hey guys greetings good evening mark boswell boswell emergency medical education coming at you with another video short and this was going to be something you really want to look at if you're taking your ce exam or planning on it i'm going to tell you 10 things you must know for the exam so what are these 10 things where i get them where they come from because as you know one of your exam principles or exam rules is you have to respect their proprietary stuff you're not supposed to talk about things that you see specifically on the exam keyword being specifically hey i'm only telling you stuff it's on the blueprint this is public accessible knowledge what i'm doing is different here is i'm telling you ten things that are frequently seen on the exam both for my personal experience taking all the times i've taken it versus people who've taken it before other students other exam takers so i'm going to tell you 10 things that show up on the exam very frequently and at least make sure you can address these 10 things before you take that exam so take these next 10 bullets i'm going to give you do a little extra study make sure you got them down you're going to see most of these on the exam statistically all right number one you need to know your rule of nines we're talking about our burn patients here right you need to and this is also now i recommend that you write down during the test you either draw a picture of a stick man or a hangman or whatever and then your pediatric one and be comfortable with your different zones on that picture and where the nines are as far as calculating your burden percentage you're going to get a burn question most likely you're going to have to calculate the rule of nines be familiar be comfortable with this okay next one you need to know your stemi patterns you're going to see at least one question about semis acute mis um you will not see an ekg on the test but what you'll read about in the stem of the question is they'll describe to you where the st elevations are you need to be familiar with your ekg simple you just need to be familiar with the typical 4x3 grid that has that you can label all your different lead names and the different infarct patterns so you know which one you're dealing with all right the common ones on the test inferior septal anterior and lateral and there's your key word i see all leads inferior 2 3 septal v1 v2 anterior v1 through v4 lateral v5 v6 lead 1 and avl you need to know that practice writing it down practice drawing a picture so when you get your piece of paper during the test you can draw it out and already have on the paper when your stemi question comes up because you're going to see a stemming question you need to know either muddles or sludge them what is that this is your organophosphates you're gonna get most likely a question organophosphate toxidrome or exposure the nerve agent okay you only need to know one of these two words and just remember the word you don't need to define it you can figure it out during the test okay what do we know about organophosphates we talk about patients having fluids coming out of every orifice right they're just they're leaking fluid out of everywhere so can you remember the word muddles and go to the when you get the test question can you make each of those fluid symptoms match something from either muddles or sludge i'm gonna do it for you right here right now i'm not reading notes i'm doing just off the spur of the moment so muddles uh letter m okay this is not a fluid word but there is something with the eyes and for organophosphates is the pupils are meiotic meiosis you're going to focus on the letter o in meiosis and remember o for organophosphates and o for the word constricted c-o-n okay so m is from meiosis you well the fluid there is urination d you've got a couple choices it could be diarrhea diaphrasis defecation so a couple options there l lacrimation so watering the eyes e that's not a fluid one but that's three this is the reason why valium is sometimes given for organophosphate poisoning because the central nervous system excitation seizures and then s for salivation let's look at sludge right quick see if we make those matches well too so sludge them s salivation l lacrimation u urination d i've got a couple options diarrhea diaphoresis or defecation g that's a little different on this one g is for gi that's emesis that's vomiting that's the fluid there e again is still excitation so possibly seizures and m again from meiosis you need to know one of these two words you don't need to know both of them just one will work you'll answer the question you're going to see this likely 75 of the time on the exam placenta previa versus placental abruption one of our obstetrical emergencies these are on the exam frequently i can't tell you enough how do you identify these two every time i've taken this test i will tell you it's based upon the pain the level of pain this patient's reporting placenta previa has a p for placenta and a p for previa you can remember painless privates no it's not always painless but it's definitely a low grade pain maybe a one two or three on the 10 scale placental abruption has a p and an a and you remember the a is for always the p is for painful this is a significant pain like a seven eight or nine on the 10th scale the other thing with this if they ask you which fetus needs to have be prioritized or taken care of or which mother placental abruption has a p and a and this reminds you that a is for always and p for priority because this fetus is most likely in distress due to the separation of the placenta and not oxygenate okay so those two are on the test very commonly measles versus chickenpox this is on the exam frequently okay these childhood rash illness viral illnesses all right what do you need to know about these how do you tell them apart i'm gonna give you three ways to tell these two apart measles and it's gonna be about you're gonna ask where did it start what does it look like and does it run together those three things will tell these two apart where did it start mom where'd you first see it what does it look like and do they overlap measles starts in the face chicken pox starts in the trunk measles all looks the same chicken pox various stages some are flat some are pink some are raised some are pustules some have broken open and some are crusted various stages measles runs together chickenpox does not there's your three right there easy way to tell these apart again you're three-fourths 75 likely to see measles versus chickenpox on your exam torsion versus epididymitis okay so we've got a testicular problem here this is commonly on exam also how do we tell these two apart time of onset torsion is an ischemic testicle due to the rotation of the testicle and the artery the oxygenating flow being cut off this is the pain of ischemia this will crescendo and the patient will come in for care usually within about four or six hours all right epididymitis gradual onset over a couple days that's an infection the epididymis using std in these younger guys typically in the 30s or 20s yes if the epididymitis guy tells you hey oh nurse it just started hurting tonight ask them what did you notice yesterday the day before if it's epididymitis they will say yeah there was something a little uncomfortable there i felt some discomfort some swelling