The plum card: ten cues, ten minutes
A card-fill panel rotated one degree with tape strips at opposing corners, holding ten mono rows of cue, plum arrow, and crisis, with a vertical plum rule bracketing the rows into neuro, renal, and endocrine.
THE TEN CUES
| THE QUIET CUE | THE CRISIS IT PRECEDES | |
|---|---|---|
| ☐ N | Harder to rouse than an hour ago | Herniation · CRITICAL |
| ☐ N | A deficit that matches one vascular territory | The thrombolytic window closing |
| ☐ N | Seizure activity past 5 minutes | Airway loss and metabolic collapse · CRITICAL |
| ☐ N | Pounding headache in an injury at the sixth thoracic level or above | Hypertensive stroke and death · CRITICAL |
| ☐ R | Urine output falling with creatinine off this patient's baseline | Uremia, overload, lethal hyperkalemia |
| ☐ R | Cloudy peritoneal effluent | Peritonitis becoming sepsis |
| ☐ R | Headache and confusion during an early dialysis run | Disequilibrium syndrome |
| ☐ E | Deep, rapid Kussmaul breathing | Acidotic collapse |
| ☐ E | Weight gain without edema | Hyponatremic seizure |
| ☐ E | Hypotension that will not answer fluid in a steroid-dependent patient | Adrenal crisis · CRITICAL |
THE TEN-MINUTE DRILL
Minutes 1 to 3. Cover the right column. Read each cue aloud and name the crisis it precedes. Anything you hesitate on gets a mark, and the marks tell you which page to reopen.
Minutes 4 to 7. The two confusion pairs. Say the seven rows of diabetic ketoacidosis against hyperosmolar hyperglycemic state from page 5 without looking, then finish with the shared sequence: fluid, insulin, potassium, and the potassium check that interrupts between the first two. Then the six rows of syndrome of inappropriate antidiuretic hormone against diabetes insipidus from page 6, starting from the urine and predicting the sodium.
Minutes 8 to 10. Recite the dysreflexia sequence in order: sit upright with legs lowered, loosen everything constricting, recheck pressure every 2 to 5 minutes, find the trigger starting with the bladder, notify, anticipate the antihypertensive. Then order the signs of rising intracranial pressure from the change in level of consciousness through to Cushing's triad.
THE FOUR MEMORY HOOKS
- KETONES ARE KUSSMAUL
- SIADH SOAKS, DI DRAINS
- CLOUDY MEANS CALL
- SIT, LOOSEN, LOOK
CROSS-LINK INDEX
- Values and arterial blood gas interpretation ......... → BOOK 07
- Calculations ......... → BOOK 06
- Drug classes and antidotes ......... → BOOK 05
- Shock states ......... → BOOK 09
- Priority frameworks ......... → BOOK 03
- Isolation categories ......... → BOOK 04
- Domain maps ......... → BOOK 01 · PP 45–47
Margin noteten cues, three systems, one habit. Every glycemic number in this book must be re-verified against the current ADA Standards of Care in Diabetes, which is revised annually.
Takeawayevery emergency in this book announces itself quietly first, and this card is the list of those announcements.