Emergency Medicine Workbook

Perform the ABCDE primary survey

Take a full medical history from the patient

Order a CT head immediately

Contact the patient's GP for background

Standard (green)

Very Urgent (orange)

Non-urgent (blue)

Urgent (yellow)

Allergies

Past history

Medications

Events leading to presentation

Speed up drug administration

Assign roles to team members

Document interventions in real time

Confirm tasks are understood and completed

Correct application of universal precautions

Poor situational awareness

Breach of duty of care

Unnecessary delay in treatment

Head-tilt chin-lift

Nasopharyngeal airway insertion

Jaw thrust

Oropharyngeal airway with neck extension

Auscultation of bilateral breath sounds

Waveform capnography

Absence of epigastric sounds

Chest X-ray

To sedate the patient for intubation

To reduce the risk of aspiration

To maintain haemodynamic stability

To achieve rapid complete muscle relaxation for laryngoscopy

Surgical cricothyroidotomy

Re-attempt orotracheal intubation with a smaller tube

Insert a nasopharyngeal airway

Apply continuous positive airway pressure (CPAP)

Nasal cannula at 2 L/min for 5 minutes

Non-rebreather mask at 15 L/min for 3 minutes

Bag-valve mask with room air

Venturi mask at 28% FiO2

Deliver an unsynchronised DC shock

Administer adrenaline 1 mg IV

Insert an advanced airway

Obtain 12-lead ECG

Tube displacement into the oesophagus

Hyperventilation by the rescuer

Return of spontaneous circulation

Tension pneumothorax

Deliver immediate defibrillation

Identify and treat reversible causes (4Hs and 4Ts)

Administer amiodarone

Obtain 12-lead ECG

60-80 per minute

80-100 per minute

120-140 per minute

100-120 per minute

Reduce neurological injury from ischaemia-reperfusion

Prevent recurrent ventricular fibrillation

Improve coronary artery perfusion

Correct metabolic acidosis

Distributive (septic) shock

Hypovolaemic (haemorrhagic) shock

Obstructive shock

Cardiogenic shock

IM adrenaline into the anterolateral thigh

IV hydrocortisone

IV chlorphenamine

IV fluid bolus with normal saline

Fever above 38.5 degrees Celsius

Confirmed source of infection

Persisting hypotension requiring vasopressors and elevated lactate

Tachycardia with a white cell count above 12 x 10^9/L

0.6

0.83

1.0

1.2

Hypotension (systolic below 90 mmHg)

Elevated serum lactate

Tachycardia above 100 bpm

Reduced urine output below 0.5 mL/kg/hr

Left anterior descending artery

Left circumflex artery

Right coronary artery

Left main stem

NSTEMI

Unstable angina

STEMI

Stable angina

STEMI

Pulmonary embolism

Pericarditis

Aortic dissection

History

ECG changes

Risk factors

Troponin level

T-wave inversion in V1-V4

New left bundle branch block with ischaemic symptoms

Sinus tachycardia with ST depression in II and aVF

Prolonged QT interval

Moderate asthma

Severe asthma

Life-threatening asthma

Near-fatal asthma

Immediate needle decompression without waiting for imaging

Urgent chest X-ray to confirm side

CT thorax for definitive diagnosis

Intercostal drain under ultrasound guidance

Type 1 respiratory failure

Type 2 respiratory failure

Metabolic acidosis without respiratory component

Respiratory alkalosis

Acute COPD exacerbation with hypercapnia

Neuromuscular respiratory failure

Severe community-acquired pneumonia

Cardiogenic pulmonary oedema

Reduced left ventricular ejection fraction

Right ventricular dilation and hypokinesis

Pericardial effusion with tamponade physiology

Inferior wall motion abnormality

Administer aspirin and observe in the ED

Arrange MRI brain before any treatment

Administer IV thrombolysis if eligible

Contact neurology for outpatient review

Benzodiazepines

Phenytoin

Levetiracetam

Sodium valproate

CT head

IV antibiotics should be given immediately without delaying for investigations

Lumbar puncture

Blood cultures before any antibiotics

MRI brain with gadolinium

Carotid Doppler ultrasound

EEG

Lumbar puncture for xanthochromia

Quantify stroke severity and guide treatment decisions

Differentiate ischaemic from haemorrhagic stroke

Identify the occluded vessel on imaging

Assess capacity for discharge

Urgent CT angiography of the abdomen

Immediate surgical alert and blood product resuscitation

IV fluid resuscitation with 2L normal saline before any imaging

IV morphine and recheck BP in 30 minutes

High-risk bleed requiring immediate endoscopy

ICU admission is required

Surgical consultation for laparotomy

Low risk, potentially suitable for outpatient management per local protocol

Vomiting and colicky pain only

Central dilated loops on AXR

Localised peritonism, fever, and haemodynamic instability

Absolute constipation for 24 hours

Acute mesenteric ischaemia

Acute appendicitis

Perforated peptic ulcer

Acute diverticulitis

Urgent CT pan-scan

IV morphine for pain control

Apply a pelvic binder and activate major haemorrhage protocol

Foley catheter insertion to monitor urine output

Hypothermia

Acidosis

Hypovolaemia

Coagulopathy

Repeat the FAST in 15 minutes

Order urgent CT abdomen/pelvis

Administer 2L normal saline IV

Immediate surgical consultation for operative haemorrhage control

Immediate (red)

