Emergency Medicine Mnemonics f3t70

Emergency Medicine Mnemonics

Kendrick Extrication Device (K.E.D.): order of placing straps "My Baby Looks Hot Tonight": Middle Bottom Legs Head Top · Note: K.E.D. is a device used to extract patients out of a crashed car or similar tight space.

Seizure: quick history taking FACT: Focus: generalized vs. local activity Activity: tonic-clonic vs. absence Color: red, blue, ashen--possible indicator of hypoxia Time: length of seizure

Asthma acute attack: 5 life threatening signs SHOCK: Silent chest Hypotension One third of best/predicted PFR Cyanosis Konfusion

Fits: causes HOWARD: Hypertension Obesity Warfarin Alcohol Retardation Drugs

Blackout/collapse: causes THE VESPA MC: TIA Hypoglycemia Epilepsy Vasovagal Epilepsy Situation Ppostural hypotension/ PE Arrthymia/ Aortic stenosis(HOCM) Myocardial infarction Carotid sinus hypersensitivity

Snakebite scoring system · 6 T's: Toothless T-shirt Tattooed Trailer park Testosterone Tequila (EtOH) · One point for each positive. · 3 or more positive T's suggests venomous bite.

Motor Vehicle Collision (MVC): Single vehicle MVC differential of causes · 7 S's: Suds (EtOH) Suicide Sleep Seizure Sugar Stroke (bleed) Stupidity

ARDS: diagnostic criteria ARDS: Acute onset Ratio (PaO2/FiO2) less than 200 Diffuse infiltration Swan-Ganz Wedge pressure less than 19 mmHg

ARDS: full differential CARDS? HOPE ITS NOT ARDS: CNS disorders Aspiration (gastric) Radiation Drugs (heroin, morphine, barbiturates, etc) Smoke, toxic gas inhalation Hypotension, shock Oxygen toxicity Pancreatitis Emboli Infection, sepsis Transfusion reaction Surgery (esp. cardiac) Near drowning Obstetrical emergencies (eg eclampsia, HELLP) Thermal injuries/ burns Altitude sickness Renal failure DIC SLE

Pneumothorax: causes SIT, 3 A's, 3 C's: Spontaneous (often tall thin men) Iatrogenic Trauma Asthma Alveolitis AIDS COPD

Carcinoma Cystic fibrosis

Coma: differential UNCONSCIOUS: Units of insulin Narcotics Convulsions Oxygen Nonorganic Stroke Cocktail I Organism Urea Shock

Shock: general features CHORD ITEM: Cold, clammy skin Hypotension Oliguria Rapid, shallow breathing Drowsiness, confusion Irritability Tachycardia Elevated or reduced central venous pressure Multi-organ damage

Shortness of breath: short differential AAAA PPPP: Airway obstruction Angina Anxiety Asthma Pneumonia Pneumothorax

Pulmonary Edema Pulmonary Embolus

Dyspnea: differential 3A's: Three Airways: Airway obstruction, Anaphylaxis, Asthma 3P's: Three Pulmonary's: Pneumothorax, PE, Pulmonary edema 3C's: Three Cardiacs: Cardiogenic pulmonary edema, Cardiac ischemia, Cardiac tamponade 3M's: Three Metabolics: (DOC) DKA, Organophosphates, Carbon monoxide poisoning

Seizures: differential SICK DRIFTER: Substrates (sugar, oxygen) Isoniazid overdose Cations (Na, Ca, Mg) Kids (ecclampsia) Drugs (CRAP: Cocaine, Rum (alcohol), Amphetamines, P) Rum (alchohol withdrawl) Illnesses (chronic seizure disorder or other chronic disorder) Fever (meningitis, encephalitis, abscess) Trauma (epidural, subdural, intraparynchymal hemorrhage) Extra: toxocologic (TAIL: Theo, ASA, Isoniazid, Lithium) and 3 Anti's: (Antihistamine overdose, Antidepressant overdose, Anticonvulsants (too high dilanitin, tegretol) or benzo withdrawl. Rat poison (organophospates poisoning)

Pneumonia: hospitalisation criteria ABCD: Age greater than 60 Blood urea greater than 7 mmol/l Confusion Diastolic BP less than 60 mmHg ·Hospitalise the pneumonia patient if 2 or more of these criteria are met.

