ER Board cheat sheet

STEMI: new ST elevation ≥1 mm in two contiguous limb leads or ≥2 mm in two contiguous precordial leads, with age- and sex-specific V2-V3 thresholds.

Acute aortic dissection: start IV beta-blockade to heart rate <60/min, then add a vasodilator to target systolic pressure 100-120 mm Hg before definitive imaging.

Cardiac tamponade: Beck triad is hypotension, elevated jugular venous pressure, and muffled heart sounds; pulsus paradoxus and electrical alternans support the diagnosis.

Stable SVT: adenosine 6 mg rapid IV push, then 12 mg if ineffective, after vagal maneuvers and with continuous cardiac monitoring.

Hyperkalemia with ECG changes: give IV calcium first for membrane stabilization, then insulin plus glucose, albuterol, and sodium bicarbonate if acidosis is present.

Unstable bradycardia: atropine 1 mg IV every 3-5 minutes up to 3 mg; if ineffective, use transcutaneous pacing and dopamine or epinephrine infusion.

Acute hypertensive heart failure: IV nitroglycerin plus noninvasive ventilation reduces preload and afterload; avoid nitrates if systolic pressure <90 mm Hg or right ventricular infarction.

Hypertensive emergency without aortic dissection: lower mean arterial pressure by no more than 10-20% in the first hour, with condition-specific exceptions.

Tension pneumothorax: perform immediate needle decompression before chest imaging; sites include second intercostal space midclavicular line or fifth intercostal space anterior axillary line.

COPD exacerbation with carbon dioxide retention risk: titrate oxygen to SpO2 88-92%; noninvasive ventilation reduces intubation in respiratory acidosis.

Severe asthma: peak expiratory flow <40% predicted, accessory muscle use, and inability to speak full sentences indicate severe attack; give inhaled beta-agonist plus ipratropium.

Massive pulmonary embolism: persistent hypotension or shock warrants systemic thrombolysis or catheter or surgical embolectomy when no contraindication exists.

ARDS Berlin criteria: onset within one week, bilateral opacities, PaO2/FiO2 ≤300 with PEEP ≥5 cm H2O, and respiratory failure not primarily cardiogenic.

Light criteria: pleural fluid is exudative if protein ratio >0.5, lactate dehydrogenase ratio >0.6, or pleural LDH exceeds two-thirds the upper normal serum limit.

Primary spontaneous pneumothorax: asymptomatic small collapse <2 cm may be observed; larger or symptomatic pneumothorax requires aspiration or tube thoracostomy.

Pulmonary embolism workup: PERC excludes PE in low pretest probability; D-dimer is useful in low or intermediate probability; CT pulmonary angiography is used for high probability or positive D-dimer.

ATLS primary survey sequence: airway with cervical spine protection, breathing, circulation with hemorrhage control, disability, and exposure.

Class III hemorrhage: 30-40% blood loss causes tachycardia, hypotension, narrowed pulse pressure, oliguria, and altered mental status despite initial compensation.

Pelvic binder: apply at the level of the greater trochanters, not the iliac crests, to reduce pelvic volume and stabilize suspected pelvic ring fractures.

Compartment syndrome: pain out of proportion and pain with passive stretch are early signs; compartment pressure >30 mm Hg or within 30 mm Hg of diastolic pressure supports fasciotomy.

Open fracture: give IV antibiotics within one hour, provide tetanus prophylaxis, irrigate with saline, splint, and arrange urgent surgical debridement.

Neurogenic shock: spinal cord injury causes hypotension with bradycardia from loss of sympathetic tone; treat with fluids and vasopressors such as norepinephrine.

Trauma in pregnancy beyond 20 weeks: use left lateral tilt 15-30 degrees or manual uterine displacement while resuscitating the mother first.

Ottawa ankle rules: ankle radiography is indicated for malleolar pain plus bone tenderness at the posterior edge or tip of either malleolus or inability to bear weight four steps.

Acute ischemic stroke: IV thrombolysis is generally given within 4.5 hours of last known well after CT excludes hemorrhage; thrombectomy may be used up to 24 hours in selected large vessel occlusion.

Status epilepticus: give a benzodiazepine first, such as IM midazolam or IV lorazepam, then a second-line agent such as levetiracetam, fosphenytoin, or valproate.

Subarachnoid hemorrhage: noncontrast head CT is highly sensitive within six hours; if negative with persistent suspicion, perform lumbar puncture for xanthochromia.

Bacterial meningitis: give dexamethasone before or with the first antibiotic dose, especially for suspected pneumococcal disease, plus vancomycin and ceftriaxone.

Increased intracranial pressure: elevate head to 30 degrees, maintain normoxia and normotension, and use hypertonic saline or mannitol; brief hyperventilation temporizes herniation.

Wernicke encephalopathy: give thiamine before glucose in at-risk patients; the triad is confusion, ataxia, and ophthalmoplegia.

Bell palsy: corticosteroids within 72 hours improve recovery; add antiviral therapy for severe disease or Ramsay Hunt syndrome.

