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EM · Topics

Topics

179 units across 148 domains — 179 topics for Emergency Medicine.

Back to EMJump to first domain
Emergency Medicine Topics
Plate — emMedVellum Press
179Units
148Domains
ABCDE approachAbdominal aortic aneurysmAbdominal traumaAcute abdominal pain (approach)Behavioural and mental health emergenciesAcute appendicitisAcute coronary syndromes (STEMI/NSTEMI)Acute decompensated heart failureAcute COPD exacerbationAcute ischaemic strokeAcute kidney injuryAcute limb ischaemiaAcute pancreatitisAcute severe asthmaEndocrine emergenciesED airway management & RSIToxicology and environmental emergenciesEnvironmental emergenciesAnaemia and transfusionAnaphylaxisObstetric, gynaecological and sexual-health emergenciesAntimicrobial stewardship in the emergency departmentAortic dissectionApplied anatomy and physiology (basic sciences)Applied pharmacology for EMABG interpretation (approach)Aspiration pneumonia & lung abscessFacial nerve and cranial nerve palsiesBiliary diseaseBowel obstructionBradyarrhythmiasCommunication and breaking bad newsProcedural & diagnostic ED skillsBurn managementCarbon monoxide poisoningCardiac arrest & ALSCardiogenic shockCervical spine injury & clearanceChest traumaClinical handover and ISBARComaCommunity-acquired pneumoniaCT interpretation and usage (approach)Consent, capacity and medico-legalCyanide poisoningDamage control resuscitationDeep vein thrombosisGeriatric and behavioural emergenciesDisaster & mass casualtyDisaster preparedness and hospital incident commandDiabetic emergenciesDrowningEctopic pregnancyED flow and access blockElectrical and lightning injuryElectrolyte emergencies — potassium and sodiumEnd-of-life and goals of careResuscitationForeign body ingestion and aspirationGeriatric and special-population emergenciesGeriatric traumaNeuromuscular junction disordersHaemoptysisHypertensive disorders of pregnancyHypertensive emergencyHypothermiaImaging choice and radiation riskImmunocompromised host and febrile neutropeniaInfective endocarditisIntracerebral haemorrhageLaboratory interpretation (approach)Limb & extremity traumaLower gastrointestinal bleedMajor trauma resuscitationMandatory reporting and child protectionMass-gathering and event medicineMassive haemorrhage & transfusionMedical error and patient safetyMeningitis and encephalitisMyocarditis & pericarditisPaediatric emergenciesNon-invasive ventilationOxygen therapy & acute respiratory failurePaediatric abdominal emergenciesPaediatric fever and serious bacterial illnessPaediatric fluid and electrolyte managementPaediatric rashes and febrile illnessPaediatric respiratory distressPaediatric sepsis and septic shockPaediatric traumaParacetamol poisoningED systems, safety and professionalPelvic inflammatory diseasePelvic traumaPerforated viscusPeri-arrest arrhythmiasPericardial tamponadePleural effusionPneumothoraxGeriatric and medication-safety emergenciesPost-cardiac arrest carePostpartum haemorrhagePulmonary embolismPulmonary oedemaQuality and ED metricsRadiation and chemical exposureRaised intracranial pressureRecognition of deterioration (track and trigger)Red-flag headacheRenal colic and nephrolithiasisResearch, EBM and biostatisticsRespiratory failure (type 1 & 2)Resuscitation team leadership & CRMRural & retrieval traumaSecondary surveySeizures and first fitSepsis and septic shock (approach)Septic shock in the EDSexual assault and intimate partner violenceShockHaematology and general medical emergenciesSpinal cord compressionStatus epilepticusSubarachnoid haemorrhageSubdural and extradural haematomaSyncope (approach)TachyarrhythmiasTeaching, supervision and feedbackTeam-based care and CRMTesticular torsionECG interpretation (approach)The anticoagulated trauma patientAustralasian Triage ScaleThe deadly ECG patternsMental Health Act and compulsory treatmentPrimary surveyPaediatric resuscitationToxicology and environmental emergencies (approach)Transient ischaemic attackTrauma in pregnancyTrauma team leadershipTraumatic brain injuryTuberculosisUpper airway obstructionUpper gastrointestinal bleedVasoactive drugs in resuscitationVertigo and dizzinessPlain radiograph interpretation (approach)
AtlasEMTopics

Domain

ABCDE approach

1

high

ABCDE approach to the deteriorating patient

A structured, prioritised approach to the recognition and resuscitation of the deteriorating emergency department patient — airway, breathing, circulation, disability, exposure — built on oxygen-delivery physiology, early-warning scoring, the pathophysiology of compensated shock, and time-critical sepsis care. ACEM-primary, globally tagged.

Open

Domain

Abdominal aortic aneurysm

1

high

Abdominal aortic aneurysm (ruptured and intact)

The abdominal aortic aneurysm — the triad of sudden abdominal or back pain, hypotension and a pulsatile mass in a ruptured AAA, the permissive-hypotension resuscitation principle (do not disrupt the retroperitoneal tamponade), the clinical (not radiological) diagnosis of the unstable rupture, the immediate repair (open or endovascular), and the massive haemorrhage protocol. ACEM-primary, globally tagged.

Open

Domain

Abdominal trauma

1

high

Abdominal trauma

Abdominal trauma from blunt and penetrating mechanisms through FAST, CT and DPL; the solid organ (spleen, liver) and hollow viscus injuries; non-operative management with observation, angioembolisation and splenectomy; the damage-control laparotomy; the seat-belt injury with the Chance fracture and the mesenteric tear; and the anticoagulated trauma patient.

Open

Domain

Acute abdominal pain (approach)

1

high

Acute abdominal pain — the emergency department approach

The acute abdominal pain approach — the structured emergency department framework that separates the surgical abdomen from the medical, the time-critical from the benign; the three clinical axes (the surgical vs the medical, the upper vs the lower, the colicky vs the constant); the demographic sieve by the age and the sex (the child — the appendicitis, the intussusception; the woman of the reproductive age — the ectopic, the PID, the ovarian; the elderly — the AAA, the mesenteric ischaemia, the SBO, the perforation, the biliary); the location-specific pain patterns (the epigastric, the RUQ, the RLQ, the LLQ, the diffuse); the investigation ladder (the bloods, the urine, the beta-hCG, the lipase, the lactate, the X-ray, the ultrasound, the CT); and the resuscitation with the named drug doses (the morphine 5 mg IV, the ondansetron 4 mg IV, the ceftriaxone 2 g IV, the metronidazole 500 mg IV, the 500 mL fluid bolus). ACEM-primary, globally tagged.

Open

Domain

Behavioural and mental health emergencies

3

high

Acute agitation and rapid tranquillisation

Acute agitation in the emergency department — the behavioural emergency defined by motor overactivity, emotional distress and imminent danger to self, staff or others. De-escalation first (verbal, environmental, autonomy-respecting), then the graded pharmacological ladder: oral (olanzapine 5 to 10 mg PO, lorazepam 1 to 2 mg PO) then intramuscular rapid tranquillisation (droperidol 5 to 10 mg IM, olanzapine 5 to 10 mg IM, midazolam 5 to 10 mg IM, haloperidol 5 mg IM). Post-administration monitoring (airway, SpO2, BP, ECG for QT). Restraint complications — positional asphyxia, excited-delirium death, rhabdomyolysis, neuroleptic malignant syndrome, torsades de pointes. The organic mimics (hypoxia, hypoglycaemia, sepsis, intracranial, post-ictal, toxidrome) excluded first. Differential of delirium versus psychosis versus intoxication versus withdrawal. ACEM-primary, globally tagged.

Open

high

Deliberate self-harm and suicide risk assessment

The patient who presents after deliberate self-harm — the sequence of medical clearance before psychosocial assessment, the structured suicide risk assessment (ideation, plan, intent, means, protective factors), the SAD PERSONS and Columbia tools, and the risk-stratified disposition (psychiatric admission for high risk, crisis team for moderate risk, GP follow-up with a safety plan for low risk). Covers the toxicological workup and antidotes (N-acetylcysteine for paracetamol, naloxone for opioid, sodium bicarbonate for tricyclic), the differential of accidental injury and intoxication, and the legal authority to detain. ACEM-primary, globally tagged.

Open

high

Mental health and behavioural emergencies

Mental health and behavioural emergencies — the medical clearance of the psychiatric patient (excluding the organic cause: hypoglycaemia, hypoxia, sepsis, intracranial lesion, toxidrome, delirium), the structured risk assessment for self-harm, suicide and violence to others, the Mental State Examination, and psychiatric referral. The specific presentations: the suicidal patient (SAD PERSONS, means, plan, intent, safe disposition), the acutely psychotic patient (schizophrenia versus drug-induced; haloperidol 5 mg IM, olanzapine 10 mg PO), and the anxious or agitated patient (de-escalation, lorazepam 1 to 2 mg IV or PO, rapid tranquillisation ladder with droperidol and midazolam). Includes the Mental Health Act framework, involuntary detention, and the four-stage test of capacity. ACEM-primary, globally tagged.

Open

Domain

Acute appendicitis

1

high

Acute appendicitis

Acute appendicitis — the obstruction of the appendiceal lumen (the faecolith, the lymphoid hyperplasia) driving the mucus accumulation, the bacterial translocation, the ischaemia and the perforation; the central pain migrating to the right iliac fossa over 12 to 24 hours with the anorexia, the nausea, the low-grade fever and the McBurney point tenderness (the Rovsing, the psoas, the obturator signs); the Alvarado (MANTRELS) and the Appendicitis Inflammatory Response (AIR) scores; the ultrasound first in the child and the young woman, the CT in the adult male and the atypical; the surgical referral, the laparoscopic appendicectomy first-line, the ceftriaxone 2 g IV plus the metronidazole 500 mg IV as the perioperative prophylaxis. ACEM-primary, globally tagged.

Open

Domain

Acute coronary syndromes (STEMI/NSTEMI)

1

high

Acute coronary syndromes (STEMI, NSTEMI and unstable angina)

The acute coronary syndrome spectrum — plaque rupture and thrombus, the STEMI / NSTEMI / unstable-angina classification, the 10-minute ECG and high-sensitivity troponin strategy, the GRACE/TIMI/HEART risk scores, the immediate drug bundle with doses, the reperfusion decision (primary PCI versus fibrinolysis for STEMI; risk-stratified invasive timing for NSTEMI), the mechanical and arrhythmic complications, and the oxygen and right-ventricular-infarct traps. ACEM-primary, globally tagged.

Open

Domain

Acute decompensated heart failure

1

high

Acute decompensated heart failure and cardiogenic pulmonary oedema

Acute decompensated heart failure and cardiogenic pulmonary oedema — the pump-failure pathophysiology, the wet/dry × warm/cold phenotype classification, the acute-pulmonary-oedema bundle (oxygen, non-invasive ventilation, nitrates, a loop diuretic) with doses, the role of nitrates in the hypertensive patient and inotropes in the cold-shocked patient, the precipitant search, and the BNP/NT-proBNP and chest-radiograph diagnosis. ACEM-primary, globally tagged.

Open

Domain

Acute COPD exacerbation

1

high

Acute exacerbation of chronic obstructive pulmonary disease

The acute COPD exacerbation — the Anthonisen criteria for the clinical definition, the controlled-oxygen principle (88 to 92 per cent, not 94 to 98 per cent), the four-pillar management (controlled oxygen, nebulised bronchodilators with doses, a systemic corticosteroid, antibiotics for the purulent exacerbation), the early non-invasive ventilation (BiPAP) for the respiratory acidosis (the strongest evidence in emergency respiratory medicine), and the CO2-retainer dangers. ACEM-primary, globally tagged.

Open

Domain

Acute ischaemic stroke

1

high

Acute ischaemic stroke

Acute ischaemic stroke — sudden focal neurological deficit from arterial occlusion, the ischaemic penumbra and the rationale for permissive hypertension, recognition with FAST and the ROSIER score, non-contrast CT to exclude haemorrhage versus CT angiography to find the large-vessel occlusion, intravenous alteplase 0.9 mg/kg (maximum 90 mg, 10 per cent bolus) within 4.5 hours, mechanical thrombectomy within 6 hours or up to 24 hours with imaging mismatch, the BP thresholds and the exclusion criteria, and the mimics (Todd paresis, hypoglycaemia, hemiplegic migraine, functional). ACEM-primary, globally tagged.

Open

Domain

Acute kidney injury

1

medium

Acute kidney injury

Acute kidney injury (AKI) is an abrupt fall in glomerular filtration producing a rise in creatinine and/or a fall in urine output, classified by KDIGO (creatinine rise of at least 26.5 micromol per litre in 48 hours, or at least 1.5 times baseline within seven days, or urine output under 0.5 mL per kilogram per hour for six hours). Split by site into pre-renal (reduced perfusion, intact tubules), intrinsic (acute tubular necrosis is the emergency exemplar) and post-renal (obstruction). The bedside discriminator is the BUN-to-creatinine ratio over 20 to 1 and a fractional excretion of sodium under 1 per cent for pre-renal disease, against a ratio under 15 and FENa over 2 per cent for intrinsic disease. Management is to treat the cause, give a fluid challenge, stop nephrotoxins, and manage the complications — hyperkalaemia with calcium chloride 10 mL of 10 per cent IV first, then insulin-dextrose and salbutamol, and renal replacement therapy for the AEIOU indications. ACEM-primary, globally tagged.

Open

Domain

Acute limb ischaemia

1

medium

Acute limb ischaemia (the emergency of the 6 Ps)

Acute limb ischaemia — the 6 Ps (pain, pallor, pulseless, paraesthesia, paralysis, perishing cold), the embolic versus the thrombotic cause, the Rutherford classification (viable through irreversible), the immediate anticoagulation (unfractionated heparin 80 units per kilogram bolus then 18 units per kilogram per hour infusion), the definitive management (the Fogarty embolectomy for the embolic, the catheter-directed thrombolysis for the thrombotic), the 6-hour window for the limb salvage, and the fasciotomy for the reperfusion. ACEM-primary, globally tagged.

Open

Domain

Acute pancreatitis

1

high

Acute pancreatitis

Acute pancreatitis — severe epigastric pain radiating straight through to the back with vomiting, a lipase 3 times the upper limit of normal, gallstones and alcohol as the dominant causes (GET SMASHED), the Ranson and Glasgow severity scores, aggressive but goal-directed fluid resuscitation, morphine analgesia, early enteral feeding, antibiotics reserved for infected necrosis, and ERCP for the obstructive biliary case. ACEM-primary, globally tagged.

Open

Domain

Acute severe asthma

1

high

Acute severe asthma

Acute severe asthma — the bronchoconstriction and airway-inflammation pathophysiology, the severity classification (acute severe, life-threatening, near-fatal with a rising CO2), the escalating therapy ladder with doses (oxygen, salbutamol, ipratropium, a systemic corticosteroid, intravenous magnesium), the danger of a normal or rising PaCO2, the hazards of intubating the asthmatic, and the tension-pneumothorax risk in the ventilated patient. ACEM-primary, globally tagged.

Open

Domain

Endocrine emergencies

2

high

Adrenal crisis (Addisonian crisis)

Adrenal crisis (Addisonian crisis) is the acute, life-threatening state of cortisol deficiency producing vasodilatory shock refractory to fluid, abdominal pain, vomiting and the classic biochemistry of hyponatraemia, hyperkalaemia and hypoglycaemia. The triggers are an infection, surgery, trauma, sepsis and the abrupt withdrawal of chronic steroids. The Fellowship-critical management is hydrocortisone 200 mg intravenously as a stat dose then 100 mg intravenously every six hours, aggressive 0.9 per cent saline 1 L rapidly, and glucose if hypoglycaemic — fludrocortisone is not needed acutely because hydrocortisone has mineralocorticoid activity at the high doses. Hydrocortisone is never delayed for the cortisol result: the blood is drawn but treatment is immediate. The differential is septic shock, the upper gastrointestinal bleed and diabetic ketoacidosis. ACEM-primary, globally tagged.

Open

high

Thyroid emergencies — thyroid storm and myxoedema coma

Thyroid storm (the thyrotoxic crisis) is the rare, life-threatening decompensation of thyrotoxicosis producing a hypermetabolic state of tachycardia, hyperthermia, agitation, atrial fibrillation and high-output heart failure, graded by the Burch-Wartofsky score. Myxoedema coma is its mirror image: severe decompensated hypothyroidism presenting as hypoventilation, hypothermia, bradycardia, hyponatraemia and coma. Thyroid storm is treated with beta-blockade (propranolol 60 to 80 mg orally every 4 hours or esmolol IV), propylthiouracil 500 mg loading then 250 mg every 4 hours, Lugol iodine 8 drops every 6 hours started at least 4 hours after the PTU, hydrocortisone 100 mg IV every 8 hours, cooling and fluids. Myxoedema coma is treated with levothyroxine 200 to 500 mcg IV loading, hydrocortisone 100 mg IV, and supportive care with ventilation and active rewarming. Both are clinical diagnoses treated empirically before the thyroid function result returns. ACEM-primary, globally tagged.

Open

Domain

ED airway management & RSI

1

high

Airway management and rapid sequence intubation

The emergency airway end-to-end: indications for a definitive airway, predicting the difficult airway (LEMON), preoxygenation and apnoeic oxygenation, the rapid sequence intubation sequence, induction and paralytic agents with doses and scenario-specific choice, capnographic confirmation, video versus direct laryngoscopy, the bougie, the unanticipated difficult-airway algorithms (DAS, Vortex, AIDAA) and front-of-neck access, the common and dangerous peri-intubation complications, and special situations.

Open

Domain

Toxicology and environmental emergencies

10

medium

Alcohol and benzodiazepine withdrawal (emergency department recognition and management)

ACEM emergency-department approach to alcohol and benzodiazepine withdrawal: GABA-glutamate pathophysiology, staged clinical presentation through to delirium tremens, CIWA-Ar-guided benzodiazepine-ladder management, and the thiamine-before-glucose safety rule.

