- Beck's triad
- Hypotension + jugular venous distension + muffled heart sounds = cardiac tamponade.
- STEMI ECG criteria
- ST elevation ≥1 mm in ≥2 contiguous leads, or a new left bundle branch block.
- Door-to-balloon goal for STEMI
- Primary PCI within 90 minutes of first medical contact.
- ED chest-pain bundle
- 12-lead ECG within 10 minutes, aspirin, O₂ only if hypoxic, nitroglycerin, serial troponins.
- When to withhold nitroglycerin
- Inferior/right-ventricular MI, hypotension, or recent PDE-5 inhibitor (sildenafil) use.
- NSTEMI vs unstable angina
- Both lack ST elevation; NSTEMI has an elevated troponin, unstable angina does not.
- Leads for an inferior MI
- II, III, and aVF (right coronary artery territory).
- Epinephrine dose in cardiac arrest
- 1 mg IV/IO every 3–5 minutes.
- Amiodarone dose in VF/pulseless VT
- 300 mg IV/IO first dose, then 150 mg.
- Shockable arrest rhythms
- Ventricular fibrillation and pulseless ventricular tachycardia.
- Non-shockable arrest rhythms
- Asystole and pulseless electrical activity (PEA) — CPR + epinephrine.
- First treatment for symptomatic bradycardia
- Atropine 1 mg IV (max 3 mg), then transcutaneous pacing.
- Treatment for stable narrow-complex SVT
- Vagal maneuvers, then adenosine 6 mg rapid push, then 12 mg.
- Treatment for UNSTABLE tachycardia
- Synchronized cardioversion.
- Drug for torsades de pointes
- Magnesium sulfate 1–2 g IV.
- Adenosine administration tip
- Rapid IV push followed by a saline flush; a brief pause/asystole is expected.
- Pulsus paradoxus
- Systolic BP drop >10 mmHg on inspiration — seen in tamponade and severe asthma.
- Treatment of cardiac tamponade
- Pericardiocentesis (or thoracotomy in penetrating trauma).
- Cardiogenic shock
- Pump failure (large MI) → cold, clammy skin, pulmonary edema, low output.
- Acute pulmonary edema treatment
- Sit upright, oxygen/BiPAP, nitrates, and diuretics.
- Aortic dissection classic signs
- Sudden tearing chest/back pain with a BP difference between arms.
- Aortic dissection management
- Aggressively lower heart rate and blood pressure; arrange imaging and surgery.
- Leaking abdominal aortic aneurysm
- Abdominal/flank pain + pulsatile mass + hypotension = surgical emergency.
- Hypertensive emergency
- Severe hypertension WITH end-organ damage; lower BP gradually, not abruptly.
- Hypertensive urgency vs emergency
- Urgency = high BP, no organ damage; emergency = high BP WITH organ damage.
- Endocarditis classic finding
- New murmur + fever; risk with IV drug use and prosthetic valves.
- Pericarditis ECG
- Diffuse ST elevation and PR depression; pleuritic pain relieved by sitting forward.
- Deep vein thrombosis signs
- Unilateral leg swelling, warmth, pain; risk for pulmonary embolism.
- Right-sided vs left-sided heart failure
- Right = peripheral edema/JVD; left = pulmonary congestion/crackles.
- Troponin significance
- A cardiac biomarker that rises with myocardial injury; trend with serial draws.
- Cardioversion vs defibrillation
- Cardioversion is synchronized to the R wave; defibrillation is unsynchronized.
- Earliest sign of hypovolemic shock
- Tachycardia and a narrowing pulse pressure; hypotension is late.
- Silent chest in asthma
- An ominous sign of severe obstruction and impending respiratory failure — prepare to intubate.
- Asthma/COPD first-line treatment
- Inhaled bronchodilators (albuterol + ipratropium) and systemic steroids.
- BiPAP role in COPD
- Non-invasive ventilation that can prevent intubation in respiratory acidosis.
- Tension pneumothorax signs
- Absent breath sounds + hyperresonance one side, hypotension, JVD, late tracheal deviation.
- Tension pneumothorax treatment
- Immediate needle decompression, then a chest tube — don't wait for an X-ray.
