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
ICP
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,
PCP)
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 administer
resuscitative meds, remember 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 CPR 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
