Shor tt r i cksofi mpor t antt opi cs Bykef Car eofCl i enti nTr act i on( TRACTI ON) T-Temper at ur e( Ext r emi t y , I nf ect i on) R-Ropeshangf r eel y A-Al i gnment C-Ci r cul at i onCheck( 5P' s) T-Ty pe&Locat i onoff r act ur e I-I ncr easef l ui dei nt ake O-Ov er headt r apeze N-Nowei ght sonbedorf l oor St epsi nt heNur si ngPr ocess ADPI E( ADel i ci ousPI E) Assessment D-i agnosi s Pl anni ng I mpl ement at i on Ev al uat on Aci dBase( ROME) Respi r at or y Opposi t e Met abol i c Equal CANCER' SEar l yWar ni ngSi gns CAUTI ONUP Changei nbowel orbl adder A-l esi ont hatdoesnotheal Unusual bl eedi ngordi schar ge Thi ckeni ngorl umpi nbr eastorel sewher e I ndi gest i onordi f f i cul t yswal l owi ng Obv i ouschangesi nwar tormol e Naggi ngcoughorper si st enhoar seness Unexpl ai nedwei ghtl oss Per ni ci ousAnemi a CANCERI nt er v ent i ons Comf or t Al t er edBodyI mage Nut r i t i on Chemot her apy Ev al uat er esponset omeds Respi t ef orcar et aker s Hy pogl y cemi a( TI RED) -anabnor mal decr easeofbl oodi nt hesugar Tachy car di a I r r i t abi l i t y Rest l ess Excessi v eHunger Di aphor esi s/Depr essi on Adr enal Gl andHor mones( SSS) Sugar( Gl ucocor t i coi ds) Sal t( Mi ner al cor t i coi ds) Sex( Andr ogens) Pul monar yEdema( MADDOG) MMor phi ne AAmi nophy l l i ne D-Di gi t al i s DDi ur et i cs( Lasi x) O-Oxy gen G-ases( Bl oodGasesABG' s) 5P' sofCi r cul at or yChecks PPai n PPar est hesi a PPar al y si s PPul se PPal l or( Pal eness) Hy per t ensi onNur si ngCar e( DI URETI C) Dai l yWei ght I -nt akeandOut put( I&O) U-r i neOut put ResponseofBP El ect r ol y t es TakePul ses I schemi cEpi sodes( TI A) Compl i cat i ons: 4C' s Ev al ut i onofEpi si ot omyHeal i ng( REEDA) R-Redness E-Edema E-Ecchy mosi s D-Di schar ge, Dr ai nage A-Appr oxi mat i on Ev al ut i onofEpi si ot omyHeal i ng( REEDA) R-Redness E-Edema E-Ecchy mosi s D-Di schar ge, Dr ai nage A-Appr oxi mat i on Post Par t um Assessment( BUBBLE) Br east s Ut er us Bowel s Bl adder Lochi a Epi si ot omy / l at er at i on/ Csect i oni nci si on Tr acheal Esophageal Fi st ul a( 3C' s) C-Choki ng C-Coughi ng C-Cy anosi s Cl ef tLi p-PostOpCar e( CLEFTLI P) Choki ng Li eonback Ev al uat eAi r way FeedSl owl y Teachi ng Lar gerni ppl eopeni ng I nci dencei ncer asei nmal es Pr ev entcr ustf or mat i onandaspi r at i on Si t uat i onsr equi r i ngCr i si sSi t uat i on: RAPE R-Rut hl ess A-Abusi v e P-Per sonal E-Exper i ence War ni ngSi gnsofaChi l dAbuse/Negl ect : CHI LDABUSE Chi l d' sexcessi v eknowl edgeonsex&abusi v ewor ds Hai rgr owt hi nv ar i ousl engt hs I nconsi st entst or i esf r om t hechi l d&par ent / s Lowsel f est eem Depr essi on Apat hy , noemot i on Br ui sed Unusual i nj ur i es Ser i ousi nj ur i es Ev i denceofol di nj ur i esnotr epor t ed TheHYPERKALEMI A" Machi ne"-CausesofI ncr easedSer um K+ M -Medi cat i ons-ACEi nhi bi t or s, NSAI DS A-Aci dosi s-Met abol i candr espi r at or y C-Cel l ul ardest r uct i on-Bur ns, t r aumat i ci nj ur y H-Hy poal dost er oni sm, hemol y si s I-I nt ake-Excesssi v e N-Nephr ons, r enal f ai l ur e E-Excr et i on-I mpai r ed MURDER Si gnsandSy mpt omsofI ncr easedSer um K+ M -Muscl eweakness U-Ur i ne, ol i gur i a, anur i a R-Respi r at or ydi st r ess D-Decr easedcar di accont r act i l i t y E-ECGchanges R-Ref l exes, hy per r ef l exi a, orar ef l exi a( f l acci d) Tor ememberwhi chbl oodt y pesar ecompat i bl e, v i sual i zet hel et t er" O"asanor br epr esent i ng t heuni v er se, becauset y peObl oodi st heuni v er sal donorbl ood.Pat i ent swi t hanybl oodt y pe canr ecei v ei t .ButOal someans" oddmanout " : Pat i ent swi t ht y peObl oodcanr ecei v eonl yt y pe Obl ood.Thi nkBEEPt or emembert hesi gnsofmi norbl eedi ng: B: Bl eedi nggums E: Ecchy moses( br ui ses) E: Epi st axi s( nosebl eed) P: Pet echi ae( t i nypur pl i shspot s) Hav i ngdi f f i cul t ydi st i ngui shi nghy popl asi af r om hy per pl asi a? Wheny ouseepl asi ai nanywor d, t hi nkof" pl ast i c. "Pl ast i c, i nt ur n, meansf or mi ngordev el opi ng. Asf orhy poandhy per , t hat ' st heeasypar t .Hy pomeansunder , orbel ownor mal .Hy permeans excessi v e, orabov enor mal .Thus, hy popl asi ameansunder dev el opment , andhy per pl asi ameans ov er dev el opment . Tor emembert hef ourcausesofcel l i nj ur y , t hi nkofhowt hei nj ur yt i pped( orTI PD)t