Emergency Medicine Mnemonics

Aaron Tjomsland
Emergency Medicine Mnemonics

Most podcasts are about understanding. This emergency medicine podcast is about knowledge recall. Active learning requires your brain to process actively. Can you withstand sitting with the discomfort of being asked a question until you can answer it easily and readily? I promise you won’t be comfortable listening to each episode, but after you withstand the discomfort, your ability to recall, will be far superior than any other passive, listening.

  1. Glasgow-Blatchford Score (Glass Cow Black Ford): Upper GI Bleed indications for hospital admission

    29 OCT

    Glasgow-Blatchford Score (Glass Cow Black Ford): Upper GI Bleed indications for hospital admission

    To determine if the patient requires admission or can be discharged, the Glasgow-Blatchford Score (GBS) is used. Here’s the ABCDEF mnemonic and why these factors increase the risk of an upper GI bleed: ​ A - Active: Conditions like syncope or melena indicate ongoing or significant bleeding, increasing risk severity. ​ B - Blood Urea Nitrogen: Levels ≥ 7 mg/dL suggest impaired kidney function, which is often associated with poor systemic clearance and bleeding risk. ​ C - Circulation: A systolic blood pressure ≥ 110 mm Hg may reflect hemodynamic instability or stress response to bleeding. ​ D - Drop in Hemoglobin: Hemoglobin levels ≤ 12.9 g/dL (men) or ≤ 11.9 g/dL (women) indicate anemia, suggesting significant blood loss. ​ E - Elevated Pulse: A pulse rate ≥ 100/min signals compensatory tachycardia, often a response to blood loss. ​ F - Failure: Cardiovascular or liver disease impairs clotting and hemodynamic stability, exacerbating bleed risk. Developed in Scotland, the GBS is a risk assessment tool for upper GI bleeds and considers symptoms, vital signs, and lab values on admission. Key factors in the score include melena, syncope, liver disease, heart failure, heart rate, blood pressure, hemoglobin, and BUN levels. Points are assigned based on these variables to assess the severity of bleeding and volume loss. For example: ​Melena suggests significant GI bleeding, whereas isolated hematemesis (like coffee-ground emesis) has no scoring points.​Syncope, tachycardia, hypotension, and changes in Hb/BUN levels suggest volume loss.​Comorbid conditions (e.g., liver disease) may indicate a need for admission, especially if variceal bleeding is suspected. Discharge criteria also include access to follow-up care, a support system, and a nearby hospital for emergency returns if symptoms worsen. For more on current recommendations, consult the 2021 American Journal of Gastroenterology guidelines on upper GI bleeding.

    17 min
  2. H’s and T’s mnemonic: OKTV, THROW TEN TOXIC TAMPONS

    7 OCT

    H’s and T’s mnemonic: OKTV, THROW TEN TOXIC TAMPONS

    The “H’s and T’s” refer to a mnemonic used in medicine to help healthcare professionals quickly recall the most common causes of cardiac arrest during a code (a medical emergency requiring CPR). Memorizing these is crucial because identifying and addressing these causes rapidly can improve the chances of saving a patient’s life. Here’s a breakdown: The H’s: OK TV Hypoxia - Lack of oxygen to tissues can lead to a heart stopping, so ensuring proper oxygenation is key. Hypo-/Hyperkalemia - Abnormal potassium levels affect the heart’s electrical activity, potentially causing it to stop. Hypothermia - Low body temperature can slow heart function and lead to cardiac arrest. Hypovolemia - Loss of blood or fluids can lead to insufficient circulation and cardiac arrest. Hydrogen ion (acidosis) - A build-up of acid in the blood (often due to respiratory failure or shock) can disrupt heart function. The T’s: THROW TEN TOXIC TAMPONS Thrombosis (pulmonary or coronary) - Blood clots in the lungs (pulmonary embolism) or heart (myocardial infarction) can obstruct blood flow, leading to cardiac arrest. Tension Pneumothorax - Air trapped in the chest cavity compresses the heart and lungs, affecting circulation. Toxins - Certain substances (medications, drugs, poisons) can disrupt heart rhythms. Tamponade (cardiac) - Accumulation of fluid around the heart prevents it from pumping effectively. Importance of Memorizing the H’s and T’s: These causes cover many reversible conditions that may lead to cardiac arrest. During a code, time is critical, so having these potential causes at the top of your mind helps quickly assess and treat the patient. Remembering the “H’s and T’s” mnemonic ensures that a healthcare provider methodically works through possible causes and provides the best chance of resuscitation.

