Codes & Resuscitation

⚠ LOCALIZE THIS CARD: the targets below are the current AHA/LITFL/WikEM evidence base, not a site-specific order set. Confirm locally: your unit's actual cooling method/device (this card assumes ice packs/cooling blankets — a commercial surface or intravascular device may have its own protocol), who gets paged for ICU-level post-arrest care, and — if your site transfers STEMI out (card 21) — whether a post-arrest patient without a clear STEMI also needs transfer for ICU/cath-lab capability, and to where.

12-LEAD ECG OBTAINED — LOG IT TEMP. MANAGEMENT STARTED — LOG IT

Sources: Oxygenation (SpO₂ 90–98%, PaO₂ 60–105), ventilation (PaCO₂ 35–45), hemodynamics (MAP ≥65 minimum), temperature control (32–37.5°C, held ≥36h), and glucose (70–180 mg/dL) targets — 2025 American Heart Association Guidelines for CPR and ECC, Part 11: Post–Cardiac Arrest Care, cpr.heart.org (Class 1/2a, Level B-R, current guideline — supersedes the older 32–34°C and 36°C-only targets some references still show). Immediate-action checklist structure (arterial line, CXR, POCUS, Foley/urine-output goal, central line) — ALIEM, The Post-ROSC Checklist. General approach, higher-MAP discussion, and prognostication timing — LITFL Post Cardiac Arrest Care and Immediate Post-ROSC Management (this second LITFL page's own listed temperature target, 32–34°C, is the pre-2013 protocol it was written against — presented here only for historical context, not as the current target). Seizure/EEG guidance, immediate-vs-delayed angiography evidence, and 72-hour prognostication window — WikEM, Post Cardiac Arrest Care. Algorithm cross-check — ACLS-Algorithms.com. MAP target is a genuinely unsettled area between sources (65 vs. 70 vs. 80+) — presented above as a floor-plus-discussion rather than a single false-precise number.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

GIVE ATROPINE 1 mg — LOG IT

SEARCH FOR A CAUSE — "BRADI"

• BRASH — bradycardia + renal failure + AV-nodal blocker + shock. Check K⁺ (card 11).
• Reduced vitals — hypoxia, hypoglycemia, hypothermia, hypothyroidism.
• Acute coronary occlusion — get the ECG.
• Drug cause? Beta-blocker/CCB — calcium, glucagon 5 mg IV (repeat at 10 min), HIET. Digoxin — DigiFab.
• Raised ICP — Cushing's triad: bradycardia + hypertension + irregular breathing.

Sources: 2020 AHA Adult Bradycardia Algorithm — atropine 1 mg IV q3–5min (max 3 mg; increased from the older 0.5 mg dose in the 2015/2020 update), dopamine 5–20 mcg/kg/min, epinephrine 2–10 mcg/min, and the Mobitz-II/3rd-degree pacing caveat (AHA Bradycardia Algorithm PDF). "BRADI" differential mnemonic and toxicology antidote doses are supplementary EM teaching, not part of the AHA algorithm itself (EM Cases; WikEM) — verify antidote doses with pharmacy before administering.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

🗄 Stroke Box (Omnicell): the lytic/TNK response bundle is a premade box pulled from the Omnicell, not stocked loose on the code cart — confirm its current contents/checklist against the physical box before treating. Code cart drawer reference →

Sources: the originating hospital's Stroke Alert Role-Based Checklist (MD/PA/APRN) — TNK 0.25 mg/kg IV bolus (max 25 mg) as the originating hospital's primary lytic agent, NIHSS ≥6/FAST-ED ≥4 CTA and thrombectomy triggers, labetalol/nicardipine BP-lowering doses, transfer-center contact, and the neurologic-decline/symptomatic-ICH/angioedema complication pathway. AHA/ASA 2019 Guidelines for Early Management of Acute Ischemic Stroke — general pre-/post-lytic BP targets, alteplase dosing as an accepted alternative, thrombectomy window (0–6h standard/6–24h extended, DAWN/DEFUSE-3 criteria). Exclusion list is abbreviated for cognitive-load reasons — use the full checklist on the Stroke Box before treating.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

SEARCH FOR A CAUSE

• Opioid / CNS depressant overdose — naloxone (see above).
• Airway obstruction / foreign body — look, suction, consider Heimlich/direct laryngoscopy removal.
• Anaphylaxis — see card 08.
• Severe asthma — bronchodilators. Bagging feels tight? Think breath-stacking.
• Neuromuscular weakness / high spinal cord injury — may need prolonged ventilatory support.