Open

low

Bites and stings

Bites and stings common to the Australasian emergency department — mammalian bites (dog, cat, human), insect stings (bee and wasp), and stingray puncture injuries. Cat and dog bites seed Pasteurella multocida, which establishes infection within 12 hours; human bites seed Eikenella corrodens, and the clenched-fist injury is an orthopaedic emergency because it penetrates the metacarpophalangeal joint. The single antibiotic covering the full bite-flora spectrum is amoxicillin-clavulanate 875/125 mg orally twice daily for five to seven days; flucloxacillin and cephalexin alone miss Pasteurella and Eikenella. Stingray venom is heat-labile — immerse the limb in water at 45 °C for 30 to 90 minutes, then explore every wound for a retained barb fragment and the integumentary sheath. Bee and wasp stings cause local reactions managed with antihistamines and cold packs, and systemic anaphylaxis managed with intramuscular adrenaline. Tetanus prophylaxis is addressed on every bite; rabies post-exposure prophylaxis is considered for bat bites anywhere and for dog bites sustained overseas.

Open

medium

Iron poisoning

Iron poisoning — the heavy-metal overdose whose lethality rides on a single pharmacological concept: the body has no excretory route for free iron, so any dose that overwhelms transferrin's binding capacity releases catalytic free iron that drives free-radical lipid peroxidation of mitochondrial membranes. The clinical course unfolds in five stereotyped stages the Fellowship candidate must recite: gastrointestinal (nausea, vomiting, haematemesis, diarrhoea, 0 to 6 hours), quiescent (apparent recovery, 6 to 24 hours — the lethal trap), shock (distributive shock with capillary leak and metabolic acidosis, 12 to 24 hours), hepatotoxicity (centrilobular necrosis from mitochondrial free-radical injury, 1 to 3 days), and gastrointestinal obstruction (corrosive scarring with pyloric or intestinal stricture, 2 to 6 weeks). The serum iron level drawn at 4 to 6 hours drives treatment: desferrioxamine 15 mg per kg per hour intravenous chelation for any symptomatic patient or a level over 350 mcg per dL (60 micromol per L), continued until the patient is clinically well and the level is falling. Whole bowel irrigation with polyethylene glycol is the decontamination of choice for enteric-coated or sustained-release tablets and for a radio-opaque pill mass on abdominal X-ray; activated charcoal does not adsorb iron and has no role. The differential is other heavy metals (lead, arsenic) and the tricyclic antidepressant overdose (wide QRS). ACEM-primary, globally tagged.

Open

medium

Lithium poisoning

Lithium poisoning — the narrow-therapeutic-index cation handled entirely by the kidney, presenting in two distinct patterns. Acute overdose produces early gastrointestinal upset (nausea, vomiting, diarrhoea) and a fine tremor, with neurotoxicity developing hours later as lithium distributes into cells. Chronic toxicity (accumulation in the elderly, the dehydrated, the renally impaired, or after an interacting drug) presents with neurotoxicity at lower serum levels: coarse tremor, ataxia, confusion, fasciculations, seizures, and coma, often with nephrogenic diabetes insipidus. The ECG shows T-wave flattening or inversion and QT prolongation. Management is aggressive normal saline for enhanced renal elimination (lithium is reabsorbed with sodium proximally), with haemodialysis per the EXTRIP criteria (above 5.0 mmol/L regardless, above 4.0 with features in acute, above 2.5 with symptoms in chronic). ACEM-primary, globally tagged.

Open

high

Opioid poisoning and the opioid toxidrome (emergency department diagnosis and management)

Opioid poisoning — the classic toxidrome of central nervous system depression, pin-point pupils (miosis) and respiratory depression (a reduced respiratory rate AND depth), caused by heroin, morphine, oxycodone, fentanyl, methadone and tramadol through mu-receptor agonism at the medullary respiratory centre. The management is airway, oxygen and titrated naloxone 400 micrograms intravenously every two to three minutes to adequate ventilation (NOT to full consciousness), naloxone 800 micrograms intramuscularly when intravenous access is absent, and a naloxone infusion at two-thirds of the effective bolus per hour for the long-acting opioids such as methadone. The differential is the pontine haemorrhage and the clonidine (alpha-2 agonist) overdose; tramadol adds seizures and serotonin syndrome. ACEM-primary, globally tagged.

Open

high

Salicylate poisoning

Salicylate (aspirin) poisoning — the uncoupling of oxidative phosphorylation (fever, hypermetabolism), the direct stimulation of the respiratory centre (respiratory alkalosis), and the Krebs-cycle interference (high anion gap metabolic acidosis), producing the classic mixed respiratory alkalosis and high anion gap metabolic acidosis on the blood gas. The clinical picture is tinnitus, hyperventilation, sweating, vomiting, agitation, dehydration and hyperthermia. Management is activated charcoal 50 g, sodium bicarbonate 1 to 2 mmol/kg IV for alkaline diuresis (urine pH above 7.5 enhances salicylate excretion), IV fluid, potassium replacement, and haemodialysis for the severe case (level over 700 mg/L, severe acidosis, renal failure, pulmonary oedema). Intubation is avoided where possible because loss of the respiratory compensation worsens the acidosis. ACEM-primary, globally tagged.

Open

high

Snake envenomation

ANZ snake envenomation — elapid bites from the brown snake, tiger snake, taipan, death adder, mulga/black snake and rough-scaled snake. The four venom syndromes are venom-induced consumption coagulopathy (VICC — INR above 3, D-dimer markedly raised, fibrinogen low, from procoagulant prothrombin-activator venoms), neurotoxicity (descending paralysis — ptosis, ophthalmoplegia, bulbar palsy, respiratory failure — from presynaptic phospholipase A2 and postsynaptic three-finger toxins), rhabdomyolysis, and renal failure. First aid is the pressure immobilisation bandage. Diagnosis is clinical plus the snake venom detection kit (SVDK). Treatment is monovalent antivenom (brown snake 1 to 2 vials, tiger snake 2 to 4 vials) or polyvalent antivenom when the snake is unidentified, with adrenaline premedication and blood products only after antivenom. ACEM-primary, globally tagged.

Open

medium

Spider and marine envenomation

ANZ spider and marine envenomation — five syndromes the Fellowship candidate must hold as patterns. Latrodectism (red-back) is sustained painful muscle contraction with regional diaphoresis and autonomic surge, driven by alpha-latrotoxin opening presynaptic calcium channels; treatment is analgesia and red-back spider antivenom (efficacy contested). Funnel-web spider envenomation is the only ANZ spider that kills — fasciculations, profuse sweating, hypertension, pulmonary oedema and catecholamine cardiomyopathy from robustoxin blocking neuronal sodium channels; first aid is pressure immobilisation and treatment is funnel-web antivenom two vials intravenously, repeated. Box jellyfish (Chironex fleckeri) sting causes immediate severe pain, ladder-track dermonecrosis and sudden cardiac arrest from pore-forming cardiotoxins; first aid is vinegar then box-jellyfish antivenom. Irukandji syndrome is a delayed catecholamine-surge cardiomyopathy with troponin leak and hypertension. Blue-ringed octopus envenomation is rapid tetrodotoxin flaccid paralysis with an awake patient — supportive ventilation is definitive, there is no antivenom. Differential is snake bite and allergic reaction. ACEM-primary, globally tagged.

Open

high

Toxic alcohol poisoning (methanol and ethylene glycol)

Toxic alcohol poisoning — methanol (windshield washer, illicit spirits) and ethylene glycol (antifreeze) are small alcohols metabolised by alcohol dehydrogenase to the acids that do the harm: methanol to formaldehyde then formic acid (the blindness, the putaminal necrosis on CT, the high anion gap metabolic acidosis), ethylene glycol to glycolic acid and oxalic acid (the calcium oxalate crystals in the urine, the acute kidney injury). The bedside signature is a high anion gap metabolic acidosis paired with an elevated osmolar gap. Management is alcohol dehydrogenase blockade with fomepizole 15 mg/kg IV loading then 10 mg/kg every 12 hours (or 10 per cent ethanol at 10 mL/kg bolus then 1 to 2 mL/kg/h as the cheaper alternative), cofactors (folinic acid 1 mg/kg for methanol; thiamine and pyridoxine for ethylene glycol), and haemodialysis for the severe case. The differential is the high anion gap metabolic acidosis: lactic acidosis, DKA, salicylate, uraemia. ACEM-primary, globally tagged.

Open

high

Tricyclic antidepressant poisoning (emergency department diagnosis and management)

Tricyclic antidepressant poisoning — the fast sodium-channel blockade of the myocardium (the QRS over 100 ms, the right-axis deviation of the terminal R wave in aVR, the tachycardia), the anticholinergic toxidrome (the dry, the hot, the red, the dilated pupils, the urinary retention), the cardiovascular toxicity (the VT, the VF, the hypotension) and the CNS toxicity (the seizures, the coma). The management is sodium bicarbonate 8.4 per cent, 50 mL IV (1 to 2 mmol/kg), repeated to QRS narrowing and pH 7.45 to 7.55, with hyperventilation, IV fluid and a vasopressor; lipid emulsion 1.5 mL/kg of 20 per cent for refractory cardiovascular toxicity; and never flumazenil or a class Ia antiarrhythmic. ACEM-primary, globally tagged.

Open

Domain

Environmental emergencies

2

low

Altitude illness

Altitude illness is the spectrum that develops after rapid ascent above 2500 m, divided into acute mountain sickness (AMS — headache plus one of nausea, fatigue, dizziness or insomnia), high altitude cerebral oedema (HACE — ataxia and altered consciousness, the lethal brain swelling) and high altitude pulmonary oedema (HAPE — dyspnoea at rest, cough and crackles, the non-cardiogenic pulmonary oedema). The three pillars of management are descent (the definitive cure), oxygen to a saturation above 90 per cent, and drugs — dexamethasone 8 mg then 4 mg every 6 hours for HACE, nifedipine slow-release 30 mg daily for HAPE, sildenafil 50 mg as an adjunct, and acetazolamide 125 mg twice daily for prophylaxis. Prevention is gradual ascent (above 3000 m sleep no more than 500 m higher per night with a rest day every 1000 m) and acetazolamide. The differential is pneumonia, migraine, dehydration, hypothermia and intracerebral events. ACEM-primary, globally tagged.

Open

high

Heat illness and heat stroke

Heat illness is the spectrum from heat cramps and heat syncope through heat exhaustion (core 37.5 to 40 degrees, sweating intact, mental state preserved) to heat stroke — core temperature above 40 degrees with central nervous system dysfunction and multi-organ failure, divided into exertional (young, fit, sweating usually preserved) and classic (elderly, heat wave, often anhidrotic). Heat stroke is hyperthermia, not fever: the hypothalamic set point is normal, so antipyretics do not work and the patient is cooled by physical means. The gold standard for exertional heat stroke is cold water immersion (about 0.15 degrees per minute); evaporative cooling (tepid mist plus fan) is the method of choice for classic heat stroke; ice packs to neck, axil…

Open

Domain

Anaemia and transfusion

1

medium

Anaemia and blood transfusion in the emergency department

Anaemia and blood transfusion — the symptomatic anaemia that crosses the threshold at a haemoglobin around 70 g/L (or 80 g/L in the ischaemic heart disease), the restrictive transfusion strategy proven by TRICC, FOCUS, TRISS and Villanueva, the transfusion reactions (TACO, TRALI, the acute haemolytic, the allergic, the febrile non-haemolytic), and the massive transfusion protocol with its 1-to-1-to-1 ratio and the tranexamic acid. The management — the crossmatch, the consent including the option to decline, the bedside two-identifier check, the monitoring. The differential — the GI bleed, the haemolysis, the marrow failure. ACEM-primary, globally tagged.

Open

Domain

Anaphylaxis

1

high

Anaphylaxis (the emergency of the IM adrenaline)

Anaphylaxis — the rapid, severe, multi-system allergic reaction; the IgE-mediated mast cell degranulation; the clinical diagnostic criteria (the sudden onset with the skin or the mucosal change and the respiratory and/or the cardiovascular involvement); the triggers (the food, the venom, the drug, the contrast, the latex, the exercise); the emergency management (the intramuscular adrenaline 500 micrograms into the anterolateral thigh, repeated every 5 minutes; the high-flow oxygen; the intravenous fluid; the chlorphenamine; the hydrocortisone; the observation for the biphasic reaction); the refractory anaphylaxis (the intravenous adrenaline infusion); and the beta-blocker patient (the glucagon). ACEM-primary, globally tagged.

Open

Domain

Obstetric, gynaecological and sexual-health emergencies

1

high

Antepartum haemorrhage

Antepartum haemorrhage (APH) is bleeding from the genital tract from 24 weeks of gestation until the onset of labour or birth. The four major causes are placenta praevia (painless, bright-red, recurrent bleeding from a low-lying placenta), placental abruption (painful, dark bleeding with a rigid woody tender uterus and concealed or revealed retroplacental haemorrhage), vasa praevia (fetal bleeding at rupture of membranes with fetal distress and a stable mother), and uterine rupture. The physiological show and cervical or vaginal lesions are the benign mimics. Management is simultaneous maternal and fetal resuscitation — ABCDE, two large-bore cannulae, crossmatch 4 units, coagulation and fibrinogen, continuous CTG, Kleihauer-Betke with anti-D for the Rh-negative mother, speculum (never digital) examination until praevia is excluded, early obstetric referral, and Caesarean section for praevia covering the os. ACEM-primary, globally tagged.

Open

Domain

Antimicrobial stewardship in the emergency department

1

medium

Antimicrobial stewardship in the emergency department — right drug, dose, route and duration, syndromic empirical therapy, de-escalation and resistance

Antimicrobial stewardship in the emergency department — the coordinated set of interventions to optimise antimicrobial use, captured in the principle of the right drug, the right dose, the right route and the right duration, with de-escalation when culture and susceptibility data return; the syndromic empirical therapy matrix for the front door — sepsis (ceftriaxone 2 g), community-acquired bacterial meningitis (ceftriaxone plus vancomycin, plus ampicillin if Listeria is a risk), community-acquired pneumonia (ceftriaxone plus azithromycin), cellulitis (flucloxacillin 2 g) and urinary tract infection (trimethoprim or nitrofurantoin); the de-escalation rule of narrow-to-spectrum, stop-when-non-infectious and switch-to-oral when stable; the resistance patterns (MRSA, VRE, ESBL, CPE) and their treatment implications; the Beers 2023 and STOPP/START criteria for the elderly patient; and the regional stewardship frameworks (Australian Therapeutic Guidelines — Antibiotic and ACSQHC, NICE NG15, IDSA/SHEA and the CDC Core Elements). ACEM-primary, globally tagged.

Open

Domain

Aortic dissection

1

high

Aortic dissection

Acute aortic dissection — intimal tear and the propagating false lumen, the Stanford/DeBakey classification, the sudden tearing migrating pain, the aortic dissection detection risk score (ADD-RS), the beta-blocker-first haemodynamic sequence with heart-rate and blood-pressure targets, surgery for Type A and medical-or-TEVAR for Type B, malperfusion syndromes, and the dissection-into-the-right-coronary-ostium trap. ACEM-primary, globally tagged.

Open

Domain

Applied anatomy and physiology (basic sciences)

1

medium

Applied anatomy and physiology for emergency medicine

Applied anatomy and physiology for emergency medicine — the body-region tour of anatomy that changes emergency management (the airway and the cricothyroid membrane for the front-of-neck access, the vocal cords and the recurrent laryngeal nerve, the femoral and internal jugular vessels for the line access, the brachial plexus and the facial nerve for the blocks and the palsies, the coronary arteries and the conduction system for the ECG, the biliary tree and the appendiceal positions for the surgical abdomen) paired with the four governing physiology principles — the Starling forces, the oxygen-haemoglobin dissociation curve, the baroreceptor reflex and the Frank-Starling mechanism — and the normal-versus-variant anatomy that misleads. ACEM-primary, globally tagged.

Open

Domain

Applied pharmacology for EM

1

medium

Applied pharmacology for the emergency department

Applied pharmacology for the emergency department — the drug knowledge a consultant exercises under pressure: the resuscitation drugs given from memory (adrenaline, noradrenaline, amiodarone, lignocaine, atropine, calcium, sodium bicarbonate, naloxone, flumazenil, NAC, tranexamic acid) each with dose, route, indication, mechanism, onset and duration; the pharmacokinetic framework of onset, duration, half-life and clearance that decides route and interval; the high-yield drug–drug interactions and the unifying cytochrome-P450 mechanism (warfarin plus macrolides, SSRI plus tramadol, statin plus macrolides); the dose modification in renal, hepatic, paediatric, elderly and pregnant patients; and the differential of the correct versus the incorrect …

Open

Domain

ABG interpretation (approach)

1

high

Arterial blood gas interpretation — the systematic emergency department approach

The systematic approach to the arterial blood gas for the emergency medicine trainee — the six values (pH, PaO2, PaCO2, HCO3, base excess, lactate), the respiratory-versus-metabolic rule (pH and PaCO2 move opposite in respiratory disorders, together in metabolic), the compensation formulas (Winter's, the respiratory rules), the anion gap Na minus Cl plus HCO3, the delta-delta for mixed disorders, and the venous-versus-arterial comparison. Includes the gas-driven drug doses — sodium bicarbonate 8.4 percent, insulin 0.1 units per kg per hour, fomepizole 15 mg per kg, naloxone 400 micrograms. ACEM-primary, globally tagged.

Open

Domain

Aspiration pneumonia & lung abscess

1

medium

Aspiration pneumonia and lung abscess

Aspiration pneumonia and lung abscess — the two-hit mechanism (the chemical pneumonitis from the acid and the bacterial infection from the oropharyngeal flora), the risk factors (the reduced consciousness, the dysphagia, the alcohol, the seizure, the stroke), the organisms (the anaerobes and the mixed aerobes), the presentation (the fever, the foul-smelling sputum, the cavitation), the management (the clindamycin or the co-amoxiclav covering the anaerobes, the 2-to-4-week course, the drainage for the large abscess), and the treatment of the underlying cause. ACEM-primary, globally tagged.

Open

Domain

Facial nerve and cranial nerve palsies

1

low

Bell palsy and cranial nerve palsies

Bell palsy — acute, idiopathic, unilateral lower motor neurone facial (CN VII) paralysis. The load-bearing distinction is lower motor neurone (Bell palsy, forehead involved) versus upper motor neurone (stroke, forehead spared). Management is oral corticosteroid started within 72 hours (prednisolone 50 mg daily for 5 days then taper), antivirals reserved for Ramsay Hunt syndrome (herpes zoster oticus), and mandatory corneal protection. Roughly 70 per cent recover fully. Differential includes stroke, Ramsay Hunt, Lyme, otitis media and bilateral causes (Guillain–Barre). The broader cranial nerve lens adds the dangerous CN III pupil-involving palsy (posterior communicating artery aneurysm). ACEM-primary, globally tagged.

