by Ozlem Dikme


3 D’s: Beck’s triad (cardiac tamponade)

D = Distant heart sounds
D = Distended jugular veins
D = Decreased arterial pressure

4 P’s: Arterial occlusion

P = Pain
P = Pallor
P = Pulselessness
P = Paresthesias


ABC/2: Volume of intracranial bleed of CT

A = Maximal diameter of the hematoma by CT
B = Diameter 90° to A, and
C = Approximate number of CT slices with hemorrhage multiplied by the slice thickness
Vol > 20 – 30 ml consider surgery


ABCDE: Supraventricular tachycardia (treatment)

A = Adenosine
B = Beta-blocker
C = Calcium channel antagonist
D = Digoxin
E = Excitation (vagal stimulation)


ABCDEFGHIJK: Haematuria differential in children

A = Anatomy (cysts, etc)
B = Bladder (cystitis)
C = Cancer (Wilm’s tumour)
D = Drug related (cyclophosphamide)
E = Exercise induced
F = Factitious (Munchausen by proxy)
G = Glomerulonephritis
H = Haematology (bleeding disorder, sickle cell)
I = Infection (UTI)
J = inJury (trauma)
K = Kidney stones (hypercalciuria)


ABC HELP: Causes of ST Elevation in ECG

B = Brugada
C = CNS Pathologies
H = Hypertrophy (LVH)
E = benign Early repolarization
P = Pericarditis


AEIOU TIPS: Causes of altered mental status

A = Alcohol
E = Epilepsy, electrolytes
I = Infection
O = Overdose
U = Urea
T = Trauma
I = Insulin
P = Psychiatric
S = Sepsis, shock


APGAR: System to evaluate newborn’s condition

A = Appearance (color)
P = Pulse (heart rate)
G = Grimmace (reflex, irritability)
A = Activity (muscle tone)
R = Respiratory effort


APPENDICITIS: RLQ pain differential

A = Appendicitis/ Abscess
P = PID/ Period
P = Pancreatitis
E = Ectopic/ Endometriosis
N = Neoplasia
D = Diverticulitis
I = Intussusception
C = Crohns Disease/ Cyst (ovarian)
T = Torsion (ovary)
I = Irritable Bowel
S = Syndrome Stones


ASCLAST: Eliciting history of present illness and exploring symptoms

A = Aggravating and alleviating factors
S = Severity
C = Character, quality
L = Location
A = Associated
S = Setting
T = Timing


ASTHMA: Common Medications used to treat Asthma

A = Albuterol
S = Steroid
T = Theophylline
H = Humidified Oxygen
M = Magnesium (MgSO4)
A = Antileukotrienes


BATS: Subarachnoid hemorrhage causes

B = Berry aneurysm
A = Arteriovenous malformation / Adult polycystic kidney disease
T = Trauma (e.g., being struck with baseball bat)
S = Stroke


BE FEVEER: Duke’s Criteria for Bacterial Endocarditis (BE)

Major Criteria
B = persistent Blood culture positive >2 times 12 hr part (each C&S taking should be one hour apart, and 3 samples should be taken)
E = Endocardial involvement from Echo
Minor criteria
F = Fever >/= 38C
E = Echo findings not fulfilling a major
V = Vascular (vasculitis) – Janeway lesions, mycotic aneurysm, etc
EE = Evidences from microbiological/immunology (2)
R = Risk factors/predisposing factors – drug abuse, valvular diseases (predisposing factors)


BOOMAR: MI basic management

B = Bed rest
O = Oxygen
O = Opiate
M = Monitor
A = Anticoagulate
R = Reduce clot size


CARDIAC RIND: Pericarditis causes

C = Collagen vascular disease
A = Aortic aneurysm
R = Radiation
D = Drugs (such as hydralazine)
I = Infections
A = Acute renal failure
C = Cardiac infarction
R = Rheumatic fever
I = Injury
N = Neoplasms
D = Dressler’s syndrome


CAT MUD PILES: Causes of High AG Metabolic Acidosis

C = Carbon monoxide, Cyanide
A = Alcoholic ketoacidosis
T = Toluene
M = Methanol
U = Uremia
D = Diabetic ketoacidosis
P = Paraldehyde, Phenformin
I = Iron, Isoniazid
L = Lactic acidosis
E = Ethylene glycol
S = Salicylates poisoning


CHADS2: Risk factors for developing stroke in patients with nonrheumatic atrial fibrillation

C = Congestive Heart Failure
H = Hypertension or treated hypertension
A = Age 75 years or older
D = Diabetes Mellitus
S = Stroke or TIA previously


CHESS: San Francisco Syncope Rule

C = history of Congestive heart failure,
H = Hematocrit <30%,
E = Electrocardiogram abnormality,
S = Shortness of breath, or
S = Systolic blood pressure <90 mm Hg