Sources: 2020 AHA Guidelines for CPR and ECC (reaffirmed in the 2025 algorithm set) — rescue breathing rate 1 breath/6 sec (10/min) for a patient with a pulse, pulse recheck ~q2min (AHA CPR & ECC Guidelines). Naloxone dosing per standard EM/toxicology references (StatPearls, ACLS.com) — confirm the exact dose/route against your site's stocked formulary before printing a fixed number into practice.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ CAN'T INTUBATE, CAN'T OXYGENATE? Can't intubate and can't oxygenate (best BVM + iGel), SpO₂ <70% and falling → stop attempting. → DECLARE CICO — Card 18: FONA

1 · PRE-AIRWAY PREPARATION

• Physiology optimized first: fix hypotension, oxygenation, and pH before you push ("HOp killers" — EMCrit).
• Equipment out: BVM+PEEP on flush O₂ · VL + DL · OPA, bougie, SGA, scalpel · 2 suctions · eye protection. Child? Sizes → peds card 16.
• Denitrogenate ≥3 min. ApOx by NC through the attempt. Target SpO₂ 100%.
• Dentures out · cric marked · ear-to-sternal-notch · pulse ox visible and OFF the BP arm · cuff q3 min · IV tested · plan said aloud.
• Say the CICO number out loud BEFORE you start: "below ___% and falling." Default <70% (DAS 2025).

RSI MEDICATION TIMES — TAP THE DRUG AS IT IS PUSHED

Doses come from the weight in the bar at the top and are rounded to the nearest practical increment (10 mg for the RSI agents) — the syringe gets drawn to a round number, not to 84 mg. No weight entered → the tap still stamps the time and logs the drug, and says the dose was not recorded. Obesity: succinylcholine is dosed on total body weight; the right dosing weight for rocuronium is debated (total vs. ideal) — this calculator uses whatever weight is in the bar.

POST-INTUBATION — TAP THE DRUG AS IT IS GIVEN

⚠ PARALYTIC GIVEN, NOTHING LOGGED FOR PAIN OR SEDATION. Rocuronium at an RSI dose lasts about 45–60 minutes and succinylcholine wears off in minutes — either way the patient can be awake and unable to move or signal. Analgesia and sedation now, before the vent settings and before the CXR.

These are first doses for an average adult, not a sedation plan — reassess, retitrate, and hand over a target depth of sedation. Analgesia first, then sedation (SCCM PADIS 2018 analgesia-first/analgosedation approach), and treat the newly intubated hypotensive patient's sedation as a hemodynamic drug: propofol and midazolam both drop the pressure, ketamine usually does not. Every one of these is reduced in shock, in the elderly and in liver or renal failure.

Sources: the originating hospital's Adult Airway Guide — the Pre-Airway Preparation / Induction & Airway Attempt / Post-Tube Confirmation structure and most checklist items (denitrogenation/ApOx targets, ear-to-sternal-notch positioning, VL vs. DL call, ELM, bougie/2nd-intubator/iGel/cric backup plan, capnography+breath-sounds+OG+CXR confirmation) are drawn directly from it; it does not specify an induction/paralytic combination or pressor recipe. Merged into the checklist above: Weingart S, "Checkboxed Checklist" (rev. 2020-12-21), EMCrit Blog, emcrit.org — physiologic-optimization ("HOp killers": hypotension/hypoxemia/pH — EMCrit's peri-intubation resuscitation-sequence concept, not a verbatim quote from the printed card), push-dose epinephrine/post-tube norepinephrine, cricothyroid-membrane marking, pulse-ox placement, large-bore rigid suction, eye/face protection, and video-laryngoscope recording items were added from it; redundant items already covered by the originating hospital's checklist were not duplicated. Two numeric items differ between the sources and are flagged rather than silently merged: apneic-oxygenation flow (originating checklist 15 L/min vs. EMCrit's 20 L/min) and the preoxygenation SpO₂ target (originating checklist ≥95% vs. EMCrit's 100%/CPAP) — the originating checklist's figures are used as the primary checklist values. Cross-check the EMCrit item against the current version there, since EMCrit has since updated to a v2.5 checklist. RSI induction/paralytic dose ranges are standard EM references (LITFL and similar) pending a site-specific order set; waveform capnography as the gold-standard confirmation method also aligns with AHA/ASA airway guidance. Ventilator settings are institution-specific — confirm against your site's own RT protocols. CICO trigger criteria (can't intubate, can't oxygenate despite BVM/iGel, SpO₂ <70% and falling) per DAS 2025 — see card 18. The tap-to-log drug menus (RSI and post-intubation) are rendered from this file's SITE.rsiDrugs config block, which carries a per-drug source note; the per-kg figures are the mid/standard point of the ranges printed above rather than a separate recommendation, and rocuronium 1.2 mg/kg and succinylcholine 1.5 mg/kg additionally match the RSI doses in DAS 2025 (Ahmad I, El-Boghdadly K, Iliff H, et al. Br J Anaesth 2026;136(1):283–307), which /airway/ carries as its own config. Post-intubation: analgesia-before-sedation, opioid-first for non-neuropathic pain, and a light target depth of sedation are from Devlin JW, Skrobik Y, Gélinas C, et al., Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS), Crit Care Med 2018;46(9):e825–e873. PADIS states the principle but publishes no per-kg ED bolus, so the first doses offered here (fentanyl 1 mcg/kg within a conventional 0.5–2 mcg/kg range; propofol infusion started at 20 mcg/kg/min within a 5–50 mcg/kg/min range; midazolam 0.05 mg/kg; ketamine 0.5 mg/kg) are standard EM/critical-care starting doses, not guideline numbers — confirm them against your own pharmacy's concentrations and order sets before relying on them. Rounding to a practical increment (10 mg for the RSI agents, 25 mcg for fentanyl) is a local convenience decision, not a clinical recommendation.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ DECLARE CICO → FONA (Card 18)