Open

Domain

Biliary disease

1

high

Biliary disease — biliary colic, acute cholecystitis and ascending cholangitis

The biliary disease spectrum — biliary colic, the transient cystic duct obstruction with self-limiting post-prandial RUQ pain managed by elective cholecystectomy; acute cholecystitis, the sustained obstruction with RUQ tenderness, fever, a positive Murphy sign, ultrasound wall thickening over 3 mm and pericholecystic fluid, managed with analgesia, ceftriaxone 2 g IV plus metronidazole 500 mg IV, and early laparoscopic cholecystectomy; and ascending cholangitis, the obstructed infected biliary tree with Charcot triad and Reynolds pentad, managed with antibiotics, fluid resuscitation and urgent ERCP decompression. ACEM-primary, globally tagged.

Open

Domain

Bowel obstruction

1

high

Bowel obstruction

Bowel obstruction — the mechanical blockage of the intestinal lumen, split into the small bowel (the adhesions, the hernia, the malignancy) and the large bowel (the colorectal cancer, the sigmoid volvulus, the diverticular stricture). The colicky abdominal pain, the distension, the vomiting and the constipation or the obstipation; the tinkling bowel sounds early then absent. The plain film shows the dilated loops, the air-fluid levels and the step-ladder pattern of the SBO and the coffee-bean sign of the sigmoid volvulus. The CT defines the transition point, the closed-loop and the ischaemia signs — the bowel wall thickening, the mesenteric oedema, the pneumatosis and the portal venous gas. The management is the NBM, the nasogastric tube for the decompression, the IV fluid resuscitation with the 0.9 per cent saline and the potassium replacement, the surgical referral, and the laparotomy for the strangulation, the perforation or the ischaemia. The morphine 5 mg IV, the ondansetron 4 mg IV and the ceftriaxone 2 g IV for the surgical prophylaxis. ACEM-primary, globally tagged.

Open

Domain

Bradyarrhythmias

1

high

Bradyarrhythmias and atrioventricular block in the emergency department

Symptomatic bradycardia and atrioventricular block — the symptomatic-versus-incidental decision, the atrioventricular-block classification (first degree, Mobitz I and II, complete), the bradycardia algorithm (atropine 500 micrograms to a 3 mg maximum, then transcutaneous pacing, then an adrenaline or dopamine infusion, then transvenous pacing), the reversal of the precipitant, the atropine-resistant drug-overdose bradycardia (glucagon, high-dose insulin), and the inferior-versus-anterior-infarct distinction. ACEM-primary, globally tagged.

Open

Domain

Communication and breaking bad news

1

high

Breaking bad news and communication in the emergency department — the SPIKES framework

Breaking bad news and difficult communication in the emergency department — the SPIKES six-step protocol (Setting, Perception, Invitation, Knowledge, Emotion, Strategy/Summary), the governing principles of privacy, protected time, sitting down, silence, empathy and the warning shot, and the four high-stakes ED scenarios of death notification, the peri-arrest goals-of-care discussion, the medical-error disclosure and the new life-changing diagnosis. Covers the symptom-control pharmacology of the peri-arrest and dying patient, cultural considerations, open-disclosure obligations, and the clinician debrief and self-care. The framework is the centrepiece of the ACEM and FRCEM OSCE communication stations. ACEM-primary, globally tagged.

Open

Domain

Procedural & diagnostic ED skills

17

medium

Burn dressing and wound care in the emergency department

Burn dressing and wound care in the ED — the burn-depth assessment (superficial, superficial dermal, deep dermal, full-thickness), the TBSA estimation by the rule of nines and the Lund-Browder chart (children), the cooling with cool running water for 20 minutes within 3 hours of injury, the dressing selection (cling film for transfer, silver sulfadiazine, hydrocolloid), the Parkland fluid-resuscitation trigger (3 to 4 mL per kg per per cent TBSA of Hartmann's in the first 24 hours, half in the first 8), the escharotomy for the circumferential full-thickness burn, the aetiology-specific care (scald, contact, chemical, electrical), and the analgesia and tetanus cover. ACEM-primary, globally tagged.

Open

high

Central and arterial line insertion in the emergency department

Central and arterial line insertion in the ED — the indications (central venous access for vasopressors, TPN, long-term therapy, massive transfusion; arterial access for continuous blood pressure monitoring and arterial blood gas sampling), the site selection (ultrasound-guided internal jugular as first-line, subclavian for long-term ambulatory access, femoral for the crashing or coagulopathic patient), the Seldinger technique, the complications (pneumothorax with post-procedure CXR, arterial puncture, central-line-associated bloodstream infection, venous air embolism, arterial thrombosis and hand ischaemia), and the differential access options (PICC, intraosseous, midline). The radial arterial line with the modified Allen test and femoral arterial access are covered. ACEM-primary, globally tagged.

Open

low

Eye, ENT and dental procedures in the emergency department

The ED eye, ENT and dental procedures cluster — slit-lamp and fluorescein staining for the corneal abrasion, tonometry for the acute angle-closure glaucoma screen, corneal foreign-body removal and the rust-ring drill, copious ocular irrigation for the chemical burn (the Morgan lens with 2 L of saline driven to a neutral pH), epistaxis control by silver-nitrate cautery and anterior/posterior packing (the Merocel, the Rapid Rhino, the Foley), nasal foreign-body extraction by the hook, the Katz catheter and positive pressure, the avulsed permanent tooth reimplanted within 30 minutes and stored in milk or saline, and the dry socket irrigated and dressed. The Fellowship candidate must hold each technique, its landmark, its contraindication and its complication at procedural recall.

Open

high

Focused Assessment with Sonography in Trauma (FAST and E-FAST)

The FAST (Focused Assessment with Sonography in Trauma): the four views (the Morrison pouch or hepatorenal recess, the splenorenal recess, the pouch of Douglas or rectovesical space, and the pericardial or subxiphoid view), the E-FAST extension (bilateral chest for pneumothorax with lung sliding and the lung point, plus the IVC for volume status), the sensitivity of 60 to 70 per cent for free fluid rising with the repeat scan, the specificity of around 95 per cent, the role in the hypotensive trauma patient (the positive FAST equals the operating theatre, not the CT), the technique with the curvilinear probe, the depth and the gain, and the pitfalls (the false positive from ascites or fat, the false negative from pelvic-only or retroperitoneal …

Open

medium

Foreign body removal in the emergency department

Foreign body removal in the ED across the four anatomical compartments — the soft tissue FB (the wood splinter, the glass shard, the metal shaving, the needle), the ocular FB (the metallic rust ring, the conjunctival FB under the upper lid), the aural FB (the bead, the live insect, the cotton-bud tip, the button battery), and the nasal FB (where the button battery is a time-critical emergency). The technique spine — local anaesthetic, a sterile field, the right instrument (forceps, hook, needle), and a systematic wound exploration — is shared, but each compartment has its own equipment, its own pitfalls, and its own escalation trigger. The imaging logic is radio-opaque versus radiolucent: an X-ray for the metal and the glass, a high-frequency ultrasound for the wood and the plastic. The post-removal care is tetanus assessment, wound toilet, and antibiotics only for the contaminated, the bite, and the plantar puncture. The differential on every case is retained versus resolved — and the worst error is to discharge a patient with a residual fragment and a developing infection. ACEM-primary, globally tagged.

Open

high

Fracture and dislocation reduction in the ED

Closed reduction of the dislocations the emergency physician reduces in the ED — anterior and posterior shoulder, pulled elbow (nursemaid elbow), finger interphalangeal joints, and traumatic hip dislocation. The technique set is joint-specific: traction-countertraction, Stimson, scapular manipulation, Cunningham and FARES for the anterior shoulder; hyperpronation for the pulled elbow; a digital block then longitudinal traction for the finger; Allis, Stimson and the Captain Morgan lever for the hip. Analgesia and sedation follow the procedural sedation standard — ketamine 1 mg/kg IV, fentanyl 1 mcg/kg IV, propofol 1 mg/kg IV — with a pre-procedure fast, full monitoring and a trained team. The non-negotiables are the pre- and post-reduction neurovascular examination and a post-reduction radiograph on every patient. The differential that disqualifies an ED closed attempt is the fracture-dislocation and the pathological fracture. ACEM Fellowship, globally tagged.

Open

high

Front-of-neck access and the emergency surgical airway

Front-of-neck access in the ED — the scalpel-bougie-tube cricothyroidotomy for the cannot-intubate, cannot-oxygenate (CICO) event. The indication is the declared CICO state after every non-surgical lifeline (face mask, supraglottic airway, endotracheal tube) has failed. The anatomy is the cricothyroid membrane between the thyroid cartilage above and the cricoid ring below. The technique is the six-step sequence — laryngeal handshake, transverse stab incision through skin and membrane with a size 20 scalpel, turn the blade 90 degrees, pass the bougie caudally, railroad a size 6.0 mm cuffed endotracheal tube, confirm with sustained waveform capnography. The complications are bleeding, posterior tracheal wall injury, oesophageal injury, false passage and delayed tube displacement. The differential is the rescue oxygenation lifelines (face mask ventilation, supraglottic airway) and the alternative FONA technique (narrow-bore needle cricothyroidotomy with jet ventilation) — each distinguished by its place in the algorithm and its failure modes. ACEM Fellowship, globally tagged.

Open

high

Local anaesthesia and topical agents

Local anaesthesia and topical agents in the ED — the amide agents (lidocaine 3 mg/kg plain, 7 mg/kg with adrenaline; bupivacaine 2 mg/kg; ropivacaine 3 mg/kg; prilocaine, mepivacaine) versus the ester agents (cocaine, amethocaine/tetracaine, benzocaine, procaine), the maximum safe doses, the mechanism (sodium-channel blockade, ionisation, onset, duration), the adrenaline rules and the end-artery contraindication, the local anaesthetic systemic toxicity (LAST — circumoral tingling, tinnitus, agitation, seizure; hypotension, arrhythmia, cardiac arrest from bupivacaine), the treatment (stop injection, airway, lipid emulsion 20% 1.5 mL/kg bolus then 0.25 mL/kg/min), and the topical agents (EMLA, Ametop, LET gel, ethyl chloride, lidocaine spray, cocaine). ACEM-primary, globally tagged.

Open

medium

Lumbar puncture in the emergency department

Lumbar puncture in the ED — the indications (suspected meningitis or encephalitis, subarachnoid haemorrhage after a negative CT, demyelinating disease — multiple sclerosis, CIDP, Guillain-Barre, and the therapeutic uses — idiopathic intracranial hypertension, cryptococcal meningitis, intrathecal drug delivery), the contraindications (raised intracranial pressure with papilloedema or a focal deficit, coagulopathy with an INR over 1.4 or platelets under 50, overlying skin infection), the anatomy (the conus at L1/L2, the dural sac at S2, Tuffier's line crossing L4), the technique (L3/L4 or L4/L5, midline, the bevel parallel to the longitudinal dural fibres, the atraumatic over the cutting needle), the CSF interpretation (bacterial — high neutrophils, low glucose; viral — lymphocytes, normal glucose; TB — very low glucose, very high protein; SAH — xanthochromia and uniform red cells), and the post-dural puncture headache (atraumatic needle halves it; caffeine and the epidural blood patch treat it). ACEM-primary, globally tagged.

Open

medium

Paracentesis and thoracentesis in the emergency department

Paracentesis and thoracentesis in the ED — the two percutaneous fluid taps the Fellowship candidate performs, teaches and defends. Paracentesis: the diagnostic ascitic tap (the serum-ascites albumin gradient for the portal hypertension distinction, the cell count and the culture for the spontaneous bacterial peritonitis, the cytology) or the therapeutic large-volume paracentesis for the tense cirrhotic ascites, performed 2 cm superior and medial to the anterior superior iliac spine under ultrasound, with the Z-track and the local anaesthetic. Thoracentesis: the diagnostic pleural tap for the Light criteria (the transudate versus the exudate) or the therapeutic drainage, performed posteriorly one rib space below the fluid level under ultrasound. The complications — the bleeding, the bowel perforation and the post-procedure ascitic fluid leak for paracentesis; the pneumothorax, the bleeding and the re-expansion pulmonary oedema for thoracentesis — and the practical safeguards (the ultrasound, the coagulation check, the fluid-volume limits). ACEM-primary, globally tagged.

Open

high

Point-of-care ultrasound: aortic, lung and cardiac (the RUSH protocol)

Bedside point-of-care ultrasound of the aorta, the lung and the heart for the critically ill patient — the aortic measurement (the abdominal aortic aneurysm is an outer-to-outer aortic diameter over 3 cm), the lung patterns (the B-lines for pulmonary oedema, the A-lines for the normal lung or COPD, the absent lung sliding and the lung point for pneumothorax), the cardiac windows (the pericardial effusion, the eyeball left-ventricular function, the right-ventricular dilatation of pulmonary embolism) and the inferior-vena-cava collapsibility for the volume status. Integrated by the RUSH protocol (Rapid Ultrasound in Shock), which maps the pump, the tank and the pipes to answer the shock question at the bedside. ACEM-primary, globally tagged.

Open

medium

Point-of-care ultrasound: biliary and renal (and the incidental AAA)

Point-of-care ultrasound of the biliary tree, the kidneys and the incidental abdominal aortic aneurysm — the right-upper-quadrant scan for gallstones (hyperechoic with acoustic shadowing), gallbladder wall thickening over 3 millimetres, the sonographic Murphy sign and the common bile duct over 7 millimetres; the renal scan for hydronephrosis (graded mild to severe), stones and cysts; and the aorta measured in every older flank-pain patient to catch the aneurysm that masquerades as colic. Technique with the curvilinear probe and an appropriate depth; the differentials (the non-visualised post-prandial gallbladder, bowel gas, ascites); and the diagnostic accuracy (POCUS rules cholecystitis in, it does not rule it out). ACEM-primary, globally tagged.

Open

high

Procedural sedation in the emergency department

Procedural sedation in the ED — the indications (fracture reduction, dislocation reduction, abscess drainage, cardioversion, paediatric procedures), the pre-sedation assessment (fasting status, ASA physical status, the airway, the Mallampati), the monitoring (ECG, pulse oximetry, capnography, BP), the drugs (propofol 1 to 2 mg/kg, ketamine 1 to 2 mg/kg IV or 4 to 5 mg/kg IM, midazolam 0.05 to 0.1 mg/kg, fentanyl 1 to 2 mcg/kg), the antagonists (flumazenil 200 mcg, naloxone 400 mcg), the rescue airway, and the complications (hypoventilation, hypotension, hypoxia, emesis, laryngospasm). ACEM-primary, globally tagged.

Open

medium

Regional nerve blocks in the emergency department

Regional nerve blocks in the ED — the fascia iliaca and femoral blocks for hip and femoral-shaft fracture analgesia (landmark and ultrasound-guided), the wrist block (median, ulnar, radial at the wrist) and the digital ring block for hand and finger procedures, and the facial blocks (supraorbital/supratrochlear, infraorbital, mental) for facial lacerations. The local anaesthetic agents (lidocaine 1 to 2 per cent, bupivacaine 0.25 per cent, ropivacaine 0.5 per cent) with the maximum safe doses (lidocaine 3 mg/kg plain, 7 mg/kg with adrenaline; bupivacaine 2 mg/kg; ropivacaine 3 mg/kg), ultrasound guidance where available, the recognition and lipid-rescue of local anaesthetic systemic toxicity, and the pitfalls (intravascular injection, nerve injury, compartment syndrome in the anticoagulated, adrenaline in the digit). ACEM-primary, globally tagged.

Open

medium

Splinting and immobilisation in the emergency department

Splinting and immobilisation in the ED — the governing principle (immobilise the joint above and below the fracture), the device set (plaster backslab for Colles and ankle, POP cylinder for the knee, Thomas splint for the femur, sling and swath for the clavicle, rigid cervical collar and spinal board for suspected spinal injury, malleable SAM splint for the field), the layered application technique (stockinette, wool padding, plaster slabs dipped in cool water and moulded in the position of function), and the complications the Fellowship candidate must name and prevent — compartment syndrome (the 5 Ps of pain out of proportion, pallor, paraesthesia, paralysis, pulselessness), pressure sores over bony prominences, and thermal injury from the exothermic setting reaction. The central SCQ distinction is the backslab (non-circumferential, accommodates swelling, the ED acute-phase default) versus the circumferential cast (rigid, definitive, applied only after swelling resolves). ACEM Fellowship, globally tagged.

Open

high

Wound assessment and management

Wound assessment and management in the ED — the wound classes (clean, clean-contaminated, contaminated, dirty-infected) mapped to the mechanism classes (laceration, crush, bite, puncture, avulsion), the structured MEAT assessment (mechanism, examination of neurovascular-tendon-bone-depth-contamination-foreign body, age of wound, type), the irrigation standard (normal saline under 7 to 15 psi pressure via splash-guard syringe, large volume), debridement of devitalised tissue, the tetanus prophylaxis schedule (diphtheria-tetanus-acellular-pertussis vaccine 0.5 mL IM plus tetanus immune globulin 250 IU IM per the ACIP and Australian schedule by wound type and vaccination history), the antibiotic decision (amoxicillin-clavulanate 875/125 mg BD for mammalian bites covering Pasteurella), and the closure decision (primary versus delayed primary versus secondary). ACEM-primary, globally tagged.

Open

medium

Wound closure and suturing techniques

Wound closure and suturing techniques in the ED — the suture material choice (absorbable: catgut, Vicryl polyglactin, Monocryl poliglecaprone; versus non-absorbable: nylon Ethilon, polypropylene Prolene), the gauge-by-site rule (5-0 for the face, 4-0 for the body, 3-0 for the scalp and extremity), the five core techniques (simple interrupted, continuous running, vertical mattress, horizontal mattress, subcuticular intradermal) with the indication and the pitfall of each, the tissue adhesive (2-octyl cyanoacrylate, Dermabond) and adhesive strips (Steri-Strips) for the low-tension low-risk wound, the suture removal schedule (face 5 days, scalp 7 to 10, body 7 to 10, joints 14), the local anaesthetic doses for painless closure, and the recognition of the wound that must heal by secondary intention (bites, punctures, infected and heavily contaminated wounds). ACEM-primary, globally tagged.

