Making Key Decisions For Acutely Ill Patients

When presenting with an acutely ill patient, there is a very specific window of time where key decisions—life and death decisions—need to be made.

To simplify this decision-making process, we are initially taught algorithms.  ABCs of basic life support (recently changes to CAB… thanks a lot.)  But, what happens when the waters are muddy? 

The STEAM mnemonic for acutely ill patients

The mnemonic STEAM may be helpful here.  This can be used by any clinician, from paramedic or nurse, to physician, NP or PA.

When evaluating an acutely ill patient, we do our primary assessment, vital signs and secondary assessment.

The primary assessment includes looking for a pulseless patient (start CPR) and shocking them if in VF or VT.   We move to O2, monitor and IV, then to secondary assessment.

After the secondary assessment here’s the thing:

Think so hard that STEAM comes out of your ears.

S=Seizure/sugar

T=Trauma/temp

E=Electrolytes/electric shock

A=Alcohol/allergy

M=Meds/mommy

This mnemonic opens the differential of possible causes for your patient’s acutely ill presentation. If you don’t think about these causes by thinking STEAM, you will never diagnosis the problem.

These mnemonics have helped me treat patients as an EM PA for years, and I am proud to say that our CME uses this and other mnemonics to help you be a more efficient medical provider. Check out our CME shop and shoot us an email with any questions.

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