Expectant (black)

Delayed (yellow)

Minor (green)

Uses large volumes of normal saline to restore circulating volume

Aims to rapidly normalise blood pressure to 120/80

Prioritises blood products and permissive hypotension until haemorrhage control

Avoids blood transfusion to prevent transfusion reactions

Nebulised salbutamol

Oral or nebulised dexamethasone

IV antibiotics for bacterial tracheitis

Intubation to protect the airway

Inhaled salbutamol via spacer

Oral prednisolone

Hypertonic saline nebulisation

Supportive care with oxygen and hydration

Discharge with community follow-up

Splint the fracture and reassure the parents

Activate child safeguarding and admit for full skeletal survey

Refer to orthopaedics for fracture management only

Intraosseous access

Intramuscular injection

Sublingual drug administration

Central venous catheter insertion

Calculate exact vital sign thresholds by age

Rapidly identify sick children and characterise the type of physiological derangement

Diagnose the specific aetiology of illness

Score the child for hospital admission criteria

Reassure the patient and discharge with GP follow-up

Administer analgesia and observe for 4 hours

Urgent gynaecology review and transvaginal ultrasound

Immediate laparotomy for suspected ectopic

IV or oral antihypertensive agent and IV magnesium sulphate for seizure prophylaxis

IV diuretic therapy for fluid overload

Urgent CT head before any treatment

Discharge with oral antihypertensives and outpatient follow-up

Low haemoglobin with normal MCV

Thrombocytopenia alone

Elevated ALT and AST

Elevated LDH and peripheral blood schistocytes

Administer IV phenytoin

Administer IV or IM magnesium sulphate

Perform immediate caesarean section

Administer IV labetalol

Opioid toxidrome

Sympathomimetic toxidrome

Anticholinergic toxidrome

Cholinergic toxidrome

IV amiodarone for arrhythmia

Oral activated charcoal

IV sodium bicarbonate

Electrical cardioversion

Neuroleptic malignant syndrome

Serotonin syndrome

Anticholinergic toxidrome

Sympathomimetic overdose

Inhibiting paracetamol absorption from the gut

Directly inhibiting cytochrome P450 enzymes

Binding NAPQI directly in the bloodstream

Replenishing hepatic glutathione stores to detoxify NAPQI

Naloxone's shorter half-life compared to morphine leading to re-narcotisation

Morphine allergy causing anaphylaxis

Inadequate initial dose of naloxone

Concurrent benzodiazepine ingestion

IV normal saline bolus to rehydrate

Rapid active cooling (cold water immersion or ice packs to neck, axillae, groin)

Oral rehydration solution and rest

Intubation before any other intervention

Accurate and suggests mild poisoning

Low due to displacement of oxygen by CO

Falsely reassuring because pulse oximetry cannot distinguish carboxyhaemoglobin

Reliable if measured on a fingertip rather than earlobe

Acute haemolytic anaemia

Pulmonary contusion

Urinary tract infection

Rhabdomyolysis with acute kidney injury

Continued during active rewarming as recovery is possible even after prolonged arrest

Stopped after 20 minutes if ROSC has not occurred

Modified with compressions only every 5 minutes to avoid VF

Replaced by passive rewarming alone

Verbal de-escalation in a calm environment

Administer rapid tranquillisation immediately

Restrain the patient for safety

Activate a psychiatric emergency team before speaking to the patient

Severe depression

Psychotic episode

Acute organic cause such as sepsis, metabolic disturbance, or medication toxicity

Previous psychiatric history

The patient must agree with the clinician's recommended treatment

The patient must understand, retain, weigh, and communicate the relevant information

Consent must always be obtained in writing

A second opinion must be sought from a psychiatrist

Whether she has a previous history of self-harm

Whether a psychiatrist has assessed her

Her age and the severity of the overdose

Whether she can understand and weigh the consequences of refusing treatment

The patient's name, age, and location

Her clinical impression of what is happening and the degree of concern

The patient's past medical history and medications

The specific action she would like the consultant to take

Anchoring bias

Availability bias

Premature closure

Confirmation bias

Obtain specialist cardiology sign-off before discharge

Admit for overnight monitoring regardless of score

Provide clear written and verbal safety-netting advice including when to return

Arrange routine outpatient review in 6 months

Means the patient should only receive comfort care

Requires a second doctor's countersignature to be valid

Must be reviewed by the ethics committee

Applies only to CPR and does not restrict other treatments

File an internal incident report only, without informing the patient

Inform the patient, apologise sincerely, and explain what happened

Discuss with legal advisors before speaking to the patient

Inform the patient only if the harm resulted in permanent injury

--- 📋 SUMMARY Book: Emergency Medicine Workbook: A Case-Based Guide to Resuscitation, Rapid Assessment, and Critical-Care Decision-Making for Emergency Medicine Residents and Clinicians Code: EMMEWO155 Emoji: 🚨 Chapters: 15 Flashcards: 113 Quiz Questions: 74 📌 NEXT STEPS: 1. Copy the HTML above 2. In WordPress: Pages → Add New → title it "Emergency Medicine Workbook" 3. Click ⋮ menu → Code Editor 4. Paste the HTML → Publish 5. Print this access code inside your workbook: EMMEWO155 ---

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