CLADE SPADE: Fall potential causes

C = Cardiovascular/ Cerebrovascular
L = Locomotor (skeletal, muscular, neurological)
A = Ageing (increased body sway, decreased reaction time)
D = Drugs (esp. antihypertensives, antipsychotics)
E = Environmental
S = Sensory deficits (eg. visual problems)
P = Psychological/ Psychiatric (depression)
A = Acute illness
D = Dementia
E = Epilepsy


DCAP – BTLS: Things to look for in head-to-toe survey for trauma

D = Deformity
C = Contusions
A = Abrasions
P = Punctures/penetrations
B = Burns
T = Tenderness
L = Lacerations
S = Swelling


DKA precipitants (5 I’s)

Ischaemia (cardiac, mesenteric)
Ignorance (poor control)
Intoxication (alcohol)


DEMENTIA: Dementia, some common causes

D = Diabetes
E = Ethanol
M = Medication
E = Environmental (e.g., CO poisoning)
N = Nutritional
T = Trauma
I = Infection
A = Alzheimer’s


DEPRESSED ST: Depressed ST-segment (causes)

D = Drooping valve (MVP)
E = Enlargement of LV with strain
P = Potassium loss (hypokalemia)
R = Reciprocal ST- depression (in I/W AMI)
E = Embolism in lungs (pulmonary embolism)
S = Subendocardial ischemia
S = Subendocardial infarct
E = Encephalon haemorrhage (intracranial haemorrhage)
D = Dilated cardiomyopathy
S = Shock
T = Toxicity of digitalis, quinidine


DOPE: Acute Deterioration in Intubated Patient

D = Displacement of the tube
O = Obstruction of the tube
P = Patient (this is the first priority, not the machines), Pneumothorax
E = Equipment failure


DOTS: Signs to suspect fracture

D = Deformity
O = Open wound
T = Tenderness
S = Swelling


ELEVATION: ST elevation causes in ECG

E = Electrolytes
E = Early repolarization
V = Ventricular hypertrophy
A = Aneurysm
T = Treatment (e.g., pericardiocentesis)
I = Injury (AMI, contusion)
O = Osborne waves (hypothermia)
N = Non-occlusive vasospasm


FAILURE: CHF causes of exacerbation

F = Forgot medication
A = Arrhythmia/ Anaemia
I = Ischemia/ Infarction/ Infection
L = Lifestyle: taken too much salt
U = Upregulation of CO: pregnancy, hyperthyroidism
R = Renal failure
E = Embolism: pulmonary


FAST HUG: Interventions for critically ill patients in ED

F = Fluid Resuscitation and balance
A = Analgesia
S = Sedation
T = Thromboembolic prophylaxis
H = Head-of-bed elevation
U = stress Ulcer prophylaxis, and
G = Glucose/glycemic control


CING-KUF: Diabetic ketoacidosis management

C = Creatinine (check it)/ Catheterize
I = Insulin (5u/hour. Note: sliding scale no longer recommended in the UK)
N = Nasogastic tube (if patient comatose)
G = Glucose (once serum levels drop to 12)
K = K+ (potassium)
U = Urea (check it)
F = Fluids (crytalloids)


GET SMASHED: Causes of acute pancreatitis

G = Gallstones
E = Ethanol
T = Trauma
S = Steroids
M = Mumps
A = Autoimmune (PAN)
S = Scorpion bites
H = Hyperlipidemia
D = Drugs (azathioprine, diuretics)


HEADS: Stroke risk factors

H = Hypertension/ Hyperlipidemia
E = Elderly
A = Atrial fibrillation
D = Diabetes mellitus/ Drugs (cocaine)
S = Smoking/ Sex (male)


HEAD HEART VESSELS: Syncope causes, by system

  • CNS causes include HEAD:

H = Hypoxia/ Hypoglycemia
E = Epilepsy
A = Anxiety
D = Dysfunctional brain stem (basivertebral TIA)

  • Cardiac causes are HEART:

H = Heart attack
E = Embolism (PE)
A = Aortic obstruction (IHSS, AS or myxoma)
R = Rhythm disturbance
T = ventricular Tachycardia

  • Vascular causes are VESSELS:

V = Vasovagal
E = Ectopic (reminds one of hypovolemia)
S = Situational
S = Subclavian steal
E = ENT (glossopharyngeal neuralgia)
L = Low systemic vascular resistance (Addison’s, diabetic vascular neuropathy)
S = Sensitive carotid sinüs

HEPATICS: Hepatic encephalopathy, precipitating factors

H = Hemorrhage in GIT/ Hyperkalemia
E = Excess protein in diet
P = Paracentesis
A = Acidosis/ Anemia
T = Trauma
I = Infection
C = Colon surgery
S = Sedatives


