Cardiovascular Emergencies
12%of exam
ACSDysrhythmiasShockDissectionTamponade
Respiratory Emergencies
11%of exam
AirwayAsthmaCOPDPneumothoraxPE
Neurological Emergencies
11%of exam
StrokeSeizuresICPMeningitisSpinal Trauma
Gastrointestinal Emergencies
9%of exam
BleedingObstructionPancreatitisPeritonitisVarices
GU/GYN/OB Emergencies
7%of exam
EctopicTorsionPreeclampsiaDeliveryRenal
Mental Health Emergencies
9%of exam
SuicideViolencePsychosisOverdoseDe-escalation
Medical Emergencies
10%of exam
SepsisAnaphylaxisEndocrineElectrolytesWithdrawal
MSK + Wound Emergencies
7%of exam
FracturesDislocationsCompartmentAmputationLacerations
HEENT Emergencies
7%of exam
Eye TraumaEpistaxisEpiglottitisForeign BodiesRetina
Environment + Toxicology
9%of exam
Professional Issues
8%of exam
TriageMCIConsentForensicsThroughput
Quick Facts
- Exam
- CEN
- Owner
- BCEN
- Items
- 175 total
- Scored
- 150 scored
- Pretest
- 25 unscored
- Time
- 3 hours
- Pass
- 106/150 scored
- Delivery
- PSI or LRP
- Eligibility
- Unrestricted RN license
- Validity
- 4 years
- Blueprint
- Effective Jul 6 2026
- Fee
- $380 standard
Hs and Ts
Hypoxia hypovolemia hydrogen hyperkalemia toxins tamponade tension thrombosis
Hs: metabolicTs: obstructiveSearch causesTreat reversible
STEMI vs Pericarditis
STEMI
- Territorial ST
- Reciprocal changes
- Reperfusion clock
Pericarditis
- Diffuse ST
- PR depression
- Position pain
Territory vs diffuse
Cardiac Red Flags
- ACS
- Early ECG
- STEMI
- Reperfusion clock
- Dissection
- Tearing back pain
- Tamponade
- Obstructive shock
- Cardiogenic
- Cold low output
- Hypertensive Crisis
- End-organ injury
- PE
- RV strain
- Aneurysm
- Pulsatile mass
VF/pVT vs PEA/asystole
VF/pVT
- Shockable
- Defibrillate
- CPR continues
PEA/asystole
- Not shockable
- CPR/epi
- Find causes
Shock vs search
Rhythms + Shock
- VF
- Defibrillate fast
- Pulseless VT
- Shockable arrest
- PEA
- CPR plus causes
- Asystole
- CPR plus epi
- Unstable SVT
- Synchronized cardioversion
- Symptomatic Brady
- Atropine/pacing
- 12-lead
- Locate ischemia
- IO Access
- Crash access
LEMON
Look Evaluate Mallampati Obstruction Neck
LookEvaluateMallampatiObstructionNeck
Asthma vs COPD
Asthma
- Bronchospasm
- Silent chest danger
- Peak flow
COPD
- Hypercapnia risk
- Titrate oxygen
- NIPPV often
Airflow vs retention
Airway Picker
- Cannot protect airway→Intubation prep(RSI support)
- CHF distress→NIPPV(Reduce work)
- COPD exacerbation→Titrated oxygen(88-92%)
- Upper obstruction→Airway expert(Stridor threat)
- Tension signs→Needle decompression(Before imaging)
- Intubated patient→Capnography(Confirm ventilation)
Airway + Breathing
- Stridor
- Upper airway
- Silent Chest
- Impending failure
- Tension Pneumo
- Decompress now
- COPD Target
- 88-92%
- Capnography
- Ventilation trend
- NIPPV
- CHF/COPD support
- Chest Tube
- Seal below chest
- RSI
- Airway sequence
BE FAST
Balance Eyes Face Arm Speech Time
BalanceEyesFaceArmSpeechTime
Stroke vs Hypoglycemia
Stroke
- Focal deficit
- LKW matters
- CT first
Hypoglycemia
- Mimics stroke
- Check glucose
- Correct immediately
Image plus glucose
Neuro + Stroke
- FAST
- Stroke screen
- Last Known Well
- Reperfusion clock
- Glucose
- Mimic check
- Noncontrast CT
- Bleed screen
- Thunderclap
- SAH concern
- Status
- >5 min seizure
- Cushing Triad
- High ICP
- Spinal Shock
- Neurogenic hypotension
Ectopic vs Miscarriage
Ectopic
- Unilateral pain
- Shoulder pain
- Shock risk
Miscarriage
- Cramping bleeding
- Cervical findings
- Rh status
Shock changes priority
Abdomen + OB
- Appendicitis
- Migrates RLQ
- Pancreatitis
- Lipase pain
- GI Bleed
- Two large IVs
- Varices
- Portal bleeding
- Ectopic
- Pregnant shock
- Torsion
- Sudden pelvic pain
- Preeclampsia
- HTN plus symptoms
- Prolapsed Cord
- Relieve pressure
Previa vs Abruption
Previa
- Painless bleeding
- Avoid vaginal exam
- Placenta low
Abruption
- Painful bleeding
- Rigid uterus
- Fetal distress
Painless vs painful
Mental Health
- Suicide Risk
- Ask directly
- Violence
- Safety first
- Psychosis
- Reality impaired
- Overdose
- Toxidrome clues
- Withdrawal
- Seizure risk
- Restraints
- Least restrictive
- De-escalation
- Calm choices
- Therapeutic
- Low stimulus
SAMPLE
Signs Allergies Meds Past Last Events
SignsAllergiesMedsPastLastEvents
DKA vs HHS
DKA
- Ketones
- Acidosis
- Kussmaul
HHS
- Severe hyperosmolarity
- Minimal ketones
- Older adults
Acid vs osmoles
Shock Picker
- Fever hypotension→Septic shock(Cultures/antibiotics)
