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Internal Medicine -... Mnemonics !!

By: Bill Ritzer

This may only be of interest to the many pre-med students out there but it gives a great example of how to memorize complex systems.

Emergency Medicine
Coma: conditions to exclude as cause MIDAS:
Meningitis
Intoxication
Diabetes
Air (respiratory failure)
Subdural/ Subarachnoid hemorrhage

Resuscitation: basic steps ABCDE:
Airway
Breathing
Circulation
Drugs
Environment

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]

Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray":
Epinephrine
Lidocaine
Bretylium
Magsulfate
Procainamide

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

Shock: types RN CHAMPS:
Respiratory
Neurogenic
Cardiogenic
Hemorrhagic
Anaphylactic
Metabolic
Psychogenic
Septic
· Alternatively: "MR. C.H. SNAP", or "NH CRAMPS".

Shock: signs and symptoms TV SPARC CUBE:
Thirst
Vomiting
Sweating
Pulse weak
Anxious
Respirations shallow/rapid
Cool
Cyanotic
Unconscious
BP low
Eyes blank

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

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)

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)
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)

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 (<5 or >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)

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.

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)

Asystole: treatment
"Have some asystole "TEA":
Transcutaneous pacing Epi Atropine

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.

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

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

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.

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MNEMONICS

Airflow Passages
Airflows are prominent in Mouthy People who are Loud Talkers.
Mouthy
People
Loud
Talkers
Mouth
Pharynx
Larynx
Trachea
Cartilages of the Larynx
There are 4 cartilages in the larynx whose initial letters are TEAC (also the brandname of a home stereo). Associate the TEAC sound and the vocal cords, and you get the connection.
T
E
A
C
Thyroid
Epiglottis
Arytenoid
Cricoid
The snake in Garden of Eden spoke with a lisp, saying "Adam, thry thith apple." This refers to the fact that the THYRoid cartilage is also called the Adam's Apple.
Lung Lobes
The segments of the (right) Middle Lobe of the lung are Medial and Lateral [ML=ML]
Nasal Cavity
Never Call Me Needle Nose helps remember the parts of the nasal cavity: Nares (external), Conchae, Meatuses, Nares (internal), Nasopharynx.
Respiratory Tract
It's a bit of an extended version of the Airflow Passage mnemonic above. Movie Personality Lana Turner's Pretty Sexy Thighs Turn Retinas All Around helps you recall the order of the respiratory tract segments...
Movie
Personality
Lana
Turner's
Pretty
Sexy
Thighs
Turn
Retinas
All
Around
Mouth
Pharynx
Larynx
Trachea
Primary Bronchus
Secondary Bronchus
Teritary Bronchus
Terminal Bronchiole
Respiratory Bronchiole
Alveolar Duct
Alveolar Sac
Three Tonsils
People (or PPL, for short) have three tonsils: Pharyngeal, Palatine, and Lingual.