Sources: the originating hospital's Intracranial Hemorrhage (ICH) Checklist — SBP <140 mmHg goal, labetalol 10–20 mg IV q10min PRN / nicardipine 5 mg/hr titrated-drip dosing, IV access/monitoring cadence, and reversal-agent-by-anticoagulant framework (see card 10 for current agent-specific doses). 2022 AHA/ASA Guideline for the Management of Spontaneous Intracranial Hemorrhage — acute SBP target range 130–150 (floor ~130), routine seizure prophylaxis not recommended, cerebellar hemorrhage surgical criteria. Hyperosmolar-therapy dosing (mannitol/hypertonic saline) follows the Neurocritical Care Society's ENLS protocol, which the AHA/ASA guideline itself declines to specify a single regimen for — confirm your institution's chosen agent/dose before printing a fixed number.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

🗄 Anaphylaxis Box (Omnicell): premade — epinephrine, antihistamine, and steroid preloaded — pulled from the Omnicell, not stocked loose on the code cart. Code cart drawer reference →

EPI IV PUSH GIVEN — LOG IT

EPI DRIP STARTED — LOG IT

Observation after treatment: the 2020 update moved away from one universal number — low-risk patients who respond to a single epi dose may be safe after as little as ~1 hour; higher-risk patients (multiple epi doses needed, severe reaction, prior biphasic reaction, asthma, delayed treatment) warrant extended observation up to 6+ hours or admission. About half of biphasic reactions happen in the first 6–12 hours.

Sources: World Allergy Organization Anaphylaxis Guidance 2020; AAAAI/ACAAI/JCAAI Anaphylaxis — 2020 Practice Parameter Update (J Allergy Clin Immunol 2020) — epinephrine 0.01 mg/kg IM (1:1000), adult max 0.5 mg, anterolateral thigh, repeat q5–15min; 20 mL/kg fluid bolus; risk-stratified observation guidance. IV epi infusion rate, glucagon dose, and steroid doses are standard EM-reference dosing (WikEM) rather than numbers stated verbatim in the WAO guideline — confirm against your pharmacy's order set.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

TXA GIVEN — LOG IT

Sources: CRASH-2 Collaborators, Lancet 2010;376(9734):23-32 (TXA 1g/1g regimen, 3-hour window, harm signal after 3h); CRASH-3 Collaborators, Lancet 2019;394(10210):1713-1723 (TBI indication, GCS 9–15 subgroup benefit); StatPearls "Permissive Hypotension" (NBK558915) and "Hemorrhagic Shock" (NBK470382) for shock-class/BP-target guidance. The classic ATLS 4-class shock table is a teaching aid — vitals often don't correlate reliably with actual blood loss, especially in young trauma patients; trend, don't anchor on a single snapshot.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ Andexanet alfa (Andexxa) was voluntarily withdrawn from the US market in December 2025 after ANNEXA-I showed roughly double the thrombosis rate vs. usual care. 4-factor PCC is now the primary reversal strategy for factor Xa inhibitors — confirm with pharmacy whether any institutional stock remains before considering it.

