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High-Yield Revision Tables — Scroll Through All 17

Resuscitation Council UK & NICE Guidelines

Swipe or use arrows to navigate · Table 1 of 17

Table 1 — Adult ALS: Cardiac Arrest Algorithm

Step	Action	Key Details
Initial	Safety → Check response → Shout for help	Attach defibrillator/monitor immediately
CPR	30:2 ratio, 100–120/min, 5–6 cm depth	Minimise interruptions; continuous if advanced airway
Rhythm check	Every 2 minutes	—
SHOCKABLE (VF/pVT)	1 shock → Immediate CPR 2 min	150–200 J biphasic or 360 J monophasic
	After 3rd shock: Adrenaline 1 mg IV/IO	Then every 3–5 min
	After 3rd shock: Amiodarone 300 mg IV	Repeat 150 mg after 5th shock
NON-SHOCKABLE (PEA/Asystole)	Immediate CPR 2 min	Adrenaline 1 mg IV/IO ASAP, then every 3–5 min
4 Hs	Hypoxia, Hypovolaemia, Hypo/Hyperkalaemia, Hypothermia	Treat identified cause
4 Ts	Thrombosis, Tension pneumothorax, Tamponade, Toxins	Thrombolysis for massive PE/MI
ROSC	ABCDE; SpO2 94–98%; Normocapnia; 12-lead ECG	TTM 32–36°C; PCI if indicated

Table 2 — Adult Tachycardia Algorithm

Feature	Stable	Unstable
Definition	No shock, syncope, ischaemia, severe HF	Any life-threatening feature present
Immediate	Assess QRS width	Synchronised DC shock up to 3 attempts; sedate if conscious
Narrow Regular	Vagal manoeuvres → Adenosine 6 mg → 12 mg → 18 mg IV; if ineffective: Verapamil or beta-blocker
Narrow Irregular	Probable AF: Rate control (beta-blocker, Digoxin, Amiodarone if HF); anticoagulate if >48 h
Broad Regular	VT/uncertain: Amiodarone 300 mg IV over 10–60 min; if known SVT+BBB treat as narrow
Broad Irregular	AF+BBB: treat as irregular narrow; Torsades: Magnesium 2 g IV over 10 min

Table 3 — Adult Bradycardia Algorithm

Status	Heart Rate	Management
Stable	<60 bpm	Observe; treat underlying cause
Unstable (shock, syncope, MI, HF)	Any	Atropine 500 mcg IV
Atropine ineffective	—	Repeat to max 3 mg OR Isoprenaline 5 mcg/min OR Adrenaline 2–10 mcg/min OR Transcutaneous pacing
Risk of asystole	Recent asystole / Mobitz II / Complete heart block + broad QRS / Ventricular pause >3 s → Atropine → Interim → Pacing

Table 4 — Adult Choking Algorithm

Severity	Cough	Conscious?	Action
MILD	Effective	Yes	Encourage cough; monitor for deterioration
SEVERE	Ineffective	Yes	5 back blows → 5 abdominal thrusts (repeat)
SEVERE	Ineffective	No	Start CPR

Table 5 — Paediatric Advanced Life Support (PALS)

Parameter	Details
Initial CPR	5 rescue breaths, then 15:2 compression:ventilation
Compression depth	At least 1/3 anterior-posterior chest depth
Rate	100–120/min
Shockable (VF/pVT)	1 shock 4 J/kg → CPR 2 min → Adrenaline 10 mcg/kg IV/IO after 3rd shock, then every 3–5 min; Amiodarone 5 mg/kg after 3rd shock; repeat once after 5th
Non-shockable	CPR immediately; Adrenaline 10 mcg/kg ASAP, then every 3–5 min
Ventilation (with ETT)	Infants: 25/min • 1–8 yrs: 20/min • 8–12 yrs: 15/min • >12 yrs: 10–12/min
Max doses	Adrenaline 1 mg • Amiodarone 300 mg

Table 6 — Paediatric Bradycardia & Tachycardia

Arrhythmia	Definition	Management
Bradycardia	<1 yr: <80 bpm; >1 yr: <60 bpm	O2; if HR <60 + poor perfusion → CPR; Atropine 20 mcg/kg (max 600 mcg); Adrenaline if no response
Sinus Tachycardia	Gradual onset; infant 180–220, child 160–180	Treat cause (fever, pain, hypovolaemia)
SVT	Abrupt onset; infant >220, child >180	Vagal manoeuvres → Adenosine 100–300 mcg/kg (max 500 mcg) → 12 mg; synchronised cardioversion if unstable
VT	Wide complex, regular	Pulse + unstable: synchronised cardioversion; Pulseless: treat as VF (unsynchronised)
AF (irregular narrow)	—	Rate control; anticoagulate if >48 h

Table 7 — Newborn Life Support (NLS)