Myocardial infarction: some emergency treatment drugs ABCD: Aspirin Beta blockers Clot busters (thromboytics) Dynamite (nitrates)

Malaria: complications of falciparum malaria CHAPLIN: Cerebral malaria/ Coma Hypoglycemia Anaemia Pulmonary edema Lactic acidosis Infections Necrois of renal tubules (ATN)

MI: immediate treatment DOGASH: Diamorphine Oxygen GTN spray Asprin 300mg Streptokinase Heparin

Pain history checklist OLDER SAAB: Onset Location Description (what does it feel like) Exacerbating factors Radiation

Severity Associated symptoms Alleviating factors Before (ever experience this before)

Pulseless Electrical Activity (PEA): checklist PEA: Pulses check Epinepherine Atropine

PEA/Asystole (ACLS): etiology ITCHPAD: Infarction Tension pneumothorax Cardiac tamponade Hypovolemia/ Hypothermia/ Hypo-, Hyperkalemia/ Hypomagnesmia/ Hypoxemia Pulmonary embolism Acidosis Drug overdose

Trauma: motor vehicle accident considerations I AM SCARED: Impact (head-on, rear-end, t-bone, rollover, rotational etc.) Auto vs. pedestrian, bike, motorcycle (start @ speed >10mph) Medical history (cardiac, coagulolation, liver, immuno, obese, prego) Speed (>50 mph?) Compartment intrusion (>12 inches?) Age (<5 or >55 y.o.?) Restraints (lap & shoulder, either, airbag, infant or child seat?) Ejection/ Extrication (eject=25x greater death, extr>20min) Death (at scene, same vehicle, other)

V-fib/pulseless v-tach (new ACLS as of 2001) "EVAL My Pumper": Epinephrine Vasopressin Amiodarone (class IIb--better for heart failure) Lidocaine (indeterminate - better for young, healthy or persistent) MgSO4 (IIb for hypomagnesemic state or torsades) Procainamide (IIb for intermittent/recurrent VF/VT)

Asystole: treatment "Have some asystole "TEA": Transcutaneous pacing Epi Atropine

JVP: raised JVP differential PQRST (EKG waves): Pericardial effusion Quantity of fluid raised (fluid over load) Right heart failure Superior vena caval obstruction Tricuspid stenosis/ Tricuspid regurgitation/ Tamponade (cardiac)

JVP: raised JVP: extra-cardiac causes FAT PEA: Fever Anaemia Thyrotoxicosis Pregnancy Exercise A-V fistula · These are in addition to all the cardiac ones (pericardial effusion, RHF, tricuspid stenosis, SVC obstruction, etc).

Endotrachial tube deliverable drugs O NAVEL: Oxygen Naloxone Atropine Ventolin (albuterol) Epinephrine Lidocaine · If you can't get IV access established, and have necessity to ister resuscitative meds, you have the airway and can give the above drugs. · Drug delivery is enhanced if diluted with 10cc NS and rapid introduced for aeresolization. · Alternatively, bare bone version is ALE, as above.

Syncope causes, by system HEAD HEART VESSELS: · CNS causes include HEAD: Hypoxia/ Hypoglycemia Epilepsy Anxiety Dysfunctional brain stem (basivertebral TIA) · Cardiac causes are HEART: Heart attack Embolism (PE) Aortic obstruction (IHSS, AS or myxoma) Rhythm disturbance, ventricular Tachycardia · Vascular causes are VESSELS: Vasovagal Ectopic (reminds one of hypovolemia) Situational Subclavian steal ENT (glossopharyngeal neuralgia) Low systemic vascular resistance (Addison's, diabetic vascular neuropathy) Sensitive carotid sinus

Atrial fibrillation: causes of new onset THE ATRIAL FIBS: Thyroid Hypothermia Embolism (P.E.) Alcohol Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct Bad valves (mitral stenosis) Stimulants (cocaine, theo, amphet, caffeine)

Neurological focal deficits 10 S's: Sugar (hypo, hyper) Stroke Seizure (Todd's paralysis) Subdural hematoma Subarachnoid hemorrhage Space occupying lesion (tumor, avm, aneurysm, abscess) Spinal cord syndromes Somatoform (conversion reaction) Sclerosis (MS) Some migraines

Miosis: causes of pin-point pupils R ON SLIME: Clonidine Phenothiazines Resting (deep sleep) Opiates Narcotics Stroke (pontine hemorrhage) Lomotil (diphenoxylate) Insecticides Mushrooms/ Muscarinic (inocybe, clitocybe) Eye drops

Meningicoccal meningitis: complications SAD REP: Sepsis/ Shock/ Subdural effusion Ataxia/ Abscess (brain) DIC/ Deafness Retardation Epilepsy Paralysis

Activated charcoal: contraindications CHEMICAL CamP: Cyanide Hydrocarbons Ethanol Metals Iron Caustics Airway unprotected Lithium CAMphor Potassium

Ipecac: contraindications 4 C's: Comatose Convulsing Corrosive hydroCarbon

Organophosphates poisoning: symptoms DUMBBELS: Diarrhea Urination Miosis

Bradycardia Bronchospasm Emesis Lacrimation Salivation

Coma and signicantly reduced conscious state causes: causes COMA: CO2 and CO excess Overdose: TCAs, Benzos, EtOH, insulin, paracetamol, etc. Metabolic: BSL, Na+, K+, Mg2+, urea, ammonia, etc. Apoplexy: stroke, SAH, extradural, subdural, Ca, meningitis, encephalitis, cerebral abscess, etc.