Open

Domain

Burn management

1

high

Burn management in the emergency department

Burn management — the burn-depth classification (superficial, superficial dermal, deep dermal, full-thickness), the TBSA estimation by the rule of 9s and the Lund-Browder chart, the Parkland fluid-resuscitation formula (4 mL per kilogram per per cent TBSA of Ringer lactate in the first 24 hours), the inhalation-injury airway (early intubation), the escharotomy for the circumferential burn, the analgesia (morphine, ketamine), the referral criteria to a burns centre, and the electrical and the chemical burns. ACEM-primary, globally tagged.

Open

Domain

Carbon monoxide poisoning

1

high

Carbon monoxide poisoning

Carbon monoxide poisoning — the colourless, odourless gas that binds haemoglobin about 240 times more avidly than oxygen, left-shifting the oxyhaemoglobin dissociation curve and producing tissue hypoxia with a falsely normal pulse oximetry. The sources (the faulty heater, the car exhaust, the enclosed fire, the indoor barbecue), the clinical (the headache, the nausea, the confusion, the flu-like illness in multiple household members, the rare cherry-red skin), the diagnosis (the venous carboxyhaemoglobin level), and the management (100 per cent oxygen via a non-rebreather mask; hyperbaric oxygen for the severe — the loss of consciousness, the neurological deficit, the pregnancy, the COHb over 25 per cent). The delayed neurological sequelae — the cognitive impairment and the parkinsonism at 2 to 40 days. ACEM-primary, globally tagged.

Open

Domain

Cardiac arrest & ALS

1

high

Cardiac arrest and advanced life support

The full advanced life support of the arrested adult: the chain of survival, high-quality CPR, the universal ALS algorithm with the shockable and non-shockable loops, adrenaline and amiodarone, defibrillation, the four Hs and four Ts, the other arrest drugs, the team and human factors, the immediate post-ROSC period with the targeted-temperature evidence, the special arrests, and the regional algorithm differences.

Open

Domain

Cardiogenic shock

1

high

Cardiogenic shock in the emergency department

Cardiogenic shock — the spiral of low cardiac output, compensatory vasoconstriction, rising afterload and deepening hypoperfusion; the SCAI shock stages (A to E); the cause-first management (immediate revascularisation for the infarct, surgery for the mechanical complication), the pharmacologic support (noradrenaline preferred over dopamine per SOAP-2; dobutamine or milrinone as inotrope), the mechanical-circulatory-support evidence (IABP no mortality benefit per IABP-SHOCK II; Impella and VA-ECMO as a bridge), and the culprit-only PCI principle of CULPRIT-SHOCK. ACEM-primary, globally tagged.

Open

Domain

Cervical spine injury & clearance

1

high

Cervical spine injury and clearance in trauma

Cervical spine injury and clearance — the NEXUS and the Canadian C-spine clinical decision rules for the safe clearance of the C-spine without the imaging, the CT as the standard imaging (replacing the plain radiographs), the spinal-cord-injury syndromes (the complete, the central cord, the anterior cord, the Brown-Sequard), the SCIWORA, the immobilisation (the collar, the head blocks, the manual in-line stabilisation), the methylprednisolone controversy (no longer recommended by the AANS), and the neurosurgical referral. ACEM-primary, globally tagged.

Open

Domain

Chest trauma

1

high

Chest trauma (the immediately and potentially life-threatening injuries)

Chest trauma — the immediately life-threatening 'lethal six' (tension pneumothorax, open pneumothorax, massive haemothorax, flail chest with pulmonary contusion, cardiac tamponade, tracheobronchial injury) identified and managed in the primary survey, the potentially life-threatening 'hidden six' (blunt aortic injury, blunt cardiac injury, diaphragmatic rupture, oesophageal rupture, pulmonary contusion, simple pneumo/haemothorax) found on the secondary survey, the analgesia and the chest-drain management, and the CT-angiogram for the blunt aortic injury. ACEM-primary, globally tagged.

Open

Domain

Clinical handover and ISBAR

1

medium

Clinical handover and the ISBAR framework in the emergency department

Clinical handover and the ISBAR framework in the emergency department — the structured transfer of information and responsibility at every care transition; the six elements of ISBAR (Identify, Situation, Background, Assessment, Recommendation) and how the Identifier distinguishes ISBAR from its parent SBAR; the alternative and extended structures (SBAR, ISOBAR, IMIST-AMBO for paramedic-to-ED, I-PASS for the trainee-to-trainee handoff); the six ED handover types (triage-to-treatment, shift change, ED-to-ward, ED-to-ICU, ED-to-retrieval, ED-to-theatre) and the emphasis, recipient and risk profile of each; the applied steps of a structured handover from preparation through the receiver's readback to the explicit transfer of responsibility; the com…

Open

Domain

Coma

1

high

Coma and GCS assessment

The comatose patient and the Glasgow Coma Scale — the structured approach (the ABCDE, the rapid glucose, the reversible causes), the GCS (the eye, the verbal, the motor components; the best motor response is the most sensitive), the AVPU for the rapid triage, the differential (the toxic-metabolic, the structural, the infectious), the immediate investigations (the glucose, the blood gas, the CT, the drug screen), and the management (the airway, the naloxone, the thiamine, the specific antidote). ACEM-primary, globally tagged.

Open

Domain

Community-acquired pneumonia

1

high

Community-acquired pneumonia

Community-acquired pneumonia — the CURB-65 severity assessment (Confusion, Urea, Respiratory rate, Blood pressure, age 65), the pathogen classification (typical and atypical), the antibiotic regimens by severity (outpatient amoxicillin, ward IV amoxicillin and clarithromycin, ICU penicillin and a macrolide with Gram-negative cover), the Hour-1 sepsis bundle, the complications (parapneumonic effusion, empyema, lung abscess, ARDS), and the legionella and aspiration subtypes. ACEM-primary, globally tagged.

Open

Domain

CT interpretation and usage (approach)

1

medium

Computed tomography — the emergency department interpretation and usage approach

The systematic approach to requesting and interpreting computed tomography in the emergency department — the appropriate-versus-inappropriate decision, contrast versus non-contrast phases, CT angiography for pulmonary embolism and aortic dissection, CT perfusion for the stroke penumbra, the early ischaemic stroke signs with the ASPECTS score, subarachnoid haemorrhage sensitivity within six hours, renal colic and appendicitis imaging, the contrast premedication and contrast-induced nephropathy drug doses, and the 2 to 10 mSv radiation dose per scan. ACEM-primary, globally tagged.

Open

Domain

Consent, capacity and medico-legal

1

high

Consent, capacity and the medico-legal framework in the emergency department

Consent, capacity and the medico-legal framework in the emergency department — informed consent and its five elements (nature, purpose, risks, alternatives, consequences of refusal), the four-stage test of capacity (understanding, retention, weighing, communicating) with the principles of presumption, and that capacity is decision-specific and time-specific, emergency treatment without consent under the common-law doctrine of necessity, restraint (chemical, physical and the legal basis), the Mental Health Act and involuntary detention schedules, the police request for a blood sample, and child protection including the mature minor and mandatory reporting. Covers the pharmacology of acute agitation — midazolam, droperidol and olanzapine with doses. ACEM-primary, globally tagged.

Open

Domain

Cyanide poisoning

1

medium

Cyanide poisoning

Cyanide poisoning — the histotoxic toxin that halts cellular respiration by binding the ferric iron of cytochrome c oxidase (complex IV), shutting oxidative phosphorylation and forcing every tissue into anaerobic metabolism. The emergency source is the enclosed-space house fire (cyanide released from burning plastics, wool and polyurethane), and the patient is the unconscious fire survivor with soot in the mouth, a high lactate and a metabolic acidosis out of proportion to the carboxyhaemoglobin level — co-existing carbon monoxide is the rule. The clinical signs are rapid collapse, seizure and coma, an initial hypertension then bradycardic cardiovascular collapse, and the rare cherry-red skin from venous oxygen that the tissues cannot extract. Management is 100 per cent oxygen, empirical hydroxocobalamin 70 mg per kilogram (adult 5 g) intravenously — the preferred antidote because it does not cause hypotension or methaemoglobinaemia — and sodium thiosulfate 12.5 g intravenously. The smoke-inhalation kit (amyl or sodium nitrite) is avoided because methaemoglobinaemia worsens the co-existent carbon monoxide poisoning. ACEM-primary, globally tagged.

Open

Domain

Damage control resuscitation

1

high

Damage control resuscitation in trauma

Damage control resuscitation — the lethal triad of trauma (hypothermia, acidosis, coagulopathy), the permissive hypotension principle (SBP 80 to 90 until the bleeding is controlled), the haemostatic resuscitation with a balanced blood-product ratio (1:1:1), the tranexamic acid within 3 hours (the CRASH-2 trial), the calcium replacement, the damage-control surgery (control the bleeding, control the contamination, temporary closure), and the massive haemorrhage protocol. ACEM-primary, globally tagged.

Open

Domain

Deep vein thrombosis

1

medium

Deep vein thrombosis (emergency department diagnosis and management)

Deep vein thrombosis — the Wells-DVT risk score (the clinical signs, the risk factors, the alternative diagnosis — reproduced), the D-dimer and the compression ultrasound strategy, the anticoagulation management (the apixaban or the rivaroxaban first-line, the enoxaparin, the warfarin), the compression stockings, the PE cross-link, and the Wells-DVT-versus-clinical-probability approach. ACEM-primary, globally tagged.

Open

Domain

Geriatric and behavioural emergencies

1

high

Delirium in the elderly

Delirium in the elderly — the acute, fluctuating disturbance of attention and cognition that is the commonest behavioural presentation in patients over 65 and an under-recognised medical emergency with a 30-day mortality of 10 to 30 per cent. The three motor subtypes (hyperactive, hypoactive, mixed), the DELIRIUM mnemonic of precipitants (Drugs, Electrolytes and dehydration, Lack of drugs or withdrawal, Infection, Reduced sensory input, Intracranial, Urinary or faecal, Myocardial or metabolic), the bedside screens (4AT and the Confusion Assessment Method), and the management ladder — treat the cause, reorient the environment, and reserve a low-dose antipsychotic (haloperidol 0.5 to 2 mg IV or PO, olanzapine 2.5 to 5 mg PO) for distress or danger, never a benzodiazepine except withdrawal.

Open

Domain

Disaster & mass casualty

1

medium

Disaster and mass casualty

The disaster and mass casualty management: the disaster cycle, the START triage, the incident command system, the surge capacity, the decontamination for the chemical/biological/radiological incident, and the ethical framework of the greatest good for the greatest number.

Open

Domain

Disaster preparedness and hospital incident command

1

medium

Disaster preparedness — hospital incident command, surge capacity, MCI triage, decontamination and the PICE classification

Disaster preparedness in the emergency department — the systems and planning layer the consultant is accountable for, distinct from the bedside MCI response: the PICE nomenclature that classifies the event, the Hospital Incident Command System (HICS) that commands the response, the surge continuum from conventional to contingency to crisis and the crisis standards of care it invokes, the SALT and START mass-casualty triage tools and the shift to a population standard of care, the decontamination procedure and PPE for the CBRNE event, the specific antidotes with their doses, and the planning of mutual aid, redundant communication and staged evacuation. ACEM-primary, globally tagged.

Open

Domain

Diabetic emergencies

1

high

DKA, HHS and hypoglycaemia

The three diabetic emergencies — diabetic ketoacidosis (the ketosis, the metabolic acidosis and the hyperglycaemia), hyperosmolar hyperglycaemic state (the severe hyperglycaemia, the marked hyperosmolality, minimal ketosis) and severe hypoglycaemia (glucose below 3 mmol/L). The Fellowship-critical doses and rationale: the fixed-rate insulin infusion 0.1 units/kg/h for DKA, the fluid-first 0.9% saline 1 L over the first hour, the glucose switch at 14 mmol/L, the potassium 40 mmol/L per bag once under 5.5 mmol/L; the lower HHS insulin 0.05 units/kg/h with fluid as the primary therapy; and the hypoglycaemia rescue (glucose 25 g IV, glucagon 1 mg IM). ACEM-primary, globally tagged.

Open

Domain

Drowning

1

high

Drowning

Drowning — the respiratory impairment from submersion or immersion in a liquid, a primary respiratory failure produced by aspiration and laryngospasm, and a leading cause of preventable death in the young. The chain of survival (early rescue, early CPR, early advanced life support); the management (ABCDE, 100 per cent oxygen, intubation and lung-protective ventilation with a tidal volume of 6 mL/kg and PEEP for the severe case, targeted temperature management at 32 to 36 degrees for the comatose post-arrest patient, no routine prophylactic antibiotics, cervical spine immobilisation only for a diving injury); and the prognostication (submersion time, water temperature, CPR duration, initial GCS, initial rhythm — asystole carries the worst prognosis).

Open

Domain

Ectopic pregnancy

1

high

Ectopic pregnancy

The ectopic pregnancy — the implantation outside the uterine cavity, most commonly in the fallopian tube; the rupture causes the catastrophic intra-abdominal haemorrhage and is the leading cause of the pregnancy-related death in the first trimester. The clinical presentation (the abdominal pain, the vaginal bleeding, the missed period, the shoulder-tip pain from the diaphragmatic irritation, the collapse), the risk factors (the PID, the previous ectopic, the IVF, the tubal surgery, the IUD), the diagnosis (the quantitative beta-hCG, the transvaginal ultrasound), the management (the resuscitation, the surgical salpingectomy for the ruptured, the methotrexate for the stable unruptured). ACEM-primary, globally tagged.

Open

Domain

ED flow and access block

1

low

ED flow and access block — the input-throughput-output model, queuing theory, and the operational intervention ladder

ED flow as an operations-engineering problem — the input-throughput-output model of Asplin (input = demand arriving at the emergency department; throughput = assessment and treatment inside; output = discharge or admission to an inpatient bed), with the output box as the binding constraint whose failure propagates upstream as access block and crowding. Queuing theory and Little's Law (L equals lambda times W; the number in the system equals the arrival rate multiplied by the mean time in system), which predicts that a department running at 100 per cent occupancy is mathematically unstable because waiting time rises non-linearly as utilisation approaches one. Bottleneck analysis — the rate-limiting resource defines system capacity — and Khanna's patient-journey mapping of the ED bottlenecks at triage, the doctor assessment, diagnostic turnaround and the disposition decision. Access block in the ACEM operational sense (total ED length of stay greater than 8 hours for an admitted patient) as the central operational pathology, and its burden of harm: mortality 10–30 per cent higher among boarded patients (Sprivulis, Richardson, Guttmann), excess mortality in critically ill patients boarded awaiting ICU (Chalfin), the dose-response of boarding length and mortality (Singer), and the full-capacity-protocol evidence that boarding in an inpatient hallway is not demonstrably worse than continued ED corridor boarding (Viccellio). The pre-hospital face — ambulance ramping (Yoon, Cook) — and left-without-being-seen as a safety signal. The differential of good versus poor flow. The operational intervention ladder: ED-internal throughput work (team triage, senior at the front door, streaming, parallel processing, fast-track), rapid assessment, short-stay units, inpatient bed-flow management (discharge lounges, early senior-led discharge before midday, predicted discharge dates, bed-management teams, whole-of-hospital bed meetings), the full-capacity protocol, ambulance-ramping mitigation, and structural capacity. The cardinal teaching is that access block is a hospital-system problem whose consequence is felt in the emergency department, and that no amount of ED-internal throughput work alone will solve chronic access block.

Open

Domain

Electrical and lightning injury

1

medium

Electrical and lightning injury

Electrical and lightning injury — low-voltage (under 1000 V) shocks cause local contact burns and arrhythmia; high-voltage (over 1000 V) injury drives deep tissue destruction along the current path with rhabdomyolysis, myoglobinuria, compartment syndrome and cardiac arrest; lightning causes cardiopulmonary arrest, Lichtenberg figures and tympanic rupture. Management is ABCDE trauma resuscitation, ECG monitoring for 4 to 6 hours, creatine kinase and urine output surveillance, fasciotomy for compartment syndrome, and treating every case as blunt trauma. Distinguished from thermal burn, tricyclic poisoning and blunt trauma. ACEM-primary, globally tagged.

Open

Domain

Electrolyte emergencies — potassium and sodium

1

high

Electrolyte emergencies — potassium and sodium

Electrolyte emergencies — potassium and sodium. Hyperkalaemia (a serum potassium over 6.5 mmol/L, or any level with ECG change) is a time-critical arrhythmia risk treated up an antidote ladder of membrane stabilisation (calcium chloride 10 mL of 10 per cent IV), potassium shift (insulin 10 units with 50 mL of 50 per cent dextrose IV, salbutamol 10 to 20 mg nebulised, sodium bicarbonate 50 mL of 8.4 per cent IV) and potassium removal (patiromer, sodium zirconium, dialysis). Hypokalaemia (potassium under 3.5 mmol/L) shows U waves and a prolonged QU interval, precipitates torsades de pointes and potentiates digoxin toxicity, and is replaced intravenously at no faster than 10 mmol per hour peripherally and 20 mmol per hour centrally, with the magnesium corrected first. Hyponatraemia (sodium under 125 mmol/L) splits into acute — cerebral oedema and seizure, treated with 3 per cent hypertonic saline 100 mL IV bolus — and chronic, corrected slowly (under 8 mmol/L in 24 hours to avoid osmotic demyelination). Hypernatraemia (sodium over 145 mmol/L) is always a water-deficit problem, corrected at no faster than 0.5 mmol/L per hour with free water (oral or 5 per cent dextrose) and desmopressin for central diabetes insipidus. The ECG changes of hyperkalaemia (peaked T waves, widened QRS, sine wave, VF arrest), the pseudohyperkalaemia trap, and the corrected sodium for hyperglycaemia. ACEM-primary, globally tagged.

Open

Domain

End-of-life and goals of care

1

high

End-of-life care and goals-of-care discussions in the emergency department

End-of-life care and goals-of-care discussions in the emergency department — recognising the dying patient across the illness trajectories, the structured goals-of-care conversation (framing, the patient's values, realistic outcomes, and the shared decision), the not-for-resuscitation order and limitation of treatment (not for intubation, CPR, dialysis), the ED palliative pathway with its symptom-control pharmacology (morphine 2.5 mg SC/IV, midazolam 2.5 mg SC, glycopyrrolate 200 micrograms SC, haloperidol 0.5 to 2 mg IV), the family meeting, bereavement support, cultural and spiritual considerations, and the legal and ethical framework of the advance care directive, the enduring guardian and substituted judgement. The differential — the reversible causes of deterioration that must not be missed — runs through every decision. ACEM-primary, globally tagged.

