Free CEN Exam Flashcards

A rapid first pass for immediate threats: airway, breathing, circulation, disability, and exposure. Treat life threats as they are found instead of saving them for a later assessment.

A patient needing immediate life-saving intervention belongs in the highest triage category. Examples include active arrest, severe respiratory failure, unresponsiveness with airway risk, or profound shock.

Triage is not a one-time label. Reassessment looks for deterioration, new red flags, uncontrolled pain, worsening vital signs, and conditions that have become time-sensitive.

Early shock may preserve blood pressure through tachycardia and vasoconstriction. Cool skin, anxiety, delayed capillary refill, weak pulses, and narrowing pulse pressure can appear before hypotension.

Shock caused by abnormal vasodilation and maldistributed blood flow. Sepsis, anaphylaxis, and neurogenic shock are key ED patterns, but each has different first-line priorities.

Suspect infection plus poor perfusion: altered mental status, hypotension, rising lactate, oliguria, mottling, or escalating oxygen need. Early source control, cultures, antibiotics, fluids, and vasopressors may be needed.

Control bleeding and restore circulating volume. In trauma, look for external bleeding, chest, abdomen, pelvis, retroperitoneum, and long-bone sources while preparing blood products when indicated.

Maintain spinal motion restriction when mechanism, neurologic deficit, intoxication, distracting injury, or altered mental status makes cervical injury possible. Airway care still takes priority if compromised.

Obstructive shock from trapped intrathoracic air. Severe dyspnea, unilateral breath-sound loss, hypotension, jugular venous distention, or tracheal shift should prompt immediate decompression per protocol.

Blood or fluid around the heart restricts filling. Think obstructive shock after chest trauma or procedure when hypotension, distended neck veins, muffled heart sounds, or pulsus paradoxus appear.

An unstable pelvic ring can hide major hemorrhage. Avoid repeated pelvic rocking, apply a binder when indicated, and anticipate blood resuscitation and rapid trauma-team coordination.

Rising pressure in a closed muscle space threatens perfusion. Severe pain out of proportion, pain with passive stretch, tense swelling, paresthesia, or late pulse changes require urgent escalation.

Prolonged muscle compression can release potassium, acid, and myoglobin after extrication. Watch for dysrhythmias, renal injury, dark urine, and need for aggressive protocol-based resuscitation.

Chest pressure, diaphoresis, dyspnea, syncope, or atypical ischemic symptoms should trigger rapid ECG review and reperfusion planning. Do not wait for biomarkers when the ECG is diagnostic.

Ventricular fibrillation and pulseless ventricular tachycardia require defibrillation with high-quality CPR. PEA and asystole require CPR, epinephrine, and a search for reversible causes.

Tachycardia with hypotension, shock, ischemic chest discomfort, acute heart failure, or altered mental status needs immediate synchronized cardioversion while airway and IV access are supported.

Bradycardia with poor perfusion requires rapid intervention. Atropine may be used while preparing transcutaneous pacing and vasoactive support if instability persists.

Abrupt severe chest, back, or abdominal pain with neurologic deficits, pulse differences, syncope, or shock suggests dissection. Anticoagulation or fibrinolytics can be dangerous if misapplied.

Severe dyspnea with crackles, frothy sputum, hypertension or ischemia, and hypoxia suggests cardiogenic pulmonary edema. Upright positioning, oxygen support, noninvasive ventilation, and ordered preload reduction may help.

Worsening mental status, exhaustion, inability to speak, poor chest rise, cyanosis, or rising carbon dioxide are signs that oxygen alone may not be enough.

Inspiratory stridor, drooling, tripod posture, hoarseness, or facial and tongue swelling point to upper airway danger. Keep the patient calm and prepare advanced airway support early.

Minimal wheezing can mean critically low airflow, not improvement. A silent chest, fatigue, altered mentation, or poor response to bronchodilators signals impending respiratory failure.

Give oxygen for hypoxemia but titrate and reassess ventilation, mental status, and blood gases when hypercapnia is a concern. Withhold oxygen only if ordered care would be unsafe, not because COPD is present.

Sudden dyspnea, pleuritic chest pain, syncope, tachycardia, hypoxemia, hemoptysis, or unilateral leg swelling should raise concern for PE, especially with recent immobility, surgery, pregnancy, or cancer.

NIPPV can reduce work of breathing in selected COPD exacerbation or cardiogenic pulmonary edema patients. Avoid or escalate quickly if the patient cannot protect the airway, is vomiting, or is deteriorating.

