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The time-critical rules that recur on the CEN. Skim before test day, then prove it with practice.
Exam facts
- 175 questions (150 scored), 3 hours; pass-rate ~49%
- Biggest areas: cardiovascular, respiratory, neurologic, and GI/GU/Gyn/OB
Triage & trauma
- ESI level 1 = needs immediate life-saving intervention; level 5 = least urgent
- Trauma primary survey: ABCDE (airway, breathing, circulation, disability, exposure)
- Tension pneumothorax — needle decompression, 2nd intercostal space, midclavicular line
Time-critical conditions
- Stroke — establish last-known-well; thrombolytics generally within 4.5 hours
- STEMI — door-to-balloon ≤ 90 minutes
- Cushing’s triad (rising ICP) — hypertension, bradycardia, irregular respirations
Antidotes
- Acetaminophen → N-acetylcysteine; opioids → naloxone
- Benzodiazepines → flumazenil (use cautiously); beta-blockers → glucagon
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Sources & references
The exam facts on this page are drawn from official certifying-body materials, reviewed 2026-06-18 by the DrCertifications exam-prep team (10+ years in exam preparation and publishing).