Here's a detail that catches a lot of candidates off guard: the FRCEM SBA doesn't just test emergency medicine knowledge — it tests whether you know the current UK guideline for that knowledge. NICE, BTS/SIGN, JBDS, ATLS, and RCEM's own clinical guidance all update periodically, and the exam is written to reflect what's current now, not what was current when you were a junior trainee.
This is where a lot of revision goes wrong. Question banks lag behind. Old notes get recycled. And candidates walk in confidently selecting answers based on guidance that was quietly superseded a year or two ago.
This cheat sheet pulls together the guidelines that matter most for the FRCEM SBA — organised by clinical area, with the specific numbers, thresholds, and decision points the exam actually tests. Use it as a quick-reference companion alongside your topic-by-topic revision.
Why Guideline-Awareness Is Its Own Exam Skill
The RCEM curriculum is explicit: candidates are expected to manage patients in line with "national best practice," and the college points candidates toward NICE, SIGN, BTS, and other national bodies for clinical standards rather than setting its own separate set of numbers. That means the exam is, in effect, a test of your familiarity with the current versions of these guidelines — not a fixed, unchanging body of "FRCEM knowledge."
Three guidelines in particular have changed in ways that directly affect exam answers, and each one is a frequent source of lost marks for candidates revising from outdated material:
TIA risk stratification — ABCD2 scoring has been withdrawn
Paracetamol overdose — the two-line nomogram has been replaced with a single treatment line
Trauma primary survey — ABCDE has become xABCDE
If you only take one thing from this article, take this: before you trust a "rule" in a question bank, ask whether it reflects the current guideline. The sections below cover exactly that.
Cardiovascular: ACS Management
Guideline basis: ESC Guidelines for Acute Coronary Syndromes, NICE NG185
Decision point | Current answer |
|---|---|
STEMI ECG criteria | ≥1 mm limb leads, ≥2 mm precordial leads, two contiguous leads |
PPCI time target | First medical contact to balloon 120 minutes |
P2Y12 inhibitor for PCI | Prasugrel preferred over ticagrelor |
Pre-treatment before angiography | Not recommended (Class III) if early invasive strategy planned |
Oxygen | Only if SpO₂ <90% |
Troponin strategy | High-sensitivity 0h/1h algorithm |
NSTEMI invasive timing | Very high risk: immediate; high risk: <24h (Class IIa, not mandatory); intermediate: <72h |
The trap to avoid: Door-to-balloon (90 minutes) and FMC-to-balloon (120 minutes) are different metrics testing different things. Mixing them up is one of the most common ACS errors.
For full ECG patterns and STEMI equivalents, see the FRCEM STEMI vs NSTEMI guide.
Neurology: Stroke and TIA
Guideline basis: National Clinical Guideline for Stroke (latest edition), NICE NG128
This is the area where outdated revision material is most dangerous — and most commonly tested as an "update."
Decision point | Current answer |
|---|---|
TIA risk stratification | ABCD2 should not be used — immediate specialist referral for all suspected TIA |
MRI timing for TIA | Within 24 hours |
Thrombolysis window | 4.5 hours standard; 4.5–9 hours if wake-up stroke with DWI-FLAIR mismatch |
Thrombolysis age restriction | None — consider regardless of age or severity |
Thrombolytic agents | Alteplase or tenecteplase |
BP before thrombolysis | Must be <185/110 |
BP in ischaemic stroke (no thrombolysis) | Do not lower unless >220/120 |
Antiplatelet for TIA/minor stroke | Dual antiplatelet (aspirin + clopidogrel) for 21 days |
Thrombectomy window for LVO | 6 hours standard; up to 24 hours with imaging-confirmed salvageable tissue |
The trap to avoid: If a question presents an ABCD2 calculation scenario and offers "refer based on score" as an option, that's the outdated answer. Current guidance says refer immediately regardless of score.
Full worked scenarios are in the FRCEM stroke and TIA SBA guide.