- Hives wheeze shock→Anaphylaxis(IM epi)
- Bleeding trauma→Hemorrhagic shock(Control loss)
- MI cold clammy→Cardiogenic shock(Pump failure)
- JVD muffled tones→Tamponade(Obstructive)
- Absent breath sounds→Tension pneumo(Decompress)
- Spinal cord injury→Neurogenic shock(Brady hypotension)
- Vomiting dehydration→Hypovolemic shock(Volume loss)
Shock + Sepsis
- Sepsis
- Infection plus dysfunction
- Septic Shock
- Vasopressor need
- Anaphylaxis
- IM epinephrine
- Hypovolemic
- Volume loss
- Distributive
- Vasodilation
- DKA
- Ketones/acidosis
- HHS
- Hyperosmolar dehydration
- Hyperkalemia
- ECG danger
Ortho + Wounds
- Compartment
- Pain outsize
- Open Fracture
- Cover sterile
- Dislocation
- Check pulses
- Amputation
- Cool dry part
- Injection Injury
- Surgical emergency
- Degloving
- Major soft tissue
- Osteomyelitis
- Deep infection
- Hemorrhage
- Direct pressure
HEENT Threats
- Globe Rupture
- Shield only
- Hyphema
- Eye rest
- Retinal Detach
- Curtain vision
- Acute Glaucoma
- Painful pressure
- Epiglottitis
- Airway danger
- Peritonsillar
- Muffled voice
- Epistaxis
- Lean forward
- Foreign Body
- Avoid blind sweep
Contact vs Airborne
Contact
- Gown/gloves
- C diff
- MDRO
Airborne
- N95
- Negative pressure
- TB/measles
Touch vs aerosol
Tox + Environment
- CO
- High-flow oxygen
- Cyanide
- Smoke collapse
- Caustics
- Do not neutralize
- Burns
- Stop burning
- Electrical
- Cardiac monitoring
- Hypothermia
- Handle gently
- Heat Stroke
- Rapid cooling
- Submersion
- Hypoxia first
Communicable
- C diff
- Soap/water
- TB
- Airborne room
- Measles
- Airborne risk
- Pertussis
- Droplet risk
- MDRO
- Contact precautions
- Resp Viruses
- Mask early
- Hemorrhagic Fever
- Isolation escalate
- STI
- Confidential care
ABCDE
Airway Breathing Circulation Disability Exposure
A: airwayB: breathingC: circulationD: neuroE: expose
Consent vs Implied
Consent
- Capacity
- Risks/benefits
- Voluntary choice
Implied
- Emergency
- No capacity
- Delay unsafe
Permission vs emergency
Triage Picker
- Airway threatened→Resuscitation(Immediate bed)
- Chest pain unstable→Rapid ECG(STEMI screen)
- Stroke symptoms→Stroke alert(LKW rules)
- Sepsis cues→Sepsis pathway(Early bundle)
- Psych danger→Safety room(Ligature risk)
- Contaminated arrival→Decon zone(Protect ED)
- MCI surge→Incident command(Shared priorities)
- Boarded patient→Reassess cadence(Detect decline)
Exam Frame
- Total Items
- 175 questions
- Scored Items
- 150 count
- Pretest Items
- 25 hidden
- Seat Time
- 180 minutes
- Pass Mark
- 106 scored correct
- Pacing
- 62 sec/item
- Window
- 90 days
- Retest
- 90-day wait
Triage Priority
- ABCD
- Immediate life threats
- Unstable
- Resuscitation pathway
- Time Critical
- STEMI/stroke/sepsis
- MCI
- Greatest good
- Throughput
- Reassess boarded patients
- EMTALA
- Screen and stabilize
- Consent
- Capacity plus disclosure
- Forensics
- Preserve chain
Professional Practice
- MCI Triage
- Resource-based priority
- Throughput
- Flow plus safety
- Capacity
- Decision ability
- Implied Consent
- Emergency exception
- Abuse
- Mandatory report
- Diversion
- Report impairment
- Workplace Violence
- Activate safety
- Cultural Humility
- Ask preferences
Common Traps
Pretest still matters
Pretest is hidden ≠ Answer every item
Current vs July outline
Before July uses 2022 ≠ After July uses 2026
Stable vs unstable
Stable can wait ≠ Unstable gets bed
PEA vs VF
PEA needs causes ≠ VF needs shock
COPD oxygen trap
Titrate oxygen ≠ Do not withhold
Stroke mimic trap
Check glucose ≠ Do not delay alert
Previa exam trap
Avoid vaginal exam ≠ Ultrasound first
C diff sanitizer trap
Soap/water needed ≠ Alcohol insufficient
Consent shortcut trap
Capacity matters ≠ Emergency exception narrow
Forensic evidence trap
Minimize handling ≠ Document transfers
MCI fairness trap
Use objective criteria ≠ Avoid favoritism
Boarding trap
Room status irrelevant ≠ Reassessment continues
Last Minute
- 1.Jul 6 blueprint changes domains
- 2.175 items; 150 scored
- 3.Pass = 106/150 scored
- 4.Pace near 62 seconds
- 5.ABCD before diagnosis
- 6.Unstable beats chronic
- 7.STEMI gets rapid ECG
- 8.Stroke: glucose plus CT
- 9.Sepsis: recognize shock early
- 10.Anaphylaxis = IM epi
- 11.COPD target 88-92%
- 12.PEA: CPR plus causes
- 13.Previa: no vaginal exam
- 14.C diff: soap/water
- 15.MCI: greatest good
- 16.Retest wait: 90 days
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