Open

Domain

Resuscitation

1

medium

Fluid resuscitation in the emergency department

Fluid resuscitation — the rapid restoration of the circulating volume to reverse tissue hypoperfusion; the fluid types (crystalloid vs colloid, balanced vs saline), the fluid-responsiveness assessment (passive leg raise, IVC variability, pulse-pressure variation), the targets (MAP, lactate, urine output, capillary refill), the doses (crystalloid 250 to 500 mL aliquots to a working ceiling of 30 mL/kg, noradrenaline 0.05 to 0.5 mcg/kg/min), the SMART trial (balanced crystalloids lower mortality and AKI than saline), the SAFE albumin controversy (no benefit, harmful in TBI), the abandoned hydroxyethyl starch (CHEST, 6S, Perel), and the disease-specific strategies (sepsis, trauma, DKA, burns). ACEM-primary, globally tagged.

Open

Domain

Foreign body ingestion and aspiration

1

medium

Foreign body ingestion and aspiration — coins, button batteries, magnets and the choking child

Foreign body ingestion and aspiration — the two anatomic compartments and the time-critical objects. Ingestion: coins (oesophageal impaction at the three physiological narrowings, urgent oesophagogastroduodenoscopy), button battery (an EMERGENCY — electrolysis and liquefaction necrosis of the oesophageal wall within hours, oesophagogastroduodenoscopy within 2 hours, the double-ring and halo sign on X-ray, honey and sucralfate as a bridge, aortoesophageal fistula as the lethal complication), and magnets (attraction across bowel walls with pressure necrosis, perforation and fistula — emergency removal when two or more are present). Aspiration: sudden choking, stridor, monophonic or fixed wheeze, and asymmetric air entry, distinguished from croup, epiglottitis and asthma, with back blows and chest thrusts for the choking infant (abdominal thrusts for the child over one year) and rigid bronchoscopy as the gold standard. ACEM-primary, globally tagged.

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Domain

Geriatric and special-population emergencies

1

medium

Geriatric falls and immobility

Geriatric falls and immobility — the multifactorial geriatric syndrome in which an older person comes to rest unintentionally on the ground, and the spiral of deconditioning that follows. Falls affect a third of community-dwelling over-65s each year and half of over-80s, and they are the leading cause of injury death in older adults. The ED assessment is the multifactorial search: orthostatic vital signs, gait (the Timed Up and Go, abnormal over 12 seconds), cognition (the 4AT, score 4 or more is probable delirium), the drug chart (STOPP/START and the fall-risk-increasing drugs — benzodiazepines, antipsychotics, opioids, antihypertensives), and vision. Investigation targets the consequence — a hip X-ray for the fractured neck of femur and a CT head for the head strike, where age 65 or over is itself a Canadian CT Head Rule criterion. Management treats the precipitant, fixes the fracture (the femoral nerve block and early surgery), deprescribes the culprit drugs, and layers on physiotherapy, an occupational therapy home visit, and vitamin D for the deficient. The differential is syncope, occult sepsis, and stroke — the masked infective fall and the unwitnessed collapse with amnesia are the traps. ACEM-primary, globally tagged.

Open

Domain

Geriatric trauma

1

medium

Geriatric trauma

The geriatric trauma: the physiological changes of aging, the comorbidity and the polypharmacy (the anticoagulants, the beta-blockers that mask the tachycardia), the low-energy fall that produces the significant injury, the increased TBI risk, the frailty assessment, and the higher mortality for the same injury.

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Domain

Neuromuscular junction disorders

1

medium

Guillain-Barré syndrome and myasthenia gravis

Guillain-Barré syndrome — the acute ascending flaccid paralysis with areflexia and autonomic instability, the respiratory-failure thresholds (FVC under 20 mL/kg or NIF under minus 30 cmH2O), the albuminocytologic dissociation on the CSF, and the IVIG 0.4 g/kg/day for 5 days or plasma exchange; and myasthenia gravis — the fatigable weakness (ptosis, diplopia, bulbar), the AChR antibody, the neostigmine and ice-pack tests, the pyridostigmine 60 mg PO, and the IVIG or plasma exchange for the myasthenic crisis. The GBS-versus-MG-versus-Lambert-Eaton differential. ACEM-primary, globally tagged.

Open

Domain

Haemoptysis

1

medium

Haemoptysis (including massive haemoptysis)

Haemoptysis — the coughing of blood from the respiratory tract, the distinction between the non-massive (the bronchitis, the bronchiectasis, the cancer, the TB, the pneumonia) and the massive (over 100 mL in 24 hours — the life-threatening asphyxiation risk), the emergency management of the massive haemoptysis (the airway protection, the bleeding-side-down positioning, the large endotracheal tube or the double-lumen tube, the bronchoscopy, the bronchial artery embolisation), and the tranexamic acid. ACEM-primary, globally tagged.

Open

Domain

Hypertensive disorders of pregnancy

2

medium

Hypertensive disorders of pregnancy (ED)

The hypertensive disorders of pregnancy on the spectrum from the gestational hypertension through the pre-eclampsia (with and without the severe features) and the eclampsia (the seizures) to the HELLP syndrome (the haemolysis, the elevated liver enzymes, the low platelets), the pathophysiology of the abnormal placentation and the endothelial dysfunction (the failed second-wave trophoblastic invasion, the anti-angiogenic sFlt-1 with the depletion of the PlGF), the ACOG and the NICE diagnostic criteria, the severe features that trigger the severe management and the delivery, the HELLP syndrome with the Mississippi and the Tennessee classifications, the ED acute management (the intravenous labetalol or the hydralazine or the nifedipine for the blo…

Open

high

Pre-eclampsia and eclampsia

Pre-eclampsia is new hypertension (at or above 140 over 90) after 20 weeks of gestation with proteinuria or end-organ dysfunction, progressing on a spectrum through severe pre-eclampsia to eclampsia (the seizure) and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets). The pathophysiology is the failed trophoblastic invasion of the spiral arteries and the release of the anti-angiogenic factors that drive the systemic endothelial dysfunction. Management rests on three pillars: magnesium sulphate for seizure prophylaxis and treatment (4 g IV loading over 20 minutes then 1 g per hour for 24 hours, with calcium gluconate 10 mL of 10 per cent as the antidote for toxicity), blood-pressure control to the severe range (labetalol, hydralazine or nifedipine; target 140 to 150 over 90 to 100; no ACE inhibitors, ARBs or renin inhibitors), and delivery as the only cure. The differential is gestational hypertension, chronic hypertension and HELLP. ACEM-primary, globally tagged.

Open

Domain

Hypertensive emergency

1

high

Hypertensive emergency

Severe blood-pressure elevation with acute end-organ damage — the distinction between a hypertensive emergency and urgency (end-organ damage, not the number), the affected organs (brain, heart, kidney, retina, pregnancy, aorta), the rationale for controlled lowering (the shifted cerebral autoregulation curve), the titratable intravenous agents with doses and per-scenario targets, the magnesium-for-eclampsia and phaeochromocytoma-alpha-first rules, and the agents to avoid. ACEM-primary, globally tagged.

Open

Domain

Hypothermia

1

high

Hypothermia

Hypothermia — a core body temperature below 35 degrees Celsius and the staged failure of cardiovascular and neurological function that follows: mild (32 to 35 degrees, conscious and shivering), moderate (28 to 32 degrees, no shivering, Osborne J waves), and severe (below 28 degrees, unconscious, ventricular fibrillation and asystole). The rewarming ladder (passive external, active external with the Bair Hugger, active internal with warmed fluids, and extracorporeal ECMO rewarming); the modified advanced life support (gentle handling, a single shock, adrenaline withheld until the core rises above 30 degrees, prolonged cardiopulmonary resuscitation, and rewarming to at least 32 degrees before death is pronounced); and the prognostication (no one …

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Domain

Imaging choice and radiation risk

1

medium

Imaging choice and radiation risk in the emergency department

Imaging choice and radiation risk — the structured selection of the modality (X-ray, CT, MRI, ultrasound) that answers the clinical question at the lowest risk, governed by ALARA and the linear-no-threshold model. The effective doses (CXR 0.02 mSv, CT head 2 mSv, CT abdomen 10 mSv against a 2–3 mSv/yr background); the stochastic (cancer) and deterministic (skin erythema, cataract, infertility) effects; the four-modality differential with speed, cost, sensitivity and operator-dependence; the pregnancy pathway (ultrasound first, MRI second, CT last, never withhold a life-saving image on dose alone); the contrast risks — iodinated contrast-associated AKI and gadolinium-associated nephrogenic systemic fibrosis with the group I/II/III agent stratification; the appropriateness criteria and the Choosing Wisely do-not list. ACEM-primary, globally tagged.

Open

Domain

Immunocompromised host and febrile neutropenia

1

high

Immunocompromised host and febrile neutropenia

Febrile neutropenia is the oncological emergency defined by an absolute neutrophil count below 0.5 × 10⁹ per litre together with a single oral temperature of 38.3 degrees or higher (or two readings 38.0 degrees or higher an hour apart) in a patient on cytotoxic chemotherapy, with a haematological malignancy, or after stem-cell transplant. It is treated as a time-critical sepsis equivalent: blood cultures first, then empirical broad-spectrum intravenous antibiotic within one hour — piperacillin-tazobactam 4.5 g IV, ceftazidime 2 g IV, meropenem 1 g IV or cefepime 2 g IV; add vancomycin 1.5 g IV for line infection or MRSA; add aciclovir 10 mg/kg IV for HSV or VZV; add caspofungin for suspected fungal infection. The MASCC risk index stratifies the high-risk patient (admitted, intravenous) from the low-risk (may be discharged on oral ciprofloxacin). The differential is tumour lysis syndrome, the transfusion reaction and drug fever. ACEM-primary, globally tagged.

Open

Domain

Infective endocarditis

1

medium

Infective endocarditis (emergency department diagnosis and management)

Infective endocarditis — the Duke diagnostic criteria (the major and the minor, reproduced), the predisposing conditions (the prosthetic valve, the intravenous drug use, the congenital heart disease, the indwelling lines), the clinical presentation (the fever, the new murmur, the embolic and the immunological phenomena), the investigation strategy (the blood cultures before the antibiotics, the echocardiography), the empiric and the targeted antibiotic regimens with doses (the flucloxacillin, the vancomycin, the gentamicin, the rifampicin), the surgical indications, and the antibiotic prophylaxis for the high-risk dental procedures. ACEM-primary, globally tagged.

Open

Domain

Intracerebral haemorrhage

1

high

Intracerebral haemorrhage

Intracerebral haemorrhage is the spontaneous, non-traumatic bleeding into the brain parenchyma, most often from hypertensive small-vessel disease in the deep structures (the putamen, the thalamus, the pons, the cerebellum) or cerebral amyloid angiopathy in the elderly (the lobar haemorrhage). It presents with a sudden focal deficit, headache, vomiting, a depressed conscious level and marked hypertension. The non-contrast CT shows a hyperdense mass with mass effect, midline shift and intraventricular extension, graded by the Graeb score and the ICH score. Management is blood-pressure control to a systolic target of 140 mmHg (labetalol 10 to 20 mg IV or nicardipine 5 to 15 mg/h), urgent reversal of anticoagulation (prothrombin complex concentrate 25 to 50 IU/kg plus vitamin K 10 mg for warfarin; idarucizumab 5 g for dabigatran; andexanet alfa for apixaban or rivaroxaban), intracranial-pressure control (head elevation 30 degrees, mannitol 0.5 g/kg or hypertonic saline 3 per cent 250 mL), and neurosurgical evacuation for a cerebellar haematoma over 3 cm or a deteriorating lobar clot. ACEM-primary, globally tagged.

Open

Domain

Laboratory interpretation (approach)

1

medium

Laboratory interpretation in the emergency department — the systematic high-yield read

The systematic emergency department approach to the high-yield laboratory panel — lactate (sepsis and hypoperfusion), troponin (ACS), lipase (pancreatitis), beta-hCG (pregnancy), D-dimer (PE and DVT), coagulation with INR and bleeding reversal, the venous blood gas, C-reactive protein, and creatine kinase. Covers normal ranges, the critical values that trigger immediate action, clinical correlation, and the true-versus-spurious abnormal. Includes the lab-driven drug doses — calcium gluconate 10 percent 10 mL, insulin-dextrose, four-factor prothrombin complex concentrate 25 to 50 IU per kg, vitamin K 5 to 10 mg. ACEM-primary, globally tagged.

Open

Domain

Limb & extremity trauma

1

medium

Limb and extremity trauma

The limb trauma from the open fracture and the Gustilo classification, the vascular injury and the hard signs, the compartment syndrome, the neurovascular examination, the dislocation reduction, the open-fracture management with the antibiotics and the washout, and the crush injury with the rhabdomyolysis.

Open

Domain

Lower gastrointestinal bleed

1

medium

Lower gastrointestinal bleed

The lower gastrointestinal bleed — the haemorrhage distal to the ligament of Treitz presenting with haematochezia, dominated by the diverticular bleed (the commonest cause), the inflammatory bowel disease, the colorectal cancer, the angiodysplasia and the haemorrhoids. Risk stratification with the Oakland score (a score of 8 or less predicting safe discharge). Localisation with the CT angiography for the unstable patient and the colonoscopy within 24 hours for the stable. Management with the ABCDE, the fluid resuscitation, the restrictive transfusion to a haemoglobin of 70 g/L, the endoscopic therapy (epinephrine injection and clipping), and the superselective mesenteric angiographic embolisation for the ongoing bleed — always excluding the upper source first. ACEM-primary, globally tagged.

Open

Domain

Major trauma resuscitation

1

high

Major trauma resuscitation — the team-based systematic approach

The major trauma resuscitation — the team activation and the structured roles, the primary survey (ABCDE) applied to the multiply-injured patient, the adjuncts (FAST, chest drain, pelvic binder, bloods, imaging), the damage-control resuscitation principles (permissive hypotension, blood-product-first, tranexamic acid), the secondary survey (the head-to-toe after the stabilisation), and the disposition decision. ACEM-primary, globally tagged.

Open

Domain

Mandatory reporting and child protection

1

high

Mandatory reporting and child protection in the emergency department

Mandatory reporting and child protection in the emergency department — recognition of child abuse through the sentinel injuries (bruising in a non-mobile infant, the inconsistent or changing history, delay in presentation, fractures of different ages, the classic metaphyseal lesion and posterior rib fractures, and abusive head trauma with the subdural–retinal–encephalopathy triad), the validated TEN-4-FACESp bruising clinical decision rule (Pierce 2021, sensitivity 95.6 percent), child sexual abuse recognition with the STI screen, the time-windowed forensic examination and post-exposure prophylaxis (ceftriaxone, azithromycin, metronidazole, levonorgestrel, HIV PEP), the differential distinguished from accidental injury, cultural practices and fabricated or induced illness, the mandatory reporting legal duty and its reasonable-belief threshold, the forensic chain of custody, and the safeguarding referral. ACEM-primary, globally tagged.

Open

Domain

Mass-gathering and event medicine

1

low

Mass-gathering and event medicine — PICE classification, casualty prediction and event medical planning

Mass-gathering and event medicine — the provision of healthcare to defined crowds at planned events and the planning required to do it safely. The WHO functional definition of a mass gathering (a crowd with the potential to strain the planning and response resources of the host community; an operational threshold of 1000 or more attendees) and the distinction from a mass casualty incident (the casualty-generating event that shifts the standard of care to the population — the greatest good for the greatest number). The PICE (Potential Injury Creating Event) classification of any event by Type (planned or unplanned, primary or secondary), Category (static or dynamic), Status (controlled or uncontrolled) and Stage (0 to 4 by need for outside aid). The Arbon predictive model for patient presentation rate (PPR 1 to 2 per 1000 attendees, up to 5 per 1000 for high-risk events) and transport to hospital rate (TTHR 5 to 20 per cent). Event archetypes (sport, concert, pilgrimage, festival), the MEDPLAN six-domain medical plan, MIMMS CSCATT command, SALT triage, crowd crush as compressive asphyxia, MDMA-related hyperthermia and hyponatraemia, crush syndrome, and the escalation triggers that convert a mass gathering into a mass casualty incident.

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Domain

Massive haemorrhage & transfusion

1

high

Massive haemorrhage and transfusion

The emergency management of massive haemorrhage through damage-control resuscitation: the massive transfusion protocol with the 1-to-1-to-1 blood-product ratio, the tranexamic acid within three hours, the permissive hypotension and the avoidance of crystalloid, the prevention of the lethal triad of hypothermia, acidosis and coagulopathy, the laboratory and viscoelastic monitoring, the anticoagulation reversal, the transfusion complications, and the specific scenarios.

Open

Domain

Medical error and patient safety

1

high

Medical error and patient safety in the emergency department

Medical error and patient safety in the emergency department — the systems approach via Reason's Swiss cheese model with the distinction between active failures (sharp end) and latent failures (blunt end), the differential of event categories (near miss, no-harm incident, adverse event, sentinel event, never event, negligence), the open disclosure protocol and the statutory duty of candour, incident reporting (what, when and how), the steps of root cause analysis, the common ED errors (diagnostic — missed MI, SAH and AAA; medication — dosing and allergy; procedural), just culture and the Marx algorithm distinguishing human error from reckless conduct, and the second victim. ACEM-primary, globally tagged.

Open

Domain

Meningitis and encephalitis

1

high

Meningitis and encephalitis (emergency department diagnosis and management)

Acute meningitis and encephalitis — the clinical triad (fever, headache, neck stiffness), the petechial rash of meningococcaemia, the empiric regimen (ceftriaxone 2 g IV plus vancomycin plus dexamethasone 10 mg IV, with ampicillin added for listeria in the immunocompromised and over-50), aciclovir 10 mg/kg IV three times daily for HSV encephalitis, the LP timing (antibiotics never delayed for imaging), CSF interpretation (bacterial versus viral versus tuberculous), and the complications (cerebral oedema, seizures, DIC, Waterhouse-Friderichsen). ACEM-primary, globally tagged.