Time/Step	Action	Critical Values
Birth	Delay cord clamping if possible; Dry, wrap, stimulate	Start clock
60 seconds	Assess: Colour, tone, breathing, heart rate	—
If gasping/apnoeic	5 inflations (30 cm H2O), start in air	Preterm: Consider CPAP
Chest not moving	Check mask/position; 2-person support; suction; LMA/ETT; repeat inflations	—
HR <60/min after 30 s ventilation	3:1 compressions:ventilation; 100% O2; intubate	Adrenaline 10 mcg/kg (UVC or IO)
Preterm O2	28–31 weeks: 21–30%; <28 weeks: 30%	—
Target SpO2	2 min: 65% • 5 min: 85% • 10 min: 90%	—

Table 8 — Obstetric Cardiac Arrest

Feature	Specific Consideration
Positioning	Manual uterine displacement to left OR left lateral tilt 15–30°
Teams	Separate team for mother AND neonate if ≥20 weeks gestation
Defibrillation	Safe in pregnancy; standard energies
Emergency hysterotomy	≥20 weeks; perform by 5 min if no ROSC; immediately if fatal maternal injuries
Specific causes	4 Hs + 4 Ts PLUS: AFE, eclampsia, peripartum cardiomyopathy, uterine rupture, concealed haemorrhage
Drugs	Magnesium 4 g IV (eclampsia); Tranexamic acid 1 g (haemorrhage); Intralipid (local anaesthetic toxicity)

Table 9 — Difficult Airway: CICO Algorithm

Plan	Action	Key Points
A	Direct laryngoscopy (max 3 attempts)	Maintain oxygenation; bougie/stylet; video laryngoscopy
1st failure	Call HELP; prepare FONA set	—
B / C	Rescue oxygenation: 2nd gen SGA OR facemask	Max 3 attempts each; change device/operator/size
Declare CICO	→ Plan D: FONA (scalpel cricothyroidotomy)
D Step 1	Laryngeal handshake; identify cricothyroid membrane	Scalpel no.10/20 • Bougie ≤14 Fr • Cuffed tube 5.0–6.0 mm
D Step 2	Transverse stab incision
D Step 3	Turn blade 90° (sharp edge caudad)
D Step 4	Slide bougie along blade into trachea
D Step 5–6	Railroad tube; inflate cuff; confirm with capnography

Table 10 — Tracheostomy Emergency Management

Scenario	Action
Patient NOT breathing	Call resuscitation team; CPR if no pulse
Assess patency	Remove speaking valve/cap; remove inner tube
Suction catheter passes? YES	Patent → Suction, ventilate if needed, ABCDE
Suction catheter passes? NO	Deflate cuff; Look, listen, feel at mouth AND stoma
Stable/improving? YES	Partial obstruction → Continue ABCDE
Stable/improving? NO	REMOVE TRACHEOSTOMY TUBE
Still not breathing — Primary	Oral airway manoeuvres; cover stoma; BVM
Still not breathing — Secondary	Oral intubation OR stoma intubation (6.0 cuffed ETT)

Table 11 — NICE ACS: STEMI vs NSTEMI

Feature	STEMI	NSTEMI / Unstable Angina
Immediate	Aspirin 300 mg; NO routine GPI/fibrinolysis if primary PCI planned	Aspirin 300 mg; Fondaparinux (unless high bleeding risk/immediate angiography)
Reperfusion	Primary PCI vs Fibrinolysis	Risk stratification (GRACE score)
PCI timing	<12 h: Immediate; >12 h with ongoing ischaemia/shock	Intermediate/high risk: <72 h; Low risk: Conservative
Antiplatelet	Prasugrel + Aspirin (no OAC); Ticagrelor if prasugrel contraindicated	Ticagrelor + Aspirin; Clopidogrel if high bleeding risk/OAC
Anticoagulation	Unfractionated heparin with bailout GPI	Per protocol
OAC + Antiplatelet	Clopidogrel (replace prasugrel/ticagrelor) + OAC; consider aspirin

Table 12 — NICE AF: Stroke Prevention (CHA2DS2-VASc)

Score	Action
≥2 (men) / ≥3 (women)	Offer oral anticoagulant
1 (men) / 2 (women)	Consider oral anticoagulant
0 (men) / 1 (women)	Do not offer; review at 65 or if comorbidities develop
First choice	DOAC (Apixaban, Rivaroxaban, Dabigatran, Edoxaban)
If DOAC contraindicated	Warfarin — target INR 2.5 (range 2–3)
If anticoagulation contraindicated	Left atrial appendage occlusion

Table 13 — NICE AF: Rate vs Rhythm Control

Strategy	Indications	First-line Drugs
Rate control	First-line unless: reversible cause, HF caused by AF, new-onset AF, atrial flutter suitable for ablation	Beta-blocker (not sotalol) OR rate-limiting CCB; Digoxin if sedentary; avoid amiodarone long-term
Rhythm control	First-line in above exceptions; symptoms despite rate control	—
Paroxysmal AF	—	Beta-blocker; pill-in-pocket flecainide if no structural heart disease
Persistent AF >48 h	—	Anticoagulate 3 weeks before / 4 weeks after cardioversion; OR TOE-guided
Acute + instability	—	Emergency electrical cardioversion (don't delay for anticoagulation)

