ALiEM Cards is point-of-care reference library of narrowly focused, easily digestible cards for the practicing emergency physician or learner (formerly known as PV Cards). As of July 2017 led by the team of Dr. Jeremy Voros and Derek Sifford, we have rebranded these into “ALiEM Cards”.

Index of Topics

Topic	PDF	Major Subject	Minor Subject	Blog page	Date
Abdominal pain, diagnostic studies	PDF	Surgery, trauma	Diagnostics	Blog	2011/07/22
Abdominal trauma, blunt (likelihood ratios)	PDF	Surgery, trauma	Bayes	Blog	2012/04/20
Abdominal trauma, penetrating	PDF	Surgery, trauma		Blog	2010/07/09
ABG interpretation	PDF	Pulmonary, critical care	Diagnostics	Blog	2010/04/02
Acetaminophen toxicity	PDF	Toxicology, pharmacology		Blog	2011/11/04
Acute limb ischemia	PDF	Cardiovascular		Blog	2010/08/13
Acute vestibular syndrome and HINTS exam	PDF	Neurology		Blog	2011/12/02
Alcohol: Ethylene glycol	PDF	Toxicology, pharmacology		Blog	2012/06/08
Alcohol: Isopropyl alcohol	PDF	Toxicology, pharmacology		Blog	2012/06/22
Alcohol: Methanol	PDF	Toxicology, pharmacology		Blog	2012/06/15
Anaphylaxis	PDF	Allergy, Immunology		Blog	2012/02/24
Angioedema	PDF	Allergy, Immunology		Blog	2010/03/26
Ankle and Hindfoot Fractures	PDF	Orthopedics		Blog	2016/06/06
Ankle fractures	PDF	Orthopedics		Blog	2010/02/18
Anticoagulation for atrial fibrillation	PDF	Cardiovascular		Blog	2010/04/09
Aortic dissection (IRAD)	PDF	Cardiovascular		Blog	2011/05/20
Appendicitis: ACEP clinical policy	PDF	Surgery, trauma		Blog	2010/06/18
Asthma NIH classifications	PDF	Pulmonary, critical care		Blog	2011/04/29
Bayes nomogram	PDF		Bayes		2012/05/17
Bell’s Palsy: Treatment	PDF	Neurology		Blog	2013/02/21
Blood culture indications	PDF	Infectious disease	Bayes	Blog	2012/08/17
Blunt cardiac injury	PDF	Surgery, trauma		Blog	2012/06/29
Brugada syndrome	PDF	Cardiovascular		Blog	2011/05/06
Burns	PDF	Surgery, trauma		Blog	2016/04/22 update (original 7/2/2010)
C1-C2 fractures	PDF	Orthopedics		Blog	2010/09/24
C3-C7 fractures	PDF	Orthopedics		Blog	2010/10/01
Cardiac tamponade	PDF	Cardiovascular	Bayes	Blog	2011/07/08
Cerebrovascular injury, blunt	PDF	Surgery, trauma		Blog	2011/07/01
Cervical spine rules	PDF	Surgery, trauma		Blog	2010/12/10
Cervical spine, distracting injury	PDF	Surgery, trauma		Blog	2011/09/09
Charting and Coding	PDF	Administrative		Blog	2016/08/15
Chemical sedation	PDF	Toxicology, pharmacology		Blog	2011/03/25
Chest pain, low risk ACS	PDF	Cardiovascular		Blog	2010/01/29
CHF likelihood ratios	PDF	Cardiovascular	Bayes	Blog	2012/08/24
Cholecystitis tests	PDF	Surgery, trauma	Bayes	Blog	2011/03/18
Clostridium difficile	PDF	Infectious disease		Blog	2011/06/24
CNS infections	PDF	Neurology		Blog	2009/12/29
Continuous end tidal CO2 monitoring in cardiac arrest	PDF	Pulmonary, Critical Care		Blog	2015/10/20
Continuous infusions	PDF	Toxicology, pharmacology		Blog	2012/03/09
Croup	PDF	Pediatrics		Blog	2010/08/20
CT cancer risk	PDF	Radiology		Blog	2011/06/10
Cystitis/Pyelonephritis Women Antibiotics	PDF	Genitourinary		Blog	2011/09/02
D-dimer	PDF	Hematology, oncology	Diagnostics	Blog	2012/07/12
Delayed sequence intubation	PDF	Airway, pulmonary		Blog	2012/08/31
Dental infections	PDF	ENT		Blog	2011/04/22
Dental trauma	PDF	ENT		Blog	2011/04/15
Dermatomes and myotomes	PDF	Neurology	Anatomy	Blog	2010/05/28
Diabetic foot osteomyelitis	PDF	Orthopedics	Bayes	Blog	2011/09/23
Diverticulitis outpatient	PDF	Surgery, trauma		Blog	2011/05/27