Open

Domain

Myocarditis & pericarditis

1

medium

Myocarditis and pericarditis (the ACS mimic and the positional chest pain)

Myocarditis and pericarditis — the viral or the autoimmune inflammation of the heart muscle and the pericardium, the clinical presentation (the positional and the pleuritic chest pain of the pericarditis; the ACS-mimic and the arrhythmia of the myocarditis), the ECG pattern (the diffuse ST elevation and the PR depression of the pericarditis), the troponin elevation (in both), the management (the NSAID and the colchicine for the pericarditis; the supportive and the heart-failure therapy for the myocarditis), and the fulminant myocarditis needing the mechanical support. ACEM-primary, globally tagged.

Open

Domain

Paediatric emergencies

1

high

Neonatal emergencies (the sick neonate in the emergency department)

Neonatal emergencies are the life-threatening presentations of the first 28 days of life — the well-then-sick neonate who deteriorates as a ductus closes, an infection declares itself, a metabolic pathway fails, or an adrenal enzyme deficit unmasks. The four reversible, time-critical diagnoses are the duct-dependent congenital heart lesion (the hypoplastic left heart, the coarctation, the pulmonary atresia, the tricuspid atresia — collapse at 24 to 72 hours as the ductus arteriosus constricts, reversed by prostaglandin E1 0.01 to 0.05 mcg per kilogram per minute to keep the duct open), the neonatal sepsis (the group B streptococcus, the E. coli, the Listeria — full septic workup of the blood culture, the lumbar puncture and the suprapubic aspirate, then cefotaxime 50 mg per kilogram IV plus ampicillin 50 mg per kilogram IV, with aciclovir 20 mg per kilogram IV added if HSV is suspected), the congenital adrenal hyperplasia salt-wasting crisis (vomiting and dehydration with hyponatraemia and hyperkalaemia at one to two weeks, reversed by hydrocortisone 25 mg IV), and the neonatal seizure (the hypoglycaemia, the hypocalcaemia, the meningitis). The Fellowship candidate must recognise the sick neonate, start the specific therapy on suspicion rather than waiting for transfer, and pre-empt the side effects — the prostaglandin apnoea above all.

Open

Domain

Non-invasive ventilation

1

medium

Non-invasive ventilation in the emergency department (CPAP and BiPAP)

Non-invasive ventilation — the CPAP (continuous) and the BiPAP (bilevel), the evidence-based indications (the COPD type 2 acidosis and the cardiogenic pulmonary oedema — the two strongest), the contraindications (the unprotected airway, the cardiac arrest), the settings (IPAP 12 to 20, EPAP 4 to 6 for the BiPAP; 5 to 10 cm water for the CPAP), the monitoring, the failure-to-respond escalation to the intubation, and the palliative NIV. ACEM-primary, globally tagged.

Open

Domain

Oxygen therapy & acute respiratory failure

1

high

Oxygen therapy and acute respiratory failure

The physiology of oxygenation and the oxyhaemoglobin dissociation curve, the five mechanisms of hypoxaemia, the two types of respiratory failure, the oxygen-delivery devices and the precise FiO2 each delivers, target saturations and titration, the mechanism of oxygen-induced hypercapnia in COPD, high-flow nasal cannula and the ROX index, the hazards of hyperoxia and the IOTA, AVOID, DETO2X and SO2S trial evidence, oxygen in cardiac arrest and carbon monoxide poisoning, and a structured approach to the hypoxaemic patient.

Open

Domain

Paediatric abdominal emergencies

1

medium

Paediatric abdominal emergencies — intussusception, volvulus, appendicitis and pyloric stenosis

Paediatric abdominal emergencies — the four surgical conditions an ACEM Fellow must distinguish at the bedside: intussusception (3 months to 2 years, intermittent colicky pain with drawing up of the legs, a palpable sausage-shaped RUQ mass and redcurrant-jelly stool as a late sign, ultrasound target/donut sign, pneumatic or ultrasound-guided enema reduction with 80 to 90 per cent success and approximately 10 per cent recurrence), midgut volvulus from malrotation (bilious vomiting in the newborn and infant, never normal, upper GI contrast or ultrasound whirlpool sign, the time-critical Ladd procedure), atypical paediatric appendicitis (diffuse pain and diarrhoea in the under-5, over 50 per cent perforation at presentation, the Samuel Pediatric Appendicitis Score reproduced, ultrasound first), and infantile hypertrophic pyloric stenosis (projectile non-bilious vomiting at 3 to 6 weeks, palpable olive, hypochloraemic hypokalaemic metabolic alkalosis with paradoxical aciduria, correct chemistry before Ramstedt pyloromyotomy). Common management thread — weight-based 0.9 per cent saline plus KCl, nasogastric decompression, surgical referral — distinguished from the medical mimics of constipation, UTI and mesenteric adenitis. ACEM-primary, globally tagged.

Open

Domain

Paediatric fever and serious bacterial illness

1

high

Paediatric fever and serious bacterial illness (the febrile child in the emergency department)

The febrile child — the NICE traffic-light system (green low risk, amber intermediate, red high risk), the identification of the serious bacterial illness (the urinary tract infection, the pneumonia, the meningitis, the sepsis, the osteomyelitis, the septic arthritis), and the approach by age: the neonate under 28 days (full septic workup, admit, intravenous cefotaxime plus ampicillin), the infant 1 to 3 months (septic workup if unwell, ceftriaxone 50 mg per kilogram if serious bacterial illness suspected), the child over 3 months (focused assessment, the urine, the chest X-ray). The drug doses (ceftriaxone 50 mg per kilogram IV, cefotaxime 50 mg per kilogram IV, ampicillin 50 mg per kilogram IV, paracetamol 15 mg per kilogram) and the differential (the viral illness, the roseola, the Kawasaki disease). ACEM-primary, globally tagged.

Open

Domain

Paediatric fluid and electrolyte management

1

medium

Paediatric fluid and electrolyte management

Paediatric fluid and electrolyte management is four prescriptions held in one hand: maintenance, deficit, ongoing-loss, and the sodium-correction rate. Maintenance is the Holliday-Segar formula (100 mL/kg/day for the first 10 kg plus 50 mL/kg/day for the next 10 kg plus 20 mL/kg/day for each kg above 20), given as an isotonic solution to prevent hospital-acquired hyponatraemia. Dehydration is graded mild 5 per cent, moderate 10 per cent and severe 15 per cent, and the route follows the grade: oral rehydration solution first for mild-to-moderate, intravenous for shock. The shock bolus is 20 mL/kg of isotonic crystalloid, reassessed and repeated to 60 mL/kg, then an inotrope. The sodium is corrected slowly — under 8 mmol/L per 24 hours for hyponatraemia and under 10 to 12 mmol/L per 24 hours for hypernatraemia — to avoid osmotic demyelination and cerebral oedema. Paediatric DKA fluid is distinct: a 10 mL/kg bolus only if genuinely shocked, then 0.9 per cent saline with potassium chloride over 48 hours, with insulin started after the fluid. ACEM-primary, globally tagged.

Open

Domain

Paediatric rashes and febrile illness

1

medium

Paediatric rashes and febrile illness

The febrile child with a rash is a high-stakes presentation because a small number of rashes signal time-critical disease while the majority are benign viral exanthems. The Fellowship candidate must read rash morphology first: a non-blanching petechial or purpuric rash with fever is meningococcal septicaemia until proven otherwise and earns ceftriaxone 50 mg per kilogram intravenously immediately, while a fever of five days or more with bilateral non-purulent conjunctivitis, a polymorphous rash, a strawberry tongue and swollen hands is Kawasaki disease, treated with intravenous immunoglobulin 2 g per kilogram and aspirin within ten days of fever onset to prevent coronary artery aneurysm. Measles descends from the hairline after a prodrome of fever, coryza, cough and conjunctivitis with Koplik spots; chickenpox is a vesicular rash in crops at different stages; erythema multiforme is a target rash with at most one mucosal site; and Henoch-Schonlein purpura is a palpable purpura on the lower limbs with abdominal pain, arthritis and renal involvement. The differential is the viral exanthem, the drug reaction and the autoimmune vasculitis, distinguished by morphology, tempo, distribution and toxicity. ACEM-primary, globally tagged.

Open

Domain

Paediatric respiratory distress

1

high

Paediatric respiratory distress — croup, bronchiolitis and acute asthma

Paediatric respiratory distress — the three exam pillars of croup (subglottic viral oedema, inspiratory stridor, barking cough, dexamethasone 0.15 mg/kg orally with nebulised adrenaline 1:1000 at 0.5 mL/kg max 5 mL for moderate to severe), bronchiolitis (RSV bronchiolar obstruction, wheeze, hypoxia, supportive care with no routine bronchodilator or steroid), and acute asthma (salbutamol 2.5 to 5 mg nebulised, ipratropium, early steroid, magnesium sulfate 40 mg/kg), distinguished from the can't-miss mimics of foreign body aspiration, epiglottitis and bacterial tracheitis. The Poiseuille r-to-the-fourth rationale, the Westley croup score reproduced, weight-based dosing before any drug, and the escalation ladder from humidified oxygen through high-flow and non-invasive ventilation to intubation. ACEM-primary, globally tagged.

Open

Domain

Paediatric sepsis and septic shock

1

high

Paediatric sepsis and septic shock (the septic child in the emergency department)

Paediatric sepsis is the dysregulated host response to infection producing life-threatening organ dysfunction, now defined (2024 Phoenix criteria) as suspected infection plus a Phoenix Sepsis Score of 2 or more, with septic shock adding cardiovascular dysfunction. The Fellowship-critical recognition rests on age-specific physiological thresholds — the tachycardia, the tachypnoea, and the hypotension that is systolic below 70 plus 2 times the age in years for a child under 10 and below 90 for a child over 10 — and on the perfusion signs of mottled skin, a capillary refill over 3 seconds and an altered mental state. The management is the first-hour bundle: fluid boluses of 10 to 20 mL per kilogram of balanced crystalloid (titrated, up to 40 to 60 mL per kilogram), early intravenous antibiotics within the hour (ceftriaxone 50 to 75 mg per kilogram; cefotaxime plus ampicillin in the neonate), vasopressors (adrenaline 0.05 to 0.5 mcg per kilogram per minute for cold shock), and intubation for refractory shock. Children differ from adults in the weight-based dosing, the higher heart-rate thresholds and the earlier need for intubation. The differential is meningococcaemia, Kawasaki disease and the serious bacterial illnesses. ACEM-primary, globally tagged.

Open

Domain

Paediatric trauma

1

high

Paediatric trauma — the modified approach

Paediatric trauma — the different injury patterns (the larger head, the compliant chest, the less-protected abdominal organs), the physiological differences (the smaller blood volume, the faster desaturation, the higher surface-area-to-mass), the weight-based drug dosing (the Broselow tape, the formula weight equals age plus 4 times 2), the paediatric assessment triangle, the fluid bolus of 10 to 20 mL per kilogram, and the non-accidental injury consideration. ACEM-primary, globally tagged.

Open

Domain

Paracetamol poisoning

1

high

Paracetamol poisoning

Paracetamol (acetaminophen) overdose — the commonest cause of acute liver failure in the developed world, and a self-poisoning that is silent in the first 24 hours. The mechanism (the CYP2E1 oxidation to NAPQI, the glutathione depletion, the zone-3 centrilobular necrosis), the time-critical Rumack-Matthew nomogram (the paracetamol level drawn at 4 hours post-ingestion), the antidote (N-acetylcysteine — 150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours, 300 mg/kg over 21 hours), the indications (any level above the treatment line, unknown time with a detectable level, the staggered overdose, the late presentation with hepatic injury), the King's College criteria for transplantation, and the principles of treating the established acute liver failure. ACEM-primary, globally tagged.

Open

Domain

ED systems, safety and professional

2

high

Patient disposition and safety-netting in the emergency department

Patient disposition and safety-netting in the emergency department — the decision that governs where a patient goes after ED assessment: discharge, observation or short-stay unit, or inpatient admission (ward, HDU, ICU, theatre). The decision rests on four pillars (physiological stability, diagnostic certainty, therapeutic completeness, and social or support capacity), and is applied through the admission criteria (physiological instability, uncontrolled pain, an abnormal investigation needing action, and social factors) and the discharge criteria (stable observations, controlled symptoms, a clear diagnosis or documented plan, and follow-up arranged). The observation or short-stay unit is defined as protocol-driven short-duration care for the patient who is not yet safe for discharge but does not need inpatient admission. Safety-net advice is made adequate by being specific, written, condition-based, and accompanied by a plan and a check of understanding. The differential running through every decision is the patient who should not be discharged — the masked high-risk diagnosis, the frail elder, the socially isolated, the patient whose observations have not normalised, and the patient who cannot comply with the safety-net advice. ACEM-primary, globally tagged.

Open

medium

Retrieval and inter-hospital transfer

Retrieval and inter-hospital transfer is the structured process of moving a patient between facilities (or from scene to facility) to deliver a level or type of care the referring site cannot provide. The decision rests on three transfer types — time-critical (STEMI door-to-balloon, stroke thrombolysis and thrombectomy windows), specialist (trauma, burns, neurosurgery, paediatric, neonatal, ECMO), and repatriation — each with its own urgency, mode, and team. Pre-transfer packaging converts an unsafe move into a safe one: secure the airway (RSI before transfer for the patient with GCS 8 or less), secure the lines (two large-bore IVs, an arterial line, central access for the unstable), secure the monitors (ECG, SpO2, NIBP, capnography), secure the ventilation (mechanical ventilator with set parameters), and secure the sedation (morphine 2.5 mg with midazolam 2.5 mg, titrated). Mode — road, fixed-wing, or rotary — is chosen on distance, physiology, weather, and the time-versus-stability trade-off. Team composition (physician-staffed versus paramedic/nurse) is matched to the predicted deterioration risk. The governing differential is the decision itself: stay-and-play (resuscitate to stability first) versus scoop-and-run (load and go, manage on the move), with the time-critical bypass (direct to PCI, to thrombolysis, to a trauma centre) as the third path. Transport-related deterioration — hypoxia, hypotension, hypothermia, gas expansion at altitude, line and tube loss, undetected desaturation — is the central risk, and the discipline is to minimise it by preparation, not improvisation. ACEM-primary, globally tagged.

Open

Domain

Pelvic inflammatory disease

1

medium

Pelvic inflammatory disease

Pelvic inflammatory disease is the ascending infection of the upper female genital tract — endometritis progressing to salpingitis, oophoritis, parametritis and sometimes a tubo-ovarian abscess. It is a clinical syndrome with polymicrobial aetiology (Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, anaerobes and bacterial-vaginosis-associated organisms). The Fellowship candidate must hold the clinical diagnosis (the minimum CDC criteria of cervical motion, uterine or adnexal tenderness, sharpened by fever, discharge and raised inflammatory markers), the mandatory beta-hCG to exclude ectopic pregnancy, the outpatient and inpatient antibiotic regimens, the admission criteria, the tubo-ovarian abscess pathway, the partner treatment, and the 72-hour review — and must never forget the long-term sequelae of tubal infertility, ectopic pregnancy and chronic pelvic pain. ACEM-primary, globally tagged.

Open

Domain

Pelvic trauma

1

high

Pelvic trauma

The pelvic ring fracture and its life-threatening haemorrhage: the Young and Burgess classification, the pelvic binder at the greater trochanters, the FAST and the CT angiogram, the angiographic embolisation, the external fixation and the pelvic packing, the REBOA, and the associated injuries of the bladder, the urethra and the rectum.

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Domain

Perforated viscus

1

high

Perforated viscus

Perforated viscus — the full-thickness breach of a hollow abdominal organ releasing gas and contents into the peritoneal cavity, the perforated peptic ulcer (the sudden severe epigastric pain, the rigid abdomen, the free gas under the diaphragm on the erect CXR), the perforated appendix (the localised right lower quadrant peritonitis), the perforated diverticulum (the Hartmann procedure), the perforated colon (the colorectal cancer, the colitis). The management is the NBM, the NG tube, the IV fluid resuscitation, the broad-spectrum antibiotics (the piperacillin-tazobactam 4.5 g IV or the ceftriaxone 2 g IV plus the metronidazole 500 mg IV), the morphine 5 mg IV, the urgent surgical referral and the laparotomy for the generalised peritonitis. The erect CXR (the free gas under the diaphragm, the sensitivity about 70 per cent), the CT (the definitive test — the free gas, the free fluid, the site of the perforation). The differential — the acute pancreatitis, the mesenteric ischaemia, the ruptured AAA, the inferior MI. ACEM-primary, globally tagged.

Open

Domain

Peri-arrest arrhythmias

1

high

Peri-arrest arrhythmias

The peri-arrest arrhythmia algorithms: the stable-versus-unstable and broad-versus-narrow framework, the bradycardia and the tachycardia pathways, synchronised cardioversion versus defibrillation, the broad-complex VT and the torsades-with-magnesium, the narrow-complex SVT with adenosine, atrial fibrillation, the pre-excited AF trap, the peri-arrest drugs, and the electrolyte and reversible drivers.

Open

Domain

Pericardial tamponade

1

high

Pericardial tamponade

Pericardial tamponade — the Beck triad of hypotension, a raised jugular venous pressure and muffled heart sounds, the preload-limited diastolic pathophysiology (why a nitrate or a diuretic collapses the output and a fluid bolus temporises), the bedside echocardiogram as the diagnostic test, the drainage decision (echo-guided pericardiocentesis for the medical tamponade, a resuscitative thoracotomy for the traumatic clotted tamponade, surgery for the aortic-dissection tamponade), and the pulsus paradoxus. ACEM-primary, globally tagged.

Open

Domain

Pleural effusion

1

medium

Pleural effusion (the emergency department workup and the Light criteria)

Pleural effusion — the transudate-versus-exudate distinction by the Light criteria (the pleural fluid to serum protein ratio over 0.5, the LDH ratio over 0.6, the pleural fluid LDH over two-thirds the upper limit of normal), the causes (the heart failure, the pneumonia, the malignancy, the PE), the diagnostic approach (the chest radiograph, the ultrasound, the pleural fluid analysis), the management (the treat-the-cause, the therapeutic drainage, the chest drain for the empyema), and the parapneumonic effusion and the empyema. ACEM-primary, globally tagged.

Open

Domain

Pneumothorax

1

high

Pneumothorax (including tension pneumothorax)

Pneumothorax — primary and secondary spontaneous, traumatic, iatrogenic, and tension. The one-way-valve pathophysiology of tension and why it kills, the clinical (not radiological) diagnosis of tension, the 5th-intercostal-space decompression site, the size-based management of a spontaneous pneumothorax (observe, aspirate, drain), the chest-drain landmarks and the underwater seal, the re-expansion-oedema pitfall, and the bulla-mimic trap. ACEM-primary, globally tagged.

