ER Board study guide
ER Board · Work through your exam, one topic at a time.
The Qualifying Examination is the written, multiple-choice examination that serves as the first of two examination steps toward certification by the American Board of Emergency Medicine; ABEM lists the Certifying Exam as a separate step in the same process. It is aimed at physicians who have completed or are completing emergency medicine residency training and who are pursuing ABEM certification, and it verifies the breadth of knowledge expected of a practicing emergency physician rather than only the conditions a given candidate happens to see often. The ER Board study guide has 8 sections and about 2,438 words.
01Cardiovascular Emergencies
Acute coronary syndrome anchors this domain. Know the STEMI thresholds (≥1 mm in two contiguous limb leads; ≥2 mm in V2–V3 for men ≥40, ≥2.5 mm for men <40, ≥1.5 mm for women) and the equivalents: posterior MI (ST depression V1–V3 with upright T waves), left main or severe multivessel disease (aVR elevation with diffuse depression), de Winter and Wellens patterns, and the Sgarbossa criteria for LBBB.
326 words, about 2 min02Respiratory and Thoracic Emergencies
Asthma and COPD exacerbations hinge on recognizing impending respiratory failure: a silent chest, exhaustion, altered mentation, or a normal-to-rising PaCO2 in a tachypneic asthmatic means the patient is tiring. Treat with continuous albuterol, ipratropium, systemic steroids, and magnesium; noninvasive ventilation helps COPD acidosis but is used cautiously in asthma.
279 words, about 1 min03Trauma and Musculoskeletal Emergencies
Trauma care is the primary survey, repeated: catastrophic hemorrhage control (direct pressure, tourniquet, pelvic binder at the level of the greater trochanters), airway with cervical protection, breathing (breath sounds, chest wall integrity), circulation (two large-bore IVs, type and cross), disability (GCS, pupils, glucose), and exposure with log-roll plus prevention of hypothermia. Hemorrhagic shock triggers massive transfusion in a balanced ratio (approximately 1:1:1), tranexamic acid within 3 hours, and damage-control surgery.
300 words, about 2 min04Neurologic Emergencies
Acute ischemic stroke is time-critical: check glucose first, obtain noncontrast CT within 20 minutes of arrival, and calculate the NIHSS. Intravenous thrombolysis is offered within 4.5 hours when blood pressure is below 185/110 (and maintained below 180/105 afterward) and there is no hemorrhage; thrombectomy extends to 6 hours for large-vessel occlusion and up to 24 hours in selected patients.
308 words, about 2 min05Gastrointestinal, Genitourinary, and Renal Emergencies
Gastrointestinal bleeding: resuscitate first, then risk-stratify. Suspected variceal hemorrhage gets octreotide, ceftriaxone, and endoscopy within 12 hours; ulcer bleeding gets high-dose proton-pump inhibitor infusion.
301 words, about 2 min06Toxicologic, Environmental, and Metabolic Emergencies
Learn toxidromes rather than individual drugs: anticholinergic (hot, dry, flushed, mydriatic, agitated), cholinergic (SLUDGE plus bradycardia), sympathomimetic (hypertensive, tachycardic, diaphoretic), opioid (miosis, hypoventilation), sedative-hypnotic, serotonin (clonus, hyperreflexia, dilated pupils), and neuroleptic malignant syndrome (rigidity, hyporeflexia, delayed onset). Acetaminophen toxicity is predicted by the Rumack-Matthew nomogram at 4 hours; give N-acetylcysteine when timing is unknown or delayed.
299 words, about 1 min07Infectious Disease, Hematologic, and Oncologic Emergencies
Sepsis: suspect it with infection plus new organ dysfunction, check lactate, draw cultures, and give broad-spectrum antibiotics plus 30 mL/kg crystalloid for hypotension or lactate ≥4. Oncologic emergencies: febrile neutropenia requires an empiric antipseudomonal beta-lactam within 60 minutes, with vancomycin added for line infections or skin sources.
293 words, about 1 min08Behavioral, Pediatric, and Obstetric/Gynecologic Emergencies
Behavioral emergencies: use verbal de-escalation first, exclude hypoglycemia, hypoxia, and head injury, then use rapid tranquilization with a butyrophenone or second-generation antipsychotic plus a benzodiazepine. Distinguish serotonin syndrome (clonus, hyperreflexia, rapid onset after serotonergic drugs) from neuroleptic malignant syndrome (lead-pipe rigidity, hyporeflexia, days of antipsychotic exposure) and from anticholinergic toxicity.
332 words, about 2 min