Step into the macrocytic anemia caboose and remember the non-megaloblastic causes with the mnemonic My Liver Bleeds a Lot:

• My → Multiple Myeloma (CRAB: Hypercalcemia, Renal failure, Anemia, Bone lesions)

• Liver → Liver disease

• Bleeds → Hemolysis

• A → Alcohol use

• Lot → Hypothyroidism

We start at the front half of the caboose with the non-megaloblastic nun holding a sign with crossed-out “mega” dynamite, marking the absence of hypersegmented neutrophils. The kingpin character raises an alcohol bottle (liver logo) in a toast—reminding us of alcohol as a cause—bumping it into his tuxedo labeled “TSH > 10” for hypothyroidism. Above him, three red balloons drip a drop of blood onto the liver logo, tying in the phrase “My liver bleeds a lot.”

In the back half of the caboose, the B12 sumo baby wears a bandanna labeled “MMA” for methylmalonic acid (elevated in B12 deficiency), reaching up toward a Sistine Chapel ceiling to touch a finger labeled “↑ homocysteine” (seen in both folate and B12 deficiency). These back-half characters remind us that megaloblastic macrocytosis does have hypersegmented neutrophils, and is tied to DNA synthesis problems.

For alcohol-related macrocytosis, we recall Wernicke’s encephalopathy—classic triad:

1. Ophthalmoplegia (eye movement abnormalities)

2. Ataxia (gait disturbance)

3. Confusion (altered mental status)

ED Application:

• In AMS + alcohol use, always give thiamine before glucose to prevent progression to Korsakoff syndrome (confabulation, severe memory deficits).

• Macrocytosis without anemia can be an early alcohol toxicity sign—screen for liver disease, nutritional deficiencies, hypothyroidism, and myeloma.

• Suspect multiple myeloma? Check calcium, renal function, Hgb, and order imaging for bone lesions.

• Non-megaloblastic macrocytosis = treat underlying cause (alcohol cessation, thyroid replacement, liver management, transfusion for hemolysis).

• Megaloblastic macrocytosis = give B12/folate; avoid masking B12 deficiency with folate alone to prevent neurologic damage.

In the fast-paced, high-stakes world of emergency medicine, every second matters—especially when it comes to sickle cell crisis.

This podcast takes you straight to the heart of what matters most for ED clinicians, walking you through the essential “4 R’s” that can mean the difference between stabilization and rapid deterioration:

• Recognize — Identify the telltale signs of sickle cell crises early. Understand presentations like acute pain episodes, acute chest syndrome, stroke, and splenic sequestration, and learn how to differentiate these from other causes of acute pain or respiratory distress.

• Reverse — Act fast to correct life-threatening complications. From oxygen and aggressive IV fluids to urgent infection management, you’ll get evidence-based, bedside-ready strategies to halt progression.

• Radiology — Know when and why to image. From chest X-rays in acute chest syndrome to brain imaging for suspected stroke, we’ll break down which modalities to order—and how to interpret findings in the sickle cell patient.

• Refer — Recognize when escalation of care is critical. Whether to hematology, critical care, or transfer to a higher-level facility, we’ll cover the decision-making process and timing.

Hosted with a focus on clinically relevant, ED-ready pearls, each episode blends:

• Case-based storytelling — Putting you in the room with the patient, step-by-step.

• Mnemonic-rich recall tools — Like our “crime scene outline” visual, with key stickers marking the 4 R’s across the patient’s limbs for fast memory anchoring.

• Practical takeaways — What you can do immediately, what you must watch for, and what to avoid.

The principles behind the Sickle Cell 4 R’s is delivered in a no-fluff, high-yield format designed for busy clinicians who want to sharpen their edge in real emergencies.

Whether you’re a seasoned emergency medicine provider, a resident looking to solidify your sickle cell knowledge, or simply someone passionate about critical care, Sickle Cell Crisis: The 4 R’s will give you the skills and confidence to take decisive action when it matters most.

Hemolytic Anemias Mnemonic for the ED: TAG MY SUITCASE

In this high‑impact episode of Emergency Medicine Mind Palace, we break down hemolytic anemias into a memorable 5‑suitcase system that will stick with you on your next shift.

If you’ve ever seen dark urine, anemia, or dropping hemoglobin and felt that twinge of uncertainty about which hemolytic process is at play, this episode will lock in the key visual cues and ED actions you need to recall under pressure.

We explore the TAG MY SUITCASE mnemonic, where each suitcase represents a dangerous hemolytic anemia type:

T → Thrombocytopenia suitcase (TTP / HUS / ITP / DIC / HELLP / HIT)

• VW slug bug sticker with TTP & HUS clues

• ITP “plate on the road” visual

• DIC, HELLP, and HIT taped reminders

• ED takeaway: These can kill fast—recognize the pentad, check for microangiopathic hemolysis, and know when to call heme & transfuse.