hescal eof homeost asi s: T: Toxi norot herl et hal ( cy t ot oxi c)subst ance I : I nf ect i on P: Phy si cal i nsul tori nj ur y D: Def i ci t , orl ackofwat er , oxy gen, ornut r i ent s. Whenaski ngassessmentquest i ons, r emembert heAmer i canCancerSoci et y ' smnemoni c dev i ceCAUTI ON: C: Changei nbowel orbl adderhabi t s A: Asor et hatdoesn' theal U: Unusual bl eedi ngordi schar ge T: Thi ckeni ngorl ump I : I ndi gest i onordi f f i cul t yswal l owi ng O: Obv i ouschangesi nawar tormol e N: Naggi ngcoughorhoar seness. Uset heABCDr ul et oassessamol e' smal i gnantpot ent i al : A: Asy mmet r y I st hemol ei r r egul ari nshape? B: Bor der I st hebor deri r r egul ar , not ched, orpoor l ydef i ned? C: Col or Doest hecol orv ar y( f orexampl e, bet weenshadesofbr own, r ed, whi t e, bl ue, orbl ack) ? D: Di amet er I st hedi amet ermor et han6mm? Si deef f ect sofst er oi ds.The5S' s. Si ck-easi ert ogetsi ck Sadcausesdepr essi on Sexi ncr easesl i bi do Sal t r et ai nsmor eandcauseswei ghtgai n Sugar r ai sesbl oodsugar PERRLA Pupi l sEqual l yRoundandReact i v et oLi ghtandAccomodat i on Lear ni ngt heSy st emsoft heBody ? MRDI CERUNS M=Muscl e R=Respi r at or y D=Di gest i v e I =I nt egument ar y C=Ci r cul at or y E=Endocr i ne R=Repr oduct i v e U=Ur i nar y N=Ner v ous S=Skel et al Tr oubl ef i gur i ngoutwhi chey ei swhi ch? OSi sl ef tey e ODi st her i ghtey e Youcanr ememberwhi chonei st her i ghtey e( OD) , becausey oucanmaket heDi nt oanR-You j usthav et odr awt ost i ckl egsont hebot t om oft heD.Wr i t ei tdownonpaper , y ou' l l seewhatI mean( i t ' shar dt oshowy ouwhenal l Icandoi st y pe) S/ SofHy ponat r emi a St upor / coma Anor exi a, N&V Let har gy Tendonr ef l exesdecr eased Li mpmuscl es( weakness) Or t host at i chy pot ensi on Sei zur es/ headache St omachcr ampi ng I mmedi at et r eat mentofMI , t hi nkMONA: M Mor phi nesul f at e OOxy gen NNi t r ogl y cer i n AASA Tr eat mentofCHF, t hi nkUNLOADFAST: Usi tUpr i ght NNi t r o LLasi x OOxy gen AAmi nophy l l i ne DDi goxi n FFl ui ds-decr ease AAf t er l oad-decr ease SSodi um -decr ease TTest s: di gl ev el , ABG, K+ Assi st i v edev i ces-Canes: CCane OOpposi t e AAf f ect ed LLeg Si gnsofaChol i ner gi cCr i si s, t hi nkSLUD: SSal i v at i on LLacr i mat i on UUr i nat i on DDef i cat i on Memor yTr i ck: Needt or ememberwhi chki ndofbet abl ockerhaswhi chact i on? B1Bl ockst hehear t( y ouhav eonl yonehear t ) B2Bl ockst hel ungs( y ouhav et wol ungs) f et al accel er at i onsanddecel er at i ons! ! ! Justr ememberVEALCHOP Var i abl eCor dcompr essi on Ear l yHeadcompr essi on Accel er at i onsOK Lat ePl acent al i nsuf f i ci ency Hear tsounds: S3=Hear tf ai l ur e( 3sy l l abl es) S4=Hy per t ensi on( 4sy l l abl es) ef f ect sofant i chol i ner gi cs: Can' tsee Can' tpee Can' tspi t Can' tdef ecat e Ni nepoi ntPost par t um Assessment . . . BUBBLEHER B-Br east s U-Ut er us B-Bl adder B-Bowel f unct i on L-Lochi a E-Epi si ot omy H-Homan' ssi gn E-Emot i onal St at us R-Respi r at or ySy st em The5P' sofci r cul at i onl ossi nal i mb. Pai n, Pal l or , Pul sel essness, Par ast hesi a, Poi ki l ot her mi a si deef f ect s&adv er ser eact i onst oi mmuni zat i ons: F-Fev er I -I t chi ng S-St i f f ness H-Headache E-Edema R-Redness F-Fussy L-Local i zedTender ness A-Appet i t edecr ease G-Gener al AchesPai ns HYPERNATREMI A " YouAr eFr i ed" F-Fev er( l owgr ade) , f l ushedski n R-Rest l ess( i r r i t abl e) I-I ncr easedf l ui dr et ent i onandi ncr easedBP E-Edema( per i pher al andpi t t i ng) D-Decr easedur i nar yout put , dr ymout h Canal souset hi sone: SALT S=Ski nf l ushed A=Agi t at i on L=Lowgr adef ev er T=Thi r st " CATS"of" HYPOCALCEMI A" C-Conv ul si ons A-Ar r hy t hmi as T-Tet any S-Spasmsandst r i dor Remembert hather ei nt heUSAy ouDdr i v eont her i ghtsi deoft her oad. O=opt i cal A=audi t or y AD-r i ghtear AS-l ef tear AU-bot hear s OD-r i ghtey e OS-l ef tey e OU-bot hey es Mneumoni cdev i cef orr emember i ngquest i onst oaskemer gencyr oom admi t s: Car ?