Major Trauma & BOAST Guidelines
According to BOAST guidelines for Open Fractures, antibiotics (typically Co-amoxiclav + Gentamicin) should be administered within this timeframe of injury.
What is 1 hour? (Or "Usually 3 hours, but BOAST says 1 hour").
The calculation used to estimate the weight of a child aged 1–10 years old in the 2021 Resus Council UK guidelines.
What is (Age + 4) x 2? (Note: It used to be (Age + 4) x 3 or 2(Age+4) depending on year, but (Age+4)x2 is the current APLS guidance for 1-10yrs).
This drug is a specific antagonist for Benzodiazepines, but its use in mixed overdose is controversial due to the risk of precipitating seizures.
What is Flumazenil?
The dose of Magnesium Sulfate given as a loading bolus for Eclampsia.
What is 4g (IV over 5-10 mins)?
This 2015 Supreme Court ruling fundamentally changed consent in the UK, moving from the "Bolam Test" to a patient-centred standard of "Material Risk."
What is Montgomery v Lanarkshire Health Board?
In a traumatic cardiac arrest, if ROSC is not achieved after addressing reversible causes (hypoxia/tension pneumothorax), blood products should be stopped and efforts terminated after this time period.
What is 20 minutes? (Per RCUK/ERC guidelines).
In Paediatric DKA (BSPED Guidelines), IV fluid boluses are no longer routine. They are only indicated if the patient is shocked, and the volume is restricted to this amount per kg.
What is 10 ml/kg?
According to RCEM guidelines on Ketamine sedation, this specific phenomenon (laryngospasm) occurs in approximately 0.3% of cases, and is managed initially with this manoeuvre.
What is Larson’s Manoeuvre (or Jaw Thrust/CPAP)?
In a perimortem Caesarean section (Resuscitative Hysterotomy), the procedure should ideally be commenced within this many minutes of cardiac arrest onset.
What is 4 minutes? (With delivery by minute 5).
A patient with capacity refuses life-saving treatment. This common law principle protects the doctor from prosecution for assault if they treat the patient after they lose capacity, assuming the treatment is in their best interests.
What is the Doctrine of Necessity?
For a patient with a spinal cord injury at T6 or above, this type of shock presents with hypotension and bradycardia due to loss of sympathetic tone.
What is Neurogenic Shock?
A neonate presenting with collapse at Day 10 of life with low glucose and high potassium likely has this endocrine emergency.
What is Congenital Adrenal Hyperplasia (CAH)?
This is the required fasting time for solids prior to elective procedural sedation in the ED, though RCEM acknowledges urgency often overrides this in trauma.
What is 6 hours? (2 hours for clear fluids).
This condition, defined by painless vaginal bleeding after 24 weeks gestation, is an absolute contraindication to digital vaginal examination in the ED.
What is Placenta Praevia?
In Critical Appraisal, this plot type is used in a Meta-Analysis to display the results of individual studies and the pooled effect estimate.
What is a Forest Plot? (Not a Funnel Plot - that's for publication bias).
This specific grading system for Open Fractures (ranging I, II, IIIA/B/C) is used in the UK to predict limb salvage outcomes, focusing on wound size and soft tissue coverage.
What is the Gustilo-Anderson Classification?
For a child in status epilepticus with established IV access, this is the RCEM/APLS first-line benzodiazepine and dose.
What is Lorazepam 0.1 mg/kg?
When using Propofol for sedation, the addition of this opiate often leads to a higher incidence of apnoea and necessitates a lower dose of Propofol.
What is Fentanyl (or Alfentanil)?
In potential Rhesus D sensitisation (e.g., trauma in a Rh-negative pregnant woman), this test is used to quantify the volume of foetal-maternal haemorrhage to calculate the required Anti-D dose.
What is the Kleihauer-Betke test?
Under the Mental Capacity Act 2005, this specific person (usually a family member or friend) must be consulted when making Best Interest decisions for a patient without capacity who has no LPA.
What is the IMCA (Independent Mental Capacity Advocate)? Correction/Nuance: The IMCA is only if there are no family/friends. If family exists, they are the consultee.
In Silver Trauma (Geriatric), BOAST guidelines state that for patients on Warfarin with intracranial haemorrhage, the INR should be reversed to this specific target value immediately.
What is INR < 1.5? (Using Prothrombin Complex Concentrate/Beriplex).
In the management of a breathless child, this clinical sign—characterized by a grunting noise on expiration—indicates the child is generating PEEP to keep alveoli open.
What is Grunting?
The specific anatomic depth evaluation (Mallampati) is less useful in emergency sedation than evaluating the "3-3-2 rule" and this specific capability of the mandible.
What is Mandibular Protrusion (or Prognathism)?
A pregnant patient presenting with vomiting, abdominal pain, and neurological changes (Wernicke’s) likely has this severe form of morning sickness.
What is Hyperemesis Gravidarum?
This statistical bias occurs when early termination of a trial happens because the results look "too good to be true," often overestimating the treatment effect.
What is Stopping Rule Bias (or Interim Analysis Bias)?
A patient presents with a pH of 7.55, High PaCO2, High Bicarbonate, and Low Chloride. They have a history of COPD but have recently been vomiting. The calculated "Expected PaCO2" is higher than the measured PaCO2, implying a co-existing respiratory alkalosis is not present.
This specific triple-word diagnosis explains the metabolic alkalosis features.
!What is a "Saline-Responsive Metabolic Alkalosis" (or Contraction Alkalosis)?!