A → Autoimmune hemolysis suitcase (Warm & Cold)

• Warm side: Sun with spleen + IgG, holding butterfly (lupus) & RX bottle (drug‑induced)

• Cold side: Blue hand with IgM, complement‑mediated, “cold agglutinin” with a tiny microphone (think Mycoplasma)

• ED takeaway: Identify warm vs. cold; call heme; avoid cold exposure; supportive care first.

G → G6PD suitcase (G6 Police Department)

• Police badge, radical sticker with O₂ radicals attacking RBCs

• Fava beans & Heinz ketchup with a bitten lid (Heinz bodies, bite cells)

• ED takeaway: Stop the offending agent—the “police arrest the radicals.” Supportive transfusion only if unstable.

M → Mechanical / ECMO suitcase (Sales Rep)

• Heart valve + ECMO plush lung

• Cola urine bottle (hemoglobinuria) & cardiology business card

• ED takeaway: Shear stress causes hemolysis; check urine, hemolysis labs, MAP not pulse; coordinate with cardiology/CT surgery.

S → Sickle Cell suitcase (Crime Scene Outline)

• White briefcase with faint crescent RBC pattern

• The 4 R’s for ED management:

1. Recognize – Sickle crisis & life‑threatening complications

2. Reverse – Pain control, oxygen, fluids, antibiotics (Uno reverse card sticker)

3. Radiology – Targeted imaging: CT head, CXR→CT chest, CTA limb, priapism eval

4. Refer – Heme, Neuro, Vascular, Urology early

• X marks on chest, brain, leg, pelvis: Acute Chest, Stroke, Limb Ischemia, Priapism

⸻

By the end of this episode, you’ll be able to:

• Rapidly recognize which hemolytic anemia you’re facing

• Recall ED priorities and life‑saving interventions

• Use the TAG MY SUITCASE mnemonic to never miss a high‑risk patient

Key ED Reminder:

• Stabilize first, follow local protocols, and call for help early.

• When in doubt, think: Recognize → Reverse → Radiology → Refer.

🎧 Listen now and step into the Hemolytic Anemia Mind Palace—where visuals and memory hooks turn complex hematology into rapid recall.

Step aboard the Anemia Train and enter the Normocytic Skeleton Car—the middle car of your anemia mind palace—designed specifically for busy ED clinicians who need fast recall without flipping through textbooks.

In this episode, you’ll:

• 🧠 Visualize the Normocytic Train Car: Skeleton passengers holding reticulocyte balloons, split by a divider wall between low retic (front) and high retic (back).

• 🎈 Lock in Retic Logic for the ED:

• Low retic = Hypoproliferative (CKD with low EPO / Aplastic with high EPO but no marrow response)

• High retic = Hyperproliferative (Hemolysis vs. Acute Blood Loss)

• 🩸 Master Key ED Presentations:

• CKD skeleton with sagging balloon (↓EPO), struggling for signal on a dead cell phone

• Aplastic skeleton with a ringing phone he can’t answer, sitting on a frying pan (pancytopenia)

• Hemolytic skeleton with bursting balloons, a Reuben sandwich with a lemon (↑LDH), stepping on a smiley‑face sticker (↓haptoglobin)

• Acute Blood Loss skeleton in a puddle of blood, holding a GBS ping‑pong paddle (Glasgow‑Blatchford), with a soft BP cuff falling off his arm reminding you to check code status and be MTP ready

• 🧳 Tour the Hemolytic Suitcases (final segment):

1. TTP/HUS VW suitcase with 5 bullet holes and brown diarrhea door → plasmapheresis + fluids

2. Autoimmune suitcase: Warm IGG sun w/ spleen & butterfly, Cold IGM iceberg with blue hand → consult heme

3. G6PD suitcase: G6 Police Dept badge, fava beans, Heinz ketchup bite cap, “Radical” free radical sticker → stop offending agents

4. Medical Sales suitcase: Heart valve + ECMO plush lungs, cola urine bottle, business card for cardiology → check hemolysis panel & hemodynamics

⸻

Why It Matters in the ED

• 🚨 Rapid Retic Check = Life‑Saving Triage: Quickly determine production vs. destruction vs. loss

• ⚡ Know When to Act:

• Hyperproliferative side = ED danger zone (hemolysis & acute blood loss)

• Hypoproliferative side = usually outpatient follow‑up unless profoundly symptomatic or pancytopenic

• 💉 Immediate Actions:

• Transfuse if symptomatic or unstable

• Initiate MTP for massive GI bleeds

• Call heme or GI early for high‑risk or crashing patients

• 📊 ED Labs to Prioritize: CBC w/ indices + retic, hemolysis panel, type & screen, stool/urine checks as indicated

⸻

Disclaimer:

This podcast is for educational purposes only. Always check local ED protocols and consult specialists for patient‑specific management.

