Upper extremity injuries are one of the common reasons for visits to the emergency department. A quick physical exam, including both motor and sensory exam of the hand, can help triage the severity and urgency for referral to upper extremity specialists. When assessing the distal peripheral nerve motor functions of the hand, try using this mnemonic: “Rock, Paper, Scissors”. The combinations of movements by muscles innervated by the three peripheral nerves make up …
Tiny Tips: STEMI? Don’t forget your PAILS!
Reading ECGs is a bread and butter emergency medicine skill. At busy centres a triage nurse may hand you tens of them to glance at per shift. It can be a mindless, monotonous task, but your brain needs to know where to look. So, when you identify legitimate ST elevation and you are concerned about a STEMI, where are those reciprocal changes found again? Think of PAILS! This mnemonic identifies that ST segment …
Tiny Tip: “STAB” as a Tool for Diagnosing Occipital Neuralgia
Approaching the complaint Occipital neuralgia is a headache disorder characterized by shooting neuropathic pain secondary to greater or lesser occipital nerve pathology. The diagnosis should be considered in a patient presenting with the following: Unilateral or bilateral pain originating at the skull base Sharp, shooting, lancinating, or burning pain that radiates forward along the dermatomes supplied by the greater or lesser occipital nerves Paroxysmal pain lasting seconds to minutes Dysesthesia or allodynia over …
Tiny Tip: START Triage Protocol RPM – 30 – 2 – Can Do
If you’re like me, you appreciate the value of triage systems in emergency medicine and prehospital care but find it hard to remember the components of each. The START Triage (Simple Triage And Rapid Treatment) protocol was designed to quickly assess victims of mass casualty, categorising them into four colour-coded groups that communicate the urgency of treatment.1 Patients designated ‘green’ are the walking wounded; these individuals can move and follow commands. They should …
Tiny Tips: “KULT IMPACT” as a mnemonic for Anion Gap Metabolic Acidosis
Every medical student learns the differential diagnosis for an anion gap metabolic acidosis. The list is particularly crucial for emergency physicians, who often see this finding in sick, undifferentiated patients. Many people use the mnemonics “MUDPILES CAT” or “GOLDMARK” to help remember this list. An alternative mnemonic, “KULT IMPACT”, provides a practical and organized way of remembering the differential. “KULT” denotes the most common organic causes: Ketones: diabetic ketoacidosis (DKA), alcoholic ketoacidosis, starvation …
Tiny Tips: ICH for ICH – Brain Herniation
Brain herniation is a catastrophic sequela of increased intracranial pressure (ICP) or local mass effect from intracranial lesions. Different types of brain herniation can occur depending on the location of mass effect and how rapidly this mass effect develops.1 Any mass lesion, including hemorrhage, tumor, vasogenic or cytotoxic edema, trauma or infection can cause herniation. However spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury (TBI) are common causes of herniation in the acute …