( ci r cumst ancesofev ent ) Pl ease( pr eci pi t at i ngev ent s) Li st en( l ocat i onofev ent ) ToThi s: ( Ti meofev ent ) Wat ch( whensy mpt omsappear ed) Under age( unconsci ousnessaf t eri nj ur y ? ) Al cohol i cs( ar r i v al t i mei nER) Headi ng( hospi t al admi t spr ev i ousl y ? ) Home( pr ev i oushi st or y / heal t hst at us) And( al l er gi es) May be( medi cat i ons) Fl at t eni ng( f ear sf orsaf et y ) My( meal , t i meofl ast ) Poodl e( per i od, t i meofl astmenst r ual ) Dog( pr i mar ydoct or , nameandl ocat i onof ) Toni ght( t et anus, dat eofl asti mmuni zat i on) Ev er y oneknowst omaket heABCD( ai r waybr eat hi ngci r cul at i onandneur ol ogi cdi sabi l i t y ) assessmentf i r st .Thenassoonaspossi bl e, f ur t herassessment / i nt er v ent i oni sdone, whi ch i ncl udes: Hi s( heal t hhi st or y ) Head( headt ot oeassessment ) I s( i nser tmoni t or i ngdev i ces-cat hs, ECG, ar t er i al l i nes) So( spl i nt sf orf r act ur es) Wi de( woundcar e) Ol i v i a( ot heri nt er v ent i ons) Thepat hophy si ol ogyofARDS: Assaul tont her espi r at or ysy st em Respi r at or ydi st r ess Decr easedl ungcompl i ance Sev er er espi r at or yf ai l ur e Di agnost i ccr i t er i aofARDS Acut eonset Rat i o( PaCO2/ Fi O2)<200span=" " > Di f f usei nf i l t r at i on SwanGanzwedgepr essur e( PAWP)<18mm hg=" "span=" " > Compl i cat i onsoft hr ombol y t i ct her apy : The3B' s Bl eedi ng Br ady ' s( dy sr hy t hmi as) Bl oodcl ot s( d/ texcessi v et hr ombi n) Compl i cat i onsofcar di opul monar yby pass( CPB) : The3H' s Hy pot her mi a( t odecr easeO2consumpt i on) . . . Ef f ect sSVR( v asoconst r i ct i on)andcauses my ocar di al depr essi on( decr easescont r act i l i t y ) Hemodi l ut i on( t oi mpr ov emacr oci r cul at i on) . . . f l ui dshi f t i ng( t hi r dspaci ng) , el y t ei mbal ances( K+, Mg+&Ca++of t enneedr epl aci ng! ) Hepar i nzat i on( t opr ev entcl ot si nci r cui t ) . . . moni t oraPTT. Si gnsandsy mpt omsofcar di act amponade( Beck' sTr i ad) : TheThr eeD' s Di st anthear tsounds Di st endedj ugul arv ei ns Decr easedpul sepr essur e( t hi nkofanar r owpul sepr essur easopposedt oawi deone) At r i al Ar r hy t hmi as: ABCDE Adenosi ne/ ami odor oneorant i coagul at e( i fAf i b/ Fl ut t erhasbeenpr esent>48h) Bet abl ocker s Cal ci um channel bl ocker s Di goxi n El ect r ocar di ov er t( i f<48hspan=" " > Forv ent r i cul arar r hy t hmi as: AL Ami odor one Li docai ne NSAI DDr ugs N-Napr oxen S-Sal i cy l at es A-Adv i l I-I bupr of en D-Di cl of enac S-Sul i ncl ac 8A' sf orHepat ot oxi cDr ugs( CheckSGPT/ SGOT) Ant i t uber cul osi s Ant i conv ul sant S-sodi um Lumi nal G-gabapent i n P-pheny t oi n T-t egr et ol Ant i cancer Aspi r i n Al cohol Ant i f ami l y( cont r acept i cepi l l s) Acet ami nophen Af l at oxi ns Par ki nson' sMedi cat i ons: " Al i Lov esBoxi ngMat ches" AAmant adi ne L-Lev odopa B-Br omocr i pt i ne MMAOi nhi bi t or s The4H' st hati nv al i dat eaneur oexam: Hy pot ensi on Hpoxi a Hy pogl y cemi a Hy pot her mi a* Pi npoi ntpupi l s: Dr ugs, dr ops&near l ydead Dr ugs: opi at es Dr ops: medsf orgl aucoma Near l ydead: damagei nt heponsar eaoft hebr ai nst em Di l at edpupi l s: Fear , Fi t s&FastLi v i ng Fear : pani c, ext r emeanxi et y Fi t s: sei zur es FastLi v i ng: cocai ne, cr ack, phency cl i di ne( PCP) ADLs( Act i v i t yofDai l yLi v i ng) BATTED Bat hi ng Ambul at i on Toi l et i ng Tr ansf er s Eat i ng Dr essi ng I ADLS( I nst r ument al Act i v i t i esofDai l yLi v i ng)SCUM Shoppi ng Cooki ngandCl eani ng Usi ngt el ephoneort r anspor t ai t on Managi ngmoneyandmedi cat i ons Bl eedi ngPr ecaut i ons( RANDI ) R-RazorEl ect r i c/Bl ades A-Aspi r i n N-Noneedl es( esp.i nsmal l gauge) D-Dodecr easei nneedl est i cks) I-I nj ur y( Pr ot ectf r om) CanesandWal ker s( COAL) C-Cane O-Opposi t e A-Af f ect ed L-Leg CanesandWal ker s( WWAL) Wander i ngWi l ma' sAl way sLat e W-Wal ker W-Wi t h A-Af f ect ed L-Leg CommonCausesofTr ansi entI ncont i nence( DI APPERS) Del i r i um I nf ect i on At r ophi cUr et hr a Phar maceut i cal s Psy chol ogi c ExcessUr i neOut put Rest r i ct edMobi l i t y St ool I mpact i on Pr omot i onofNor mal El i mi nat i on( POOPERSCOOP) Posi t i on Out put Of f erFl ui ds Pr i v acy Exer ci se Repor tResul t s Si ze( Amount ) Consi st ency Occul tBl ood Odor Per i st al si s Emer gencyTr aumaAssessment ( ABCDEFGHI ) Ai r way Br eat hi ng Ci r cul at i on Di sabi l i t y Exami ne Fahr enhei t GetVi t al s Headt oToeAssessment I nt er v ent i on Tr aumaSur ger y( AMPLE) af t eri ni t i al assessment Al l er gi es Medi cat i ons PastMedi cal Hi st or y LastMeal Ev ent sSur