    8 min
  3. KEEP: UTI organisms & antibiotic treatment mnemonic (I KEEP getting UTIs)

    2 OCT

    KEEP: UTI organisms & antibiotic treatment mnemonic (I KEEP getting UTIs)

    The “KEEP” mnemonic is a tool to remember the most common organisms causing urinary tract infections (UTIs). Here’s how the mnemonic breaks down, followed by key information relevant for emergency medicine boards: K - Klebsiella species • Relevance: Klebsiella is the second most common organism causing UTIs, especially hospital-acquired infections. • Key Points: • Gram-negative rod. • Often seen in patients with underlying conditions like diabetes, or those with urinary catheters. • Resistant to many antibiotics, so susceptibility testing is important. • Treatment Options: Cephalosporins (like ceftriaxone), carbapenems in resistant cases. E - Escherichia coli (E. coli) • Relevance: The most common organism causing both community-acquired and some hospital-acquired UTIs. • Key Points: • Gram-negative rod. • Responsible for approximately 70-90% of uncomplicated UTIs. • Often originates from the gut. • Can exhibit antibiotic resistance, particularly to trimethoprim-sulfamethoxazole. • Treatment Options: Trimethoprim-sulfamethoxazole (Bactrim), nitrofurantoin, fosfomycin, or ciprofloxacin based on resistance patterns. E - Enterococcus species • Relevance: More common in complicated UTIs, particularly in hospital settings. • Key Points: • Gram-positive cocci. • Often found in patients with catheters, immunocompromised status, or structural abnormalities in the urinary tract. • Can be resistant to many antibiotics, including vancomycin-resistant Enterococcus (VRE). • Treatment Options: Ampicillin or amoxicillin when susceptible; for resistant cases, vancomycin or linezolid. P - Proteus species • Relevance: Known for causing complicated UTIs and is associated with kidney stones. • Key Points: • Gram-negative rod. • Produces urease, which increases urine pH and can lead to the formation of struvite stones. • Can cause upper UTIs and is known to colonize catheters. • Treatment Options: Ciprofloxacin, trimethoprim-sulfamethoxazole, cephalosporins; nitrofurantoin is usually not effective. Summary of the Mnemonic ‘KEEP’ • Klebsiella: Second most common UTI organism; hospital-acquired; antibiotic resistance common. • E. coli: Most frequent cause of UTIs; community-acquired; potential resistance to some antibiotics. • Enterococcus: Complicated and hospital-acquired UTIs; often found in patients with urinary abnormalities. • Proteus: Associated with kidney stones; catheter-related UTIs; produces urease. By remembering “KEEP,” you can recall the key organisms responsible for UTIs and their relevance to diagnosis and treatment in emergency settings.

    18 min
  4. IMPACTS: timeout mnemonic pre-procedure (your smooth professional timeout impacts everything)

    1 OCT

    IMPACTS: timeout mnemonic pre-procedure (your smooth professional timeout impacts everything)