Endocrine: DKA and HHS
Guideline basis: JBDS 02 (DKA), JBDS 06 (HHS)
Decision point | Current answer |
|---|---|
DKA diagnostic criteria | Glucose >11 mmol/L, ketones >3 mmol/L, pH <7.3 or bicarbonate <15 |
HHS diagnostic criteria | Glucose ≥30, osmolality ≥320, ketones ≤3, pH >7.3 |
Order of treatment | Fluids before insulin |
Initial FRIII rate | 0.1 units/kg/hour |
FRIII rate when glucose ≤14 mmol/L | Reduce to 0.05 units/kg/hour, add 10% glucose |
Long-acting insulin | Continue throughout treatment |
DKA resolution | pH >7.3, bicarbonate >15, ketones <0.6 — not glucose |
HHS insulin | Withhold initially unless ketones rising or glucose not falling with fluids |
HHS correction window | 24–72 hours (slower than DKA) |
HHS anticoagulation | Treatment-dose LMWH |
The trap to avoid: The FRIII de-escalation rule (0.1 → 0.05 units/kg/hour at glucose ≤14) is a recent change that many older resources don't reflect. Continuing at 0.1 units/kg/hour is now the wrong answer.
Full protocol detail is in the FRCEM DKA and HHS guide.
Respiratory: Asthma and COPD
Guideline basis: BTS/SIGN British Guideline on Asthma Management, GOLD COPD Strategy
Decision point | Current answer |
|---|---|
Asthma life-threatening features | PEF <33%, SpO₂ <92%, silent chest, normal/rising PaCO₂ |
Normal CO₂ in severe asthma | Danger sign, not reassurance |
Asthma escalation | Salbutamol → ipratropium → IV magnesium sulphate (1.2–2g over 20 min) |
IV aminophylline | Not routine — senior/ICU decision only |
COPD oxygen target | 88–92% via Venturi mask |
COPD NIV indications | pH <7.35 with PaCO₂ >6 kPa despite medical therapy |
COPD antibiotics | Only if purulent sputum + another cardinal symptom |
COPD steroid course | Prednisolone 30–40 mg for 5 days |
The trap to avoid: Giving COPD patients the same oxygen target as asthma (94–98%) risks CO₂ narcosis. This is one of the most frequently tested oxygen-therapy distinctions in the exam.
The FRCEM asthma and COPD guide covers full severity classifications and escalation pathways.
Toxicology: Paracetamol and TCA Overdose
Guideline basis: MHRA/CHM paracetamol guidance, RCEM SNAP protocol, GEMNet TCA guidelines, TOXBASE
Decision point | Current answer |
|---|---|
Paracetamol nomogram | Single line at 100 mg/L at 4 hours — two-line risk-factor system is obsolete |
Staggered/unknown timing overdose | Treat with NAC immediately, no nomogram |
NAC efficacy window | Near 100% within 8 hours of ingestion |
NAC hypersensitivity reaction | Pause, treat, restart — not a contraindication |
NAC regimes | Standard 3-bag (21h) or SNAP (12h, RCEM-endorsed) |
TCA key investigation | ECG — QRS >100 ms, terminal R wave in aVR |
TCA QRS widening treatment | Sodium bicarbonate, target pH 7.45–7.55 |
TCA seizures | Benzodiazepines only — phenytoin contraindicated |
TCA + benzodiazepine co-ingestion | Flumazenil contraindicated |
TCA observation period | 6 hours |
The trap to avoid: RCEM clinical guidance specifically addresses paracetamol overdose as one of its core topic areas — this reflects how heavily it's weighted in both practice and the exam. The single-nomogram-line change is one of the most consequential recent updates.
Full management protocols are in the FRCEM paracetamol and TCA overdose guide.
Trauma: ATLS Primary Survey
Guideline basis: ATLS 11th Edition, NICE NG232
Decision point | Current answer |
|---|---|
Primary survey sequence | xABCDE — x = exsanguinating haemorrhage control (tourniquet, packing, pelvic binder) |
Tension pneumothorax | Clinical diagnosis — immediate needle decompression, don't wait for CXR |
Massive transfusion ratio | 1:1:1 (RBC:FFP:platelets) |
Crystalloid in haemorrhagic shock | Minimise — early blood products preferred |
TXA for major haemorrhage | 1g bolus + 1g infusion, within 3 hours |
TXA for isolated TBI | 2g bolus within 2 hours, no extracranial bleeding needed |
GCS threshold for intubation | ≤8 |
Immediate CT head (NICE NG232) | GCS <13 at any time, GCS <15 at 2h, focal deficit, seizure, >1 vomiting episode, basal skull fracture signs |
CT head within 8h | Patients on anticoagulants/antiplatelets (excl. aspirin monotherapy) |
Hyperventilation in head injury | Avoid routinely — only for acute herniation |
Permissive hypotension | SBP 80–90 in penetrating trauma without head injury |
The trap to avoid: If a question describes a patient with catastrophic external haemorrhage and the first listed step in the "correct sequence" is airway assessment, that's the old ABCDE answer. Haemorrhage control comes first under xABCDE.