- Needle decompression sites
- 2nd intercostal space midclavicular line, or 4th/5th anterior axillary line.
- Open pneumothorax treatment
- Three-sided occlusive dressing, then a chest tube.
- Pulmonary embolism presentation
- Sudden dyspnea + pleuritic pain, tachycardia, hypoxia, often clear lungs.
- Pulmonary embolism risk factors
- Immobility, recent surgery, cancer, oral contraceptives, prior clots.
- Massive PE with shock treatment
- Thrombolytics (in addition to anticoagulation).
- ARDS definition
- Refractory hypoxemia with bilateral infiltrates, non-cardiogenic edema.
- ARDS ventilation strategy
- Lung-protective, low-tidal-volume ventilation.
- Rapid sequence intubation
- A sedative + a paralytic given together to secure an emergency airway.
- Capnography use
- Confirms ET tube placement and tracks perfusion and return of circulation.
- Croup hallmark
- A barking, seal-like cough with inspiratory stridor in a young child.
- Pneumonia treatment basics
- Oxygen, fluids, and timely antibiotics; assess severity.
- Aspiration risk
- Decreased level of consciousness or impaired gag reflex; protect the airway.
- Flail chest
- ≥3 adjacent ribs broken in ≥2 places → paradoxical movement + pulmonary contusion.
- Hemothorax (massive)
- >1,500 mL initial chest-tube output → tube + surgery.
- CO₂ narcosis sign
- Rising CO₂ with drowsiness in a tiring COPD patient — heading for failure.
- Normal arterial pH
- 7.35–7.45.
- Normal PaCO₂ and HCO₃⁻
- PaCO₂ 35–45 mmHg; HCO₃⁻ 22–26 mEq/L.
- Respiratory acidosis
- Low pH, high PaCO₂ — hypoventilation (COPD, opioid overdose, fatigue).
- Respiratory alkalosis
- High pH, low PaCO₂ — hyperventilation (anxiety, PE, pain, sepsis).
- Metabolic acidosis
- Low pH, low HCO₃⁻ — DKA, lactic acidosis, renal failure, diarrhea; check the anion gap.
- Metabolic alkalosis
- High pH, high HCO₃⁻ — vomiting, NG suction, diuretics.
- How to read an ABG
- Check pH first, then decide whether the CO₂ or the bicarbonate matches the pH direction.
- Inhalation injury clues
- Facial burns, singed nasal hairs, soot, hoarseness — intubate early.
- First priority in any respiratory emergency
- Airway and oxygenation.
- BE-FAST stroke screen
- Balance, Eyes, Face, Arms, Speech, Time — recognize stroke fast.
- Why CT comes first in stroke
- To rule out a hemorrhagic stroke before giving clot-busting thrombolytics.
- Ischemic vs hemorrhagic stroke
- Ischemic = a clot blocks flow; hemorrhagic = bleeding into/around the brain.
- Ischemic stroke treatment
- IV thrombolytics within the window; thrombectomy for a large-vessel occlusion.
- Last-known-well time
- When the patient was last seen normal; it sets treatment eligibility for stroke.
- TIA
- A transient neurologic deficit that fully resolves — a warning of future stroke.
- NIHSS
- A standardized score quantifying stroke deficit severity.
- Cushing's triad
- Hypertension with widening pulse pressure + bradycardia + irregular respirations = rising ICP.
- Normal intracranial pressure
- About 5–15 mmHg.
- Rising ICP management
- Head of bed elevated, head midline, normocapnia, normothermia, osmotic therapy.
- Glasgow Coma Scale range
- 3 (lowest) to 15 (highest); ≤8 is severe impairment.
- GCS components
- Eye opening (1–4) + verbal response (1–5) + best motor response (1–6).
- Status epilepticus definition
- A seizure >5 minutes, or repeated seizures without recovery of consciousness.
- Status epilepticus first drug
- A benzodiazepine (lorazepam/diazepam/midazolam), then a longer-acting antiepileptic.
- Bacterial meningitis signs
- Fever, headache, neck stiffness, Kernig and Brudzinski signs, photophobia.
