Umfmed



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 (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.

[pic]

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

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