Posts tagged mnemonic

Admission Orders

The other day, I was asked to write the admission orders for a sick patient for the very first time. Every doctor I have seen has taken different approaches towards writing these notes. For me, the two acronyms below has worked well for me and covers most issues that needs to be addressed when admitting.

AD DAVID

  • Admit to / Allergies
  • Diagnosis
  • Diet type
  • Activity level
  • Vitals / IV 
  • Investigations (e.g. blood work, imaging, consults)
  • Drugs

Under the medication orders, I use the following acronym: BE SAD PP

  • Bowel protocol
  • Emesis protocol
  • Sleep
  • Antibiotics
  • DVT prophylaxis
  • Pain
  • Pre-admission medications

I GET SMASHED for Acute Pancreatitis

Idiopathic: Hypertensive sphincter or microlithiasis

Gallstones (45%)
Ethanol (35%)
Tumours: Pancreas. Ampulla. Choledochocele

Scorpion stings
Microbiological

  • Bacteria: Mycoplasma. Campylobacter. TB. M. avium intracellular. Legionella. Leptospirosis
  • Viral: Mumps. Rubella. Varicella. Viral hepatitis. CMV. EBV. HIV. Coxsackie virus. Echovirus. Adenovirus
  • Parasites: Ascariasis. Clonorchiasis. Echinococcosis

Autoimmune: SLE. Polyarteritis nodosa. Crohn’s
Surgery or trauma

  • Manipulated sphincter of Oddi (ERCP). Post cardiac surgery. Blunt trauma to abdomen. Penetrating peptic ulcer

Hyperlipidemia 

  • (TG >11.3 mmol/L; >1000mg/dL). Hypercalcemia. Hypothermia

Emboli or ischemia
Drugs or toxins

  • Azathioprine. Mercaptopurine. Furosemide. Estrogen. Methyldopa. H2blockers. Valproic acid. Antibiotics. Acetaminophen. Salicylates. Methanol. Organophosphates. Steroids

Clinically assessing suicide risk

A new mnemonic tool we learned today for assessing suicide risk is SAD PERSONS by Patterson et al.:

  • Social support (lack of)
  • Age (<19 years old and >45 years old)
  • Depression
  • Previous attempts
  • Ethanol abuse
  • Rational thinking loss
  • Sex (male)
  • Organized plan
  • No spouse
  • Sickness (chronic or debilitating)

A clinician quickly pointed out that while this is an excellent framework, the focus should always be on the patient and assessing them holistically. Other subtle factors from their general responses and appearances can also give us an idea of suicide risk in these situations. In addition, while points are assigned equally among these factors, it would be intuitive to believe that some factors, such as having an organized plan would be weighted more heavily in the assessment than others. What good suicide risk assessment eventually boils down to as the clinician summarizes, is experience.

Layers of Your Scalp

An acronym for the layers in your scalp is amusingly, SCALP:

  • Skin
  • Connective tissue (Dense)
  • Aponeurosis
  • Loose connective tissue
  • Periosteum

Well that is one less thing to worry about I guess. Next concept!

Altered Mental Status

A short acronym shared by my classmate on how to quickly generate some causes of altered mental status:

  • Alcohol
  • Epilepsy, endocrine, exocrine, electrolyte imbalance
  • Infection
  • Overdose, opioids, oxygen deprived
  • Uremia
  • Trauma, temperature, toxins
  • Insulin
  • Psychosis
  • Stroke, shock

Systemic Lupus Erythematosus

A diagnostic criteria for SLE is to fulfill at least four of the following eleven letters that make up the mnemonic “SOAP BRAIN MD”:

  • Serositis
  • Oral ulcers
  • Arthritis
  • Photosensitivity
  • Blood disorders
  • Renal disease
  • Anti-nuclear antibody positive
  • Immunologic abnormalities
  • Neurologic disease
  • Malar rash
  • Discoid rash

That is a lot of ground to cover. Are you sure it is not lupus, House?

APEX and PAIN of the Knee

In remembering the origin and direction of insertion of the anterior and posterior cruciate ligaments of the knee:

Anterior cruciate ligament begins in the intercondylar area of the tibia and runs Posteriorly, inserting into the EXternal (lateral) condyle of the femur. APEX

Posterior cruciate ligament begins in the intercondylar area of the tibia and runs Anteriorly, inserting into the INternal (medial) condyle of the femur. PAIN

Multiple Myeloma makes you CRABby

The clinical features of multiple myeloma include:

  • Hyper Calcemia
  • Renal insufficiency
  • Anemia
  • Bony disease/lesions

TAILS of Microcytic Anemia

A low mean corpuscular volume is a sign of microcytosis. When coupled with signs of reduced blood point to a microcytic anemia. Potential causes include:

  • Thalassemia
  • Anemia of chronic disease
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic anemia

Never Let Monkeys Eat Bananas

Ranking the order of a normal differential count for white blood cells:

  • Neutrophils (60-70%)
  • Lymphocytes (20-40%)
  • Monocytes (3-10%)
  • Eosinophils (1-4%)
  • Basophils (~1%)