- Meningitis priorities
- Early antibiotics and droplet precautions (don't wait for the LP).
- Thunderclap headache
- A sudden 'worst headache of life' — suspect subarachnoid hemorrhage.
- Temporal arteritis
- New headache + jaw claudication in an older adult; risk of vision loss → steroids.
- Myasthenic crisis warning
- Worsening respiratory muscle weakness; monitor vital capacity, not just SpO₂.
- Guillain-Barré syndrome
- Ascending weakness; watch for respiratory failure and autonomic instability.
- Epidural vs subdural hematoma
- Epidural = arterial, biconvex, lucid interval; subdural = venous, crescent, older/anticoagulated.
- Subarachnoid hemorrhage CT
- Blood in the sulci/cisterns (star pattern); thunderclap headache.
- Neurogenic shock
- After a high cord injury: hypotension WITH bradycardia and warm, dry skin.
- Spinal shock vs neurogenic shock
- Spinal shock = temporary loss of reflexes/function; neurogenic = a blood-pressure problem.
- Cerebral perfusion pressure
- CPP = MAP − ICP; keep it adequate to protect the brain.
- Seizure safety
- Protect from injury, position on the side, don't restrain or put anything in the mouth.
- First priority in altered mental status
- Check a glucose (and airway) — hypoglycemia is a quick, reversible cause.
- Decorticate vs decerebrate posturing
- Decorticate = flexion toward the core; decerebrate = extension — decerebrate is worse.
- Autonomic dysreflexia
- In cord injuries ≥T6: a hypertensive crisis from a stimulus below the lesion → sit up, remove the trigger.
- Hematemesis vs melena
- Hematemesis = vomiting blood/coffee grounds; melena = black, tarry stools (upper GI bleed).
- Upper GI bleed priorities
- Airway, two large-bore IVs, fluid then blood resuscitation, early endoscopy.
- Esophageal varices
- High-mortality upper GI bleed in cirrhosis → octreotide, antibiotics, banding.
- Lower GI bleed sign
- Bright-red blood per rectum (hematochezia).
- Peritonitis signs
- Rigid, board-like abdomen with rebound tenderness = surgical emergency.
- Appendicitis
- RLQ pain, rebound at McBurney's point, low-grade fever; keep NPO, surgical consult.
- Cholecystitis
- RUQ pain after a fatty meal with a positive Murphy's sign.
- Pancreatitis
- Severe epigastric pain radiating to the back, vomiting, elevated lipase.
- Pancreatitis treatment
- NPO, aggressive IV fluids, and pain control.
- Bowel obstruction signs
- Distension, vomiting, no stool or flatus → NPO + NG decompression.
- GI perforation
- Sudden severe pain, rigid abdomen, free air → resuscitate, antibiotics, surgery.
- Hepatic encephalopathy
- Confusion and asterixis from ammonia in liver failure → lactulose.
- Spontaneous bacterial peritonitis
- Infection of ascitic fluid in cirrhosis → antibiotics.
- Diverticulitis
- LLQ pain, fever; treat with antibiotics, watch for perforation/abscess.
- Intussusception (peds)
- Telescoping bowel → currant-jelly stools and a sausage-shaped mass.
- Acute abdomen pain control myth
- Analgesia does NOT mask the diagnosis — treat the pain.
- Murphy's sign
- Inspiratory arrest on RUQ palpation — suggests cholecystitis.
- Cullen's / Grey-Turner's sign
- Periumbilical / flank bruising — suggests retroperitoneal or pancreatic hemorrhage.
- Blood loss sign before hypotension
- Tachycardia and a narrowing pulse pressure precede a falling BP.
- GI bleed lab to send early
- Type and crossmatch (plus CBC and coags).
- Mallory-Weiss tear
- An esophageal mucosal tear from forceful vomiting → upper GI bleeding.
- Hepatitis transmission
- A and E are fecal-oral; B, C, and D are bloodborne/body-fluid.
- Cholangitis (Charcot's triad)
- Fever, RUQ pain, and jaundice from biliary infection — a sepsis risk.