HARD-UPS: Causes of Normal Anion Gap Metabolic Acidosis

H = Hyperventilation (chronic)
A = Acetazolamide, Acids (e.g., hydrochloric), Addison’s disease
R = Renal tubular acidosis
D = Diarrhea
U = Ureterosigmoidostomy
P = Pancreatic fistulas and drainage
S = Saline (in large amounts) (hyperchloremic metabolic acidosis)


HOLT: Jugular venous pressure elevation causes

H = Heart failure
O = Obstruction of venea cava
L = Lymphatic enlargement – supraclavicular
T = intra-Thoracic pressure increase


INFARCTIONS: Myocardial infarction treatment

I = IV access
N = Narcotic analgesics (e.g., morphine, pethidine)
F = Facilities for defibrillation (DF)
A = Aspirin/ Anticoagulant (heparin)
R = Rest
C = Converting enzyme inhibitor
T = Thrombolysis
I = IV beta blocker
O = Oxygen
N = Nitrates
S = Stool Softeners


KUSSMAL: Causes of High AG Metabolic Acidosis

K = dKA
U = Uremia
S = Salicylates poisoning
S = Sepsis
M = Methanol poisoning
A = Alcoholic ketoacidosis
L = Lactic acidosis


LEMON: Difficult laryngoscopy

L = Look externally, e.g. short neck, large tongue, large teeth, etc
E = Evaluate 3-3-2
– 3 = adequacy of oral access
– 3 = to assess capacity of mandibular space to accommodate tongue
– 2 = distance of larynx to level of base of tongue
M = Mallampati scoring
O = Obstruction
N = Neck mobility


LOAD: Rapid Sequence Intubation Premedications

L = Lidocaine
O = Opioids
A = Atropine
D = Defasciculating dose of competitive NMB


MANTRELS: Clinical Decision Rules for Appendicitis

M = Migration of pain RLQ
A = Anorexia
N = N/V
T = Tenderness in RLQ
R = Rebound pain
E = Elevated temp >= 37.3 C
L = Leukocytosis >=10
S = Shift of WBC to left


METHODS Discharge Planning

M = Medication
E = Environment and exercise
T = Treatment
H = Health Teachings
O = Out Patient
D = Diet
S = Spiritual Nursing


MOANS: Difficult BVM

M = Mask seal not good, e.g. beard, facial deformity, etc
O = Obesity (difficult ventilate), 3rd trimester pregnancy, or obstruction e.g. neck swelling, angioedema, hematomas, cancer, etc
A = Age, elderly, loss of muscle tone to support the upper airway
N = No teeth (no teach causing caved in face)
S = Stiff lungs – upper airway obstruction – exacerbation of asthma, COPD, etc


MEALSSS: Rapid Sequence Intubation Equipments

M = Mask – well fitting snugly
E = ETT (appropriate size + 1 size above and 1 size below); for children, ETT size = (age/4) + 4 or child’s little finger (less accurate)
A = Airway gadgets in case of difficult airway or failed airway, e.g. Oropharyngeal airways, surgical airways, Quicktrach, cricothyrodotomy set, LMAs
L = Laryngoscope blade: Straight (in BM, “L”urus, therefore, Mi”L”ler), “C”urved = Ma”C”intosh; good light source
S = Syringe to test and inflate cuff balloon of ETT
S = Stylet
S = Suction catheter, Yankauer catheter


MIDAS: Coma (conditions to exclude as cause)

M = Meningitis
I = Intoxication
D = Diabetes
A = Air (respiratory failure)
S = Subdural/ Subarachnoid hemorrhage


OLDER SAAB: Pain history checklist

O = Onset
L = Location
D = Description (what does it feel like)
E = Exacerbating factors
R = Radiation
S = Severity
A = Associated symptoms
A = Alleviating factors
B = Before (ever experience this before)


O NAVEL: Endotrachial tube deliverable drugs

O = Oxygen
N = Naloxone
A = Atropine
V = Ventolin (albuterol), Vasopressin
E = Epinephrine
L = Lidocaine


O SHIT: Management of acute severe asthma

O = Oxygen (high dose: >60%)
S = Salbutamol (5mg via oxygen-driven nebuliser)
H = Hydrocortisone (or prednisolone)
I = Ipratropium bromide (if life threatening)
T = Theophylline (or preferably aminophylline-if life threatening)


PATCH MED: Pulseless electrical activity – causes

P = Pulmonary embolus
A = Acidosis
T = Tension pneumothorax
C = Cardiac tamponade
H = Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia
M = Myocardial infarction
E = Electrolyte derangements
D = Drugs