GENERAL APPROACH

• Identify the specific agent and time of last dose.
• Assess bleeding severity/location and hemodynamic stability.
• Call pharmacy/hematology immediately — don't calculate high-stakes reversal doses alone.
• Apply local hemostatic measures (packing, pressure, endoscopic/surgical control as indicated).
• Avoid platelet transfusion unless thrombocytopenic or bleeding is from an antiplatelet agent.

Sources: 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants (JACC 2020) — 4F-PCC/vitamin K dosing for warfarin, general approach; idarucizumab FDA label (5g, two 2.5g vials); ISTH SSC 2024 Guidance on Reversal of DOACs. FDA Safety Communication, Andexxa market withdrawal, Dec 2025. Heparin/LMWH protamine dosing per institutional pharmacy references — time-decay tables vary between sources, confirm your site's own protocol before hardcoding.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

EKG progression: peaked T waves → PR prolongation/P-wave flattening → QRS widening → sine wave (usually K⁺ >9) → VF/asystole. A normal-looking EKG does not exclude imminent arrest — serum K⁺ doesn't correlate tightly with ECG findings.

Sources: ACEP Management Algorithm for the Adult with Hyperkalemia; EMCrit IBCC — Hyperkalemia; LITFL Hyperkalaemia ECG Library (EKG progression). Insulin dose split (5 vs 10 units) and specific glucose-recheck cadence reflect practice-variable, patient-factor-dependent dosing — confirm with your institution's protocol. UK Kidney Association/Renal Association 2022 Hyperkalaemia Guideline is a KDIGO-adjacent reference worth reading directly if you want additional authority behind the printed numbers.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: The originating hospital's Massive Transfusion Protocol policy (effective 07/01/2026; document owner: Chief Medical Officer; original approval 06/28/23; reviewed 02/29/24, 03/04/24, 08/01/25, 06/26) — activation indications, blood bank notification/issue process, procedure steps A–S, end-point/goal-directed transfusion thresholds, and adverse-outcome monitoring list. That policy itself notes printed copies are discouraged and defers to the electronic copy for the approved version — recheck this card against the current EMR policy periodically. Supplementary, not from the originating MTP policy: ACS TQIP Massive Transfusion in Trauma Guidelines (Oct 2014) and Nunez et al., J Trauma 2009 (ABC score derivation, penetrating mechanism/pulse/SBP/FAST components); calcium dosing (gluconate 2 g peripheral or chloride 1 g central) and repeat-lab cadence context — wikem.org — Massive transfusion. Magnesium — evidence conflict, flagged rather than resolved: WikEM lists empiric magnesium alongside calcium with no dose given; a more recent analysis (Ekelund et al., PMC 10419839) found massive transfusion more often raises serum magnesium (57–67% hypermagnesemic by 24–48h, likely from mild hemolysis) and does not recommend empiric dosing. This card follows the more recent data — check magnesium, don't empirically dose it — pending your own transfusion medicine director's guidance. Whole-blood substitution and platelet-availability notes reflect the originating site's current blood bank practice, not the written policy text — reconfirm with your blood bank.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

SEARCH FOR A CAUSE

• Hypoglycemia, hyponatremia/electrolyte derangement, hypoxia.
• Toxin exposure or withdrawal — especially alcohol/benzodiazepine withdrawal.
• Eclampsia in pregnancy — give magnesium sulfate.
• Fever/CNS infection (meningitis/encephalitis) — consider LP once stabilized.
• Medication non-adherence in a known epileptic — check AED levels.

Sources: the originating hospital's Status Epilepticus Checklist — lorazepam 4 mg IV q2min (max 10 mg)/midazolam 10 mg IM as first-line, levetiracetam 60 mg/kg (max 4500 mg) or valproate 40 mg/kg as second-line, intubation triggers (>30 min despite meds, or GCS <8/persistent airway compromise) with ketamine-preferred RSI, and STAT transfer to a Neuro ICU center. American Epilepsy Society, Guideline for Treatment of Prolonged Seizures in Children and Adults (Glauser et al., Epilepsy Currents 2016) — timed-phase structure and AES-equivalent weight-based dosing alternatives; Silbergleit et al. (RAMPART), NEJM 2012 (IM midazolam); Kapur et al. (ESETT), NEJM 2019 (2nd-line agent equivalence, valproate dosing cap); Trinka et al., Epilepsia 2015 (ILAE operational definition, 5-min t1 for convulsive SE).

