To determine if the patient requires admission or can be discharged, the Glasgow-Blatchford Score (GBS) is used.

Here’s the ABCDEF mnemonic and why these factors increase the risk of an upper GI bleed:

• ​ A - Active: Conditions like syncope or melena indicate ongoing or significant bleeding, increasing risk severity.

• ​ B - Blood Urea Nitrogen: Levels ≥ 7 mg/dL suggest impaired kidney function, which is often associated with poor systemic clearance and bleeding risk.

• ​ C - Circulation: A systolic blood pressure ≥ 110 mm Hg may reflect hemodynamic instability or stress response to bleeding.

• ​ D - Drop in Hemoglobin: Hemoglobin levels ≤ 12.9 g/dL (men) or ≤ 11.9 g/dL (women) indicate anemia, suggesting significant blood loss.

• ​ E - Elevated Pulse: A pulse rate ≥ 100/min signals compensatory tachycardia, often a response to blood loss.

• ​ F - Failure: Cardiovascular or liver disease impairs clotting and hemodynamic stability, exacerbating bleed risk.

Developed in Scotland, the GBS is a risk assessment tool for upper GI bleeds and considers symptoms, vital signs, and lab values on admission. Key factors in the score include melena, syncope, liver disease, heart failure, heart rate, blood pressure, hemoglobin, and BUN levels. Points are assigned based on these variables to assess the severity of bleeding and volume loss.

For example:

• ​Melena suggests significant GI bleeding, whereas isolated hematemesis (like coffee-ground emesis) has no scoring points.
• ​Syncope, tachycardia, hypotension, and changes in Hb/BUN levels suggest volume loss.
• ​Comorbid conditions (e.g., liver disease) may indicate a need for admission, especially if variceal bleeding is suspected.

Discharge criteria also include access to follow-up care, a support system, and a nearby hospital for emergency returns if symptoms worsen.

For more on current recommendations, consult the 2021 American Journal of Gastroenterology guidelines on upper GI bleeding.

CENTOR criteria Fever PAIN: Strep Throat mnemonic

The “H’s and T’s” refer to a mnemonic used in medicine to help healthcare professionals quickly recall the most common causes of cardiac arrest during a code (a medical emergency requiring CPR). Memorizing these is crucial because identifying and addressing these causes rapidly can improve the chances of saving a patient’s life.

Here’s a breakdown:

The H’s: OK TV

Hypoxia - Lack of oxygen to tissues can lead to a heart stopping, so ensuring proper oxygenation is key.

Hypo-/Hyperkalemia - Abnormal potassium levels affect the heart’s electrical activity, potentially causing it to stop.

Hypothermia - Low body temperature can slow heart function and lead to cardiac arrest.

Hypovolemia - Loss of blood or fluids can lead to insufficient circulation and cardiac arrest.

Hydrogen ion (acidosis) - A build-up of acid in the blood (often due to respiratory failure or shock) can disrupt heart function.

The T’s: THROW TEN TOXIC TAMPONS

Thrombosis (pulmonary or coronary) - Blood clots in the lungs (pulmonary embolism) or heart (myocardial infarction) can obstruct blood flow, leading to cardiac arrest.

Tension Pneumothorax - Air trapped in the chest cavity compresses the heart and lungs, affecting circulation.

Toxins - Certain substances (medications, drugs, poisons) can disrupt heart rhythms.

Tamponade (cardiac) - Accumulation of fluid around the heart prevents it from pumping effectively.

Importance of Memorizing the H’s and T’s:

These causes cover many reversible conditions that may lead to cardiac arrest. During a code, time is critical, so having these potential causes at the top of your mind helps quickly assess and treat the patient. Remembering the “H’s and T’s” mnemonic ensures that a healthcare provider methodically works through possible causes and provides the best chance of resuscitation.

These are the adventitious lung sounds Mneumonics.

Strider:

Everyone can take in stride.

Crackles:

A fine chap with firecrackers.

Wheezing:

Just ask any whale: Can you HAC the wheeze?

Rhonchi:

I BOPped the wrong guy

Plural friction rub:

PPP (3 words 3 P’s)

The “KEEP” mnemonic is a tool to remember the most common organisms causing urinary tract infections (UTIs). Here’s how the mnemonic breaks down, followed by key information relevant for emergency medicine boards:

K - Klebsiella species

• Relevance: Klebsiella is the second most common organism causing UTIs, especially hospital-acquired infections.

• Key Points:

• Gram-negative rod.

• Often seen in patients with underlying conditions like diabetes, or those with urinary catheters.

• Resistant to many antibiotics, so susceptibility testing is important.