Drug Card Emergency Department	PDF	Toxicology, pharmacology		Blog	2013/09/11
DVT Diagnostic Guidelines (ACCP)	PDF	Cardiovascular		Blog	2013/01/24
Dysphagia	PDF	ENT		Blog	2010/02/03
Early goal directed therapy in sepsis	PDF	Infectious disease		Blog	2010/04/16
ECG: Early repolarization vs STEMI	PDF	Cardiovascular		Blog	2013/05/16
ECG: Electrolyte imbalance	PDF	Cardiovascular, Endocrine		Blog	2012/09/21
ECG: Geography of AMI	PDF	Cardiovascular	Diagnostic	Blog	2011/04/08
ECG: Lead aVR	PDF	Cardiovascular	Diagnostic	Blog	2011/11/18
ECG: Right and posterior leads	PDF	Cardiovascular	Diagnostic	Blog	2011/03/11
Ectopic Pregnancy	PDF	Obstetrics/gynecology	Bayes	Blog	2013/05/09
EMTALA rules in the transfer of ED patients	PDF	Administrative		Blog	2012/09/14
Genital ulcers	PDF	Genitourinary		Blog	2012/05/04
GRACE score	PDF	Cardiovascular		Blog	2012/04/13
Head CT before LP	PDF	Neurology		Blog	2010/04/23
Head CT in trauma: Decision rules	PDF	Surgery, trauma		Blog	2011/05/13
Hyperkalemia	PDF	Endocrine, metabolic		Blog	2010/03/12
Hypertension: First line treatment	PDF	Cardiovascular		Blog	2011/02/11
Hypothermia, accidental	PDF	Environmental		Blog	2011/02/04
Influenza treatment	PDF	Infectious disease		Blog	2011/10/28
Intimate partner violence	PDF	Trauma		Blog	2013/07/31
Intraosseous lab interpretation	PDF	Hematology, oncology	Diagnostics	Blog	2012/01/13
IV fluid composition and Chloride-restrictive fluids in ICU	PDF	Endocrine, metabolic		Blog	2012/01/03
Kawasaki disease	PDF		Pediatrics	Blog	2012/03/23
Knee exam	PDF	Orthopedics		Blog	2010/03/19
Laceration repair and sutures	PDF	Trauma		Blog	2017/03/06
Legionnaires disease	PDF	Pulmonary, critical care		Blog	2011/09/16
Local anesthetic toxicity	PDF	Toxicology, pharmacology		Blog	2014/06/13
Metacarpal fracture	PDF	Orthopedics		Blog	2013/12/13
Methotrexate and ectopic pregnancy	PDF	Gynecology, obstetrics		Blog	2011/11/11
Murmurs and need for echocardiography	PDF	Cardiovascular		Blog	2010/09/17
Neutropenic fever and cancer	PDF	Infectious disease		Blog	2011/10/07
NSAID bleeding risk	PDF	Toxicology, pharmacology		Blog	2011/07/15
One minute preceptor: NERDS mnemonic	PDF	Education		Blog	2015/08/01
Open fractures and antibiotics	PDF	Orthopedics		Blog	2012/01/20
Osmolal gap	PDF	Toxicology, pharmacology		Blog	2012/06/01
Ottawa knee, ankle, foot rules	PDF	Orthopedics		Blog	2010/05/07
Overanticoagulation and supratherapeutic INR	PDF	Hematology, oncology		Blog	2012/08/10
Pain medications: Initial options in the ED	PDF	Toxicology		Blog	2015/10/23
Palliative Care Screening in the ED	PDF	Palliative Care		Blog	2015/07/27
Paracentesis and ascites assessment	PDF	Gastroenterology		Blog	2010/06/25
PE clinical decision rules	PDF	Pulmonary, critical care		Blog	2011/06/03
PE indications for fibrinolysis	PDF	Pulmonary, critical care		Blog	2011/07/29
Pediatric assessment triangle	PDF	Pediatrics		Blog	2013/05/30
Pediatric fever (1-3 months old)	PDF	Infectious disease	Pediatrics	Blog	2012/02/02
Pediatric fever (3 mo- 3 yrs old)	PDF	Infectious disease	Pediatrics	Blog	2012/02/09
Pediatric fever (neonate)	PDF	Infectious disease	Pediatrics	Blog	2012/01/27
Pediatric head trauma (PECARN)	PDF	Surgery, trauma	Pediatrics	Blog	2010/02/04
Pediatric ingestion dose thresholds for ED referral	PDF	Toxicology, pharmacology	Pediatrics	Blog	2014/07/09
Pediatric pertussis algorithm	PDF	Pulmonary, critical care	Pediatrics	Blog	2010/10/29
