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EMERGENCY MEDICINE
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
Acute LVF management
LMNOP:
Lasex (frusemide)
Morphine (diamorphine)
Nitrates
Oxygen (sit patient up)
Pulmonary ventilation (if doing badly)
Asystole: treatment
"Have some asystole "TEA":
Transcutaneous pacing
Epi
Atropine
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)
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
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.
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).
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)
PEA/Asystole (ACLS): etiology
ITCHPAD:
Infarction
Tension pneumothorax
Cardiac tamponade
Hypovolemia/ Hypothermia/ Hypo-, Hyperkalemia/ Hypomagnesmia/
Hypoxemia
Pulmonary embolism
Acidosis
Drug overdose
Pulseless Electrical Activity (PEA): checklist
PEA:
Pulses check
Epinepherine
Atropine
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
Shock: signs and symptoms
TV SPARC CUBE:
Thirst
Vomiting
Sweating
Pulse weak
Anxious
Respirations shallow/rapid
Cool
Cyanotic
Unconscious
BP low
Eyes blank
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
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
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)
.
Vfib/Vtach drugs used according to ACLS
"Every Little Boy Must Pray":
Epinephrine
Lidocaine
Bretylium
Magsulfate
Procainamide
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)
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
Coma: differential
UNCONSCIOUS:
Units of insulin
Narcotics
Convulsions
Oxygen
Nonorganic
Stroke
Cocktail
ICP
Organism
Urea
Shock
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]
Meningicoccal meningitis: complications
SAD REP:
Sepsis/ Shock/ Subdural effusion
Ataxia/ Abscess (brain)
DIC/ Deafness
Retardation
Epilepsy
Paralysis
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
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
Organophosphates poisoning symptoms
MILES:
Miosis
Increased urinary frequency
Lacrimation
Enuresis
Salivation
Organophosphates poisoning: symptoms
DUMBBELS:
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Emesis
Lacrimation
Salivation
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)
Unconciousness: differential
FISH SHAPED:
Fainted
Illness/ Infantile febrile convulsions
Shock
Head injuries
Stroke (CVE)
Heart problems
Asphxia
Poisons
Epilepsy
Diabetes
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.
Coma: conditions to exclude as cause
MIDAS:
Meningitis
Intoxication
Diabetes
Air (respiratory failure)
Subdural/ Subarachnoid hemorrhage
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]
Resuscitation: basic steps
ABCDE:
Airway
Breathing
Circulation
Drugs
Environment
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
Shock: types
RN CHAMPS:
Respiratory
Neurogenic
Cardiogenic
Hemorrhagic
Anaphylactic
Metabolic
Psychogenic
Septic
_ Alternatively: "MR. C.H. SNAP", or "NH CRAMPS".
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)
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
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)
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.
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
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?
.
Pneumothorax: causes
SIT, 3 A's, 3 C's:
Spontaneous (often tall thin men)
Iatrogenic
Trauma
Asthma
Alveolitis
AIDS
COPD
Carcinoma
Cystic fibrosis
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
Fall: potential causes
I'VE FALLEN:
Illness
Vestibular
Environmental
Feet/ Footwear
Alcohol and drugs
Low blood pressure
Low O2 states
Ears/ Eyes
Neuropathy