Acute ischemic stroke blood pressure: before thrombolysis target <185/110 mm Hg; without thrombolysis, permissive hypertension up to 220/120 mm Hg is acceptable in most patients.

Upper gastrointestinal bleeding: resuscitate, give IV proton pump inhibitor, and perform endoscopy within 24 hours; suspected variceal bleeding also needs octreotide plus ceftriaxone.

Acute pancreatitis: lipase >3 times the upper limit of normal supports diagnosis; use aggressive isotonic fluids and reserve antibiotics for infection.

Renal colic: noncontrast CT is preferred for diagnosis; NSAIDs are first-line analgesia; a normal urine dipstick does not exclude stone disease.

KDIGO acute kidney injury: creatinine rise ≥0.3 mg/dL in 48 hours, ≥1.5 times baseline in 7 days, or urine output <0.5 mL/kg/hour for 6 hours.

Severe hyperkalemia: give IV calcium, insulin plus glucose, albuterol, and sodium bicarbonate for acidosis; hemodialysis is used for refractory or severe cases.

Testicular torsion: immediate urology consultation is required; do not delay detorsion for ultrasound when history and examination strongly suggest torsion.

Bowel obstruction: use nasogastric decompression and IV fluids with serial examinations; surgery is indicated for strangulation, perforation, or closed-loop obstruction.

Ischemic priapism lasting >4 hours: aspirate corpora cavernosa and inject phenylephrine; urology consultation is required for persistent or recurrent cases.

Acetaminophen toxicity: N-acetylcysteine is the antidote; risk is assessed with the Rumack-Matthew nomogram using a timed serum acetaminophen concentration.

Salicylate toxicity: urinary alkalinization with sodium bicarbonate increases elimination; hemodialysis is indicated for severe acidosis, renal failure, central nervous system toxicity, or high levels.

Opioid overdose: titrate naloxone to adequate respirations; an infusion may be needed because naloxone has a shorter half-life than many opioids.

Carbon monoxide poisoning: give 100% oxygen; hyperbaric oxygen is considered for severe poisoning, loss of consciousness, acidosis, or pregnancy.

Diabetic ketoacidosis: give isotonic fluids; start insulin only after potassium is above 3.3 mmol/L; add dextrose when glucose falls below 200-250 mg/dL.

Alcohol withdrawal: use symptom-triggered benzodiazepines and give thiamine, folate, and glucose; benzodiazepines are first-line for withdrawal seizures.

Organophosphate poisoning: give atropine until secretions dry for muscarinic effects and pralidoxime for nicotinic effects, plus skin and clothing decontamination.

Serotonin syndrome: clonus, hyperreflexia, and agitation are typical; stop serotonergic drugs, give benzodiazepines, and use cyproheptadine for severe cases.

Septic shock: measure lactate, obtain blood cultures before antibiotics when this causes no delay, and give broad-spectrum antibiotics within one hour.

Febrile neutropenia: absolute neutrophil count <500 cells/µL with fever ≥38.3°C once or ≥38.0°C for one hour requires empiric antipseudomonal beta-lactam therapy.

Thrombotic thrombocytopenic purpura: severe ADAMTS13 deficiency is treated urgently with plasma exchange; avoid platelet transfusion unless life-threatening bleeding occurs.

Disseminated intravascular coagulation: prolonged PT and PTT, low fibrinogen, elevated D-dimer, and schistocytes occur; treatment focuses on the underlying cause.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia occur; treat with aggressive hydration and rasburicase for elevated uric acid.

Sickle cell vaso-occlusive crisis: give opioids and fluids, provide oxygen only if hypoxemic, and monitor for acute chest syndrome.

Meningococcal meningitis: use droplet precautions until 24 hours of effective antibiotics; provide chemoprophylaxis to close contacts.

Neutropenic fever: avoid rectal temperatures and rectal medications because of mucosal injury and infection risk.

Suicidal ideation: assess intent, plan, access to lethal means, and psychosis; remove lethal means and use involuntary hold when imminent risk is present.

Acute agitation: begin with verbal de-escalation and treat hypoglycemia, hypoxia, or intoxication; after organic causes are addressed, benzodiazepines or antipsychotics may be used.

Pediatric dehydration: oral rehydration solution is used for mild to moderate dehydration; isotonic 20 mL/kg IV bolus is used for shock, with reassessment after each bolus.

Simple febrile seizure: occurs in children aged 6 months to 5 years, lasts under 15 minutes, is generalized, and does not require long-term antiseizure medication.

PALS bradycardia: heart rate <60/min with poor perfusion despite oxygenation and ventilation is an indication to start CPR.

Ectopic pregnancy: use serum beta-hCG and transvaginal ultrasound; absence of intrauterine pregnancy above the discriminatory zone raises concern, and unstable patients need surgery.

Severe preeclampsia: magnesium sulfate prevents and treats seizures; control blood pressure with labetalol, hydralazine, or nifedipine and plan delivery.

Postpartum hemorrhage: uterine atony is the most common cause; initial management includes fundal massage, oxytocin, and tranexamic acid.