r oundi ngI nj ur y Tr aumaSur ger y( AMPLE) af t eri ni t i al assessment Al l er gi es Medi cat i ons PastMedi cal Hi st or y LastMeal Ev ent sSur r oundi ngI nj ur y 6P' sofDy spnea P-Pul monar yBr onchi al Const r i ct i on P-Possi bl eFor ei gnBody P-Pul monar yEmbol us P-Pneumot hor ax P-PumpFai l ur e P-Pneumoni a Li docai neToxi ci t y( SAMS) Sl ur r edSpeech Al t er edCent r al Ner v ousSy st em Muscl eTwi t chi ng Sei zur es TDCI( TheseDr ugsCanI nt er act ) T-Theophy l i ne D-Di l ant i n C-Coumadi n I-l osone( Er y t hr omy ci n) Ser i ousCompl i cat i onsofOr al Bi r t hCont r ol Pi l l s( ACHES) A-Abdomi nal Pai n C-ChestPai n H-Headache E-Ey ePr obl ems S-Sev er eLegPai n Emer gencyDr ugst oLEANon L-Li docai ne E-Epi nephr i ne A-At r opi neSul f at e N-Nar can Dr ugsf orBr ady car di a&l owBP( I DEA) I-I sopr ot er enol D-Dopami ne E-Epi nephr i ne A-At r opi neSul f at e Chol i ner gi cCr i si s( SLUD) Sal i v at i on Lacr i mat i on Ur i nat i on Def ecat i on Depr essi onAssessment( SI G) Sl eepDi st ur bances I nt er estDecr eased Gui l t yFeel i ngs Ener gyDecr eased( CAPS) Concent r at i ondecr eased Appet i t e Psy chomot orf unct i ondecr eased Sui ci dal I deat i ons 5A' st oAl zhei merDi agnosi s Amnesi a Anomi a Apr axi a Agnosi a Aphasi a Maj orSy mpt omsofaMani cAt t ack( DI GFAST) D-Di st r act i bi l i t y I-I ndi scr et i on G-Gr andi osi t y F-Fl i ghtofI deas A-Act i v i t yI ncr ease S-Sl eepDef i ci t T-Tal kat i v e 3P' sofBl i ndness P-Pr ev ent abl e P-Pai nl ess P-Per manent Sy mpt omsofHy poxi a( i nPedi at r i cs)-FI NES Feedi ngdi f f i cul t y I nspi r at or ySt r i dor Nar esFl ar es Expi r at or yGr unt i ng St er nal Ret r act i ons ManagementofASTHMA Adr ener gi cs( Al but er ol ) St er oi ds Theophy l l i ne Hy dr at i on( I V) Mask( Oxy gen) Ant i bi ot i cs Epi gl ot t i t i s( AI RRAI D) Ai r wayCl osed I ncr easedPul se Rest l essness Ret r act i ons Anxi et yI ncr eased I nspi r at or ySt r i dor Dr ool i ng Bl oodFl owThr ought heCar di acVal v es( Ti ssuePaperMyAsset s) Tr i cuspi d Pul moni c Mi t r i al Aor t i c I mmedi at eTr eat mentofaMy ocar di al I nf ar ct i onCl i ent( MONA) M-Mor phi ne O-Oxy gen N-Ni t r ogl y cer i ne A-ASA Tr eat i ngCHF( UNLOADFAST) Upr i ghtPosi t i on Ni t r at es( i nl owdose) Lasi x Oxy gen Ami nophy l l i ne Di goxi n Fl ui ds( decr ease) Af t er l oad( decr ease) Sodi um r est r i ct i on Test( Di gl ev el , ABGs, Kl ev el ) DEMENTI A Makesur et heydon' thav epr obl emswi t h: Dr ugandal cohol Ey esandear s Met abol i candendocr i nedi sor der s Emot i onal di sor der s Neur ol ogi cdi sor der s Tumor sandt r auma I nf ect i on Ar t er i ov ascul ardi sease Ost eopor osi sRi skFact or s( ACCESS) Al cohol Use Cor t i cost er oi dUse Cal ci um l ow Est r ogenl ow Smoki ng Sedent ar yl i f est y l e/ s ACCESSl eadst oOSTEOPOROSI S Whoneedsdi al y si s?( Checkt hev owel s: AEI OU) A-Aci dBasePr obl ems E-El ect r ol y t ePr obl ems I -I nt oxi cat i ons O-Ov er l oadoff l ui ds U-Ur emi cSy mpt oms Pr ost at ePr obl emsar eno. . .FUN F-Fr equency U-Ur gency N-Noct ur i a BRATDi et( f orsev er edehy dr at i on) B-Banana R-Ri ce A-Appl e T-Toast edBr ead Gl ut enFr eeDi et( ROW) R-Ry e O-Oat s W-Wheat AssessChangesi nSeni l eDement i a( JAMCO) J-Judgment A-Af f ect M-Memor y C-Cogni t i on O-Or i ent at i on .* * * * * * * * * * * * * * * * Bykef * * * * * 3P' sofDi abet esMel l i t us-Ty pe1Si gns&Sy mpt oms P-Pol y ur i a( excessi v eur i nat i on) P-Pol y dy psi a( excessi v et hi r st ) P-Pol y phagi a( excessi v ehunger ) Ri ght Si dedHear tFai l ur e( HEAD) H-Hepat omegal y E-Edema( Bi pedal ) A-Asci t es D-Di st endedNeckVei n Lef t Si dedHear tFai l ur e( CHOP) C-Cough H-Hemopt y si s O-Or t hopnea P-Pul monar yCongest i on( cr ackl es/r al es) Hy per kal emi aManagement( KI ND) K-Kay exal at e( or al l y /enema) I -I nsul i n N-NaHCO3 D-Di ur et i cs( Fur osemi de&Thi azi des) ManagementofMy ocar di al I nf ar ct i on( MONATAS) M-Mor phi ne O-Oxy gen N-Ni t r at es( Ni t r ogl y cer i n) A-Aspi r i n( ASA) T-Thor mbol y t i cs A-Ant i Coagul ant s S-St ool Sof t ener s El ect r ol y t es-PI SO P-Pot assi um I -I nsi de S-Sodi um O-Out si de Eat i ngDi sor der : ANOREXI A Amenor r headel ay ed Noor gani cf act or saccount sf orwei ghtl oss Obv i ousl yt hi nbutf eel sFAT Ref usal t omai