EM BOARD KEYWORDS, ASSOCIATIONS, AND
FOILS
Bike handle-bar injury
Bitter almond smell
Box-carring of retinal vessels
Brick-red bleeding
Bronze, violaceous wound
Cells and flare (snowflakes and headlights)
Cherry red skin
Cherry red spot
Chocolate brown blood
Christmas tree pattern rash
Cobblestoning
Cocci in chains
CT with “ring-enhancing” lesion
Currant jelly sputum, Bulging fissure
Currant jelly sputum
Currant jelly stool
CXR that looks worse than the patient
Diastolic decrescendo, Water hammer, AustinFlint, Quincke’s sign
Dinner fork deformity
Diastolic murmur or heart valve question, plus
pregnant and pulm edema or hemoptysis
Fat through eyelid wound
Firm, painful lower uterine segment
Fishy odor
Floaters, curtain over vision
Floppy baby, feeble cry, farm, honey
Grape-like cluster
Grape-like clusters (gross)
Grey-yellow frothy discharge
Hot-cold reversal
Immediate collapse at scene of fire
Kleinhauer-Betke test
Duodenum or pancreas
Cyanide
Central retinal artery occlusion
Meckel’s diverticulum
Tetanus or gangrene
Uveitis
Carbon monoxide poisoning
Central retinal artery occlusion
Methemoglobinemia (also SO4Hg)
Pityriasis rosea
Ulcerative colitis
Strep
Toxoplasmosis
Klebsiella pneumonia
Klebsiella pneumonia
Intussusception
Mycoplasma pneumoniae
Aortic regurgitation
Colles Fracture
Mitral Stenosis
Ophthalmology consult
Abruption
Gardnerella (anaerobic vaginitis)
Retinal detachment
Botulism
Staph
Molar pregnancy
Trichomonas
Ciguatera
Cyanide (amyl nitrate)
Fetal nucleated RBCs in maternal
blood
Lancet shaped
Lupus-like syndrome
Machine-like murmur
Millet seed appearance
Multinucleated giant cells
Osler, Janeway, Roth, splinter hemorrhages
Pain out of proportion of physical findings
Palpable abdominal sausage-like mass
Palpable olive in the abdomen
Palpable purpura (dependent areas)
Positive wet-mount
Post-influenza pneumonia
Pseudomembrane
Pseudomembrane
Pseudomembrane
Punctured sneaker
Rash, photo of buccal mucosa
Rice water diarrhea
Rust colored sputum
Rust remover, glass etching
Sandpaper rash
Sausage-linked retinal vessels
Sharp, “cutting” pain
Skip lesions
Slapped cheek appearance
Staccato cough
Strawberry Cervix
Strawberry Tongue
Sudden, painless loss of vision
Tachycardia
“Tearing” chest or back pain
Uncoupling of oxidative phosphorylation
Unilateral rhinorrhea
Unilateral wheezing
Violin string seen on laparoscopy
Walked into dark (movie theater)
Yellow vision
Pseudomonas (s. pneumoniae)
Hydralazine or Procainamide
Air embolus
Miliary TB
Herpes
Infective endocarditis
Mesenteric ischemia
Intussusception
Pyloric Stenosis
Henoch-Schonlein purpura
Vaginitis
Staph Aureus
Diphtheria
ENT-Corynebacterium diphtheriae
GI-Clostridium difficile
Pseudomonas osteomyelitis
Rubeola
Vibrio cholera
Pneumoccocal pneumonia
Hydrofluoric acid
Scarlet fever
Cancer related hyperviscosity
Anal fissure
Crohn’s disease, Temporal arteritis
Fifth’s disease
Chlamydia pneumonia
Trichomoniasis
Scarlet Fever
Central retinal artery occlusion
Clostridium
Aortic dissection
Salicylate toxicity
Nasal foreign body
Foreign body aspiration
PID
Acute glaucoma
Digitalis toxicity
FOODS IN EM FOR THE BOARDS
Bitter almonds
Cyanide
Bitter Almonds
Cyanide
Carrots
Water hemlock
Cherry red skin
Carbon monoxide poisoning
