Why guidelines matter so much in the SBA
A predictable and substantial slice of the SBA tests whether you know current UK guidance and can apply it. RCEM's position is that you should follow relevant national standards — NICE, SIGN, BTS and others — for specific conditions, with RCEM guidance and best-practice guidelines filling the gaps where evidence is contentious or EM-specific.
Because guidelines are updated regularly, revising from current versions is essential: questions are written to the latest standards, and answering from outdated practice is a common way to lose marks. The guidance below is among the highest-yield, but is not exhaustive.
Resuscitation and the acutely unwell adult
Sepsis
Know the NICE suspected-sepsis guidance and risk stratification, and be fluent in NEWS2. Understand the principles of early recognition, the sepsis bundle, lactate and antibiotic timing, and escalation. (Note that NICE's sepsis guidance has been recently updated — revise the current version rather than older summaries.)
Anaphylaxis
Revise the Resuscitation Council UK 2021 anaphylaxis guidance, which made several important changes:
- Emphasis on early intramuscular adrenaline, repeated after five minutes if there is no improvement.
- Refractory anaphylaxis is defined as no improvement in respiratory or cardiovascular symptoms after two appropriate doses of IM adrenaline — treated with an IV adrenaline infusion and IV fluids.
- Antihistamines downgraded to third-line.
- Corticosteroids no longer routinely recommended.
Take mast cell tryptase when the diagnosis is uncertain.
Acute asthma and COPD
A landmark change: the first joint BTS/NICE/SIGN asthma guideline was published on 27 November 2024 (NICE NG245), replacing the older separate NICE (NG80) and BTS/SIGN guidance.
NG245 covers diagnosis, monitoring and chronic management and does not cover acute attacks, which sit in a separate asthma pathway — so revise acute asthma severity grading (moderate/acute severe/life-threatening) and management separately.
Acute coronary syndromes and arrhythmias
Know STEMI and NSTEMI recognition and management, high-risk STEMI-equivalent ECG patterns (such as Wellens' and De Winter's), and the Resuscitation Council UK peri-arrest tachyarrhythmia and bradycardia algorithms.
Diabetic and metabolic emergencies
Revise the management of DKA (including the paediatric version), hyperosmolar hyperglycaemic state, hypoglycaemia and the adrenal/thyroid emergencies, along with electrolyte and acid–base disturbances.
Pulmonary embolism and atrial fibrillation
For PE, know risk stratification and the NICE venous thromboembolism diagnosis pathway, including the role of Wells scoring, age-adjusted D-dimer and definitive imaging.
For atrial fibrillation, know the NICE AF guidance on rate versus rhythm control, anticoagulation, and the management of new-onset and haemodynamically unstable AF in the ED.
Major trauma and injury
Head injury
NICE NG232 (published May 2023) is essential and high-yield. Know the criteria for a CT head within one hour, which include:
- GCS of 12 or less on initial assessment;
- GCS less than 15 at two hours;
- suspected open/depressed or basal skull fracture;
- post-traumatic seizure;
- focal neurological deficit;
- more than one episode of vomiting.
There are separate within-eight-hours criteria for patients with loss of consciousness or amnesia plus risk factors (age 65 or over, dangerous mechanism, coagulopathy, or more than 30 minutes' retrograde amnesia).
For patients on anticoagulants or antiplatelets (other than aspirin monotherapy) with no other indication, the recommendation is now to "consider" a CT head within eight hours rather than mandate it.
Note also the distinct tranexamic acid guidance — a 2g IV bolus within two hours for isolated head injury with GCS 12 or less, which differs from the major-trauma TXA regimen.
Major trauma and haemorrhage
Revise the NICE major trauma guidance, catastrophic haemorrhage control, the principles of damage-control resuscitation and major haemorrhage protocols, c-spine assessment, and the management of specific chest, abdominal and pelvic injuries.
Paediatric emergencies
The febrile child
NICE NG143 (fever in under-5s) and its traffic-light system are core. Know the red, amber and green features and safety-netting, plus the specific rules for infants:
- an infant under three months with a temperature of 38°C or above is high-risk;
- infants under one month warrant lumbar puncture and parenteral antibiotics;
- those aged 1–3 months who appear unwell, or have a white-cell count below 5 or above 15 ×10⁹/L, also warrant fuller work-up.
Pair this with paediatric sepsis and meningococcal disease recognition.
Toxicology
Know the management of paracetamol overdose (including the treatment nomogram and acetylcysteine), and common poisonings, using TOXBASE and RCEM toxicology guidance as your reference points.
Medicolegal, mental health and RCEM best-practice guidance
Revise the legal frameworks underpinning SLO7: the Mental Capacity Act and assessment of capacity, the Mental Health Act, consent, DNACPR, and safeguarding.
RCEM best-practice guidelines also cover EM-specific areas such as pain management, the patient in custody, frequent attenders, and the alcohol toolkit.
How to revise guidelines efficiently
You do not need to memorise guidelines word for word — you need the decision points the exam tests: thresholds, time windows, first-line treatments and red flags. Summarise each guideline to a single page of key facts, and test yourself on the numbers.
This is exactly how the Bolus reference library is structured: each entry distils the relevant NICE, RCEM and Resuscitation Council UK guidance into the key points behind the questions, so reviewing a question links straight to the guidance it is testing.
Revise these alongside the SBA blueprint so your guideline reading is weighted towards the SLOs that carry the most marks.