nt ai nnor mal bodywei ght Epi gast r i cdi scomf or ti scommon Xsy mpt oms( pecul i arsy mpt oms) I nt ensef ear sofgai ni ngwei ght Al way st hi nki ngoff oods Sy mpt omsofLeukemi a( ANT) A-Anemi a N-Neut r openi a T-Thr ombocy t openi a Exer ci seGui def orDi abet i cFi t ness( FI T) F-Fr equency( 3xperweek) I-I nt ensi t y( 6080%ofMaxi mal Hear tRat e) T-Ti me( Aer obi cAct i v i t y ) Sy mpt omsofHy poxi a( RATBED) Ear l yHy poxi a: Rest l essness Anxi et y Tachy car di a/Tachy pnea Lat eHy poxi a: Br ady car di a Ext r emeRest l essness Dy spnea Eat i ngDi sor der : BULI MI A Bi ngeeat i ng Underst r i ctdi et i ng Lackscont r ol ov er eat i ng I nducedv omi t i ng Mi ni mum oft obi ngeeat i ngepi sodes I ncr ease/ Per si st entconcer nofbodysi ze/ shape Abuseofdi ur et i cs&l axat i v es Fi ndi ngsofaBul i mi acl i ent : WASHED Wei ghtl ossof15%ofor i gi nal bodywei ght Amenor r hea Soci al wi t hdr awal Hi st or yofhi ghact i v i t y&achi ev ement El ect r ol y t eI mbal ance Depr essi on/Di st or t edBodyI mage Out comeofAl cohol i sm: BAD B-Br ai nDamage A-Al cohol i cHal l uci nosi s D-Deat h 5D' sofBehav i or al Pr obl emsofAl cohol i sm D-Deni al D-Dependency D-Demandi ng D-Dest r uct i v e D-Domi neer i ng Br eastsel fexami nat i on( i madeasongoutoft hi s) ♫♪♪♫1l i t t l e2, l i t t l e3l i t t l ef i nger s DoBSE7day saf t ermenses Pr essni ppl eoncecheckf ordi schar ge Cal l y ourdoct or I ' m sur ey ouwi l l doi tmor e. . . ♫♪♪♫ Al kal osi sandAci dosi s Al kal osi s-hasa' k' -Ki cki ngt hepHup Aci dosi s-hasa' d' -Dr oppi ngt hepHdown Sol ut i ons: I sot oni c, Hy pot oni c, Hy per t oni c I sot oni c-" SameasI "-t hesol ut i onusedwi l l bet hesameasnor mal bodyf l ui dcomposi t i on. Fl ui dsr emai ni nsi dei nt r av ascul arspace. Hy pot oni c-" Hy po, hi ppo"-t hesol ut i onpul l sf l ui df r om t hei nt r av ascul arspacei nt ot heI CF-t he cel l " swel l sl i keahi ppo" . Forr emember i ngt hecor onar yar t er i esandwhi chsi det heyar eon: Ihav eaRI GHTt oCAMPi fy ouLEFTof ft heAC Ri ght=Ri ght C=or onar y A=Ar t er y M=Mar gi nal Ar t er y P=Post er i orI nt er v ent r i cul arAr t er y Lef t =Lef t A=Ant er i orI nt er v ent r i cul arAr t er y C=Ci r cumf l exAr t er y I nf l ammat i on( HI PER) Heat I ndur at i on Pai n Edema Redness 4C' sofHy per t ensi on( Compl i cat i ons) C-Cor onar yAr t er yDi sease C-Cor onar yRheumat i cFev er C-Congest i v eHear tFai l ur e C-Car di oVascul arAcci dent Compl i cat i onsofTr aumaCl i ent( TRAUMATI C) Ti ssuePer f usi onPr obl ems Respi r at or yPr obl ems Anxi et y Unst abl eCl ot t i ngFact or s Mal nut r i t i on Al t er edBodyI mage Thr omboembol i sm I nf ect i on Copi ngPr obl ems Cy anot i cDef ect s: 4T' s T-Tet r al ogyofFal l ot T-Tr uncusAr t er i osus T-Tr anspor t at i onoft heGr eatVessel s T-Tr i cuspi dAt r esi a Cr ani al Ner v eMnemoni c01 OLy mpi c( Ol f act or y ) OPi um ( Opt i c) OCcupi es( Ocul omot or ) TROubl ed( Tr ochl ear ) TRI at hl et es( Tr i gemi nal ) Af t er( Abducens) Fi ni shi ng( Faci al ) VEgas( Vest i bul ocochl ear ) Gambl i ng( Gl ossophar y ngeal ) VAcat i ons( Vagus) St i l l ( Spi nal Accessor y ) Hi gh( Hy pogl ossal ) Cr ani al Ner v eMnemoni c02 O-Oh O-Oh O-Oh T-To T-Touch A-And F-Feel A G-i r l ' s V-agi na S-So H-Heav enl y Cr ani al Ner v eMnemoni c03 O-On OOl d O-Obando T-Tower T-Top AF-Fi l i pi no A-Ar my G-Guar ds V-Vi l l ages A-And H-Hut s Cr ani al Ner v eMnemoni cs ( Sensor y , Mot ororBot h) S-Some S-Say s M-Mar i l y n M-Monr oe B-But M-My B-Br ot her S-Say s B-Br i dget B-Bar dot M-Mmm M-Mmm Cr ani al Ner v eMnemoni cs02 ( Sensor y , Mot ororBot h) S-Some S-Say M -Mar r y M-Money B-But M-My B-Br ot her S-Say s B-Bad B-Busi ness M -Mar r y M -Money OBNonSt r essTest( NNN) 3negat i v esi nar owt oi nt er pr etr esul t sofNonSt r essTest N-Nonr eact i v e N-Non-St r essi s N-Notgood Sev er ePr eEcl ampsi a( HELLP) H-emol y si s E-l ev at ed L-i v erf unct i ont est s L-ow P-l at el etcount AssessmentTest sf orFet al Wel l Bei ng( ALONE) A-Amni ocent esi s LCar eofCl i enti nTr act i on( TRACTI ON) T-Temper at ur e( Ext r emi t y , I nf ect i on) R-Ropeshangf r eel y A-Al i gnment C-Ci r cul at i onCheck( 5P' s) T-Ty pe&Locat i onoff r act ur e I-I ncr easef l ui dei nt ake O-Ov er headt r apeze N-Nowei ght sonbedorf l oor St epsi nt heNur si ngPr ocess