Table 14 — NICE VTE: DVT & PE Diagnosis

Condition	Wells Score	Next Step
DVT Likely	≥2	Proximal leg vein USS within 4 h; OR D-dimer + interim anticoagulation → scan within 24 h
DVT Unlikely	≤1	D-dimer in 4 h; +ve → scan; −ve → stop anticoagulation
PE Likely	>4	Immediate CTPA; OR interim anticoagulation
PE Unlikely	≤4	D-dimer in 4 h; +ve → CTPA; −ve → stop anticoagulation

Table 15 — NICE VTE: Anticoagulation Treatment

Patient Group	Anticoagulant	Duration
Standard (no renal impairment/cancer/APS/instability)	Apixaban or Rivaroxaban (1st line); OR LMWH → Dabigatran/Edoxaban; OR LMWH + VKA	≥3 months
Renal impairment CrCl 15–50	Apixaban, Rivaroxaban, or LMWH → Edoxaban/Dabigatran (≥30); OR LMWH/UFH + VKA	≥3 months
CrCl <15	LMWH or UFH; OR LMWH/UFH + VKA	≥3 months
Active cancer	Consider DOAC; OR LMWH; OR LMWH + VKA	3–6 months
Antiphospholipid syndrome (triple positive)	LMWH + VKA	Long-term
PE with haemodynamic instability	Continuous UFH; consider thrombolysis	—

Table 16 — Post-Resuscitation Care (ROSC)

System	Target / Action
Airway	Advanced airway if needed; waveform capnography
Breathing	SpO2 94–98%; Normocapnia (PaCO2 35–45 mmHg)
Circulation	SBP >100 mmHg; 12-lead ECG; reliable IV access; consider vasopressors
Temperature	TTM 32–36°C for ≥24 h; prevent fever for 72 h
Neurology	Sedation; control shivering; delay prognostication ≥72 h
Investigations	Echocardiography; CT brain if non-cardiac cause; CTPA if PE suspected
Coronary reperfusion	Emergency angiography/PCI if ST elevation or suspected cardiac cause
Secondary prevention	ICD if indicated; screen inherited disorders; risk factor management

MRCEM Exam — Key Numbers to Memorise

Parameter	Value
CPR compression rate	100–120 /min
CPR compression depth (adult)	5–6 cm
CPR ratio (adult)	30:2
CPR ratio (paediatric, 2 rescuers)	15:2
Shock energy — adult biphasic	150–200 J
Shock energy — adult monophasic	360 J
Shock energy — paediatric	4 J/kg
Adrenaline frequency	Every 3–5 minutes
Amiodarone (adult)	300 mg, then 150 mg
Amiodarone (paediatric)	5 mg/kg, repeat once
Atropine max (adult)	3 mg
Newborn ventilation pressure	30 cm H2O initial; 25 cm H2O preterm
Targeted temperature management	32–36°C
Emergency hysterotomy timing	By 5 minutes if no ROSC
CHA2DS2-VASc — anticoagulate	≥2 (men) / ≥3 (women)

🎯

You've reviewed all 17 tables. Ready to test your knowledge?

Sample Question — See What to Expect

Select one best answer

A 28-year-old woman presents to the Emergency Department with a suspected paracetamol overdose taken 3 hours ago. She is haemodynamically stable. Her serum paracetamol level is above the treatment line on the nomogram. Which of the following is the most appropriate initial management?

A

Activated charcoal 50 g orally

✓

B

Intravenous N-acetylcysteine (NAC) infusion

✓

C

Methionine 2.5 g orally four times a day

✓

D

Observe and repeat paracetamol level at 8 hours

✓

E

Urgent liver transplant referral

✓

Answer & Explanation

Correct answer — B. Intravenous N-acetylcysteine (NAC) infusion

NAC is the treatment of choice for paracetamol overdose when the level falls above the treatment line on the Rumack-Matthew nomogram. It works by replenishing glutathione stores, preventing the toxic metabolite NAPQI from binding to hepatocytes.

Activated charcoal (A) is only useful within 1–2 hours of ingestion. At 3 hours, it offers little benefit and is not the priority when NAC is clearly indicated.

Methionine (C) is an oral alternative when IV access is unavailable, but it is second-line and less effective. It is rarely used in UK emergency practice.

Observation alone (D) is inappropriate when the level is above the treatment line — active treatment is required, not watchful waiting.

Transplant referral (E) is only considered in established acute liver failure meeting King's College Criteria — far too premature at 3 hours post-ingestion. 🧠 High-yield fact: The MHRA 2012 guidelines simplified the paracetamol nomogram to a single treatment line at 100 mg/L at 4 hours. All patients above this line receive the standard 3-bag NAC regimen (200 mg/kg over 4 h → 100 mg/kg over 16 h).

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