• Treatment Options: Cephalosporins (like ceftriaxone), carbapenems in resistant cases.

E - Escherichia coli (E. coli)

• Relevance: The most common organism causing both community-acquired and some hospital-acquired UTIs.

• Key Points:

• Gram-negative rod.

• Responsible for approximately 70-90% of uncomplicated UTIs.

• Often originates from the gut.

• Can exhibit antibiotic resistance, particularly to trimethoprim-sulfamethoxazole.

• Treatment Options: Trimethoprim-sulfamethoxazole (Bactrim), nitrofurantoin, fosfomycin, or ciprofloxacin based on resistance patterns.

E - Enterococcus species

• Relevance: More common in complicated UTIs, particularly in hospital settings.

• Key Points:

• Gram-positive cocci.

• Often found in patients with catheters, immunocompromised status, or structural abnormalities in the urinary tract.

• Can be resistant to many antibiotics, including vancomycin-resistant Enterococcus (VRE).

• Treatment Options: Ampicillin or amoxicillin when susceptible; for resistant cases, vancomycin or linezolid.

P - Proteus species

• Relevance: Known for causing complicated UTIs and is associated with kidney stones.

• Key Points:

• Gram-negative rod.

• Produces urease, which increases urine pH and can lead to the formation of struvite stones.

• Can cause upper UTIs and is known to colonize catheters.

• Treatment Options: Ciprofloxacin, trimethoprim-sulfamethoxazole, cephalosporins; nitrofurantoin is usually not effective.

Summary of the Mnemonic ‘KEEP’

• Klebsiella: Second most common UTI organism; hospital-acquired; antibiotic resistance common.

• E. coli: Most frequent cause of UTIs; community-acquired; potential resistance to some antibiotics.

• Enterococcus: Complicated and hospital-acquired UTIs; often found in patients with urinary abnormalities.

• Proteus: Associated with kidney stones; catheter-related UTIs; produces urease.

By remembering “KEEP,” you can recall the key organisms responsible for UTIs and their relevance to diagnosis and treatment in emergency settings.

The **SPIT** mnemonic is used to help remember common causes of **altered mental status in children**. Here's what each letter stands for:

- **S**eizures: Includes both febrile and non-febrile seizures that can cause confusion or unconsciousness.

- **P**oisoning: Exposure to toxins or ingestion of substances like medications, household chemicals, or recreational drugs.

- **I**nfections: Infections such as meningitis, encephalitis, sepsis, or any systemic infection that can lead to altered mental status.

- **T**rauma: Head injuries, concussions, or other physical trauma leading to changes in consciousness.

This mnemonic helps quickly identify potential life-threatening causes of altered mental status in a pediatric patient.

Procedure Timeout Mnemonic:

This mnemonic covers the key elements to verify before starting, ensuring patient safety and team communication. Here's what **IMPACTS** stands for:

1. **I – Identify**:

- **Verify the Patient's Identity**: Confirm the patient's full name, date of birth, and medical record number using their wristband and verbally with the patient if possible.

2. **M – Match the Procedure**:

- **Verify the Procedure Being Done**: State the exact name of the procedure to be performed. Ensure the team agrees, and that it matches the consent form and the patient's understanding.

3. **P – Position and Site**:

- **Verify the Correct Site, Side, and Patient Positioning**:

- Mark the **correct site** and **laterality** if applicable (e.g., right arm, left knee).

- Confirm the patient's **positioning** on the table (supine, prone) to avoid confusion during the procedure.

4. **A – Allergies**:

- **Confirm Allergies**: Double-check any known allergies (medications, latex, iodine) and ensure the team is aware so appropriate precautions can be taken.

5. **C – Consent**:

- **Verify Consent**: Ensure that **informed consent** has been obtained, signed, and documented. Confirm that the patient or guardian understands the risks, benefits, and alternatives to the procedure.

6. **T – Tools and Equipment**:

- **Check Equipment and Instruments**: Make sure all necessary instruments, tools, and medications are prepared, functional, and sterile. Have backup supplies ready as well.

7. **S – Staff Roles and Safety Concerns**:

- **Assign and Confirm Roles**: Ensure each team member knows their specific role during the procedure.

- **State Safety Concerns**: Allow a moment for the team to voice any concerns or potential issues before proceeding.

Using **IMPACTS** ensures that all the critical components are reviewed before starting a procedure, enhancing both patient safety and team coordination.

This is the CATS mnemonic to remember the signs for hypocalcemia.

### **Causes of Hypocalcemia**

- **Hypoparathyroidism**: Often due to surgical removal of parathyroid glands.