- Ectopic pregnancy triad
- Amenorrhea + unilateral pelvic pain + vaginal bleeding; rupture → shock.
- Ectopic pregnancy risk factors
- Prior PID/STI, previous ectopic, tubal surgery, IUD in place.
- Abruptio placenta
- PAINFUL vaginal bleeding with a rigid, tender uterus.
- Placenta previa
- PAINLESS bright-red bleeding; NO vaginal exam.
- Preeclampsia
- Hypertension + proteinuria after 20 weeks; risk of seizures (eclampsia).
- Eclampsia/preeclampsia drug
- Magnesium sulfate for seizure prophylaxis, plus blood-pressure control.
- Magnesium toxicity sign
- Loss of deep tendon reflexes; antidote is calcium gluconate.
- HELLP syndrome
- Hemolysis, Elevated Liver enzymes, Low Platelets — a severe preeclampsia variant.
- Postpartum hemorrhage cause
- Most often uterine atony → fundal massage and uterotonics.
- Preterm labor
- Regular contractions before 37 weeks; may use tocolytics and steroids for fetal lungs.
- Uterine rupture
- Sudden severe abdominal pain, loss of fetal station, fetal distress — emergency.
- Ovarian torsion
- Sudden severe unilateral pelvic pain → surgical emergency.
- Testicular torsion
- Sudden severe scrotal pain, high-riding testis, absent cremasteric reflex → urology now.
- Renal colic
- Severe colicky flank pain radiating to the groin with hematuria (kidney stone).
- Sexual-assault care priorities
- Safety, medical care, trauma-informed support, forensic evidence with consent.
- Hyperkalemia ECG
- Peaked T waves → widening QRS → sine wave.
- Hyperkalemia treatment order
- Calcium (cardioprotection), then insulin/glucose, then removal.
- Priapism
- A persistent painful erection; an emergency that can cause permanent damage.
- Pregnancy test in any woman with abdominal pain
- Always check — an ectopic is the can't-miss diagnosis.
- Perimortem cesarean timing
- Considered within ~4 minutes of maternal arrest after ~20–24 weeks.
- Left lateral tilt in pregnancy
- After ~20 weeks, relieves aortocaval compression that lowers cardiac output.
- Acute urinary retention
- Sudden inability to void with a distended bladder → catheterize for relief.
- Pyelonephritis
- Flank pain, fever, and dysuria — an upper urinary-tract infection.
- First priority in a mental health emergency
- Safety — of the patient and of the staff.
- Asking about suicide
- Does NOT plant the idea; ask directly about thoughts, plan, means, and intent.
- Highest suicide risk markers
- A specific plan, available means, and clear intent.
- Suicidal patient safety steps
- Continuous observation, remove means, document the risk assessment.
- Medical clearance
- Rule out medical mimics (hypoglycemia, hypoxia, infection, toxic ingestion) before psych disposition.
- Agitation first approach
- Verbal de-escalation: calm voice, space, clear limits, remove triggers.
- Restraint principles
- Last resort; provider order, least restrictive type, continuous monitoring, remove ASAP.
- Chemical sedation
- Used when de-escalation fails and the patient endangers self or others.
- Acute psychosis
- Disorganized thinking, hallucinations, delusions; ensure safety and psychiatric care.
- Mania (bipolar)
- Elevated mood, decreased sleep, risky behavior; protect from harm.
- Serotonin syndrome
- Agitation, hyperthermia, clonus, autonomic instability from serotonergic drugs.
- Neuroleptic malignant syndrome
- Rigidity, hyperthermia, altered mental status with antipsychotics.
- Panic attack vs medical cause
- Diagnose panic only after ruling out hypoxia, ACS, PE, and other causes.
- Excited delirium caution
- Severe agitation with hyperthermia; high risk of sudden deterioration — monitor closely.
- Depression red flag
- Hopelessness with suicidal ideation; assess and ensure safety.
- Therapeutic communication
- A calm, nonjudgmental, validating approach reduces agitation.
- Duty to protect
- Credible threats to identifiable others may require warning/protective action.
- Involuntary hold criteria
- Danger to self, danger to others, or grave disability from mental illness.
