Mnemonic Archives

One of the most convenient ways of learning and remembering the main components of disease and identifying a medical condition on an exam are Triads, and medical students/interns/residents swear by them.

Be it a question during rounds, a multiple-choice exam question to be solved, or even in medical practice, the famous triads help physicians recall important characteristics and clinical features of a disease or treatment in an instant.

Since exam season is here, this could serve as a rapid review to recall the most common medical conditions.

While there are a vast number of triads/pentads available online, I have listed the most important (high-yy) ones that every student would be asked about at least once in the duration of their course.

1) Lethal Triad also known as The Trauma Triad of Death
Hypothermia + Coagulopathy + Metabolic Acidosis

2) Beck’s Triad of Cardiac Tamponade
Muffled heart sounds + Distended neck veins + Hypotension

3) Virchow’s Triad – Venous Thrombosis
Hypercoagulability + stasis + endothelial damage

4) Charcot’s Triad – Ascending Cholangitis
Fever with rigors + Right upper quadrant pain + Jaundice

5) Cushing’s Triad – Raised Intracranial Pressure
Bradycardia + Irregular respiration + Hypertension

6) Triad of Ruptured Abdominal Aortic Aneurysm
Severe Abdominal/Back Pain + Hypotension + Pulsatile Abdominal mass

7) Reactive Arthritis
Can’t See (Conjunctivitis) + Can’t Pee (Urethritis) + Can’t Climb a Tree (Arthritis)

8) Triad of Opioid Overdose
Pinpoint pupils + Respiratory Depression + CNS Depression

9) Hakims Triad – Normal Pressure Hydrocephalus
Gait Disturbance + Dementia + Urinary Incontinence

10) Horner’s Syndrome Triad
Ptosis + Miosis + Anydrosis

11) Mackler’s Triad – Oesophageal Perforation (Boerhaave Syndrome)
Vomiting + Lower Thoracic Pain + Subcutaneous Emphysema

12) Pheochromocytoma
Palpitations + Headache + Perspiration (Diaphoresis)

13) Leriche Syndrome
Buttock claudication + Impotence + Symmetrical Atrophy of bilateral lower extremities

14) Rigler’s Triad – Gallstone ileus
Gallstones + Pneumobilia + Small bowel obstruction

15) Whipple’s Triad – Insulinoma
Hypoglycemic attack + Low glucose + Resolving of the attack on glucose administration

16) Meniere’s Disease
Tinnitus + Vertigo + Hearing loss

17) Wernicke’s Encephalopathy- Thiamine Deficiency
Confusion + Ophthalmoplegia + Ataxia

18) Unhappy Triad – Knee Injury
Injury to Anterior Cruciate Ligament + Medial collateral ligament + Medial or Lateral Meniscus

19) Henoch Schonlein Purpura
Purpura + Abdominal pain + Joint pain

20) Meigs Syndrome
Benign ovarian tumor + pleural effusion + ascites

21) Felty’s Syndrome
Rheumatoid Arthritis + Splenomegaly + Neutropenia

22) Cauda Equina Syndrome
Low back pain + Bowel/Bladder Dysfunction + Saddle Anesthesia

23) Meningitis
Fever + Headache + Neck Stiffness

24) Wolf Parkinson White Syndrome
Delta Waves + Short PR Interval + Wide QRS Complex

25) Neurogenic Shock
Bradycardia + Hypotension + Hypothermia

Emergency departments and critical care units are very busy areas with a high turnover of patients, as well as the urgency of care provided with even smaller details matter in routine patient management. There should be strong efforts to improve the quality of patient care and to reduce medical errors, which are dangerous in such complex and busy areas. Thus, to support safe, effective care and closed-loop communication, patient medical records should be up to date so that timely care should be provided in emergency departments and ICU. Different protocols, standard operating procedures, checklist and physician rounds are all part of the attempt to improve clinical care. Very strict care is mandatory irrespective of the cause in critically ill and emergency patients. For the same, a shortened mnemonics for remembering elements of routine care is very important both in the emergency department and ICU. This is very important in daily clinical rounds.

In 2005, Jean Vincent came up with FAST HUGS, an abbreviated mnemonic for remembering important issues to look for in critical patients. It was basically a CME exercise from its origins and developed into an interesting article (1).

Subsequently, after four years, it became a valuable tool, and Vincent and Hatton upgraded the mnemonic to FAST HUGS BID in 2009 by including additional components of spontaneous breathing trial, bowel care, indwelling catheter removal and de-escalation of antibiotics (2).

Feeding/fluids
Analgesia
Sedation
Thromboprophylaxis
Head up position
Ulcer prophylaxis
Glycemic control
Spontaneous breathing trial
Bowel care
Indwelling catheter removal
De-escalation of antibiotics

Chris Nickson on Life In The Fast Lane Critical Care Compendium (CCC) expanded it further to FAST HUGS IN BED Please, with additional environmental control for delirium, a reminder to de-escalate therapies finishing it with psychosocial support (3).

FAST HUGS IN BED Please

Fluid therapy and feeding
Analgesia, antiemetics, and ADT (AAA)
Sedation and spontaneous breathing trial
Thromboprophylaxis
Head up position (30 degrees) if intubated
Ulcer prophylaxis
Glucose control
Skin/eye care and suctioning
Indwelling catheter
Nasogastric tube
Bowel cares
Environment (e.g., temperature control, appropriate surroundings in delirium)
De-escalation (e.g., end of life issues, treatments no longer needed)
Psychosocial support (for patient, family, and staff)

The above version was meant and applied in the emergency department or the intensive care unit as per Dr. Chris Nickson, last update July 23, 2019:3

Finally, this same concept can be easily applied in the emergency department as a modification FAST HUGS IN BED ED.

FAST HUGS IN BED ED will help both undergraduate medical students and residents in emergency medicine and critical care to revise and remember important areas of care. This has enormous benefits in a busy emergency resuscitation room as well as in complex ICU care settings.

References and Further Reading

Vincent, Jean-Louis. “Give your patient a fast hug (at least) once a day.” Critical care medicine 33.6 (2005): 1225-1229.
Vincent, William R., and Kevin W. Hatton. “Critically ill patients need “FAST HUGS BID”(an updated mnemonic).” Critical care medicine 37.7 (2009): 2326-2327.
Dr. Chris Nickson, last update July 23, 2019, Life in the Fastlane – https://litfl.com/fast-hugs-in-bed-please/

Cite this article as: Temesgen Beyene, Ethiopia, "A mnemonic for the care of critical ED patients," in International Emergency Medicine Education Project, December 16, 2019, https://iem-student.org/2019/12/16/a-mnemonic-for-the-critical-ed-patients/, date accessed: April 2, 2023