CAQ-EM flashcards

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

Primary survey order

ABCDE: Airway with C-spine protection, Breathing, Circulation with hemorrhage control, Disability (GCS, pupils, glucose), Exposure with temperature control. Reassess after each intervention.

Tension pneumothorax management

Clinical diagnosis with hypotension, unilateral absent breath sounds, distended neck veins, tracheal deviation. Immediate needle decompression, then tube thoracostomy. Never delay for imaging.

Anaphylaxis first-line drug

Epinephrine 0.3–0.5 mg IM of 1 mg/mL solution in the mid-anterolateral thigh; repeat every 5–15 minutes. Antihistamines and steroids are adjuncts and must not delay epinephrine.

STEMI reperfusion timing

Door-to-balloon 90 minutes for primary PCI; door-to-needle 30 minutes if fibrinolysis is chosen. Aspirin 162–325 mg chewed plus P2Y12 inhibitor and anticoagulation.

Stroke thrombolysis window

IV alteplase within 4.5 hours of last known well after noncontrast CT excludes hemorrhage. Mechanical thrombectomy up to 24 hours for selected large-vessel occlusion.

qSOFA criteria

Respiratory rate ≥22/min, altered mentation, systolic BP ≤100 mmHg. Two or more criteria suggest sepsis with higher mortality risk; cultures before antibiotics, antibiotics within 1 hour in shock.

DKA insulin and potassium

Start insulin infusion 0.1 units/kg/h only after potassium ≥3.3 mEq/L. Add dextrose when glucose <200–250 mg/dL. Replace potassium aggressively since total body stores are depleted.

Naloxone dosing principle

0.04–2 mg IV/IM/IN titrated to adequate respiratory effort rather than full arousal. Half-life is shorter than most opioids; observe for recurrent respiratory depression and re-dose.

Massive transfusion ratio

Balanced 1:1:1 plasma:platelets:packed RBCs. Permissive hypotension SBP ~90 mmHg until hemorrhage control in penetrating trauma without traumatic brain injury.

FAST exam windows

Four windows: perihepatic (Morison's pouch), perisplenic, pelvic, subxiphoid/pericardial. Detects free fluid; a negative FAST in a stable patient may need repeat or CT.

HEART score components

History, ECG, Age, Risk factors, Troponin. Scores 0–3 low risk, 4–6 intermediate, 7–10 high risk for 6-week major adverse cardiac events.

Pediatric defibrillation energy

First shock 2 J/kg, subsequent shocks 4 J/kg. Estimate weight by length-based tape or formula: weight kg ≈ (age in years × 2) + 8 for ages 1–10.

Status epilepticus first-line

Benzodiazepine: lorazepam 0.1 mg/kg IV up to 4 mg, or IM midazolam 10 mg if no IV access. Second-line fosphenytoin, valproate, or levetiracetam.

Hyperkalemia ECG changes treatment

IV calcium gluconate 10% 10–30 mL stabilizes myocardium; insulin with glucose shifts potassium intracellularly; sodium bicarbonate if acidotic; dialysis for refractory cases.

Severe asthma adjuncts

Nebulized salbutamol plus ipratropium, systemic corticosteroids within 1 hour, magnesium sulfate 2 g IV for severe exacerbations, and consideration of noninvasive ventilation.

NEXUS cervical spine criteria

No posterior midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, no distracting injury. All five absent allows clinical clearance without imaging.

Acetaminophen overdose antidote

N-acetylcysteine, most effective when started within 8–10 hours of ingestion. Use Rumack-Matthew nomogram for acute single ingestion to guide treatment duration.

Organophosphate poisoning antidotes

Atropine titrated to drying secretions plus pralidoxime to reactivate acetylcholinesterase. Decontaminate and support airway; avoid succinylcholine due to prolonged blockade.

Rapid sequence intubation sequence

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), intubation confirmed by waveform capnography.

Glasgow Coma Scale components

Eye opening 1–4, verbal response 1–5, motor response 1–6; total 3–15. Score ≤8 indicates need for airway protection and intubation consideration.

Cushing triad

Hypertension with widened pulse pressure, bradycardia, and irregular respirations. Signals raised intracranial pressure and impending herniation; requires urgent neurosurgical evaluation and ICP control.

Acute aortic dissection treatment

IV beta-blockade to target heart rate <60 and systolic BP 100–120 mmHg before vasodilators. Type A requires emergent surgery; type B usually medical management unless complicated.

Pulmonary embolism risk score

Wells criteria or Geneva score estimate pretest probability; PERC rules out PE in low-risk patients. D-dimer for low/intermediate risk; CT pulmonary angiography for high risk.

Atrial fibrillation with instability

Unstable AF (hypotension, ischemia, altered mentation, heart failure) requires urgent synchronized cardioversion. Stable rate control with beta-blocker or calcium channel blocker.

Narrow complex tachycardia

Regular narrow-complex tachycardia: vagal maneuvers then adenosine 6 mg IV push, then 12 mg. Unstable patients require synchronized cardioversion rather than pharmacologic conversion.

Hypoglycemia treatment

Conscious: oral glucose. Unconscious or unable to swallow: IV dextrose 50% 25–50 mL or IM glucagon 1 mg. Recheck glucose in 15 minutes and provide long-acting carbohydrate.

Burns fluid resuscitation

Parkland formula: 4 mL × body weight kg × %TBSA burned in 24 hours, half in first 8 hours from burn time. Use lactated Ringer's; avoid over-resuscitation.

Carbon monoxide poisoning

Pulse oximetry is falsely normal; measure carboxyhemoglobin. Give 100% oxygen; hyperbaric oxygen for severe poisoning, loss of consciousness, or pregnancy with elevated levels.

Digoxin toxicity antidote

Digoxin-specific Fab antibody fragments for life-threatening arrhythmias or hyperkalemia. Correct electrolyte abnormalities and avoid calcium; monitor for bradyarrhythmias.

Beta-blocker overdose antidote

High-dose glucagon 3–10 mg IV reverses bradycardia and hypotension; add high-dose insulin euglycemia therapy and vasopressors. Pacing for refractory bradycardia.

Acute pulmonary edema treatment

Sit upright, oxygen or noninvasive ventilation, IV nitroglycerin for hypertension, and loop diuretic if volume overloaded. Avoid aggressive diuresis in hypotensive patients.

Sepsis fluid resuscitation

30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, then reassess perfusion. Start broad-spectrum antibiotics within 1 hour for septic shock.