- De-escalation body language
- Open posture, calm tone, give space, avoid sudden moves or cornering the patient.
- Anaphylaxis first-line treatment
- Intramuscular epinephrine — given immediately, before antihistamines.
- Anaphylaxis signs
- Hives, swelling, wheeze/stridor, hypotension within minutes of exposure.
- Sepsis definition
- Life-threatening organ dysfunction from a dysregulated response to infection.
- Septic shock
- Sepsis with fluid-refractory hypotension needing vasopressors + lactate >2.
- Sepsis bundle
- Lactate, blood cultures before antibiotics, early broad-spectrum antibiotics, 30 mL/kg fluids.
- First-line vasopressor in septic shock
- Norepinephrine (target MAP ≥65 mmHg).
- Lactate meaning
- A marker of tissue hypoperfusion; it should fall with effective resuscitation.
- DKA labs
- High glucose + anion-gap metabolic acidosis + ketones.
- DKA treatment order
- Fluids first, then insulin infusion, with careful potassium replacement.
- Insulin and potassium
- Insulin drives K⁺ into cells; don't start it if K⁺ is low until replaced.
- HHS
- Hyperosmolar hyperglycemic state — very high glucose, minimal ketosis/acidosis.
- Hypoglycemia treatment
- IV dextrose (D50), or glucagon if no IV access.
- Thyroid storm
- Hyperthyroid crisis: high fever, tachycardia, altered mental status.
- Adrenal (Addisonian) crisis
- Hypotension, hyponatremia, hyperkalemia → IV fluids and hydrocortisone.
- Hyperkalemia ECG
- Peaked T waves, then a widening QRS; give calcium first.
- Hyponatremia caution
- Correct sodium SLOWLY to avoid osmotic demyelination.
- Hypocalcemia signs
- Chvostek and Trousseau signs, tetany, prolonged QT.
- DIC
- Simultaneous clotting and bleeding; treat the underlying cause and replace products.
- Sickle cell crisis care
- Aggressive analgesia, hydration, oxygen, and treat triggers like infection.
- Neutropenic fever
- Fever in an immunocompromised patient → urgent broad-spectrum antibiotics.
- Alcohol withdrawal tool & drug
- CIWA score guides symptom-triggered benzodiazepines.
- Delirium tremens
- Severe alcohol withdrawal: confusion, agitation, autonomic instability — high mortality.
- Opioid overdose reversal
- Naloxone; watch for re-sedation (short half-life).
- Anaphylaxis vs anaphylactoid
- Treatment is the same — IM epinephrine first regardless of mechanism.
- Myxedema coma
- Severe hypothyroid crisis: hypothermia, bradycardia, altered mental status.
- SIADH vs diabetes insipidus
- SIADH = water retention, low sodium; DI = water loss, high sodium, dilute urine.
- Tumor lysis syndrome
- After chemo: high potassium, phosphate, uric acid; low calcium → acute kidney injury.
- Compartment syndrome 6 P's
- Pain (out of proportion/on stretch), Paresthesia, Pallor, Pulselessness, Paralysis, Poikilothermia.
- Earliest sign of compartment syndrome
- Pain out of proportion and pain on passive stretch.
- Compartment syndrome treatment
- Emergent fasciotomy; do NOT elevate above the heart or apply ice.
- Open fracture care
- Early antibiotics, tetanus prophylaxis, and a sterile dressing.
- Neurovascular checks for fractures
- Assess pulses, sensation, and motor before AND after splinting.
- Fat embolism syndrome
- Hypoxia, confusion, and a petechial rash 24–72 h after a long-bone fracture.
- Amputated part care
- Wrap in saline-moistened gauze, seal in a bag, place the bag on ice (never frozen/direct ice).
- Extremity hemorrhage control
- Direct pressure, then a tourniquet (note the time applied).
- Crush injury complication
- Rhabdomyolysis → acute kidney injury → aggressive IV fluids.
- Rhabdomyolysis labs
- Elevated CK and dark, tea-colored urine.
- Dislocation priority
- Assess neurovascular status; reduce promptly and reassess after reduction.