Open

Domain

Geriatric and medication-safety emergencies

1

medium

Polypharmacy and adverse drug events

Polypharmacy and adverse drug events — the emergency presentation of medication harm in the older patient on five or more regular medicines, driven by the high-risk drug classes (anticoagulants, antiplatelets, insulin, sulfonylureas, opioids, benzodiazepines, antipsychotics, anticholinergics, NSAIDs), the pharmacology of ageing that amplifies each drug's effect, the ADE syndromes (falls, bleeding, hypoglycaemia, delirium, acute kidney injury) mapped to the culprit class, the screening tools (STOPP/START v2 and the 2023 AGS Beers criteria), the best possible medication history and seven-step reconciliation, and the deprescribing ladder (Scott — ascertain indications, weigh harm against benefit, rank, taper and cease with monitoring, document and…

Open

Domain

Post-cardiac arrest care

1

medium

Post-cardiac-arrest care

The post-ROSC bundle that determines neurological survival: the oxygen and the carbon-dioxide targets, the circulation and the reperfusion, the targeted-temperature evidence (TTM2: normothermia over hypothermia), the seizure and glucose control, the identification and treatment of the cause, the avoidance of the secondary brain injuries, and the multimodal deferred prognostication.

Open

Domain

Postpartum haemorrhage

1

high

Postpartum haemorrhage

The postpartum haemorrhage — the primary PPH (the blood loss over 500 mL within the 24 hours of the delivery, or the over 1000 mL after the Caesarean) and the secondary PPH (the bleeding from the 24 hours to the 12 weeks postpartum). The four Ts of the cause (the Tone — the uterine atony, the commonest at 70 per cent; the Trauma — the vaginal or the cervical tear; the Tissue — the retained products; the Thrombin — the coagulopathy). The management: the ABCDE, the two large-bore cannulae, the crossmatch 4 units, the fluid resuscitation, the uterotonics (the oxytocin 10 IU IM or 5 IU IV, the ergometrine 500 mcg IM — avoid in the hypertension; the carboprost 250 mcg IM every 15 minutes up to 8 doses — avoid in the asthma; the misoprostol 800 mcg per rectum), the tranexamic acid 1 g IV, the Bakri balloon, the bimanual compression, the surgical ligation, the hysterectomy for the refractory. ACEM-primary, globally tagged.

Open

Domain

Pulmonary embolism

1

high

Pulmonary embolism (acute, in the emergency department)

Acute pulmonary embolism — the PE–DVT continuum and the Virchow risk factors, the right-ventricular-afterload pathophysiology that kills in massive PE, the Wells and PERC risk-stratification tools, the workup (D-dimer, CTPA, V/Q, echo, ECG), the risk-tiered management (massive PE with shock to thrombolysis or embolectomy; submassive and low-risk to anticoagulation with a DOAC), the cautious-fluids-in-shock rule, and the pregnancy pathway. ACEM-primary, globally tagged.

Open

Domain

Pulmonary oedema

1

high

Pulmonary oedema

The pulmonary oedema from the fluid in the alveolar interstitium through the CARDIOGENIC (the raised pulmonary capillary pressure from the left ventricular failure — the ischaemia and the MI, the hypertensive crisis, the arrhythmia, the valve, the cardiomyopathy) distinguished from the NON-CARDIOGENIC (the ARDS, the increased permeability), the flash pulmonary oedema, the presentation (the dyspnoea, the orthopnoea, the frothy pink sputum, the bilateral crackles, the cardiac asthma), and the management (the upright position, the high-flow oxygen and the CPAP, the IV GTN, the IV furosemide, and the treat-the-cause).

Open

Domain

Quality and ED metrics

1

medium

Quality and ED metrics — performance measurement, the four-hour target and quality improvement

Quality and emergency department metrics — the Donabedian structure-process-outcome framework; the National Emergency Access Target (NEAT), the four-hour rule requiring 90 per cent of ED presentations discharged or admitted within four hours; the core ED metrics of time-to-treatment (door-to-doctor, door-to-ECG, door-to-antibiotic, door-to-needle), admission rate, LWBS (left without being seen) rate and mortality; access block (length of stay greater than eight hours for an admitted patient) and overcrowding as the dominant drivers of metric failure and excess mortality (Sprivulis, Guttmann, Howlett, Nicolaidis); the differential of drivers of access block (input, throughput and output factors); quality improvement methodology — Plan-Do-Study-Act, run charts with the probability-based rules for special-cause variation, statistical process control (SPC) Shewhart charts distinguishing common-cause from special-cause variation, and benchmarking against peer departments; and the unintended consequences of the target — gaming, premature discharge and short-stay-unit inflation. ACEM-primary, globally tagged.

Open

Domain

Radiation and chemical exposure

1

low

Radiation and chemical exposure

Radiation and chemical exposure — the receiving-hospital side of a CBRN incident. The topic pairs two threats the Fellowship candidate must hold together: ionizing radiation, whose whole-body dose produces the acute radiation syndrome (prodromal nausea and vomiting within hours, marrow suppression and pancytopenia over days to weeks, cutaneous burns), and the chemical warfare and industrial agents — nerve agents that inhibit acetylcholinesterase, the vesicant sulfur mustard, and cyanide. The single most tested decision is decontamination before any casualty crosses the emergency-department threshold: remove the clothing to clear the majority of the contaminant, shower with water and soap, contain the runoff, and protect the staff in personal protective equipment. The antidotes are narrow and must be named with dose and route — atropine 2 mg and pralidoxime 30 mg per kilogram for the nerve agent, hydroxocobalamin 5 g for cyanide, and no antidote at all for mustard, where decontamination and supportive burns care are everything. ACEM-primary, globally tagged.

Open

Domain

Raised intracranial pressure

1

medium

Raised intracranial pressure

Raised intracranial pressure is the syndrome of the cranial contents exceeding the compensatory reserve of the rigid skull — the Monro-Kelly doctrine and the compliance curve, the cerebral perfusion pressure equation (CPP = MAP minus ICP), the Cushing triad as a late pre-terminal sign, the herniation syndromes (uncal, central, tonsillar), the emergency management ladder (head elevation, osmotherapy with mannitol 0.5 g per kg or hypertonic saline 3 per cent 250 mL, transient hyperventilation to PaCO2 35, neurosurgery), the LP-before-CT contraindication, and the no-steroids-in-trauma rule. ACEM-primary, globally tagged.

Open

Domain

Recognition of deterioration (track and trigger)

1

high

Recognition of deterioration: track-and-trigger and early-warning scores

Recognising the deteriorating patient before arrest: the antecedents of in-hospital cardiac arrest, the physiology of compensation and decompensation, the three types of track-and-trigger system, and the National Early Warning Score 2 (NEWS2) — its parameters, scoring bands and escalation thresholds — with the evidence base, the afferent/efferent-limb failure modes, and regional systems (NEWS2 UK, Between the Flags ANZ).

Open

Domain

Red-flag headache

1

high

Red-flag headache (approach)

The red-flag headache approach — the structured identification of the dangerous secondary causes of the headache (the SNNOOPS/SNNOPT10 mnemonic); the thunderclap (the SAH), the fever and the neck stiffness (the meningitis), the age over 50 (the giant cell arteritis), the papilloedema (the idiopathic intracranial hypertension or the tumour), the positional (the low-CSF-pressure or the venous sinus thrombosis), the visual change (the angle-closure glaucoma); the diagnostic pathway (the CT, the LP, the ESR, the CRP); and the management of the specific cause. ACEM-primary, globally tagged.

Open

Domain

Renal colic and nephrolithiasis

1

medium

Renal colic and nephrolithiasis

Renal colic — the acute ureteric obstruction by a stone producing severe colicky flank pain radiating to the groin, with nausea, vomiting and haematuria; investigated by urinalysis, urine culture, U&E and creatinine, and CT KUB (the gold standard), with ultrasound reserved for pregnancy, children and recurrent known stone-formers; managed with diclofenac 75 mg IM (NSAID first-line) and morphine 5 mg IV for refractory pain, an antiemetic, medical expulsive therapy (tamsulosin 0.4 mg nocte for distal stones 5 to 10 mm), a stone filter and outpatient urology follow-up — with the infected obstructed system (pyonephrosis) distinguished as the urological emergency needing urgent decompression by ureteric stent or percutaneous nephrostomy and intravenous antibiotics. ACEM-primary, globally tagged.

Open

Domain

Research, EBM and biostatistics

1

medium

Research, evidence-based medicine and biostatistics — appraising and applying evidence at the bedside

Research, evidence-based medicine and biostatistics — Sackett's definition of evidence-based medicine as the integration of best research evidence, clinical expertise and patient values; the hierarchy of evidence from meta-analysis and systematic review through randomised controlled trial, cohort, case-control, cross-sectional and ecological designs down to case series and expert opinion; formulating the focused clinical question with PICO (Population, Intervention, Comparator, Outcome); the three-question critical appraisal of validity, results and applicability; the measures of treatment effect — absolute and relative risk reduction, number needed to treat and to harm (NNT and NNH, Laupacis); the measures of diagnostic test performance — sensitivity, specificity, predictive values and likelihood ratios (Jaeschke); statistical inference — confidence intervals, p-values, type I and type II errors and power; synthesis of evidence in meta-analysis with heterogeneity (I-squared, Higgins), forest and funnel plots and publication bias; grading the body of evidence with GRADE and the risk-of-bias tools (Cochrane RoB 2, ROBINS-I) and the reporting guidelines (CONSORT, PRISMA, STROBE, QUADAS-2); and the differential of good versus poor quality evidence. ACEM-primary, globally tagged.

Open

Domain

Respiratory failure (type 1 & 2)

1

high

Respiratory failure (type 1 and type 2)

Respiratory failure — the type 1 (hypoxaemic) and type 2 (hypercapnic) classification from the arterial blood gas, the oxygen targets (94 to 98 per cent for most, 88 to 92 per cent for the CO2 retainer), the oxygen device ladder with inspired fractions, the mechanism by which excess oxygen worsens the CO2 (the Haldane effect and the loss of hypoxic pulmonary vasoconstriction), and the escalation to non-invasive ventilation (BiPAP for type 2, CPAP for type 1 pulmonary oedema) and invasive ventilation. ACEM-primary, globally tagged.

Open

Domain

Resuscitation team leadership & CRM

1

medium

Resuscitation team leadership and crisis resource management

The non-technical skills of the resuscitation: crisis resource management, the allocated team roles, the standing-back team leader, the closed-loop communication and the structured handover, the fixation error and the cognitive biases, the checklist and the cognitive aids, the simulation training, the debrief, and the human factors of fatigue and hierarchy.

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Domain

Rural & retrieval trauma

1

low

Rural and retrieval trauma

The rural and retrieval trauma: the challenges of the remote setting, the prolonged time to the definitive care, the aeromedical retrieval principles, the damage control at the rural hospital, the telemedicine and the clinical decision-making, and the system design.

Open

Domain

Secondary survey

1

high

Secondary survey

The ATLS secondary survey — the head-to-toe examination of the stable trauma patient, the AMPLE history, the clinical decision rules for the head CT (the Canadian CT Head Rule) and the cervical spine clearance (the NEXUS and the Canadian C-Spine Rule), the special investigations (the FAST and eFAST, the whole-body CT, the pelvic film), the tertiary survey and the continuous re-evaluation for the missed injury.

Open

Domain

Seizures and first fit

1

high

Seizures and the first fit

The first seizure in the emergency department — the operational definition (an epileptic seizure, ILAE 2014 definition of epilepsy: two unprovoked seizures over 24 hours apart, or one unprovoked seizure with at least 60 per cent recurrence risk over 10 years), the provoked versus unprovoked distinction that drives every downstream decision, the workup (capillary glucose, sodium, calcium, magnesium, toxicology, ECG, beta-hCG, non-contrast CT, lumbar puncture if fever, EEG within 24 to 72 hours, outpatient MRI), the management (ABCDE, a benzodiazepine only if ongoing or recurrent, admission if first seizure with abnormal neurology or recurrent in the department, antiepileptic drug initiation based on recurrence risk with levetiracetam preferred and valproate avoided in women of childbearing potential), the recurrence prognosis (about a third recur at two years, higher with an abnormal EEG, an imaging lesion, a nocturnal seizure or a prior neurological insult), the differential (syncope, psychogenic non-epileptic seizure, hypoglycaemia, TIA, Todd paresis), and the driving restrictions (Austroads: 6 months off a private licence after a first unprovoked seizure, 12 months for established epilepsy, 5 to 10 years commercial). ACEM-primary, globally tagged.

Open

Domain

Sepsis and septic shock (approach)

1

high

Sepsis and septic shock — the emergency department approach

Sepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection, defined by Sepsis-3 as suspected infection with an acute rise in the SOFA score of 2 or more, and septic shock as sepsis requiring vasopressors to hold a mean arterial pressure of 65 or above with a serum lactate over 2 mmol per litre despite adequate fluid. The emergency department approach rests on the qSOFA prompt (a respiratory rate of 22 or above, an altered mentation, a systolic blood pressure of 100 or below) and delivers the Surviving Sepsis Campaign Hour-1 bundle — the lactate, the blood cultures before the antibiotic, the broad-spectrum antibiotics (ceftriaxone 2 g IV, piperacillin-tazobactam 4.5 g IV, meropenem 1 g IV; vancomycin 1.5 g IV for MRSA; metronidazole 500 mg IV for anaerobic cover), the 30 mL per kilogram crystalloid, and the early vasopressor for a mean arterial pressure below 65 — followed by the lactate-guided resuscitation and the source control. The differential is the other shock states and the SIRS mimics. ACEM-primary, globally tagged.

Open

Domain

Septic shock in the ED

1

high

Septic shock in the emergency department

Septic shock as infection complicated by a dysregulated host response and circulatory failure: the Sepsis-3 definitions and qSOFA, the pathophysiology, the time-critical principle, the Surviving Sepsis Hour-1 bundle, antibiotics and fluids and vasopressors, the MAP target, adjunctive corticosteroids and source control, the evolution from early goal-directed therapy, the endpoints of resuscitation, and the pitfalls.

Open

Domain

Sexual assault and intimate partner violence

1

high

Sexual assault and intimate partner violence in the emergency department

Sexual assault and intimate partner violence in the emergency department — the trauma-informed approach that governs the entire encounter, the patient-centred consent that runs throughout, the time-windowed forensic examination (the sexual assault kit and the chain of custody within 72 hours), the STI prophylaxis (ceftriaxone 500 mg IM, azithromycin 1 g PO, metronidazole 2 g PO), the HIV post-exposure prophylaxis within 72 hours, and the emergency contraception (levonorgestrel 1.5 mg PO or ulipristal 30 mg PO), the safety assessment and safety planning, the mandatory reporting considerations, and the differential distinguished from intimate partner violence. ACEM-primary, globally tagged.

Open

Domain

Shock

1

high

Shock states — the recognition and the approach

Shock — the definition (the inadequate tissue perfusion and the cellular hypoxia); the four patterns by the haemodynamics (the hypovolaemic, the distributive, the cardiogenic, the obstructive); the compensated vs the decompensated phases; the clinical signs (the compensatory tachycardia, the vasoconstriction, the tachypnoea that precede the hypotension); the lactate as the occult-shock marker; the bedside ultrasound (the IVC, the cardiac); and the management framework (the treat-the-cause, the fluid, the vasopressor, the transfusion, the targets). ACEM-primary, globally tagged.

Open

Domain

Haematology and general medical emergencies

1

medium

Sickle cell crisis

Sickle cell crisis is the umbrella for the acute, life-threatening events of sickle cell disease (HbS disease): the vaso-occlusive pain crisis, acute chest syndrome, splenic sequestration crisis and aplastic crisis. The Fellowship-critical syndromes are acute chest syndrome — fever with a new pulmonary infiltrate and hypoxia, the leading cause of death in sickle cell disease — and the rapidly fatal childhood splenic sequestration. The management backbone is oxygen, cautious isotonic hydration, and prompt opioid analgesia (morphine 0.1 mg/kg intravenously), with exchange transfusion to reduce the HbS fraction below 30 per cent for the severe acute chest syndrome, stroke and refractory vaso-occlusive crisis. The reticulocyte count is the diagnostic discriminator: it is high in the vaso-occlusive, sequestration and haemolytic crises but absent in the parvovirus B19 aplastic crisis. ACEM-primary, globally tagged.

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Domain

Spinal cord compression

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Spinal cord compression

Spinal cord compression — the time-critical neurological emergency from the extrinsic compression of the spinal cord by the tumour, the disc, the abscess or the haematoma; the clinical (the progressive back pain, the motor weakness, the sensory level, the bladder and bowel dysfunction); the urgent MRI whole spine within 4 to 6 hours; the dexamethasone 10 mg IV loading then 4 mg every 6 hours; the neurosurgical and the oncological referral; and the time-to-treatment determining the ambulatory outcome. ACEM-primary, globally tagged.

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Domain

Status epilepticus

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high

Status epilepticus

Status epilepticus — a continuous seizure lasting over 5 minutes, or recurrent seizures without recovery of consciousness, stratified into early (0-5 min), established (5-30 min) and refractory (over 30 min) phases, managed up a pharmacological ladder of benzodiazepine (lorazepam 4 mg IV or midazolam 10 mg IM), then a second-line anti-seizure medication (fosphenytoin 20 mg PE/kg, levetiracetam 60 mg/kg, valproate 30 mg/kg), then anaesthetic infusion (propofol, midazolam, thiopentone) for refractory disease. The causes (non-compliance, alcohol withdrawal, intracranial pathology, metabolic), the airway (recovery position, oxygen, intubation for refractory), and the complications (hypoxia, aspiration, rhabdomyolysis, hyperthermia). ACEM-primary, globally tagged.

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Domain

Subarachnoid haemorrhage

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high

Subarachnoid haemorrhage

Subarachnoid haemorrhage — the non-traumatic bleeding into the subarachnoid space, usually from a ruptured intracranial aneurysm; the thunderclap headache (the worst headache of my life, the maximal intensity within seconds to minutes); the CT sensitivity (98 per cent within 6 hours), the lumbar puncture for the xanthochromia if the CT is negative or the presentation is delayed; the nimodipine 60 mg every 4 hours for the vasospasm prophylaxis; the BP control; the aneurysm securing by the endovascular coiling or the surgical clipping; and the complications (the rebleeding, the vasospasm at day 4 to 14, the hydrocephalus, the hyponatraemia). ACEM-primary, globally tagged.