ADPI E( ADel i ci ousPI E) Assessment D-i agnosi s Pl anni ng I mpl ement at i on Ev al uat on Aci dBase( ROME) Respi r at or y Opposi t e Met abol i c Equal CANCER' SEar l yWar ni ngSi gns CAUTI ONUP Changei nbowel orbl adder A-l esi ont hatdoesnotheal Unusual bl eedi ngordi schar ge Thi ckeni ngorl umpi nbr eastorel sewher e I ndi gest i onordi f f i cul t yswal l owi ng Obv i ouschangesi nwar tormol e Naggi ngcoughorper si st enhoar seness Unexpl ai nedwei ghtl oss Per ni ci ousAnemi a CANCERI nt er v ent i ons Comf or t Al t er edBodyI mage Nut r i t i on Chemot her apy Ev al uat er esponset omeds Respi t ef orcar et aker s Hy pogl y cemi a( TI RED) -anabnor mal decr easeofbl oodi nt hesugar Tachy car di a I r r i t abi l i t y Rest l ess Excessi v eHunger Di aphor esi s/Depr essi on Adr enal Gl andHor mones( SSS) Sugar( Gl ucocor t i coi ds) Sal t( Mi ner al cor t i coi ds) Sex( Andr ogens) Pul monar yEdema( MADDOG) MMor phi ne AAmi nophy l l i ne D-Di gi t al i s DDi ur et i cs( Lasi x) O-Oxy gen G-ases( Bl oodGasesABG' s) 5P' sofCi r cul at or yChecks PPai n PPar est hesi a PPar al y si s PPul se PPal l or( Pal eness) Hy per t ensi onNur si ngCar e( DI URETI C) Dai l yWei ght I -nt akeandOut put( I&O) U-r i neOut put ResponseofBP El ect r ol y t es TakePul ses I schemi cEpi sodes( TI A) Compl i cat i ons: 4C' s Ev al ut i onofEpi si ot omyHeal i ng( REEDA) R-Redness E-Edema E-Ecchy mosi s D-Di schar ge, Dr ai nage A-Appr oxi mat i on Ev al ut i onofEpi si ot omyHeal i ng( REEDA) R-Redness E-Edema E-Ecchy mosi s D-Di schar ge, Dr ai nage A-Appr oxi mat i on Post Par t um Assessment( BUBBLE) Br east s Ut er us Bowel s Bl adder Lochi a Epi si ot omy / l at er at i on/ Csect i oni nci si on Tr acheal Esophageal Fi st ul a( 3C' s) C-Choki ng C-Coughi ng C-Cy anosi s Cl ef tLi p-PostOpCar e( CLEFTLI P) Choki ng Li eonback Ev al uat eAi r way FeedSl owl y Teachi ng Lar gerni ppl eopeni ng I nci dencei ncer asei nmal es Pr ev entcr ustf or mat i onandaspi r at i on Si t uat i onsr equi r i ngCr i si sSi t uat i on: RAPE R-Rut hl ess A-Abusi v e P-Per sonal E-Exper i ence War ni ngSi gnsofaChi l dAbuse/Negl ect : CHI LDABUSE Chi l d' sexcessi v eknowl edgeonsex&abusi v ewor ds Hai rgr owt hi nv ar i ousl engt hs I nconsi st entst or i esf r om t hechi l d&par ent / s Lowsel f est eem Depr essi on Apat hy , noemot i on Br ui sed Unusual i nj ur i es Ser i ousi nj ur i es Ev i denceofol di nj ur i esnotr epor t ed TheHYPERKALEMI A" Machi ne"-CausesofI ncr easedSer um K+ M -Medi cat i ons-ACEi nhi bi t or s, NSAI DS A-Aci dosi s-Met abol i candr espi r at or y C-Cel l ul ardest r uct i on-Bur ns, t r aumat i ci nj ur y H-Hy poal dost er oni sm, hemol y si s I-I nt ake-Excesssi v e N-Nephr ons, r enal f ai l ur e E-Excr et i on-I mpai r ed MURDER Si gnsandSy mpt omsofI ncr easedSer um K+ M -Muscl eweakness U-Ur i ne, ol i gur i a, anur i a R-Respi r at or ydi st r ess D-Decr easedcar di accont r act i l i t y E-ECGchanges R-Ref l exes, hy per r ef l exi a, orar ef l exi a( f l acci d) Tor ememberwhi chbl oodt y pesar ecompat i bl e, v i sual i zet hel et t er" O"asanor br epr esent i ng t heuni v er se, becauset y peObl oodi st heuni v er sal donorbl ood.Pat i ent swi t hanybl oodt y pe canr ecei v ei t .ButOal someans" oddmanout " : Pat i ent swi t ht y peObl oodcanr ecei v eonl yt y pe Obl ood.Thi nkBEEPt or emembert hesi gnsofmi norbl eedi ng: B: Bl eedi nggums E: Ecchy moses( br ui ses) E: Epi st axi s( nosebl eed) P: Pet echi ae( t i nypur pl i shspot s) Hav i ngdi f f i cul t ydi st i ngui shi nghy popl asi af r om hy per pl asi a? Wheny ouseepl asi ai nanywor d, t hi nkof" pl ast i c. "Pl ast i c, i nt ur n, meansf or mi ngordev el opi ng. Asf orhy poandhy per , t hat ' st heeasypar t .Hy pomeansunder , orbel ownor mal .Hy permeans excessi v e, orabov enor mal .Thus, hy popl asi ameansunder dev el opment , andhy per pl asi ameans ov er dev el opment . Tor emembert hef ourcausesofcel l i nj ur y , t hi nkofhowt hei nj ur yt i pped( orTI PD)t hescal eof homeost asi s: T: Toxi norot herl et hal ( cy t ot oxi c)subst ance I : I nf ect i on P: Phy si cal i nsul tori nj ur y D: Def i ci t , orl ackofwat er , oxy gen, ornut r i ent s. Whenaski ngassessmentquest i ons, r emembert heAmer i canCancerSoci et y ' smnemoni c dev i ceCAUTI ON: C: Changei nbowel orbl adderhabi t s A: Asor et