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

DISCONNECT FROM VENT — BAG WITH 100% O₂

Sources: UCSF Hospital Handbook, "Troubleshooting the Ventilator" — disconnect-and-bag first step, peak/plateau pressure differentiation; LITFL Critical Care Compendium, "High airway and alveolar pressures." DOPE is standard PALS/ACLS/EM teaching for the crashing ventilated patient; a proposed extension to "DOPES" (adding Stacked breaths) exists in some sources but is not universally adopted — not included here.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: the originating hospital's Status Asthmaticus Management Checklist — severity tiers, first-line nebulizer/steroid/magnesium/epinephrine dosing, Vision 2000 ventilator BiPAP settings, intubation indications, ketamine-preferred RSI with dosing, sedative cautions, and disposition criteria. Dosing generally aligns with GINA (Global Initiative for Asthma) and NAEPP EPR-3 severe-exacerbation guidance for albuterol/ipratropium/corticosteroids/magnesium — the BiPAP settings and epinephrine IV bolus/infusion recipe above are the originating hospital's own specification, not verbatim from a national guideline; confirm against current respiratory therapy protocol before printing as fixed numbers.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: the originating hospital's Angioedema Management Checklist — histaminergic vs. bradykinin-mediated branch point, avoid-RSI/awake-fiber-optic-preferred airway approach with cricothyrotomy backup, icatibant/FFP/C1-esterase-inhibitor dosing, and disposition criteria. Cross-references: card 04 (TNK-associated orolingual angioedema) and card 08 (anaphylaxis) for related/overlapping presentations.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: Adapted from the originating hospital's "Granular Rubric for Evaluating a Tracheostomy Emergency" — originally a training/scoring rubric, converted here into a bedside action checklist. The laryngectomy-status critical decision point, systematic patency check via suction catheter, <7-day stoma-maturity threshold for safe reinsertion, and laryngectomy-specific stoma-bagging/reintubation pathway are drawn directly from it. Verify your local ENT/RT backup-call process and tracheostomy-supply cart contents.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

See card 06 (Intubation/RSI) for the pre-airway and induction phases. This card is Plan D — what to do when the patient is paralyzed and you can't intubate AND can't oxygenate by mask or supraglottic device (LMA/iGel).

UNDO

Sources: Difficult Airway Society (DAS) 2025 guidelines for management of unanticipated difficult tracheal intubation in adults, Br J Anaesth 2026;136:283–307 (CICO/"Plan D" trigger, and the emphasis on confirming anatomical endpoints before incision — a change from the 2015 DAS guidance). Laryngeal-handshake landmark technique — widely taught airway-literature convention (Levitan RM et al.). The 9-step scalpel-finger-bougie sequence (vertical incision → blunt dissection → horizontal membrane incision → finger confirmation of the tract → bougie → tube "only far enough" → ETCO₂/BVM confirmation → suture) reflects departmental clinical review and correction of an earlier draft of this card — verify against your current credentialed technique. This card is also linked from the Trauma tool.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: LVAD Emergency Manual, Page 1 — Responsive Patient (Pump Running, Hum Present) — departmental draft reference provided for this card, transcribed with its thresholds intact (Doppler MAP 70–80/≥60 target, alarm-pattern table, echo differentiation table, pump-thrombosis lab criteria, do-not-start-compressions-initially arrest sequence, AP pad placement). Not an official device manual — verify against the patient's own VAD center guidance and device documentation before use, and fill in the VAD coordinator contact locally.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ TIME-CRITICAL. If the aortic valve is oversewn → the patient has ZERO cardiac output without the pump. A non-running pump creates retrograde flow (functional aortic regurgitation).

Sources: LVAD Emergency Manual, Page 2 — Unresponsive Patient (Pump NOT Running, No Hum) — departmental draft reference provided for this card, transcribed with its thresholds and sequence intact (5-step timed restart sequence, compressions-indicated-if-no-perfusion stance, stop compressions if MAP >50 after restart, norepinephrine/dobutamine/milrinone support, outflow-graft clamping only on VAD-surgeon direction, cause-of-failure list). Not an official device manual — verify against the patient's own VAD center guidance and device documentation before use.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ LOCALIZE THIS CARD: confirm your site's actual STEMI activation process (who gets paged, current Omnicell box contents, current transfer agreements/preferred receiving center). The dosing/decision content below is the general evidence base, adapted to the originating hospital's documented TNK-based pharmaco-invasive protocol (matching the existing Stroke card) — verify locally before treating.