Cherry red spot
Central retinal artery occlusion
Chocolate brown blood
Methemoglobinemia (also SO4Hg)
Currant jelly sputum, alcoholism,
Klebsiella
bulging fissure
Currant jelly stool
Intussusception
Fishy odor
Gardnerella (anaerobic vaginitis)
Fruity
DKA, Isopropanol
Garlic
Organophosphates, Arsenic
Grape-like cluster
Staph
Grape-like clusters (gross)
Molar pregnancy
Honey-crusted lesions
Staphylococcus impetigo
Palpable abdominal sausage-like
Intussusception
mass
Palpable olive in the abdomen
Pyloric Stenosis
Peanuts
Rodenticide
Pear
Chloral hydrate
Peppery-tasting fish
Pizza pie sign
Raw seafood
Rice water diarrhea
Rotten Eggs
Sausage finger
Sausage-linked retinal vessels
Strawberry tongue
Scombroid toxicity
Lunate dislocation
Vibrio parahemolyta
Vibrio cholera
Sulfur dioxide, Hydrogen sulfide
tenosynovitis
Cancer related hyperviscosity
Kawasaki disease toxic shock
syndrome, and scarlet fever
Trichomoniasis
Candidiasis
Strawberry cervix
White cottage cheese vaginal
discharge
TYPE
Amatoxin
Coprine
Gyromitrin
Ibotenic/Muscimol
Muscarine
Orellanine
Psilocybin
MUSHROOMS
SIDE EFFECT
Liver Failure
Disulfiram reaction
Seizures
Anticholinergic/Sedation
SLUDGE syndrome
Renal failure
Hallucinations
Vital Signs IN TOXICOLOGY
BRADYCARDIA (P.A.C.E.D)
P
PROPRANOLOL (B-BLOCKERS), POPPIES (OPIATES)
A
ANTICHOLINESTERASE DRUGS
C
CLONIDINE, CALCIUM CHANNEL BLOCKERS
E
ETHANOL/ALCOHOLS
D
DIGOXIN
TACHYCARDIA (F.A.S.T)
F
FREE BASE (COCAINE)
A
ANTICHOLINERGICS, ANTIHISTAMINES, AMPHETAMINES
S
SYMPATHOMIMETICS, SOLVENT ABUSE
T
THEOPHYLLINE
HYPOTHERMIA (C.O.O.L.S)
C
CARBON MONOXIDE
0
OPIATES
0
ORAL HYPOGLYCENLICS, INSULIN
L
LIQUOR
S
SEDATIVE HYPNOTICS
HYPERTHERMIA (N.A.S.A)
N
NEUROLEPTIC MALIGNANT SYNDROME, NICOTINE
A
ANTIHISTAMINES
S
SALICYLATES, SYMPATHOMIMETICS
A
ANTICHOLINERGICS, ANTIDEPRESSANTS
HYPOTENSION (C.R.A.S.H)
C
CLONIDINE, CALCIUM CHANNEL BLOCKERS
R
RESERPINE (ANTIHYPERTENSIVE AGENTS)
A
ANTIDEPRESSANTS, AMINOPHYLLINE
S
SEDATIVE HYPNOTICS
H
HEROIN (OPIATES)
HYPERTENSION (C.T.S.C.A.N)
C
COCAINE
T
THYROID SUPPLEMENTS
S
SYMPATHOMIMETICS
C
CAFFEINE
A
ANTICHOLINERGICS, AMPHETAMINES
N
NICOTINE
HYPOVENTILATION (S.L.0.W)
S
SEDATIVE HYPNOTICS
L
LIQUOR
0
OPIATES
W
WEED (MARIJUANA)
HYPERVENTILATION (P.A.N.T)
P
PCP, PNEUMONITIS (CHEMICAL)
A
ASA (SALICYLATES)
N
NONCARDIOGENIC PULMONARY EDEMA
T
TOXIC METABOLIC ACIDOSIS
MIOSIS (C.O.P.S)
C
CHOLINERGICS, CLONIDINE
O
OPIATES, ORGANOPHOSPHATES
P
PHENOTHIAZINES, PILOCARPINE, PONTINE BLEED
S
SEDATIVE HYPNOTICS
MYDRIASIS (A.A.A.S)
A
ANTIHISTAMINES
A
ANTIDEPRESSANTS
A
ANTICHOLINERGICS, ATROPINE
S
SYMPATHOMIMETICS (COCAINE, AMPHETAMINES)
SEIZURES IN TOXICOLOGY (O.T.I.S C.A.M.P.B.E.L.L)
0
T
I
S
ORGANOPHOSPHATES
TRICYCLIC ANTIDEPRESSANTS
INH, INSULIN
SYMPATHOMIMETICS
C
A
M
P
B
E
L
L
CAMPHOR, COCAINE
AMPHETAMINES
METHYLXANTHINES (THEOPHYLLINE)
PHENCYCLIDINE (PCP)
BENZO WITHDRAWAL, BOTANICALS
ETHANOL WITHDRAWAL
LEAD, LITHIUM
LIDOCAINE, LINDANE
Mnemonic for the causes of coma and convulsions (AEIOU TIPS)
A
ALCOHOL
E
ENDOCRINE, ELECTROLYTE DISTURBANCES, EPILEPSY
I
INTOXICATION
0
OXYGEN DEPRIVATION
U
UREMIA AND METABOLIC DISORDERS HEPATIC, HYPERTENSION
T
I
P
S
TRAUMA, TUMOR
INFECTION
PSYCHOLOGICAL
SHOCK, STROKES (CARDIOVASCULAR ACCIDENT)
DERMAL CHANGES IN TOXICOLOGY