PIRATES: Atrial fibrillation causes

P = Pulmonary: PE, COPD
I = Iatrogenic
R = Rheumatic heart: mirtral regurgitation
A = Atherosclerotic: MI, CAD
T = Thyroid: hyperthyroid
E = Endocarditis
S = Sick sinus syndrome


PQRST: Mnemonic for a complete pain history

P3 = Positional, palliating, and provoking factors
Q = Quality
R3 = Region, radiation, referral
S = Severity
T3 = Temporal factors (time and mode of onset, progression, previous episodes)


PULSE: MI signs and symptoms

P = Persistent chest pains
U = Upset stomach
L = Lightheadedness
S = Shortness of breath
E = Excessive sweating


RATE: Hemolytic-Uremic Syndrome components

R = Renal failure
A = Anemia (microangiopathic, hemolytic)
T = Thrombocytopenia
E = Encephalopathy (TTP)


RESS: Principles of management in toxicology

R = Reduce absorption
E = Enhance elimination
S = Specific antidote
S = Supportive treatment


RN CHAMPS: Shock types

R = Respiratory
N = Neurogenic
C = Cardiogenic
H = Hemorrhagic
A = Anaphylactic
M = Metabolic
P = Psychogenic
S = Septic


RODS: Difficult extraglottic devices

R = Restrictied mouth opening
O = Obstruction upper airway
D = Disrupted or distorted upper airway
S = Stiff lungs, spine of cervical


SAD PUCKER: Structures in retroperitoneal space

S = Suprarenal glands (adrenals)
A = Aorta/IVC
D = Duodenum (2nd – 3rd, and 4th segments)
P = Pancreas (tail is intraperitoneal)
U = Ureters
C = Colon (only the ascending and descending parts)
K = Kidneys
E = Esophagus
R = Rectum


SAMPLE: Focused History in Emergency Conditions/Trauma

S = signs and symptoms
A = allergies
M = medications
P = pertinent past medical history
L = last oral intake
E = events leading up to.


Scared Lovers Try Positions That They Can’t Handle: Carpal (Wrist) Bones

S = Scaphoid
L = Lunate
T = Triquetrum
P = Pisiform
T = Trapezium
T = Trapezoid
C = Capitate
H = Hamate


SHORT: Difficult cricothyrotomy

S = previous Surgery
H = Hematoma/swelling around neck
O = Obesity
R = Radiation distortion
T = Tumor


SIMPLE: Criteria to define simple febrile seizure

S = Seizure of focal type
I = Intracranial infection
M = Multiple times a day
P = Past history of afebrile seizure
L = Last longer than 15 minutes
E = Examination abnormalities


SINUS BRADICARDIA (sinus bradycardia): Sinus bradycardia aetiology

S = Sleep
I = Infections (myocarditis)
N = Neap thyroid (hypothyroid)
U = Unconsciousness (vasovagal syncope)
S = Subnormal temperatures (hypothermia)
B = Biliary obstruction
R = Raised CO2 (hypercapnia)
A = Acidosis
D = Deficient blood sugar (hypoglycemia)
I = Imbalance of electrolytes
C = Cushing’s reflex (raised ICP)
A = Aging
R = Rx (drugs, such as high-dose atropine)
D = Deep anaesthesia
I = Ischemic heart disease
A = Athletes


SITTT: Causes of hematuria

S = Stone
I = Infection
T = Trauma
T = Tumor
T = Tuberculosis


TOM SCHREPFER: Predisposing Conditions for Pulmonary Embolism

T = Trauma
O = Obesity
M = Malignancy
S = Surgery
C = Cardiac disease
H = Hospitalization
R = Rest (bed-bound)
E = Estrogen, pregnancy, post-partum
P = Past hx
F = Fracture
E = Elderly
R = Road trip


TV SPARC CUBE: Shock signs and symptoms

T = Thirst
V = Vomiting
S = Sweating
P = Pulse weak
A = Anxious
R = Respirations shallow/rapid
C = Cool
C = Cyanotic
U = Unconscious
B = BP low
E = Eyes blank


USED CARP: Causes of Normal Anion Gap Metabolic Acidosis

U = Ureteroenterostomy
S = Small bowel fistula
E = Extra chloride
D = Diarrhea
C = Carbonic anhydrase inhibitors
A = Adrenal insufficiency
R = Renal tubular acidosis
P = Pancreatic fistula


VOMITING: Vomiting, extra GI differential

V = Vestibular disturbance/ Vagal (reflex pain)
O = Opiates
M = Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia)
I = Infections
T = Toxicity (cytotoxic, digitalis toxicity)
I = Increased ICP, Ingested alcohol
N = Neurogenic, psychogenic
G = Gestation

References and Further Reading