🗄 STEMI/Chest Pain Box (Omnicell): the response bundle is a premade box pulled from the Omnicell, not stocked loose on the code cart — confirm current contents against the physical box. Code cart drawer reference →

Sources: STEMI mimics and Spodick's sign — LITFL (Pericarditis, Spodick Sign, BER, Sgarbossa, LVH, Brugada, Hyperkalaemia, Takotsubo, McGinn-White/PE); WikEM STEMI mimics. Aspirin — WikEM Aspirin; LITFL STEMI Management (minor dose variance between sources, both within guideline range). Heparin/enoxaparin fibrinolysis dosing — emDocs, Thrombolytic Use for STEMI (secondary synthesis of ACCF/AHA guidance; cross-check against pharmacy/full 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline). Atorvastatin 80 — AAFP summary of ACC/AHA lipid guidance, link. TNK weight-band dosing — FDA TNKase prescribing information (2025), cross-confirmed via DailyMed and WikEM Thrombolytics for STEMI; ≥75 half-dose practice sourced to the STREAM-1/STREAM-2 trials, not the package insert. Pressor/fluid choice — WikEM Cardiogenic Shock, SOAP-II (NEJM 2010); RV-infarct fluid-first strategy — LITFL Right Ventricular Infarction (exact bolus volume isn't specified by the source — deliberately not stamped with an invented number here). Reperfusion arrhythmias — LITFL AIVR and Bezold-Jarisch Reflex; resus.com.au, Reperfusion Arrhythmias; AIVR rate range differs slightly between these two sources — presented as a range with the disagreement flagged rather than a single false-precise number. Transfer numbers verified directly against each hospital's transfer-center page (2026-08-05) — see the TRANSFER call log above.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ This is hemorrhagic shock that happens to be bleeding into the gut. Give blood, not crystalloid. The airway decision and the resuscitation decision are the same decision — resuscitate before you induce.

ROOM 7 (RESUS BAY) CABINET · GI HEMORRHAGE / BLAKEMORE KIT
balloon-tamponade kit, wrapped in the poster, behind the door label · door label · wall poster

Sources: Resuscitation sequence, permissive hypotension, blood-not-crystalloid, SALAD, two-suction setup, head-of-bed 45°, ketamine 0.5 mg/kg / rocuronium 1.5 mg/kg, metoclopramide 10 mg IV, octreotide 50 mcg bolus then 50 mcg/hr, ceftriaxone 1 g IV, the PPI position and the aortoenteric-fistula warning — First10EM, Massive GI bleed. Transfusion thresholds (≥7 g/dL non-variceal, ~8 g/dL variceal), endoscopy timing (12 h variceal / 24 h non-variceal), the alternative PPI regimen (pantoprazole 80 mg bolus then 8 mg/hr) and balloon tamponade as a ≤24 h temporizing measure — WikEM, Upper gastrointestinal bleeding. Where good sources support more than one course, the card prints them as lettered options with the source on each rather than narrowing to one silently — the PPI question is the example here. TXA — HALT-IT Trial Collaborators, Lancet 2020;395:1927–36: no reduction in death from bleeding, increased venous thromboembolic events. Balloon-tamponade numbers (50 cm insertion mark, gastric 250–300 mL Sengstaken-Blakemore / 450–500 mL Minnesota in 50 then 50–100 mL steps, ≈1 kg traction, esophageal 30 → ≤45 mmHg in 5 mmHg steps, deflation every 6–8 h, scissors at the bedside) are carried verbatim from this manual’s own Blakemore poster, which holds the primary citations for them. Transfer-center number verified against the transfer-call log on card 21.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ The lethal problem is the good lung filling with blood. Bleeding side down, biggest tube you have, isolate early. An awake patient with a strong cough is clearing it better than you will — do not reflexively intubate.