Pediatric sizes and doses	PDF		Pediatrics	Blog	2010/10/23
Pericarditis	PDF	Cardiovascular		Blog	2015/02/05
Pertussis	PDF	Pulmonary, critical care	Bayes	Blog	2010/09/03
PESI score for pulmonary embolism	PDF	Pulmonary, critical care		Blog	2012/11/17
Pneumonia scores	PDF	Pulmonary, critical care		Blog	2011/02/25
Post-exposure prophylaxis, non-occup	PDF	Infectious disease		Blog	2011/04/01
Procedural sedation	PDF	Toxicology, pharmacology		Blog	2010/08/06
Rapid sequence intubation	PDF	Toxicology, pharmacology		Blog	2010/07/16
Rashes, approach to	PDF	Dermatology		Blog	2011/08/26
Red eye	PDF	Ophthalmology		Blog	2010/01/22
Salicylate toxicity	PDF	Toxicology, pharmacology		Blog	2015/06/15
Scaphoid fracture	PDF	Orthopedics		Blog	2016/02/01
Seizure, first time	PDF	Neurology		Blog	2011/01/13
Seizure, status epilepticus	PDF	Neurology		Blog	2011/01/20
Septic arthritis	PDF	Orthopedics	Bayes	Blog	2010/06/11
Serotonin syndrome	PDF	Toxicology, pharmacology		Blog	2012/01/06
Sgarbossa criteria for LBBB	PDF	Cardiovascular	Bayes	Blog	2010/11/05
Shift feedback card	PDF	Education		Blog	2011/12/09
Shock and RUSH protocol	PDF	Cardiovascular		Blog	2009/12/22
Shock, vasopressors and inotropes	PDF	Cardiovascular		Blog	2010/04/30
Shoulder exam	PDF	Orthopedics		Blog	2011/01/28
Spinal epidural abscess	PDF	Neurology		Blog	2011/08/05
Streptococcal pharyngitis	PDF	ENT		Blog	2010/07/30
Stroke scale NIH	PDF	Neurology		Blog	2010/02/26
Stroke: Contraindications for Thrombolytics	PDF	Neurology		Blog	2013/05/23
Subarachnoid hemorrhage, atraumatic	PDF	Neurology		Blog	2010/03/05
Subarachnoid hemorrhage, high risk	PDF	Neurology		Blog	2010/12/17
Suicide risk stratification	PDF	Psychiatry		Blog	2011/02/18
Supraventricular Tachycardia (SVT) Aberrancy vs Ventricular Tachycardia (VT): Brugada Criteria	PDF	Cardiovascular		Blog	2013/02/27
Suture materials	PDF	Surgery, trauma		Blog	2011/01/07
Tachycardia, approach to	PDF	Cardiovascular		Blog	2011/08/19
TIMI score	PDF	Cardiovascular		Blog	2010/08/27
Toxidromes and vital signs	PDF	Toxicology, pharmacology		Blog	2010/11/19
Transient ischemic attack (TIA)	PDF	Neurology		Blog	2010/01/05
Ultrasound: 1st Trimester Pregnancy (Transabdominal)	PDF	Gynceology, obstetrics		Blog	2015/02/25
Ultrasound: 1st Trimester Pregnancy (Transvaginal)	PDF	Gynceology, obstetrics		Blog	2015/03/04
Ultrasound: Abdominal Aorta	PDF	Radiology		Blog	2014/09/13
Ultrasound: Biliary Exam	PDF	Gastroenterology		Blog	2015/01/01
Ultrasound: Deep Vein Thrombosis (DVT)	PDF	Cardiovascular		Blog	2015/02/18
Ultrasound: FAST	PDF	Radiology		Blog	2014/09/14
Ultrasound: Focused Echocardiography	PDF	Cardiovascular		Blog	2015/02/11
Ultrasound: Lung Exam	PDF	Pulmonary, critical care		Blog	2015/02/04
Ultrasound Measurements: Normal Values	PDF	Radiology	Ultrasound	Blog	2015/10/15
Ultrasound: Ocular Exam	PDF	Ophthalmology		Blog	2015/01/28
Ultrasound: Skin and Soft Tissue	PDF	Dermatology		Blog	2015/01/07
Ultrasound: Testicular Exam	PDF	Genitourinary		Blog	2015/01/21
Upper GI bleed	PDF	Gastroenterology	Bayes	Blog	2011/06/17
Urine toxicology	PDF	Toxicology, pharmacology	Diagnostic	Blog	2010/07/22
UTI, cystitis	PDF	Genitourinary		Blog	2010/02/11
VBG versus ABG	PDF	Pulmonary, critical care		Blog	2013/01/31
Ventilator settings: Lung protection	PDF	Pulmonary, critical care		Blog	2011/10/14
Ventilator settings: Obstructive disease	PDF	Pulmonary, critical care		Blog	2011/10/21