    Procedure Timeout Mnemonic: This mnemonic covers the key elements to verify before starting, ensuring patient safety and team communication. Here's what **IMPACTS** stands for: 1. **I – Identify**: - **Verify the Patient's Identity**: Confirm the patient's full name, date of birth, and medical record number using their wristband and verbally with the patient if possible. 2. **M – Match the Procedure**: - **Verify the Procedure Being Done**: State the exact name of the procedure to be performed. Ensure the team agrees, and that it matches the consent form and the patient's understanding. 3. **P – Position and Site**: - **Verify the Correct Site, Side, and Patient Positioning**: - Mark the **correct site** and **laterality** if applicable (e.g., right arm, left knee). - Confirm the patient's **positioning** on the table (supine, prone) to avoid confusion during the procedure. 4. **A – Allergies**: - **Confirm Allergies**: Double-check any known allergies (medications, latex, iodine) and ensure the team is aware so appropriate precautions can be taken. 5. **C – Consent**: - **Verify Consent**: Ensure that **informed consent** has been obtained, signed, and documented. Confirm that the patient or guardian understands the risks, benefits, and alternatives to the procedure. 6. **T – Tools and Equipment**: - **Check Equipment and Instruments**: Make sure all necessary instruments, tools, and medications are prepared, functional, and sterile. Have backup supplies ready as well. 7. **S – Staff Roles and Safety Concerns**: - **Assign and Confirm Roles**: Ensure each team member knows their specific role during the procedure. - **State Safety Concerns**: Allow a moment for the team to voice any concerns or potential issues before proceeding. Using **IMPACTS** ensures that all the critical components are reviewed before starting a procedure, enhancing both patient safety and team coordination.

    21 min
  5. CATS Hypocalcemia Signs and EKG mnemonic (Southern California cool cats)

    26 SEPT

    CATS Hypocalcemia Signs and EKG mnemonic (Southern California cool cats)

    This is the CATS mnemonic to remember the signs for hypocalcemia. ### **Causes of Hypocalcemia** - **Hypoparathyroidism**: Often due to surgical removal of parathyroid glands. - **Vitamin D deficiency**: Impaired calcium absorption. - **Renal disease**: Reduced conversion of Vitamin D to its active form and poor calcium reabsorption. - **Pancreatitis**: Fat saponification binds calcium. - **Hypomagnesemia**: Leads to impaired PTH secretion. - **Medications**: Bisphosphonates, loop diuretics, phenytoin, etc. ### **Clinical Presentation** - **Neuromuscular Irritability**: - **Tetany**: Involuntary muscle contractions (e.g., carpopedal spasms). - **Paresthesias**: Numbness, tingling around the mouth, fingers, and toes. - **Seizures**: Can be a presenting symptom. - **Chvostek's Sign**: Facial twitching when tapping the facial nerve. - **Trousseau’s Sign**: Carpal spasm when inflating a blood pressure cuff above systolic pressure for 3 minutes. ### **EKG Findings in Hypocalcemia** - **Prolonged QT Interval**: Due to delayed ventricular repolarization. - Risk for **Torsades de Pointes** if significantly prolonged. - **Bradycardia and Heart Block**: May be seen in severe cases. ### **Management of Hypocalcemia** 1. **Asymptomatic or Mild Hypocalcemia**: - Oral calcium supplements (e.g., calcium carbonate). - Vitamin D supplementation (if deficient). 2. **Severe or Symptomatic Hypocalcemia (e.g., seizures, tetany, prolonged QT)**: - **IV Calcium Gluconate** or **Calcium Chloride** (more potent but more irritating to veins). - **Magnesium Replacement**: If low magnesium is present, replace it to aid calcium levels. 3. **Monitor for Cardiac Arrhythmias**: Especially if administering IV calcium. ### **Associated Conditions to Remember** - **Hypoalbuminemia**: Can lead to low total calcium, but ionized (free) calcium may be normal. - **Renal Failure**: Leads to high phosphate, low active Vitamin D, and thus low calcium. - **Pseudohypocalcemia**: Low total calcium but normal ionized calcium, usually related to hypoalbuminemia. Understanding these clinical features, causes, and management strategies, alongside the EKG findings, is crucial for emergency medicine board preparation and practice.

    15 min
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Most podcasts are about understanding. This emergency medicine podcast is about knowledge recall. Active learning requires your brain to process actively. Can you withstand sitting with the discomfort of being asked a question until you can answer it easily and readily? I promise you won’t be comfortable listening to each episode, but after you withstand the discomfort, your ability to recall, will be far superior than any other passive, listening.

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