ROOM 7 (RESUS BAY) CABINET · LUNG ISOLATION / HEMOPTYSIS KIT
bronchial blocker, coudé bougie, large ETTs and the nebulized-TXA setup · door label

Sources: Volume thresholds, dead space, bleeding-side-down positioning, ETT ≥8.0, blind mainstem success rates, DDAVP and the argument against a DLT — First10EM, Massive hemoptysis; LITFL, Haemoptysis; emDocs, Podcast 116 and EM@3AM Hemoptysis; StatPearls, Pulmonary hemorrhage. Bougie rotation technique and the give-both-TXA-routes position — EMOttawa, Practical management of acute hemoptysis. TXA trial numbers (Wand 2018, Gopinath 2023) — REBEL EM. Where more than one published value exists it is shown as options rather than narrowed to one: the definition of “massive” (>100 mL/h, >500 mL/24 h, >600 mL/24 h and >50 mL per cough are all in print), the dead-space figure, and the TXA interval. No source gives an ETT depth in cm for blind mainstem intubation, so none is printed here.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ Almost all of this is done badly for one reason: the pressure is in the wrong place. Squeeze the soft cartilage, not the bridge, and hold it without looking. A patient bleeding into the oropharynx is not a nosebleed — that is an airway.

ROOM 7 (RESUS BAY) CABINET · EPISTAXIS KIT
speculum, headlamp, pledgets, packing devices and balloons · door label

Sources: WikEM, Epistaxis (pressure duration, oxymetazoline/lidocaine mix, topical TXA preparation, posterior features, silver-nitrate rule, pack durations, anticoagulation). StatPearls, Epistaxis and Posterior epistaxis nasal pack (anatomy, clot removal, Foley and dual-balloon volumes, monitoring requirement). Iowa Head and Neck Protocols (pressure technique, cautery interval, electrocautery/device caution, Foley volumes). Internet Book of Emergency Medicine and Rapid Rhino instructions (sterile water 30 s, air-only inflation, device sizes). EM Cases via emDocs (pledget-and-clamp, palatal ice, antibiotic threshold). TXA: REBEL EM (Zahed) and First10EM on NoPAC (negative). Antibiotics: Core EM and REBEL EM against, StatPearls and Iowa for. The pressure duration and the antibiotic question are printed as options with the source on each, because the reader cannot otherwise tell a settled number from one that is still a choice.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ A magnet does opposite things to the two devices. Over an ICD it stops shocks and changes nothing about pacing. Over a pacemaker it forces asynchronous pacing and changes nothing about shocks. Never magnet a patient whose shocks are appropriate.

CODE CART · SIDE PANEL — PACEMAKER MAGNET
the magnet is the one thing on this card you need in seconds · cart section · cart label

Sources: First10EM, Electrical storm (procainamide-first position, sedation, Brugada/isoproterenol, the detection-rate trap). WikEM, Electrical storm (beta-blocker-first position and the 67% vs 5% series), ICD complications and Pacemaker malfunction. LITFL, Pacemaker malfunction ECG library (PMT 160–180/min, runaway ~200/min, Twiddler’s, pacemaker syndrome). Magnet behavior by manufacturer and the ICD-does-not-change-pacing rule — Europace 2011; appropriate-vs-inappropriate discrimination — Europace 2010. emDocs, Pacemaker and AICD management (10% magnet-rate rule, pacing-dependent caution, pads ≥8 cm). Pad distance also ANZCOR 11.4. Rescuer-contact effects — Cleveland Clinic Journal of Medicine. The first-line drug for electrical storm is shown as two options with the source on each. Magnet rates are manufacturer-specific and were cross-checked between WikEM and Europace, which differ slightly on end-of-life rates — confirm against the patient’s device card.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ DRAFT — NOT CLINICALLY REVIEWED: written from the published guidelines cited below to fill coverage gap #88. Verify every dose and threshold against local protocol and pharmacy before this card is trusted.

Sources: Wilderness Medical Society clinical practice guidelines for out-of-hospital hypothermia (WEM 2019); AHA 2020 Guidelines Part 3, special circumstances (Circulation 2020); ERC 2021 special circumstances.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ DRAFT — NOT CLINICALLY REVIEWED: written from the published guidelines cited below to fill coverage gap #86. Verify every dose and threshold against local protocol and pharmacy before this card is trusted.

This card is the sharp end — AHA/ACC Categories D and E. To classify the patient, decide admit vs outpatient, or work out whether a stable-looking PE is actually a C3, use the PE Clinical Categories calculator.

Sources: 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN guideline for the evaluation and management of acute pulmonary embolism in adults (Circulation 2026;153:e977–e1051) — categories, anticoagulant choice, vasopressor, sedation, transfer and advanced-therapy recommendations. Alteplase dosing in cardiac arrest follows AHA ECC guidance for PE-associated arrest, not the 2026 PE guideline.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: ACEP Task Force on Hyperactive Delirium 2021; Project BETA (West J Emerg Med 2012;13:17); droperidol safety per ACEP clinical policy 2020.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ DRAFT — NOT CLINICALLY REVIEWED: written from the published guidelines cited below to fill coverage gap #91. Verify every dose and threshold against local protocol and pharmacy before this card is trusted.