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Paucis Verbis: GRACE score for ACS risk stratification

Risk stratification of the undifferentiated chest pain patients in the Emergency Department continues to plague emergency physicians. It’s partly the reason why I created a TIMI risk score card for unstable angina and non-ST elevation MI in 2010.
Have you heard of the 9-variable GRACE risk stratification score? Thanks to Jeff Bray (physician assistant in a rural critical access ED), I have now. He graciously shared his personal reference card on this with me, which I only minimally reformatted to fit my Paucis Verbis card dimensions.

GRACE stands for Global Registry for Acute Coronary Events. It supposedly outperforms the TIMI scoring slightly in accurately predicting complications in the short and long term. Instead of calculating this manually, which can be a pain, now there are calculators out there:

Anyone use this scoring system?

PV Card: GRACE Risk Score for ACS

Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

References

Eagle K, Lim M, Dabbous O, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291(22):2727-2733. [PubMed]
D’Ascenzo F, Biondi-Zoccai G, Moretti C, et al. TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: a meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. Contemp Clin Trials. 2012;33(3):507-514. [PubMed]

By Michelle Lin, MD|2021-10-10T19:05:05-07:00Apr 13, 2012|ALiEM Cards, Cardiovascular|

Paucis Verbis: Kawasaki Disease

Kawasaki Disease can be easy to diagnose when you have the pediatric patient, who presents with all 5 of the classic clinical findings. What happens when you have the prerequisite fever for ≥5 days, but only 2-3 clinical criteria?

