EMS Mnemonics: AEIOU-TIPS, DUMBELS, SLUDGEM and More
The mnemonics EMTs and paramedics actually use, what each letter stands for, the common variants, and where each one fits in an assessment: AEIOU-TIPS, DUMBELS and SLUDGEM, AVPU, OPQRST, SAMPLE, DCAP-BTLS and the Hs and Ts.
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EMS runs on mnemonics. They are how a student remembers a list under stress and how a crew makes sure nothing obvious got skipped. They are memory aids, not algorithms: a mnemonic tells you what to think about, and your assessment and your protocol decide what to do.
AEIOU-TIPS: causes of altered mental status
AEIOU-TIPS is a checklist of reasons a patient might be confused, unresponsive or behaving strangely. Its value is that it stops you settling on the first explanation. A patient who smells of alcohol can also be hypoglycemic, hypoxic or head-injured, and the mnemonic makes you look.
| Letter | Common meaning | Common alternates |
|---|---|---|
| A | Alcohol | Acidosis, arrhythmia |
| E | Epilepsy (seizure, postictal state) | Electrolytes, endocrine, encephalopathy |
| I | Insulin (hypoglycemia or hyperglycemia) | Intoxication |
| O | Opiates and other overdose | Oxygen (hypoxia) |
| U | Uremia and other metabolic causes | Underdose of a prescribed medication |
| T | Trauma, especially head injury | Temperature (hypothermia or hyperthermia) |
| I | Infection, including sepsis and meningitis | |
| P | Psychiatric | Poisoning |
| S | Stroke | Shock, seizure, syncope |
Psychiatric belongs last in your thinking even though it sits in the middle of the mnemonic. Rule out the medical causes before you attribute a change in behavior to a psychiatric one.
Score the level of consciousness and record it, so a change can be seen
AVPU: a quick level of responsiveness
AVPU is the fast check you do in the primary assessment: is the patient Alert, responsive to Verbal stimulus, responsive to Pain, or Unresponsive. It is coarse on purpose. Follow it with a Glasgow Coma Scale when you have time, because the GCS shows a change that AVPU can hide.
DUMBELS and SLUDGEM: cholinergic poisoning
DUMBELS and SLUDGEM are two ways of remembering the same picture: too much acetylcholine stimulating the muscarinic receptors. The classic causes are organophosphate and carbamate insecticides and nerve agents. A patient who is wet everywhere, with small pupils and a slow heart, should make you think of it.
| Letter | Meaning |
|---|---|
| D | Diarrhea |
| U | Urination |
| M | Miosis (small pupils) |
| B | Bradycardia, bronchorrhea, bronchospasm |
| E | Emesis |
| L | Lacrimation (tearing) |
| S | Salivation and sweating |
| Letter | Meaning |
|---|---|
| S | Salivation |
| L | Lacrimation |
| U | Urination |
| D | Defecation |
| G | Gastrointestinal upset |
| E | Emesis |
| M | Miosis |
Cholinergic poisoning also stimulates nicotinic receptors, which can cause muscle twitching, weakness, a fast heart rate and large pupils. So a patient can be poisoned and still be tachycardic or have normal pupils. Do not rule the toxidrome out because one letter is missing. Treatment, including antidotes and their doses, is your protocol's.
The assessment mnemonics with their own guides
Three mnemonics carry so much of the patient assessment that each has its own guide in this library. In a line each:
- OPQRST: onset, provocation and palliation, quality, region and radiation, severity, and time. It works through the chief complaint, most often pain. See the OPQRST guide.
- SAMPLE: signs and symptoms, allergies, medications, past medical history, last oral intake, and events leading up. It is the patient's background. See the SAMPLE history guide.
- DCAP-BTLS: deformities, contusions, abrasions, punctures and penetrations, burns, tenderness, lacerations and swelling. It is what you look and feel for on a trauma assessment. See the DCAP-BTLS guide.
The Hs and Ts: reversible causes of cardiac arrest
The Hs and Ts list the causes of cardiac arrest that can be found and treated during the resuscitation. Run through them out loud during a code, especially in PEA and asystole.
| Hs | Ts |
|---|---|
| Hypovolemia | Tension pneumothorax |
| Hypoxia | Tamponade, cardiac |
| Hydrogen ion (acidosis) | Toxins |
| Hypokalemia or hyperkalemia | Thrombosis, pulmonary |
| Hypothermia | Thrombosis, coronary |
The ACLS and PALS quick-reference guides in this library place the list in each algorithm; the pediatric list adds hypoglycemia.
Organize what you found into a structured handoff
Using mnemonics well
- Learn the version your program uses and stick to it. Two versions in one head is how letters get lost.
- Ask the questions in plain language. A patient does not need to hear the mnemonic.
- Use them as a final check, not as a script. A mnemonic recited in order can miss the thing the patient is trying to tell you.
- Write the findings in your report under the same headings, so the next clinician can find them.
The short version
- AEIOU-TIPS lists the causes of altered mental status. Check a glucose every time.
- AVPU is the quick level of responsiveness; follow it with a GCS.
- DUMBELS and SLUDGEM describe cholinergic poisoning. The killer Bs are bradycardia, bronchorrhea and bronchospasm.
- OPQRST is the chief complaint, SAMPLE is the history, DCAP-BTLS is the trauma exam.
- The Hs and Ts are the reversible causes of cardiac arrest.
- Mnemonics are memory aids. Your assessment and your protocol decide care.