hatdoesn' theal U: Unusual bl eedi ngordi schar ge T: Thi ckeni ngorl ump I : I ndi gest i onordi f f i cul t yswal l owi ng O: Obv i ouschangesi nawar tormol e N: Naggi ngcoughorhoar seness. Uset heABCDr ul et oassessamol e' smal i gnantpot ent i al : A: Asy mmet r y I st hemol ei r r egul ari nshape? B: Bor der I st hebor deri r r egul ar , not ched, orpoor l ydef i ned? C: Col or Doest hecol orv ar y( f orexampl e, bet weenshadesofbr own, r ed, whi t e, bl ue, orbl ack) ? D: Di amet er I st hedi amet ermor et han6mm? Si deef f ect sofst er oi ds.The5S' s. Si ck-easi ert ogetsi ck Sadcausesdepr essi on Sexi ncr easesl i bi do Sal t r et ai nsmor eandcauseswei ghtgai n Sugar r ai sesbl oodsugar PERRLA Pupi l sEqual l yRoundandReact i v et oLi ghtandAccomodat i on Lear ni ngt heSy st emsoft heBody ? MRDI CERUNS M=Muscl e R=Respi r at or y D=Di gest i v e I =I nt egument ar y C=Ci r cul at or y E=Endocr i ne R=Repr oduct i v e U=Ur i nar y N=Ner v ous S=Skel et al Tr oubl ef i gur i ngoutwhi chey ei swhi ch? OSi sl ef tey e ODi st her i ghtey e Youcanr ememberwhi chonei st her i ghtey e( OD) , becausey oucanmaket heDi nt oanR-You j usthav et odr awt ost i ckl egsont hebot t om oft heD.Wr i t ei tdownonpaper , y ou' l l seewhatI mean( i t ' shar dt oshowy ouwhenal l Icandoi st y pe) S/ SofHy ponat r emi a St upor / coma Anor exi a, N&V Let har gy Tendonr ef l exesdecr eased Li mpmuscl es( weakness) Or t host at i chy pot ensi on Sei zur es/ headache St omachcr ampi ng I mmedi at et r eat mentofMI , t hi nkMONA: M Mor phi nesul f at e OOxy gen NNi t r ogl y cer i n AASA Tr eat mentofCHF, t hi nkUNLOADFAST: Usi tUpr i ght NNi t r o LLasi x OOxy gen AAmi nophy l l i ne DDi goxi n FFl ui ds-decr ease AAf t er l oad-decr ease SSodi um -decr ease TTest s: di gl ev el , ABG, K+ Assi st i v edev i ces-Canes: CCane OOpposi t e AAf f ect ed LLeg Si gnsofaChol i ner gi cCr i si s, t hi nkSLUD: SSal i v at i on LLacr i mat i on UUr i nat i on DDef i cat i on Memor yTr i ck: Needt or ememberwhi chki ndofbet abl ockerhaswhi chact i on? B1Bl ockst hehear t( y ouhav eonl yonehear t ) B2Bl ockst hel ungs( y ouhav et wol ungs) f et al accel er at i onsanddecel er at i ons! ! ! Justr ememberVEALCHOP Var i abl eCor dcompr essi on Ear l yHeadcompr essi on Accel er at i onsOK Lat ePl acent al i nsuf f i ci ency Hear tsounds: S3=Hear tf ai l ur e( 3sy l l abl es) S4=Hy per t ensi on( 4sy l l abl es) ef f ect sofant i chol i ner gi cs: Can' tsee Can' tpee Can' tspi t Can' tdef ecat e Ni nepoi ntPost par t um Assessment . . . BUBBLEHER B-Br east s U-Ut er us B-Bl adder B-Bowel f unct i on L-Lochi a E-Epi si ot omy H-Homan' ssi gn E-Emot i onal St at us R-Respi r at or ySy st em The5P' sofci r cul at i onl ossi nal i mb. Pai n, Pal l or , Pul sel essness, Par ast hesi a, Poi ki l ot her mi a si deef f ect s&adv er ser eact i onst oi mmuni zat i ons: F-Fev er I -I t chi ng S-St i f f ness H-Headache E-Edema R-Redness F-Fussy L-Local i zedTender ness A-Appet i t edecr ease G-Gener al AchesPai ns HYPERNATREMI A " YouAr eFr i ed" F-Fev er( l owgr ade) , f l ushedski n R-Rest l ess( i r r i t abl e) I-I ncr easedf l ui dr et ent i onandi ncr easedBP E-Edema( per i pher al andpi t t i ng) D-Decr easedur i nar yout put , dr ymout h Canal souset hi sone: SALT S=Ski nf l ushed A=Agi t at i on L=Lowgr adef ev er T=Thi r st " CATS"of" HYPOCALCEMI A" C-Conv ul si ons A-Ar r hy t hmi as T-Tet any S-Spasmsandst r i dor Remembert hather ei nt heUSAy ouDdr i v eont her i ghtsi deoft her oad. O=opt i cal A=audi t or y AD-r i ghtear AS-l ef tear AU-bot hear s OD-r i ghtey e OS-l ef tey e OU-bot hey es Mneumoni cdev i cef orr emember i ngquest i onst oaskemer gencyr oom admi t s: Car ?( ci r cumst ancesofev ent ) Pl ease( pr eci pi t at i ngev ent s) Li st en( l ocat i onofev ent ) ToThi s: ( Ti meofev ent ) Wat ch( whensy mpt omsappear ed) Under age( unconsci ousnessaf t eri nj ur y ? ) Al cohol i cs( ar r i v al t i mei nER) Headi ng( hospi t al admi t spr ev i ousl y ? ) Home( pr ev i oushi st or y / heal t hst at us) And( al l er gi es) May be( medi cat i ons) Fl at t eni ng( f ear sf orsaf et y ) My( meal , t i meofl ast ) Poodl e( per i od, t i meofl astmenst r ual ) Dog( pr i mar ydoct or , nameandl ocat i onof ) Toni ght( t et anus, dat eofl asti mmuni zat i on) Ev er y oneknowst omaket heABCD( ai r waybr eat hi ngci r