maybe torsion you asked them how did you feel yesterday it would say normal there was no precursor to this there was no prodrome they were feeling normal and then all sudden within a few hours that ischemic pain of that torsion started out so time of onset differentiates these two you need to know your priorities of care your abc's okay anytime you get an exam question when they ask you what's the first thing you do or the next thing you always go back to that a b c so in other words if they give you some information to suggest you've already checked the airway and they ask you what's the next thing you do you look for a letter b thing a breathing thing either breathing assessment or breathing intervention okay this exam is written by nurses for nurses there's no nursing care plans but you need to know your abc's okay so sometimes that throws people off because i think man i really need to check for an airway obstruction or whatever but if the exam question already says you've addressed the airway what's your next assessment is to check the breathing okay the only exception that is if we need to put c first okay for circulation which we are teaching that in tncc eighth edition now how do you factor that in when you're when you walk into the room or when ems brings you that patient or that person is coming to triage we do a quick look across the room to see and ask is there any uncontrolled massive external hemorrhage this is hemorrhage that would cause a patient to die in the next 60 seconds to 120 seconds this is hemorrhage that is an immediate threat to them if you see that on your quick look across the room or as you approach the patient then you do put c first and you do with that bleeding which might mean a tourniquet possibly if there's an amputation okay uh if it's not an amputation there's a big light you go direct pressure okay if you don't see that massive uncontrolled external hemorrhage from across the room then by default you go back to abc's you will still reassess any bleeding when you get to step c but your first thing is to look is there any mat this is keywords folks massive uncontrolled external hemorrhage will they die from this bleeding in the next 60 to 120 seconds if so i need to intervene first for the circulation you need to know your nursing process you forgot that after nursing school right i you probably didn't this exam again written by nurses for nurses what's the nursing process the first thing we do we assess we gather data what's the second thing we do based upon the data gathering we make a plan what do we do after we plan we come up with interventions to accomplish that plan and then after interventions we evaluate or reassess our interventions their effectiveness a-p-i-e assessment plan interven intervene and evaluate this is standard this is a nursing exam folks if they ask if they tell you um you've already done let's say they tell you where you got some assessments going on you got an ekg you got some labs you need a physical assessment and ask you what's the next thing you're gonna do well after assessment you need to look for either a planning answer like the goal of the patient care or an intervention based upon that assessment or let's say they've already told you you've done this intervention what's the next step what do we do after we intervene we reassess know your nursing process this exam follows that there's not many dosages on this test you need to know how do i know this again having taken this test multiple times networked many people there's so much variability in emergency medicine dosing these days i'm going to take rocephin as an example we talk about this in the classes i do i'm sure if you surveyed a hundred er nurses they're gonna tell you they've seen anywhere from 250 row seven to a thousand given for things various various things from stds to meningitis etc okay there's that's one reason allergic reactions do some of your providers give 25 im or 50 i am or how much saudi medal do they give or do they give predaton or do they even give a low dose epi okay it's all over the place do they give pepsin the ena the ce exam only asks things that are generally universal across the spectrum so therefore there's not a lot of medicine dosages on this test okay because there's a lot of variability from where you work versus where i work hell even heck even between the doctor you work with on a monday night versus a tuesday evening two different you can expect possibly two different dosing situations so but pediatric epinephrine is a standard from pals you do you know this one is easy it's 0.01 milligrams per kilogram so that's one one hundredth of a milligram per kilogram my way that i remember this i mean it's kind of silly you and i should both know probably already know what's your adult dose of epi in a cardiac arrest or resuscitation one milligram cue three to five minutes all right a pediatric dose is 1 100th so i think of an adult is this big person maybe 200 pounds okay and i think a little tiny infant little kid will resuscitate maybe okay they're really not 1 100th of an adult's weight i mean because let's face it they see 200 pounds 100 would be two pounds most even our infants are usually like six or eight pounds even but it's just that my mindset is a small number one one hundredth of a milligram per kilogram as per any most any pediatric dosing is per kilo know that it is a standard it does not change from place to place and then number 10 number 10 thing you need to know for this test a little fact here a little a little formula easy to memorize your pediatric fluid resuscitation 20 ccs per kilo that's just to replace their fluids because that's all we do in the er we do resuscitation we do replacement there's no question on this test about pediatric maintenance fluids if you're calculating pediatric maintenance fluids you have an admission or a transfer problem that pay in remember the cen is the perfect world where everything goes according to plan that patient that child should already be out of there before you're doing maintenance fluids we do resuscitation know your 20 cc per kilo all right guys that's 10 things you need to know for the exam i've actually got a few more i'm gonna do uh in another video here shortly at least that gives you a short list to start working on um statistically three-fourths of time you're going to see most of these things on tests hopefully i've just given you 10 extra points you can accumulate on this test by knowing these 10 things these things have stood the test of time they're on the exam frequently if you take the exam and you don't see at least five or seven of these ten things you let me know okay i will keep it confident i'll keep it confidential um but i keep getting the same emails from people time and time again i'm gonna let you guys go good luck with your studies um feel free to check my website if you want to get in in on any of our study sessions the flex series i'm currently doing um this year um books study guides etc a lot of other videos um the website is going to have access to members only videos without ads or the ability to fast forward or rewind if you like and previous class sessions will too check out the website www.passthecen.com because that's what you're going to do you're going to pass it all right you all stay safe love you all be good to one another