DIAPHORETIC SKIN (S.O.A.P)
S
SYMPATHOMIMETICS
O
ORGANOPHOSPHATES
A
ASA (SALICYLATES)
P
PCP
NEEDLE TRACKS
IV cocaine, heroin
RED SKIN:
Anticholinergics
Boric acid
Carbon monoxide
BLUE SKIN
Cyanosis
Methemoglobinemia: (nitrates, nitrites, analine dyes, dapsone,
phenazopyridine)
BLISTERING
Barbiturates, CO,
Sedative hypnotics
Snake/Spider bites
ODORS IN TOXICOLOGY
Bitter Almonds
Carrots
Fruity
Garlic
Gasoline
Mothballs
Peanuts
Cyanide
Water hemlock
DKA, Isopropanol
Organophosphates, Arsenic
Hydrocarbons
Camphor
Rodenticide
Pears
Rotten Eggs
Wintergreen
Chloral Hydrate
Sulfur dioxide, Hydrogen sulfide
Methyl salicylates
METABOLIC ACIDOSIS / ELEVATED ANION GAP
CAT MUD PILES
C - Cyanide, carbon monoxide
A - Alcohol
T - Toluene
M - Methanol
U - Uremia
D - DKA
P - Paraldehyde
I - Iron, Isoniazid, Inborn errors of metabolism
L - Lactic Acidosis
E - Ethylene glycol
S - Salicylates, Strychnine
ELEVATED OSMOLAR GAP (M.E D.I.E)
M
METHANOL
E
ETHYLENE GLYCOL
D
I
E
DIURETICS (MANNITOL)
ISOPROPYL ALCOHOL
ETHANOL
TOXIDROMES
Cholinergic (organophosphates)
D = Diarrhea, diaphoresis
U = Urination
M = Miosis
B = Bradycardia, bronchosecretions
E = Emesis
L = Lacrimation
S = Salivation
Anticholinergic (antihistamines, TCA's)
HOT as a hare (Hyperthermia)
DRY as a bone (Dry skin)
RED as a beet (Flushed)
BLIND as a bat (Mydriasis)
MAD as a hatter (Delirium)
FAST as cat (Tachycardia)
FULL as a tick (urinary retention)
Sympathomimetic (cocaine, amphetamines)
a. Mydriasis
b. Tachycardia
c. Hypertension
d. Hyperthermia
e. Seizures
Narcotic (heroin, methadone)
a. Miosis
b. Bradycardia
c. Hypotension
d. Hypoventilation
e. Coma
Downers/Sedatives
a. Narcotics, Tranquilizers, Alcohol, GHB
b. Decreased Respirations
c. Pulse may be slow or normal
d. Decreased level of consciousness
e. Sedation, confusion, slurred speech, abnormal gait, coma
Withdrawal
a. Alcohol (hallucinations, tremors seizures)
b. Opioids (diarrhea, mydriasis, cramps)
c. Benzodiazepines (seizures, agitation)
d. Barbiturates (seizures, agitation)
e. Antihypertensives (hypertension, tachycardia)
Hypotensives
a.
-blockers, calcium channel blockers,
clonidine)
b. Decreased blood pressure
c. Decreased heart rate
d. Decreased level of consciousness
Delayed Symptoms
•
Acetaminophen, coumadin, cardiac medications.
•
Sustained-release or delayed-release formulations.
•
Trans-dermal patches may have slower onset.
Hemodialysis / Hemoperfusion
Substances enhanced by hemodialysis may include those with
low protein binding, small volumes of distribution,
water solubility, and low molecular weigh.
I STUMBLE
I
Isopropanol
S
Salicylates
T
Theophylline
U
Uremia
M
Methanol
B
Barbiturates
L
Lithium
E
Ethylene glycol
Antidotes
TOXIN
Acetaminophen
Anticholinergics
Arsenic, Lead
B-Blockers
Benzodiazepines
Calcium Channel Blockers
Carbon monoxide
Cyanide
Digoxin
Ethylene glycol, Methanol
Iron
INH
Lead, Mercury
Methanol/Ethylene glycol
Methemoglobinemia
Opioids
Organophosphates
Tricyclic antidepressants
ANTIDOTE
N-acetylcysteine
Physostigmine
BAL chelation
Glucagon, Insulin
Flumazenil
Glucagon, Insulin
Oxygen/HBOT
Nitrites
Fab Fragments
Fomepizole, Ethanol
Deferoxamine
B6 (Pyridoxine)
Succimer/DMSA
Ethanol/Fomepizole
Methylene blue
Naloxone
Atropine/2-PAM
Sodium bicarbonate