cul at i onandneur ol ogi cdi sabi l i t y ) assessmentf i r st .Thenassoonaspossi bl e, f ur t herassessment / i nt er v ent i oni sdone, whi ch i ncl udes: Hi s( heal t hhi st or y ) Head( headt ot oeassessment ) I s( i nser tmoni t or i ngdev i ces-cat hs, ECG, ar t er i al l i nes) So( spl i nt sf orf r act ur es) Wi de( woundcar e) Ol i v i a( ot heri nt er v ent i ons) Thepat hophy si ol ogyofARDS: Assaul tont her espi r at or ysy st em Respi r at or ydi st r ess Decr easedl ungcompl i ance Sev er er espi r at or yf ai l ur e Di agnost i ccr i t er i aofARDS Acut eonset Rat i o( PaCO2/ Fi O2)<200span=" " > Di f f usei nf i l t r at i on SwanGanzwedgepr essur e( PAWP)<18mm hg=" "span=" " > Compl i cat i onsoft hr ombol y t i ct her apy : The3B' s Bl eedi ng Br ady ' s( dy sr hy t hmi as) Bl oodcl ot s( d/ texcessi v et hr ombi n) Compl i cat i onsofcar di opul monar yby pass( CPB) : The3H' s Hy pot her mi a( t odecr easeO2consumpt i on) . . . Ef f ect sSVR( v asoconst r i ct i on)andcauses my ocar di al depr essi on( decr easescont r act i l i t y ) Hemodi l ut i on( t oi mpr ov emacr oci r cul at i on) . . . f l ui dshi f t i ng( t hi r dspaci ng) , el y t ei mbal ances( K+, Mg+&Ca++of t enneedr epl aci ng! ) Hepar i nzat i on( t opr ev entcl ot si nci r cui t ) . . . moni t oraPTT. Si gnsandsy mpt omsofcar di act amponade( Beck' sTr i ad) : TheThr eeD' s Di st anthear tsounds Di st endedj ugul arv ei ns Decr easedpul sepr essur e( t hi nkofanar r owpul sepr essur easopposedt oawi deone) At r i al Ar r hy t hmi as: ABCDE Adenosi ne/ ami odor oneorant i coagul at e( i fAf i b/ Fl ut t erhasbeenpr esent>48h) Bet abl ocker s Cal ci um channel bl ocker s Di goxi n El ect r ocar di ov er t( i f<48hspan=" " > Forv ent r i cul arar r hy t hmi as: AL Ami odor one Li docai ne NSAI DDr ugs N-Napr oxen S-Sal i cy l at es A-Adv i l I-I bupr of en D-Di cl of enac S-Sul i ncl ac 8A' sf orHepat ot oxi cDr ugs( CheckSGPT/ SGOT) Ant i t uber cul osi s Ant i conv ul sant S-sodi um Lumi nal G-gabapent i n P-pheny t oi n T-t egr et ol Ant i cancer Aspi r i n Al cohol Ant i f ami l y( cont r acept i cepi l l s) Acet ami nophen Af l at oxi ns Par ki nson' sMedi cat i ons: " Al i Lov esBoxi ngMat ches" AAmant adi ne L-Lev odopa B-Br omocr i pt i ne MMAOi nhi bi t or s The4H' st hati nv al i dat eaneur oexam: Hy pot ensi on Hpoxi a Hy pogl y cemi a Hy pot her mi a* Pi npoi ntpupi l s: Dr ugs, dr ops&near l ydead Dr ugs: opi at es Dr ops: medsf orgl aucoma Near l ydead: damagei nt heponsar eaoft hebr ai nst em Di l at edpupi l s: Fear , Fi t s&FastLi v i ng Fear : pani c, ext r emeanxi et y Fi t s: sei zur es FastLi v i ng: cocai ne, cr ack, phency cl i di ne( PCP) ADLs( Act i v i t yofDai l yLi v i ng) BATTED Bat hi ng Ambul at i on Toi l et i ng Tr ansf er s Eat i ng Dr essi ng I ADLS( I nst r ument al Act i v i t i esofDai l yLi v i ng)SCUM Shoppi ng Cooki ngandCl eani ng Usi ngt el ephoneort r anspor t ai t on Managi ngmoneyandmedi cat i ons Bl eedi ngPr ecaut i ons( RANDI ) R-RazorEl ect r i c/Bl ades A-Aspi r i n N-Noneedl es( esp.i nsmal l gauge) D-Dodecr easei nneedl est i cks) I-I nj ur y( Pr ot ectf r om) CanesandWal ker s( COAL) C-Cane O-Opposi t e A-Af f ect ed L-Leg CanesandWal ker s( WWAL) Wander i ngWi l ma' sAl way sLat e W-Wal ker W-Wi t h A-Af f ect ed L-Leg CommonCausesofTr ansi entI ncont i nence( DI APPERS) Del i r i um I nf ect i on At r ophi cUr et hr a Phar maceut i cal s Psy chol ogi c ExcessUr i neOut put Rest r i ct edMobi l i t y St ool I mpact i on Pr omot i onofNor mal El i mi nat i on( POOPERSCOOP) Posi t i on Out put Of f erFl ui ds Pr i v acy Exer ci se Repor tResul t s Si ze( Amount ) Consi st ency Occul tBl ood Odor Per i st al si s Emer gencyTr aumaAssessment ( ABCDEFGHI ) Ai r way Br eat hi ng Ci r cul at i on Di sabi l i t y Exami ne Fahr enhei t GetVi t al s Headt oToeAssessment I nt er v ent i on Tr aumaSur ger y( AMPLE) af t eri ni t i al assessment Al l er gi es Medi cat i ons PastMedi cal Hi st or y LastMeal Ev ent sSur r oundi ngI nj ur y Tr aumaSur ger y( AMPLE) af t eri ni t i al assessment Al l er gi es Medi cat i ons PastMedi cal Hi st or y LastMeal Ev ent sSur r oundi ngI nj ur y 6P' sofDy spnea P-Pul monar yBr onchi al Const r i ct i on P-Possi bl eFor ei gnBody P-Pul monar yEmbol us P-Pneumot hor 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