Saudi Board Emergency Medicine Part 1 Complete Review Guide 2026–2027

4. Obtain an ECG within 10 minutes of arrival for suspected ACS, especially in older, female and diabetic patients who often present atypically.
5. Avoid nitrates within 24 hours of sildenafil (48 hours of tadalafil), in hypotensive RV infarction and in severe aortic stenosis.
6. Most specific Sgarbossa criterion in LBBB: concordant ST elevation of 1 mm or more in leads with a positive QRS.
7. Posteromedial papillary muscle rupture follows inferior MI at days 2–7, causing acute mitral regurgitation and pulmonary oedema.
8. Tachycardia with hypotension, altered mentation, ischaemic chest pain or acute heart failure is unstable and needs synchronised cardioversion.
9. Stable SVT: modified Valsalva first, then adenosine 6 mg rapid push with a flush, followed by 12 mg if needed.
10. Stable monomorphic VT: amiodarone 150 mg IV over 10 minutes, with cardioversion ready.
11. Torsades de pointes: magnesium sulfate 2 g IV even if serum magnesium is normal; stop QT-prolonging drugs.
12. Unstable bradycardia: atropine 1 mg every 3–5 minutes up to 3 mg; if no response, transcutaneous pacing or a dopamine or epinephrine infusion.
13. AF over 48 hours or unknown onset: rate control and anticoagulation first; cardioversion only after anticoagulation or TEE.
14. A magnet on a pacemaker gives asynchronous fixed-rate pacing; on an ICD it suspends shocks without stopping bradycardia pacing.
15. Acute pericarditis: diffuse concave ST elevation with PR depression; treat with a high-dose NSAID plus colchicine.
16. Tamponade: Beck's triad (hypotension, distended neck veins, muffled heart sounds) and pulsus paradoxus over 10 mm Hg; treat with ultrasound-guided pericardiocentesis.
17. Type B dissection: esmolol first to a heart rate below 60/min, then a vasodilator to a systolic pressure of 100–120 mm Hg.
18. Hypertensive emergency: lower mean arterial pressure by no more than 25% in the first hour, except in aortic dissection.
19. PERC (8 criteria): age under 50, HR under 100, SpO2 95% or more, no haemoptysis, no oestrogen, no prior VTE, no recent surgery or trauma, no unilateral leg swelling.
20. High-risk PE with shock is the main indication for systemic thrombolysis; intermediate-risk PE gets anticoagulation and monitoring.
21. Adult CPR: depth 5–6 cm, rate 100–120/min, full recoil, and pulse checks no longer than 10 seconds.
22. Non-shockable rhythms: epinephrine 1 mg as soon as possible, then every 3–5 minutes. Refractory VF: amiodarone 300 mg then 150 mg, or lidocaine.
23. Septic shock: 30 mL/kg balanced crystalloid, then norepinephrine to MAP 65 mm Hg; add vasopressin at about 0.25–0.5 µg/kg/min norepinephrine.
24. Maternal arrest: manual left uterine displacement; if the uterus is at or above the umbilicus and there is no ROSC by about 4 minutes, perform perimortem caesarean delivery.

Common mistakes in this chapter

• ✕ Waiting for troponin before reperfusion in STEMI is wrong. STEMI is diagnosed on the ECG, and delay increases myocardial loss.
• ✕ Giving nitrates in right ventricular MI with hypotension is wrong. The RV is preload dependent; give a fluid bolus first.
• ✕ ST depression in V1–V3 with tall R waves is often read as simple ischaemia but may be posterior MI. Record V7–V9.
• ✕ AV nodal blockers (adenosine, verapamil, diltiazem, digoxin) in pre-excited AF are dangerous. Use procainamide or electrical cardioversion.
• ✕ Wellens pattern is sometimes discharged because the pain has settled and troponin is near normal. It signals critical LAD stenosis and needs admission and early angiography.
• ✕ Labelling first-time flank pain in an older patient as renal colic can miss a ruptured AAA. Scan the aorta first.
• ✕ A mildly raised D-dimer in an older patient does not always mean imaging. Use the age-adjusted cut-off (age × 10 µg/L above 50).
• ✕ Many defibrillators revert to unsynchronised mode after each shock. Reactivate sync before the next cardioversion shock.