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 …
Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic
Peripheral neuropathy is prevalent in up to 2.4% of the general population1. It is often characterized by an asymmetric distribution with sensory symptoms following a dermatomal pattern. Initial investigations include a complete blood count (CBC), metabolic panel (electrolytes, glucose, urea, creatinine), and thyroid stimulating hormone (TSH)2. There are many causes for peripheral neuropathy, so when considering the etiology, think “TREADMILLS.” Toxins Ethanol, Heavy metals, Tetanus, Organophosphates, Diphtheria Renal Failure Endocrine Diabetes, Hypothyroidism Acquired …
Tiny Tips: “C-3PO’s RIVAL” Acute Unilateral Painless Vision Loss mnemonic
Early diagnosis and treatment of acute, painless vision loss greatly increases the chances of vision restoration. Though treatment for most conditions involves an ophthalmology consult, it is important to consider and evaluate for the possible etiologies. A mnemonic to remember the list of causes for acute unilateral painless vision loss is “C-3PO’s RIVAL”.1 Central Retinal Artery Occlusion (CRAO) Central Retinal Vein Occlusion (CRVO) Cerebral Vascular Accident (CVA) Posterior Vitreous Detachment (PVD) Optic Neuritis …
The Use of the Modified Valsalva Maneuver for Stable SVT
Please note that, while “supraventricular tachycardia (SVT)” is a term that can be used more broadly to refer to any tachyarrhythmia originating above the ventricles, I use its more conventional meaning here to describe AVnRT and AVRT. LITFL has a good summary of narrow-complex tachycardias. SVT is a narrow complex tachycardia commonly seen in the emergency department. In hemodynamically stable patients the first-line treatment is vagal stimulation, usually the Valsalva maneuver. However, success …