Sources: 2022 ACC/AHA guideline for the diagnosis and management of aortic disease (Circulation 2022;146:e334); classic anti-impulse regimen per IRAD analyses.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ DRAFT — NOT CLINICALLY REVIEWED: written from the published guidelines cited below to fill coverage gap #92. Verify every dose and threshold against local protocol and pharmacy before this card is trusted.

Sources: Wilderness Medical Society heat illness guidelines (WEM 2019); Epstein & Yanovich, Heatstroke (NEJM 2019;380:2449).

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: ASAM clinical practice guideline on alcohol withdrawal management 2020 — the benzodiazepine-first ladder, the front-loading principle, and the treat-the-seizure-with-benzodiazepines rule. Phenobarbital as an adjunct layered onto benzodiazepines: Rosenson et al. (J Emerg Med 2013;44:592). Phenobarbital as the FIRST agent is a departmental protocol choice, not a recommendation of either source above — ASAM 2020 describes phenobarbital chiefly as an adjunct or alternative, so that pathway is offered here for departments whose own protocol is phenobarbital-primary and is flagged for local sign-off rather than presented as guideline-backed. Both ladders' doses are rendered from this file's SITE.withdrawal config block.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ DRAFT — NOT CLINICALLY REVIEWED: written from the published guidelines cited below to fill coverage gap #95. Verify every dose and threshold against local protocol and pharmacy before this card is trusted.

Sources: AABB Technical Manual (transfusion reactions chapter); CDC NHSN hemovigilance definitions. Follow your site's blood bank policy for the workup form and re-issue rules.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

Sources: AHA 2023 guideline for management of poisoned patients in cardiac arrest and life-threatening toxicity (Circulation 2023;148:e149); ACMT position statements (lipid, HIE); Goldfrank’s Toxicologic Emergencies 11e.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.

⚠ DRAFT — NOT CLINICALLY REVIEWED: written from the published guidelines cited below for issue #179. Every rate on this card is computed from the standard bag concentrations in this file's SITE CONFIG block — if your pharmacy hangs a different mix, every number here is wrong until that block is changed. Confirm the concentration on the bag in your hand before you set a pump.

Sources: Septic/distributive — Surviving Sepsis Campaign 2021 (Evans L, et al. Crit Care Med 2021;49:e1063): norepinephrine first-line, MAP target ≥65, vasopressin added at norepinephrine ~0.25–0.5 mcg/kg/min, epinephrine third, hydrocortisone for refractory shock, and peripheral initiation while access is arranged (with CENSER, AJRCCM 2019). Cardiogenic — 2025 ACC/AHA/ACEP/NAEMSP/SCAI acute coronary syndromes guideline; norepinephrine-over-dopamine from the SOAP II cardiogenic subgroup (De Backer D, et al. N Engl J Med 2010;362:779). Post-ROSC — AHA Guidelines for CPR and ECC, post-cardiac-arrest care (avoidance of hypotension, MAP ≥65 / SBP ≥90). Massive PE — ESC 2019 acute pulmonary embolism guidelines (Eur Heart J 2019;41:543): fluid restriction, early norepinephrine, inotrope for the low-output RV. Bradycardia — AHA adult bradycardia algorithm: epinephrine 2–10 mcg/min and dopamine 5–20 mcg/kg/min, both as bridges to pacing; the epinephrine figure is published not weight-based and is carried that way here. Neurogenic — MAP 85–90 for spinal cord perfusion is the widely-taught target from the AANS/CNS acute cervical spine and spinal cord injury guidance; it rests on low-quality evidence and remains a consult conversation. Push-dose regimens, standard bag concentrations, and the phentolamine extravasation dose — EMCrit / WikEM / LITFL tertiary references; these are the values most likely to differ at your site, and they live in this file's SITE CONFIG block for exactly that reason. Pediatric (under 40 kg). Infusion dosing for children is not on this card — see Peds card 02. Vasopressin is a specific hole rather than a gap in this card: no FDA-approved or society-endorsed weight-based pediatric dose exists for vasopressin in any shock type, so entering a pediatric weight withholds that row's rate instead of showing the adult one — Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children, Pediatr Crit Care Med 2020;21(2):e52–e106.

— personal/unofficial aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment. Verify all values locally.