The FRCEM ATLS primary survey guide covers the full xABCDE framework with worked scenarios.
Resuscitation and ALS
Guideline basis: Resuscitation Council UK ALS Guidelines
Decision point | Current answer |
|---|---|
Shockable rhythms | VF/pVT → defibrillate + CPR |
Non-shockable rhythms | PEA/asystole → CPR + adrenaline ASAP |
Adrenaline timing (shockable) | After 3rd shock |
Amiodarone timing | 300mg after 3rd shock (shockable rhythms) |
Reversible causes | 4Hs and 4Ts (Hypoxia, Hypovolaemia, Hypo/hyperkalaemia, Hypothermia; Tension pneumothorax, Tamponade, Toxins, Thromboembolism) |
Advanced airway during CPR | Continuous compressions, 10 breaths/min once airway secured |
Post-ROSC | Targeted temperature management, 12-lead ECG, PCI if STEMI |
Sepsis Management
Guideline basis: NICE NG51, Surviving Sepsis Campaign, RCEM Clinical Standards
Decision point | Current answer |
|---|---|
Sepsis definition | Life-threatening organ dysfunction from dysregulated host response to infection (SOFA ≥2) |
Septic shock definition | Vasopressor needed for MAP ≥65 + lactate >2 despite adequate fluids |
Sepsis-6 (within 1 hour) | Blood cultures, IV antibiotics, fluids, lactate, urine output monitoring, oxygen |
Antibiotic timing | Within 1 hour of recognition — blood cultures first |
Fluid strategy | 500ml crystalloid boluses, reassess after each |
Vasopressor of choice | Noradrenaline |
RCEM's clinical standards specifically highlight sepsis recognition and early treatment initiation as a core ED competency — and this translates directly into exam scenarios testing the 1-hour bundle.
How to Use This Cheat Sheet
This isn't a replacement for detailed topic revision — it's a final-check reference. Use it in three ways:
During topic revision: After studying a clinical area in depth, come back to the relevant table here and check that your understanding matches the current guideline summary. If something looks unfamiliar, that's a signal to dig into the full guide for that topic.
During question practice: When a question bank gives you an answer that conflicts with a row in this table, treat the conflict as a flag. Some question banks lag behind guideline updates — and RCEM itself notes that some platforms still teach the ABCD2 score for TIA, the old two-line paracetamol nomogram, or standard ABCDE instead of xABCDE. If you spot this, verify against the current guideline rather than assuming the question bank is right.
In the final week: Run through every row as a rapid-fire self-test. If you can explain why each answer is correct — not just recite it — you're in good shape.
The FRCEM SBA is, in part, a test of how current your knowledge is. The clinical reasoning underneath rarely changes dramatically — but the specific numbers, thresholds, and first-line answers do, and that's exactly where marks are won or lost.
Bookmark this page, revisit it through your revision, and cross-check it against whatever question bank or notes you're using. If something doesn't match, it's worth five minutes to find out why.
Want SLO-mapped questions that reflect every guideline update on this page? Register with StudyFRCEM for a question bank built around current UK guidance.
Frequently Asked Questions
Do I need to read the full guideline documents?
No. FRCEM tests the clinical decision points these guidelines produce, not document-level detail. This cheat sheet, combined with topic-specific guides, covers what's tested.
How often do these guidelines change?
Major guidelines are reviewed on multi-year cycles, but updates can happen at any point — and once published, the exam reflects the new version. The three updates highlighted here (ABCD2, paracetamol nomogram, xABCDE) are relatively recent and represent the kind of change that catches out candidates using older materials.
What if my question bank teaches something different from this sheet?
Trust the current guideline. Question banks are written at a point in time and can lag behind updates — this is explicitly something RCEM-aligned resources flag as a quality issue to watch for.
Is this list exhaustive?
No — it covers the highest-yield areas where guideline knowledge directly determines the correct SBA answer. Other areas (paediatrics, mental health, ethics) also follow national guidance, but the decision points are less numerically specific and harder to summarise in table form.