Hypoglycemia, seizure, migraine, intoxication, infection, and electrolyte problems can mimic stroke. Check glucose early while still activating time-sensitive stroke evaluation when deficits are acute.

Severe unilateral weakness, gaze deviation, aphasia, neglect, or dense visual field loss suggests a high-risk stroke pattern that needs rapid imaging and stroke-team coordination.

Worsening headache, vomiting, declining level of consciousness, unequal pupils, posturing, hypertension with bradycardia, or abnormal respirations can signal dangerous intracranial pressure.

Ongoing or recurrent seizure without recovery threatens oxygenation and brain function. Protect from injury, support airway and glucose assessment, give ordered benzodiazepine therapy, and prepare second-line treatment.

Fever, neck stiffness, petechial rash, photophobia, or altered mental status requires rapid isolation precautions as indicated, sepsis assessment, cultures when feasible, and prompt antimicrobial therapy.

Hyperglycemia with dehydration, ketones, metabolic acidosis, abdominal pain, vomiting, or Kussmaul respirations suggests diabetic ketoacidosis. Treatment depends on fluids, insulin, potassium monitoring, and cause correction.

Altered mental status, diaphoresis, seizure, focal deficit, or collapse can be caused by low glucose. Confirm rapidly and treat according to airway status and available access.

Multisystem allergic reaction with airway symptoms, bronchospasm, hypotension, vomiting, or widespread hives is an epinephrine emergency. Antihistamines and steroids are adjuncts, not substitutes.

Peaked T waves, widening QRS, bradyarrhythmias, or sine-wave patterns indicate electrical instability. Prepare ordered calcium for membrane stabilization plus potassium-shifting and elimination therapies.

Severe pain requires timely analgesia, hydration assessment, oxygen only when hypoxic, and evaluation for complications such as acute chest syndrome, stroke, infection, or splenic sequestration.

Hematemesis, melena, syncope, hypotension, tachycardia, or orthostasis suggests significant blood loss. Priorities include airway readiness, large-bore access, labs, transfusion preparation, and escalation.

Reproductive-age patient with abdominal or pelvic pain, vaginal bleeding, shoulder pain, syncope, or shock needs pregnancy testing and rapid evaluation for ectopic rupture.

Pregnancy or postpartum hypertension with severe headache, visual changes, right upper quadrant pain, pulmonary edema, seizure, or abnormal labs requires urgent maternal stabilization and OB involvement.

After early pregnancy, a left uterine displacement or tilt can reduce aortocaval compression. Maternal stabilization is the best immediate fetal resuscitation.

Nasal flaring, grunting, retractions, head bobbing, poor feeding, cyanosis, or decreasing effort are serious signs. Children may compensate until they decompensate quickly.

Dry mucosa, absent tears, sunken eyes, delayed capillary refill, tachycardia, lethargy, and decreased urine output indicate escalating dehydration risk.

Injuries inconsistent with history, patterned bruises, multiple healing stages, delay in seeking care, or concerning caregiver behavior should trigger protection, documentation, and mandatory reporting procedures.

Early symptoms may be mild despite later liver injury. Obtain accurate timing and amount, check levels and liver tests per protocol, and anticipate N-acetylcysteine when indicated.

Respiratory depression with pinpoint pupils and decreased mental status suggests opioid poisoning. Ventilation support is the priority; naloxone reverses respiratory depression but may precipitate withdrawal.

Headache, dizziness, nausea, confusion, syncope, or multiple symptomatic people from the same setting should prompt high-flow oxygen and carboxyhemoglobin evaluation. Pulse oximetry may look falsely reassuring.

Hyperthermia with central nervous system dysfunction is a cooling emergency. Rapid cooling and supportive care take priority over antipyretics, which do not correct environmental heat injury.

A severely hypothermic patient can develop dysrhythmias with rough movement. Handle gently, remove wet clothing, rewarm according to severity, and continue resuscitation decisions with temperature in mind.

Protect the ED before treatment begins. Control entry, use appropriate PPE, separate contaminated patients, and perform decontamination so staff, patients, and the facility are not secondarily exposed.

A patient requesting emergency care needs an appropriate medical screening exam to determine whether an emergency medical condition exists, regardless of insurance status or ability to pay.

The receiver repeats the message or critical value, the sender confirms accuracy, and the team acts on the plan. It reduces errors during resuscitation, transfer, and mass-casualty operations.