- **Vitamin D deficiency**: Impaired calcium absorption.

- **Renal disease**: Reduced conversion of Vitamin D to its active form and poor calcium reabsorption.

- **Pancreatitis**: Fat saponification binds calcium.

- **Hypomagnesemia**: Leads to impaired PTH secretion.

- **Medications**: Bisphosphonates, loop diuretics, phenytoin, etc.

### **Clinical Presentation**

- **Neuromuscular Irritability**:

- **Tetany**: Involuntary muscle contractions (e.g., carpopedal spasms).

- **Paresthesias**: Numbness, tingling around the mouth, fingers, and toes.

- **Seizures**: Can be a presenting symptom.

- **Chvostek's Sign**: Facial twitching when tapping the facial nerve.

- **Trousseau’s Sign**: Carpal spasm when inflating a blood pressure cuff above systolic pressure for 3 minutes.

### **EKG Findings in Hypocalcemia**

- **Prolonged QT Interval**: Due to delayed ventricular repolarization.

- Risk for **Torsades de Pointes** if significantly prolonged.

- **Bradycardia and Heart Block**: May be seen in severe cases.

### **Management of Hypocalcemia**

1. **Asymptomatic or Mild Hypocalcemia**:

- Oral calcium supplements (e.g., calcium carbonate).

- Vitamin D supplementation (if deficient).

2. **Severe or Symptomatic Hypocalcemia (e.g., seizures, tetany, prolonged QT)**:

- **IV Calcium Gluconate** or **Calcium Chloride** (more potent but more irritating to veins).

- **Magnesium Replacement**: If low magnesium is present, replace it to aid calcium levels.

3. **Monitor for Cardiac Arrhythmias**: Especially if administering IV calcium.

### **Associated Conditions to Remember**

- **Hypoalbuminemia**: Can lead to low total calcium, but ionized (free) calcium may be normal.

- **Renal Failure**: Leads to high phosphate, low active Vitamin D, and thus low calcium.

- **Pseudohypocalcemia**: Low total calcium but normal ionized calcium, usually related to hypoalbuminemia.

Understanding these clinical features, causes, and management strategies, alongside the EKG findings, is crucial for emergency medicine board preparation and practice.

In emergency medicine education, understanding the fat-soluble vitamins A, D, E, and K (ADEK) is important because they play crucial roles in the body, and both their deficiency and toxicity can have serious health consequences. Here's a breakdown:

### Vitamin A:

- **Function**: Important for vision, immune function, and skin health.

- **Deficiency**: Can lead to night blindness, dry eyes, and increased infection risk.

- **Toxicity**: Excessive intake can cause symptoms like headache, dizziness, nausea, and liver damage (known as hypervitaminosis A).

### Vitamin D:

- **Function**: Key for calcium absorption, bone health, and immune system regulation.

- **Deficiency**: Causes bone disorders such as rickets in children and osteomalacia in adults, leading to weak or soft bones. It may also increase the risk of fractures.

- **Toxicity**: Overconsumption can lead to hypercalcemia (high calcium levels), resulting in confusion, abdominal pain, kidney stones, or even kidney failure.

### Vitamin E:

- **Function**: Acts as an antioxidant, helping protect cells from damage.

- **Deficiency**: Rare, but can result in neurological issues such as muscle weakness, vision problems, and impaired immune function.

- **Toxicity**: Large doses can interfere with blood clotting and increase the risk of bleeding, especially if the person is also taking blood-thinning medications.

### Vitamin K:

- **Function**: Essential for blood clotting and bone health.

- **Deficiency**: Can lead to bleeding disorders, as the body cannot clot blood effectively.

- **Toxicity**: Generally low risk because the body does not store much vitamin K, but supplementation can interfere with anticoagulant medications like warfarin.

**Emergency Medicine Takeaways**:

1. **Deficiency and Toxicity**: Be aware that both deficiency and toxicity can present with acute symptoms that may require immediate intervention.

2. **Drug Interactions**: Especially for vitamin K, consider how vitamin intake can interact with medications like anticoagulants.

3. **High-Risk Populations**: Pay attention to populations at higher risk of deficiencies, such as those with malabsorption issues (e.g., celiac disease, cystic fibrosis) or those with poor dietary intake.

4. **Fat Solubility and Storage**: Since these vitamins are fat-soluble, they are stored in the body and can accumulate over time, making toxicity a more significant risk compared to water-soluble vitamins.

Understanding these factors helps in diagnosing and treating patients who present with symptoms related to these vitamins, ensuring proper care and avoiding potential complications.