Chest pain: differential CHEST PAIN: Costochondritis/ Cocaine abuse Herpes zoster/ Hyperventilation Esophagitis/ Esophageal spasm Stenosis (AS) Trauma PE/ Pneumonia/ Pneumothorax/ Pericarditis/ Pancreatitis Angina/ Aortic dissection/ Aortic anerusym Infarction/ IV disk disease Neuropsychiatric disorders (e.g. depression, Da Costa's)

Ventricular fibrillation: treatment "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock": Shock= Defibrillate Everybody= Epinephine Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Pocainamide

Fall: potential causes I'VE FALLEN: Illness Vestibular Environmental Feet/ Footwear Alcohol and drugs Low blood pressure Low O2 states Ears/ Eyes Neuropathy

RLQ pain: differential APPENDICITIS: Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia Diverticulitis Intussusception Crohns Disease/ Cyst (ovarian) IBD Torsion (ovary) Irritable Bowel Syndrome Stones

Decompression sickness Boyle's law: volume of gas is inversely proportionate to its pressure. · Therefore, BOYLE: Breathe (as you ascend) Or Your Lung Explodes

· Breathe as you ascend after scuba diving, since the pressure decreases on surfacing, so the gas volume in lungs increases.

Unconciousness: differential FISH SHAPED: Fainted Illness/ Infantile febrile convulsions Shock Head injuries Stroke (CVE) Heart problems Asphxia Poisons Epilepsy Diabetes

Endotracheal tube: troubleshooting DOPEY: Displaced: esophagus, right mainstem, back of throat, etc Obstructed: secretions, blood, mucus plug, kink, etc Pneumothorax Equipment: malfunctions, O2, ETT, BVM, ventilator, monitor You: your approach, technique: missing something?

Organophosphates poisoning symptoms MILES: Miosis Increased urinary frequency Lacrimation Enuresis Salivation

Chest pain treatment, for nurses "MOVE your patient!": Monitor: put patient on cardiac monitor Oxygen: put patient on O2 Venous: gain large bore venous access EKG: 12 lead EKG

ICU confusion causes ICU CONFUSION: ICU psychosis Cardiac output low [hypotension, post cardiac arrest] Uncontrolled temperature [hypo/hyperthermia] Convulsion [post ictal] Oxygen [hypoxia, hypercarbia] Nociception [pain] Full bladder Uremia Sugar [hypo/hyperglycemia] Infection Opiates Natremia [hypo/hyper]

Coma: conditions to exclude as cause MIDAS: Meningitis Intoxication Diabetes Air (respiratory failure) Subdural/ Subarachnoid hemorrhage

Resuscitation: basic steps ABCDE: Airway Breathing Circulation Drugs Environment

Malignant hyperthermia treatment "Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia): Stop triggering agents Hyperventilate/ Hundred percent oxygen Dantrolene (2.5mg/kg) Bicarbonate Glucose and insulin IV Fluids and cooling blanket Fluid output monitoring/ Furosemide/ Fast heart [tachycardia]

Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium Magsulfate Procainamide

Coma causes checklist AEIOU TIPS: Acidosis/ Alcohol Epilepsy Infection Overdosed Uremia Trauma to head Insulin: too little or or too much Pyschosis episode Stroke occurred

Shock: types RN CHAMPS: Respiratory Neurogenic Cardiogenic Hemorrhagic Anaphylactic Metabolic Psychogenic Septic · Alternatively: "MR. C.H. SNAP", or "NH CRAMPS"

Shock: signs and symptoms TV SPARC CUBE: Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank

Fall: potential causes CLADE SPADE: Cardiovascular/ Cerebrovascular Locomotor (skeletal, muscular, neurological) Ageing (increased body sway, decreased reaction time) Drugs (esp. antihypertensives, antipsychotics) Environmental Sensory deficits (eg. visual problems) Psychological/ Psychiatric (depression) Acute illness Dementia Epilepsy

Acute LVF management LMNOP: Lasex (frusemide) Morphine (diamorphine) Nitrates Oxygen (sit patient up) Pulmonary ventilation (if doing badly)

Subarachnoid hemorrhage (SAH) causes BATS: Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease Trauma (eg being struck with baseball bat) Stroke