- Tetanus-prone wound
- Dirty, deep, or puncture wounds; update tetanus based on history.
- Impaled object rule
- Never remove it in the ED — stabilize it in place.
- Necrotizing soft-tissue infection
- Pain out of proportion + crepitus + systemic toxicity → surgical emergency.
- Splint principle
- Immobilize the joint above and below the injury.
- Wound closure timing
- Most clean wounds close within hours; high-risk wounds may be left open.
- Osteomyelitis
- Bone infection — pain, fever, local signs; needs prolonged antibiotics.
- Sprain vs strain
- Sprain = ligament injury; strain = muscle/tendon injury.
- RICE for soft-tissue injury
- Rest, ice, compression, elevation (for sprains/strains, NOT compartment syndrome).
- Tendon laceration sign
- Inability to move the distal joint; assess function before closure.
- Gout vs septic joint
- Both cause a hot, swollen joint; aspirate to exclude a septic joint (an emergency).
- Chemical eye burn first action
- Immediate, copious irrigation BEFORE anything else.
- Acute angle-closure glaucoma
- Severe eye pain, halos, a red eye, a mid-dilated fixed pupil, nausea.
- Glaucoma do-not
- Do not patch the eye or give a pupil-dilating drug — it can worsen it.
- Central retinal artery occlusion
- Sudden, painless loss of vision in one eye — a time-critical emergency.
- Retinal detachment
- Flashes, floaters, and a curtain over the vision — urgent ophthalmology.
- Ruptured globe care
- Shield the eye, do NOT press; keep the patient calm and NPO for surgery.
- Hyphema
- Blood in the anterior chamber after trauma → upright positioning, ophthalmology.
- Corneal abrasion
- Pain, tearing, foreign-body sensation; diagnosed with fluorescein.
- Anterior epistaxis control
- Lean forward, pinch the soft part of the nose, apply pressure; packing if needed.
- Posterior epistaxis risk
- Can be heavy and threaten the airway — may need posterior packing/balloon.
- Epiglottitis signs
- High fever, drooling, tripod position, stridor — an airway emergency.
- Epiglottitis nursing rule
- Keep the child calm; do NOT examine the throat or agitate the patient.
- Peritonsillar abscess
- Severe sore throat, 'hot potato' voice, uvular deviation — airway risk.
- Ludwig's angina
- Rapidly spreading floor-of-mouth infection — an airway emergency.
- Bell's palsy
- Sudden one-sided facial weakness including the forehead (peripheral CN VII).
- Avulsed permanent tooth
- Handle by the crown, gently rinse, reimplant or store in milk/saliva.
- Vertigo causes
- Peripheral (benign positional, Ménière's, labyrinthitis) vs central (stroke) — rule out central.
- Maxillofacial trauma priority
- The airway — blood, broken teeth, and edema can obstruct rapidly.
- Foreign body in the ear/nose
- Remove carefully; button batteries are a true emergency (tissue damage).
- Dental avulsion time matters
- Reimplant a knocked-out permanent tooth as fast as possible to save it.
- Sudden painful vs painless vision loss
- Painful → glaucoma/trauma; painless → CRAO or retinal detachment.
- First priority in a major burn
- The airway — intubate early if inhalation injury is suspected.
- Rule of Nines (adult)
- Head 9%, each arm 9%, each leg 18%, front trunk 18%, back trunk 18%, perineum 1%.
- Parkland formula
- 4 mL lactated Ringer's × kg × %TBSA; half in the first 8 hours from the burn.
- Burn fluid titration
- Titrate to a urine output of about 0.5 mL/kg/hr in adults.
- Carbon monoxide poisoning trap
- Pulse oximetry reads falsely NORMAL → give high-flow oxygen.
- CO poisoning treatment
- 100% high-flow oxygen; hyperbaric oxygen for severe cases; check carboxyhemoglobin.
- Cyanide poisoning
- Suspect in enclosed-space fires; treat with hydroxocobalamin.
- Heat stroke
- High core temperature WITH altered mental status → rapid cooling.
- Hypothermia rewarming
- Gradual rewarming and gentle handling (a cold heart is irritable).
