EMERGENCY
MEDICINE
MNEMONICS
Emergency Medicine
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
Diabetic ketoacidosis management F*KING:
Fluids (crytalloids)
Urea (check it)
Creatinine (check it)/ Catheterize
K+ (potassium)
Insulin (5u/hour. Note: sliding scale no longer recommended in the UK)
Nasogastic tube (if patient comatose)
Glucose (once serum levels drop to 12)
Asthma: management of acute severe "O S#!T":
Oxygen (high dose: >60%)
Salbutamol (5mg via oxygen-driven nebuliser)
Hydrocortisone (or prednisolone)
Ipratropium bromide (if life threatening)
Theophylline (or preferably aminophylline-if life threatening)
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)
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)
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.
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)
Asystole: treatment
"Have some asystole "TEA":
Transcutaneous pacing Epi Atropine
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.
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
Subarachnoid hemorrhage (SAH) causes
BATS:
Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease Trauma (eg being struck
with baseball bat) Stroke
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
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.
