 1.5 mg/kg), then intubation with confirmation by waveform capnography.