- Frostbite care
- Rapid rewarming in warm water; do not rub or refreeze the tissue.
- Drowning/submersion priority
- Airway and oxygenation; watch for delayed respiratory deterioration.
- Electrical injury hidden danger
- Deep tissue damage and dysrhythmias beyond the visible burn.
- Toxidrome definition
- A symptom cluster pointing to a poison class to identify the agent.
- Cholinergic toxidrome
- SLUDGE secretions, bradycardia, miosis (organophosphates) → atropine + pralidoxime.
- Anticholinergic toxidrome
- 'Hot, red, dry, and mad' — flushed, dry skin, dilated pupils, delirium.
- Opioid toxidrome
- Pinpoint pupils, slow shallow breathing, sedation → naloxone.
- Sympathomimetic toxidrome
- Agitation, tachycardia, hypertension, dilated pupils, diaphoresis.
- Acetaminophen antidote
- N-acetylcysteine (NAC).
- Tricyclic antidepressant overdose
- Wide QRS, seizures, hypotension → sodium bicarbonate.
- Contact precautions
- Gown and gloves — C. difficile, MRSA.
- Droplet precautions
- A surgical mask — influenza, pertussis, meningococcus.
- Airborne precautions
- An N95 in a negative-pressure room — TB, measles, varicella.
- C. difficile hand hygiene
- Soap and water — alcohol gel does NOT kill the spores.
- Snakebite/animal bite care
- Wound care, immobilize, antivenom where indicated, rabies prophylaxis as needed.
- Hypothermia core temperature
- A core temperature below 35°C (95°F); severe below 28°C.
- Decontamination before treatment
- For chemical exposure, decontaminate first to protect the patient and staff.
- Lightning/high-voltage cardiac risk
- Can cause cardiac arrest and dysrhythmias — monitor on telemetry.
- ESI level 1
- Resuscitation — the patient needs an immediate life-saving intervention.
- ESI level 2
- Emergent — a high-risk situation, confusion/lethargy, or severe pain/distress.
- ESI level 3 vs 4 vs 5
- Level 3 = ≥2 resources, Level 4 = 1 resource, Level 5 = 0 resources.
- ESI danger-zone vitals
- For potential Level 3: HR >100, RR >20, or SpO₂ <92% up-triages to Level 2.
- ESI resource examples
- Labs, ECG, imaging, IV fluids, IV/IM/neb meds, consults, procedures.
- Not counted as ESI resources
- History/physical, point-of-care tests, PO meds, a tetanus shot, simple dressings.
- START triage
- Mass-casualty triage by respirations, perfusion, and mental status.
- START color categories
- Red (immediate), yellow (delayed), green (minor), black (expectant/deceased).
- Mass-casualty goal
- Do the most good for the most people (not the most for each individual).
- EMTALA
- Federal law: screen and stabilize ANY ED patient regardless of ability to pay; governs transfers.
- Implied consent
- An emergency in a patient who cannot consent proceeds under implied consent.
- Informed consent / refusal
- A competent adult may refuse care after understanding the risks.
- Mandatory reporting
- Suspected abuse/neglect of children, elders, and vulnerable adults must be reported.
- Forensic evidence
- Preserve evidence and maintain chain of custody; document wounds objectively.
- HIPAA
- Protects patient privacy and limits disclosure of health information.
- Advance directives
- Honor a patient's documented wishes (living will, healthcare proxy).
- Patient throughput
- Strategies to move patients efficiently through the ED while keeping them safe.
- Cultural humility
- Respecting and adapting care to a patient's values, beliefs, and language needs.
- Workplace violence
- Recognize warning signs, de-escalate, and use safety measures and reporting.
- Impaired colleague
- A duty to act for patient safety; report drug diversion or impairment per policy.
- Just culture
- A non-punitive culture of error reporting that improves safety.
- End-of-life / palliative care
- Comfort, family support, and honoring goals of care.
- Organ/tissue donation
- Support the process per protocol after a non-survivable injury.
- Verbal vs written consent
- Document consent; in a true emergency, act under implied consent.
- SBAR handoff
- Situation, Background, Assessment, Recommendation — a structured transition of care.