Microcytic Anemia in the ED: What You’re Missing Could Kill Your Patient

🚨 Episode Summary for the Emergency Clinician:

Think you’ve got anemia figured out? Think again. In this high-yield episode, we dissect microcytic anemia from an ED-first perspective and break down what you must recognize and act on fast—because missing a few key clues could mean a delayed diagnosis with deadly consequences.

🛤️ Using a train engine metaphor, we bring the microcytic workup to life—making it unforgettable under pressure. This is the engine of our anemia workup, where iron studies and immediate red flags demand your attention.

👁️‍🗨️ Key Clinical Takeaways:

• ​ Microcytic = MCV < 80: Think iron first—but don’t stop there.
• ​ The Big 3 Microcytic Causes:

🧲 Iron Deficiency Anemia (↓ ferritin, ↑ TIBC)

♨️ Anemia of Chronic Disease (normal/high ferritin, ↓ TIBC)

🧬 Thalassemia (abnormal Hb electrophoresis)

• ​ Sideroblastic Anemia & Lead Poisoning: Don’t forget these rare but real zebras—especially if you see basophilic stippling.

💉 Emergency Treatment Highlights:

• ​ Iron Deficiency: Consider transfusion if symptomatic with Hb < 7 (or < 8 if cardiac hx). Oral or IV iron outpatient.
• ​ Anemia of Chronic Disease: Address underlying infection/inflammation. Transfuse only if symptomatic.
• ​ Thalassemia: Usually no ED intervention unless severe. Do not give iron unless iron-deficient is confirmed.
• ​ Lead Poisoning / Sideroblastic: Suspect in the right exposure history. Stabilize and refer.

🧠 Why This Matters in the ED:

• ​ Microcytic anemia is often dismissed—but a dangerously low hemoglobin could be your first and only clue to an occult GI bleed, chronic renal disease, or even a missed malignancy.
• ​ Every CBC is a vital sign. Recognizing pattern + initiating the right early steps = saving a life.
• ​ Don’t just discharge with “follow up”—ask why the anemia exists.

💡 Memory Aids Included:

We walk through vivid memory palace metaphors and layered symbolism (like sagging balloons, cloaked villains, and signal-less cell phones) to help you recall labs and differentials on shift—when it matters most.

📋 Quick Lab Tips:

• ​ Iron studies: Order ferritin + TIBC if microcytic.
• ​ Hemoglobin Electrophoresis: If you suspect thalassemia.
• ​ Peripheral Smear: For RBC morphology clues (target cells, basophilic stippling, etc.).
• ​ CRP/ESR: Helpful when working up chronic inflammatory states.

⚠️ What You’re Missing Could Kill Your Patient:

This isn’t a textbook review—it’s ED pattern recognition and decision-making under pressure. Catch microcytic anemia early, treat aggressively when needed, and don’t miss the opportunity to spot slow bleeds or signal bigger systemic diseases.

📎 Disclaimer: This episode is intended for medical education only. Always refer to your hospital’s local protocols and consult specialists as needed.

In this high-yield episode, we build a visual memory palace down the “Highway to Hell” of emergency thrombocytopenia syndromes. Each stop reveals a unique and dangerous cause of low platelets you’ll encounter in the ED—brought to life through vivid storytelling, unforgettable characters, and layered mnemonics.

🚑 What You’ll Learn (Quick Hits):

• TTP – Thrombotic Thrombocytopenic Purpura

⚠️ Medical emergency! Think fever, renal failure, confusion, and schistocytes. LDH ↑, haptoglobin ↓. No platelets? No transfusions—start plasma exchange.

• HUS – Hemolytic Uremic Syndrome

👶 Usually in kids post-E. coli O157:H7 diarrhea. Watch for MAHA, AKI, and thrombocytopenia. Supportive care is key.

• ITP – Immune Thrombocytopenic Purpura

🍽 Isolated platelets on the floor. In kids: post-viral; in adults: chronic. No MAHA. Often treated with steroids or IVIG.

• DIC – Disseminated Intravascular Coagulation

🎲 The DIC casino. Caused by trauma, sepsis, OB complications, or malignancy. PT/PTT ↑, D-dimer ↑, fibrinogen ↓, schistocytes present. Treat the cause!

