SAMPLE History
Structuring a patient's medical history
SSigns/Symptoms — what's wrong, subjective and objective
AAllergies — medications, foods, environmental
MMedications — current prescriptions and OTC drugs
PPertinent past medical history — relevant prior conditions
LLast oral intake — food/drink, timing
EEvents leading up to the incident
OPQRST
Characterizing a symptom in detail, especially pain
OOnset — sudden or gradual, what the patient was doing
PProvocation/Palliation — what makes it better or worse
QQuality — sharp, dull, crushing, burning, etc.
RRadiation — does it spread anywhere else
SSeverity — often rated on a 1-10 scale
TTime — how long it's been going on, any change over time
AVPU
Quick level-of-consciousness scale
AAlert — spontaneously aware and responsive
VVerbal — responds to voice, not spontaneously alert
PPain — responds only to a painful stimulus
UUnresponsive — no response to voice or pain
DCAP-BTLS
What to look/feel for during a trauma exam of any body region
DDeformities
CContusions
AAbrasions
PPunctures/Penetrations
BBurns
TTenderness
LLacerations
SSwelling
Cincinnati Prehospital Stroke Scale
Fast field stroke screen — any one abnormal finding is a positive screen
Facial droop — ask the patient to smile
Arm drift — ask the patient to hold both arms out, eyes closed
Speech — ask the patient to repeat a phrase, listen for slurring
Rule of Nines (Adult)
Estimating burn size as a percentage of total body surface area
Head — 9%
Each arm — 9%
Chest/abdomen (front torso) — 18%
Back (posterior torso) — 18%
Each leg — 18%
Groin — 1%
Scene Size-Up Components
What to establish before patient contact
BSI/standard precautions
Scene safety
Mechanism of injury / nature of illness
Number of patients and need for additional resources
FAST
Public-facing stroke screen, commonly used alongside the Cincinnati scale
FFace — ask the patient to smile, look for drooping on one side
AArms — ask the patient to raise both arms, look for one drifting down
SSpeech — ask the patient to repeat a phrase, listen for slurred or strange speech
TTime — note the time symptoms started (or last known well) and get the patient to definitive care fast
AEIOU-TIPS
Differential for altered mental status — reviewing this list on scene can jog a cause that isn't obvious
AAlcohol
EEpilepsy/Seizure (including postictal state)
IInsulin — hypo- or hyperglycemia
OOverdose (or Oxygen — hypoxia)
UUremia (kidney failure/toxin buildup)
TTrauma (especially head injury) or Temperature (hyper-/hypothermia)
IInfection
PPsychiatric
SStroke (or Shock, Space-occupying lesion)
CUPS
Rapid one-word patient priority classification for radio reports and transport decisions
CCritical — immediate life threat, load-and-go
UUnstable — significant problem, high risk of deterioration
PPotentially unstable — stable now, but with a concerning finding or mechanism
SStable — no significant threat identified
BE-FAST
Stroke screening. The two extra letters catch the posterior-circulation strokes that plain FAST misses — roughly one in five
BBalance — sudden loss of balance or coordination
EEyes — sudden loss or blurring of vision in one or both eyes, or double vision
FFace — ask them to smile; look for one side drooping
AArms — both arms out, eyes closed; look for one drifting down
SSpeech — slurred, wrong words, or unable to speak
TTime — time last known well, which decides what treatment is still possible. Not the time symptoms were found
APGAR
Newborn assessment at 1 and 5 minutes. Each of the five scores 0, 1 or 2, for a total out of 10
AAppearance (color) — 2 completely pink, 1 pink body with blue hands and feet, 0 blue or pale all over
PPulse — 2 over 100, 1 under 100, 0 absent
GGrimace (reflex irritability) — 2 cries or coughs, 1 grimaces, 0 no response
AActivity (muscle tone) — 2 active motion, 1 some flexion, 0 limp
RRespirations — 2 strong cry, 1 slow or irregular, 0 absent
Blue hands and feet are the trap: acrocyanosis is normal in the first minutes of life and scores 1, not 2. Scoring it as 2 is the usual reason an APGAR comes out one point high. The score never delays resuscitation — you act on the baby, not the number.
Pediatric Assessment Triangle
A from-the-doorway impression of any child, formed before you touch them — which also avoids upsetting a child whose cooperation you are about to need
Appearance — tone, interactiveness, consolability, gaze, speech or cry. The best single indicator of how sick a child is
Work of breathing — audible sounds, retractions, nasal flaring, head bobbing, abnormal positioning
Circulation to skin — pallor, mottling, cyanosis
It gives severity, not a diagnosis, and it supplements the hands-on assessment rather than replacing it. Which side of the triangle is abnormal narrows the problem: appearance alone suggests something systemic, breathing suggests respiratory, skin suggests shock.
SLUDGEM
Cholinergic toxidrome — organophosphate and carbamate pesticides, and nerve agents. Everything wet at once
SSalivation
LLacrimation — tearing
UUrination
DDefecation / diarrhea
GGastric upset — cramping
EEmesis
MMiosis — pinpoint pupils, and Muscle twitching
Diaphoresis belongs to the same picture but is not one of the letters. The two that actually kill are not in the mnemonic either: bronchorrhea and bronchospasm — the patient drowns in their own secretions. Protect yourself first; this is a contaminated patient.
RPM
The 30-second per-patient check used in START (Simple Triage And Rapid Treatment) mass-casualty triage. START tags four categories — minor, delayed, immediate, deceased. There is no expectant tag in START: that belongs to SALT.
RRespirations — absent, so reposition the airway once: still absent = deceased, breathing only after repositioning = immediate. Breathing already, but over 30/min = immediate
PPerfusion — radial pulse absent, or capillary refill >2 sec = immediate
MMental status — unable to follow simple commands = immediate
Glasgow Coma Scale
Scoring level of consciousness — three components summed for a total of 3-15
Eye opening (1-4) — 4 spontaneous, 3 to voice, 2 to pain, 1 none
Verbal response (1-5) — 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none
Motor response (1-6) — 6 obeys commands, 5 localizes pain, 4 withdraws from pain, 3 abnormal flexion, 2 abnormal extension, 1 none
A score of 8 or less is widely used as the threshold for a severely depressed level of consciousness and airway concern.
Rule of Nines (Pediatric)
Burn size estimation in infants/children — proportionally different from the adult figures above because a child's head is relatively larger and legs relatively shorter
Head — 18%
Each arm — 9%
Chest/abdomen (front torso) — 18%
Back (posterior torso) — 18%
Each leg — 13.5%
Groin — 1%
Rule of Palm
Quick estimate for small or scattered/patchy burns, where the rule of nines' large regions don't fit well
The patient's own palm (including fingers) is approximately 1% of their total body surface area — use it as a measuring stick against the burned area(s).
PERRL
Documenting a normal pupil exam
PPupils
EEqual — in size
RRound
RReactive — constrict appropriately
Lto Light
Unequal pupils (anisocoria) can be a normal variant in some people, but in the setting of trauma or altered mental status it raises concern for increased intracranial pressure.