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Domain

Subdural and extradural haematoma

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high

Subdural and extradural haematoma

Subdural and extradural haematoma — the two extra-axial traumatic collections distinguished by anatomy, source, and tempo. Extradural (epidural) haematoma: arterial bleed from the middle meningeal artery after a temporal fracture, the lentiform biconvex shape on CT, the lucid interval, the young trauma patient, the urgent craniotomy. Acute subdural haematoma: venous bridging-vein or cortical bleed, the crescent shape crossing sutures, the elderly and anticoagulated patient, the craniotomy. Chronic subdural: the insidious cognitive decline in the atrophic elderly brain, the burr-hole evacuation. Management: ABCDE, ICP control (mannitol 0.5 g per kg, head up 30 degrees, hypertonic saline 3 per cent 250 mL), urgent neurosurgical referral, and early reversal of anticoagulation. Differential: subarachnoid, contusion, tumour. ACEM-primary, globally tagged.

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Syncope (approach)

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Syncope — the emergency department approach and risk stratification

Syncope — the transient loss of consciousness from the cerebral hypoperfusion, the classification (the reflex, the orthostatic, the cardiac, the cerebrovascular), the critical cardiac-versus-non-cardiac distinction, the San Francisco Syncope Rule for the risk stratification, the ESC high-risk features, the investigation strategy (the ECG, the glucose, the bedside echo), the management (the treat-the-cause, the admission for the high-risk, the discharge with the advice for the low-risk), and the syncope-versus-seizure differential. ACEM-primary, globally tagged.

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Domain

Tachyarrhythmias

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Tachyarrhythmias in the emergency department

The ED tachyarrhythmias — the stability-first algorithm, the narrow-versus-broad-complex (QRS 120 ms) decision, the management of a regular narrow-complex SVT (vagal manoeuvres then adenosine 6-12-12 mg), a regular broad-complex rhythm assumed ventricular until proven otherwise (amiodarone if stable, cardioversion if unstable), atrial fibrillation, and the dangerous contraindication of atrioventricular-node blockers in pre-excited AF (Wolff-Parkinson-White). ACEM-primary, globally tagged.

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Teaching, supervision and feedback

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Teaching, supervision and feedback in the emergency department

Teaching, supervision and feedback in the emergency department — the clinical teacher’s core toolkit and the Fellowship Scholar domain. Bedside teaching models: the one-minute preceptor and Neher’s five microskills (get a commitment, probe the evidence, teach a general rule, reinforce what was right, correct errors), SNAPPS (Summarise, Narrow the differential, Analyse, Probe, Plan, Select — Wolpaw), and Peyton’s four-stage approach to teaching a practical skill. Feedback: the principles of specific, actionable, timely, behaviour-focused feedback (Ende); Pendleton’s rules; the R2C2 facilitated reflective model (Relationship, Reactions, Content, Coach — Sargeant, Lockyer); the feedback sandwich and why it is deprecated; and the meta-analytic evidence that feedback is among the most powerful influences on performance (Wisniewski, d = 0.48). Supervision: graded autonomy, direct versus indirect observation, and entrustment through entrustable professional activities (ten Cate, Gingerich). Assessment: the workplace-based assessment tools — mini-CEX (Norcini), DOPS, and case-based discussion (Lörwald). The differential of good versus poor teaching, and the pitfalls that erode learning and safety. ACEM-primary, globally tagged.

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Team-based care and CRM

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high

Team-based care and crisis resource management in the emergency department

Team-based care and crisis resource management (CRM) in the emergency department — the non-technical skills (leadership, communication, situational awareness, decision-making, resource management) translated from aviation to medicine; the allocated team roles and the team leader who stands back; closed-loop communication and the structured ISBAR/SBAR handover; the three levels of situation awareness and the three fixation errors; authority gradient and psychological safety (CUS, two-challenge rule, leader inclusiveness); the hot debrief and plus-delta; simulation and in-situ latent-threat identification; error prevention through checklists and cognitive aids (WHO surgical checklist, Pronovost central-line bundle); and the differential of team failures — solo-practice collapse, communication breakdown, authority-gradient suppression, fixation error. ACEM-primary, globally tagged.

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Domain

Testicular torsion

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high

Testicular torsion

The testicular torsion — the twisting of the spermatic cord on its longitudinal axis that obstructs the venous return and then the arterial supply, producing the testicular ischaemia and necrosis; the quintessential time-critical surgical emergency of the acute scrotum with the salvage window of six hours. The clinical picture (the sudden severe unilateral testicular pain, the swelling, the high-riding testis, the absent cremasteric reflex, the horizontal lie, the nausea and vomiting), the diagnosis (the clinical diagnosis, the Doppler ultrasound if uncertain but never to delay surgery, the manual detorsion), the management (the urgent surgical exploration within six hours, the bilateral orchiopexy, the orchidectomy if necrosis). The differential (the epididymo-orchitis, the appendix testis torsion, the incarcerated hernia, the renal colic). ACEM-primary, globally tagged.

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ECG interpretation (approach)

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The 12-lead ECG — the systematic emergency department interpretation approach

The systematic approach to the 12-lead ECG for the emergency medicine trainee — the rate, the rhythm, the axis, the intervals (PR 120 to 200 ms, QRS under 120 ms, QTc under 440 ms in men and under 460 ms in women), the segments and waves (ST elevation with the gender-specific STEMI thresholds, ST depression, T-wave inversion, pathological Q), the chambers (atrial enlargement, ventricular hypertrophy with the Sokolow-Lyon and Cornell criteria), the blocks (AV block, bundle branch block), and a reproducible stepwise reading method. Includes the ECG-driven drug doses — adenosine 6 then 12 mg for SVT, atropine 500 micrograms for bradycardia, amiodarone 300 mg for VT. ACEM-primary, globally tagged.

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The anticoagulated trauma patient

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The anticoagulated trauma patient

The anticoagulated trauma patient: the reversal of the warfarin (the PCC and the vitamin K), the DOACs (the dabigatran with the idarucizumab, the apixaban and the rivaroxaban with the andexanet alfa or the PCC), the antiplatelet agents, the timing of the reversal in parallel with the resuscitation, and the diagnostic limitations of the standard coagulation tests.

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Australasian Triage Scale

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The Australasian Triage Scale — categories, validity, reliability and the under-triaged patient

The Australasian Triage Scale (ATS) — the five-level urgency scale used across Australian and New Zealand emergency departments, jointly endorsed by ACEM and the Australian College of Nursing. The five categories with their maximal acceptable times to clinical treatment (ATS 1 immediately, 2 within 10 minutes, 3 within 30 minutes, 4 within 60 minutes, 5 within 120 minutes); construct and criterion validity (ATS category predicts mortality, admission, ICU and resource use — Doherty’s stepwise inpatient mortality); reliability and inter-rater agreement measured by weighted kappa (fair-to-moderate, ~0.3–0.6, never perfect, best at the extremes); the triage nurse’s role and scope of practice (brief assessment, category allocation, first-line measur…

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The deadly ECG patterns

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The deadly ECG patterns — the emergency department recognition and immediate management

The emergency department ECG patterns that immediately change disposition or trigger an antidote — the STEMI territories (anterior, inferior, lateral, posterior, right ventricular), the STEMI-equivalents that represent an acutely occluded artery without meeting ST-elevation thresholds (de Winter T waves, Wellens syndrome, hyperacute T waves, Sgarbossa criteria in left bundle branch block and paced rhythm), the Brugada type-1 coved pattern, the hyperkalaemia progression from peaked T to sine wave, the long QT over 500 ms and torsades de pointes, the pulmonary embolism right-heart-strain pattern, the broad-complex ventricular tachycardia, and the sodium-channel-blocker wide-QRS with an R-prime in aVR. Includes the ECG-driven drug doses — adenosine 6 mg for SVT, amiodarone 300 mg for VT, magnesium 2 g for torsades, calcium chloride 10 mL of 10% for hyperkalaemia, sodium bicarbonate for TCA toxicity. ACEM-primary, globally tagged.

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Mental Health Act and compulsory treatment

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The Mental Health Act and compulsory treatment in the emergency department

The Mental Health Act and compulsory treatment in the emergency department — the statutory framework separate from capacity law that authorises detention and treatment of a person with a mental illness who meets defined criteria (mental illness of nature or degree warranting treatment, risk to health or safety or to others, refusal or inability to consent, and no less-restrictive alternative). Covers the assessment by two clinicians, the statutory schedule or section, the duration of detention and the tribunal review, police powers, the duration of each order, and the appeals machinery. Distinguishes capacity versus the Mental Health Act, and informal versus formal admission. Includes the pharmacological management of the dangerous detained patient. ANZ state and territory Acts (NSW Schedule 1, Victoria Assessment and Temporary Treatment Orders, Queensland authorities), UK Mental Health Act 1983 Sections 2, 3, 4, 5, 135 and 136, US state statutes. ACEM-primary, globally tagged.

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Primary survey

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The primary survey (ABCDE) — the trauma assessment framework

The primary survey — the ABCDE framework for the systematic, prioritised assessment of the trauma patient (Airway with cervical-spine control, Breathing with ventilation, Circulation with haemorrhage control, Disability, Exposure), the immediately life-threatening conditions sought and treated at each step before moving to the next, and the transition to the secondary survey once the patient is stabilised. The foundational framework of all emergency and trauma medicine. ACEM-primary, globally tagged.

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Paediatric resuscitation

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The sick child and paediatric resuscitation

The sick child is any infant or child with actual or potential physiological failure, and paediatric resuscitation is the structured, weight-based response. Children differ from adults at every step: they compensate with a rising heart rate and intense vasoconstriction while the blood pressure holds, so hypotension is a late and pre-terminal sign; they consume oxygen at twice the adult rate and desaturate within seconds; and every drug, every fluid and every shock is dosed per kilogram, estimated with the Broselow tape or the formula weight equals age plus four times two. The structured approach is airway with cervical-spine control, breathing with oxygen and bag-valve-mask ventilation, then circulation with intra-osseous access, a 10 mL per kilogram fluid bolus and adrenaline 10 micrograms per kilogram. The paediatric arrest is usually asphyxial rather than cardiac, is managed with 15 to 2 cardiopulmonary resuscitation for two rescuers, the two-thumb encircling technique in the infant, and 4 joules per kilogram defibrillation, and runs through shockable and non-shockable loops that mirror the adult algorithm with weight-based doses. ACEM-primary, globally tagged.

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Toxicology and environmental emergencies (approach)

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The toxidrome approach and the general management of the poisoned patient

The systematic recognition of the poisoning syndrome from the constellation of signs, and the general management of the poisoned patient. The seven toxidromes are covered in full — the anticholinergic (hot, dry, red, blind, mad), the cholinergic (SLUDGE from organophosphates and nerve agents), the sympathomimetic (cocaine, amphetamine, MDMA), the opioid, the sedative-hypnotic, the serotonin syndrome (clonus, hyperreflexia, hyperthermia), and the neuroleptic malignant syndrome. The general management follows — the ABCDE, decontamination (activated charcoal within one hour, whole bowel irrigation for iron, lithium and packets), enhanced elimination (haemodialysis for lithium, salicylate, metformin and the toxic alcohols), and the antidotes (naloxone, N-acetylcysteine, flumazenil, fomepizole, sodium bicarbonate, digoxin Fab) with drug doses. ACEM-primary, globally tagged.

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Transient ischaemic attack

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Transient ischaemic attack

Transient ischaemic attack — a transient episode of focal neurological dysfunction from brain, spinal cord or retinal ischaemia WITHOUT infarction (the tissue-based definition); an infarct on diffusion-weighted MRI is a stroke, not a TIA. The ABCD2 score (Age, Blood pressure, Clinical features, Duration, Diabetes) stratifies early stroke risk; the danger is the first 48 hours. Exclude the mimics (migraine aura, postictal Todd paresis, hypoglycaemia), then urgent carotid imaging within 24 hours, aspirin 300 mg stat, short-course dual antiplatelet therapy, a high-intensity statin, and carotid endarterectomy within two weeks for symptomatic severe stenosis. A warning event, not a reassurance. ACEM-primary, globally tagged.

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Trauma in pregnancy

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Trauma in pregnancy

The trauma in pregnancy: the physiological changes that alter the response to the injury, the primary survey modifications (the left lateral tilt and the foetal assessment), the placental abruption and the uterine rupture, the perimortem caesarean at 4 minutes, the foeto-maternal haemorrhage and the Anti-D, the radiation exposure and the safe imaging, and the seatbelt advice.

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Trauma team leadership

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Trauma team leadership

The trauma team activation, composition and leadership: the pre-arrival briefing, the paramedic MIST handover, the allocated roles, the standing-back team leader who directs the primary survey, the decision points of theatre versus CT, the crisis resource management, and the post-trauma debrief.

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Traumatic brain injury

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Traumatic brain injury

The traumatic brain injury from the primary impact through the preventable secondary injury, the GCS severity classification, the emergency management that protects the brain from hypoxia, hypotension and raised intracranial pressure, the Canadian CT Head Rule, the osmolar therapy (hypertonic saline and mannitol), the ICP staircase, the corticosteroid evidence (harmful), the decompressive craniectomy evidence (DECRA and RESCUEicp), the BEST-TRIP, POLAR and prehospital hypertonic saline trials, the specific injuries (extradural, subdural, diffuse axonal) and the neurosurgical referral.

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Tuberculosis

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low

Tuberculosis (ED)

The tuberculosis from the Mycobacterium tuberculosis through the primary and the reactivation (the secondary), the risk factors (the HIV, the immunosuppression, the malnutrition, the diabetes, the migrant, the alcohol, the smoking), the presentation (the chronic cough, the haemoptysis, the night sweats, the weight loss, the fever; the extrapulmonary — the cervical lymphadenitis, the meningitis, the miliary, the spinal Pott), the ED role (the suspect, the isolate, the airborne precautions, the sputum, the public health notification), the quadruple RIPE therapy and its toxicity, and the MDR-TB.

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Upper airway obstruction

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Upper airway obstruction in the emergency department

Upper airway obstruction — the stridor and drooling presentations, the infectious causes (epiglottitis, retropharyngeal abscess, Ludwig's angina, croup) and the non-infectious (angioedema, anaphylaxis, foreign body, burn, malignancy), the Poiseuille law rationale (r to the fourth power), the golden rules (do not agitate the suspected epiglottitis; call the senior anaesthetist and ENT immediately), the cause-specific management with doses (nebulised adrenaline, ceftriaxone, dexamethasone, icatibant), and the can't-intubate-can't-oxygenate rescue (the scalpel-bougie-tube cricothyroidotomy). ACEM-primary, globally tagged.

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Upper gastrointestinal bleed

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Upper gastrointestinal bleed

The upper gastrointestinal bleed — the haemorrhage proximal to the ligament of Treitz, divided into the variceal (the oesophageal and gastric varices of the portal hypertension) and the non-variceal (the peptic ulcer, the Mallory-Weiss tear, the erosive gastritis, the upper-GI malignancy). The Glasgow-Blatchford score for the pre-endoscopic risk stratification — the haemoglobin, the urea, the systolic blood pressure, the pulse, the melaena, the syncope, the hepatic disease, the cardiac failure. The management — the ABCDE, the large-bore IV access, the restrictive transfusion at a haemoglobin threshold 70 to 80 g/L, the terlipressin 2 mg intravenously four times daily and the ceftriaxone 2 g intravenously daily for the variceal bleed, the pantoprazole 80 mg intravenous bolus then 8 mg/h infusion, the urgent oesophagogastroduodenoscopy within 24 hours (within 12 hours for the suspected variceal bleed), and the TIPSS for the refractory variceal haemorrhage. ACEM-primary, globally tagged.

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Vasoactive drugs in resuscitation

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Vasoactive drugs in resuscitation

Vasoactive drugs in resuscitation — the receptor pharmacology that decides which agent to reach for (noradrenaline alpha-greater-than-beta is the first-line vasopressor of septic and most distributive shock; adrenaline the alpha-plus-beta agent of anaphylaxis and cardiac arrest; vasopressin the V1-receptor catecholamine-sparing adjunct of septic shock; dopamine avoided because of SOAP II; dobutamine the beta-1 inotrope of cardiogenic shock; milrinone the selective PDE-3 inodilator useful for the right heart and the pulmonary vasculature), the selection of the agent by the shock type and the haemodynamic phenotype, the peripheral-versus-central administration question, and the full weight-based dosing reference. The landmark trials are SOAP II (noradrenaline over dopamine), VASST and VANISH (vasopressin), SEPSISPAM (the MAP target), APROCCHSS (hydrocortisone as the catecholamine-sparing adjunct), CLOVERS (the early vasopressor versus the early fluid) and the Surviving Sepsis Campaign 2021 framework. ACEM-primary, globally tagged.

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Vertigo and dizziness

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Vertigo and dizziness

Vertigo and dizziness — the central-versus-peripheral distinction as the load-bearing decision, the HINTS examination (Head Impulse, Nystagmus, Test of Skew) for stroke in the acute vestibular syndrome, the Bárány diagnostic criteria and the Epley manoeuvre for BPPV, vestibular neuritis and labyrinthitis, Meniere disease, the differential (posterior-circulation TIA and stroke, vestibular migraine, cardiac syncope), and the drug doses (prochlorperazine 5 mg, corticosteroids). ACEM-primary, globally tagged.

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Plain radiograph interpretation (approach)

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X-ray interpretation in the emergency department — the systematic approach

The systematic approach to plain radiography for the emergency medicine trainee — the technical-quality check (projection, penetration, rotation, inspiration), the chest radiograph method (airway, bones, cardiac, diaphragm, effusions, fields, tubes and lines), the musculoskeletal ABCCS method (adequacy and alignment, bones, cartilage and joints, soft tissue, summary), the Salter-Harris paediatric physeal classification, the fracture descriptors (transverse, oblique, spiral, comminuted, buckle, greenstick), the Ottawa ankle and knee rules and the NEXUS and Canadian C-spine rules, and the normal-vs-abnormal-vs-artefact differential. The image-to-action thresholds — free gas under the diaphragm triggering broad-spectrum antibiotics, the misplaced nasogastric tube withdrawn before any feed, hip fracture managed with a fascia-iliaca block. ACEM-primary, globally tagged.

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