• HELLP – Hemolysis, Elevated Liver Enzymes, Low Platelets

🔥 Pregnant patient near the end of the road—hypertension, RUQ pain, and MAHA. Delivery is the only definitive treatment.

• HIT – Heparin-Induced Thrombocytopenia

🕷 A clotting catastrophe. 5–10 days post-heparin. Watch for new clots and falling platelets. Stop heparin and start a direct thrombin inhibitor like argatroban.

💡 Distinctions to Remember:

• MAHA: Present in TTP, HUS, DIC, HELLP (look for schistocytes, LDH ↑, haptoglobin ↓).

• Isolated thrombocytopenia: Think ITP.

• Timing: HIT = 5–10 days after heparin; HUS = 5–10 days after diarrheal illness.

• Treatment: TTP = plasma exchange, DIC = treat cause + FFP/cryoprecipitate, HELLP = deliver, HIT = stop heparin.

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🧠 Bonus: Visual mnemonics and character scenes help lock it all in. This episode blends storytelling, pathophys, and pattern recognition so you’ll never forget what each condition looks like in real life.

📌 Save it. Share it. Pass your boards. Help your patients.

In this unforgettable bloody podcast, we bring the clotting cascade to life through a cast of hilarious and high-yield characters designed to make clinical recall effortless under pressure.

Play Table Tennis = PTT = Inside = Intrinsic.

Play Tennis = PT = Outside = Extrinsic.”

You’ll meet:

🟢 Lucky Number 7 — our tennis-playing war cry–shouting Factor VII who kicks off the extrinsic pathway by yelling “This is WAR!” 🎾 Warfarin is his signature drug, and he’s monitored using PT/INR.

🔵 Inside, we find our Intrinsic Table Tennis Team:

• Factor XII – Haggard from Hogwarts: Looks impressive but doesn’t cause bleeding (aPTT prolonged, no clinical bleeding).

• Factor XI – The Ashkenazi Post-Op Guy: Mild bleeding, especially post-surgery.

• Factor IX – Hemophilia B Player: Jersey with a bold upside-down 9 (“B”) — classic for Hemophilia B (X-linked, prolonged aPTT, normal PT).

• Factor VIII – “Dave the ATE Guy”: Sporting an “ATE” shirt and bitten fruit logo — he’s your clue for Hemophilia A (treated with Factor VIII or DDAVP).

“Ate = Eight = Hemophilia A” and “B = looks like upside-down 9 = Hemophilia B.”

🔴 In the Commons, you’ll meet:

• Jason from Friday the 13th: Our grim reaper of clotting, holding the bills for Factors 10, 5, 2, 1, and 13.

• Prothrombin (Factor II) — aka “Thumb Bill”: Turns into thrombin (the $2 bill with a big thumbprint) and activates fibrinogen (the $1 bill made of fiber) into fibrin.

• Factor XIII (Jason again) then seals the clot with a sticky web. The clot is locked. Game over.

🌿 Then enters Heparin: A barefoot hippie who amplifies Antithrombin the Ferret 🐾, whose collar reads “10 & 2 Stopper.”

• Heparin inactivates Factor 10a and Thrombin (2a), preventing the clot entirely.

• Heparin’s work is monitored by aPTT (not PT/INR).

Mnemonic: “Check the aPTT!” echoes across the commons as the web dissolves.

✅ Quick Clinical Takeaways:

• Hemophilia A = Factor VIII deficiency → Treat with Factor VIII or DDAVP

• Hemophilia B = Factor IX deficiency → Treat with Factor IX

• Both: X-linked, prolonged aPTT, normal PT

• Heparin = Acts on Factors 2a & 10a, monitored by aPTT

• Warfarin = Inhibits Factor VII, monitored by PT/INR

👨‍⚕️ Built for emergency physicians and learners who want fast recall, sticky mnemonics, and a clotting cascade you’ll never forget.

In this episode, we tackle STEMI mimics—conditions that mimic ST-segment elevation myocardial infarction on an EKG but aren’t always a heart attack.

Why’s it critical? Because ST elevation doesn’t always mean STEMI, and misdiagnosis can waste time or miss critical conditions.

ELEVATION

Electrolytes (Hyperkalemia),

Left Bundle Branch Block,

Early Repolarization,

Ventricular Hypertrophy (Left),

Aneurysm (Ventricular),

Thailand (Brugada Syndrome),

Inflammation (Pericarditis),

Osborn J Wave,

Non-Ischemic Vasospasm

We use the ELEVATION mnemonic to guide you through each mimic with clear explanations, repeated key points, and rapid-fire quizzes to lock in your recall.