What ARE the 5 classic findings?
When do you do waitful watching?
When do you perform an echo?
When do you treat empirically?

Check out the nice flowchart below which addresses these questions. They summarize the most recent (2004) American Heart Association’s consensus group’s recommendations.

PV Card: Kawasaki Disease (AHA 2004)

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

Newburger J, Takahashi M, Gerber M, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-2771. [PubMed]

By Michelle Lin, MD|2021-10-10T19:08:53-07:00Mar 23, 2012|ALiEM Cards, Cardiovascular, Pediatrics|

Paucis Verbis: Continuous Infusions

I have always been envious of the residents who carry around the Continuous Infusions cheat-sheet card, which was created by the UCSF Critical Care Units as part of a campaign for Safe Medication Prescriptions. I want one! So I finally managed to wrangle one away for a few minutes and xerox copy it. Here is the abbreviated card, after paring down the list to just ED-focused medications.

PV Card: Continuous Infusions

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-10T19:14:04-07:00Mar 9, 2012|ALiEM Cards, Tox & Medications|

Paucis Verbis: Anaphylaxis

Anaphylaxis is one of the most under-appreciated and under-treated conditions in the Emergency Department. A common misperception is that you need hypotension to diagnose it. Below is a brief summary of the diagnostic criteria and ED treatment protocol. Immediate administration of IM epinephrine is critical.

A major challenge is deciding which patients can go home and which need to be admitted, because of the risk of “rebound” or a biphasic anaphylactic response. This may occur as late as 72 hours later, but typically occur within the first 24 hours. There isn’t a good answer for this.

What’s your practice in dispositioning these patients? Personally, I admit at least those patients who present with severe hypotension, require more than 1 epinephrine dose, or have poor social support.

NOTE: Unlike the photo on the top, warn patients NOT to rest their thumb on the device because of the risk inadvertent needle puncture.

PV Card: Anaphylaxis

Adapted from [1, 2]
Go to ALiEM (PV) Cards for more resources.

References

Arnold J, Williams P. Anaphylaxis: recognition and management. Am Fam Physician. 2011;84(10):1111-1118. [PubMed]
Simons FER. Anaphylaxis. Journal of Allergy and Clinical Immunology. 2010;125(2):S161-S181. doi: 10.1016/j.jaci.2009.12.981

By Michelle Lin, MD|2021-10-10T19:17:26-07:00Feb 24, 2012|ALiEM Cards, Allergy-Immunology|

Paucis Verbis: Pediatric fever without a source (3 mo-3 yr)

In part 3 of this “Pediatric Fever Without a Source” Paucis Verbis cards, we now cover febrile infants 3 months to 3 years old (PV cards for birth-28 days and 29 days-3 months old).

Notes:

The algorithm below is a guideline for NON-toxic patients. More ill-appearing children require a more broad workup.
For the under-immunized (<2 PCV immunizations) and temperature ≥39.5C, blood cultures may be falling out of favor in the near future, because the incidence of blood culture contaminants is close to exceeding the true incidence of occult bacteremia.

PV Card: Pediatric Fever Without a Source (3 Months-3 Years)

Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.

By Michelle Lin, MD|2021-10-11T15:10:11-07:00Feb 10, 2012|ALiEM Cards, Pediatrics|

Paucis Verbis: Fever without a source (29 days-3 months old)

In part 2 of this “Pediatric Fever Without a Source” Paucis Verbis cards, we now cover febrile infants aged 29 days to 3 months (PV card for birth-28 days). Note that there is no single correct answer in how to manage these patients. There can be a wide variation in practices, partly because of the slightly different criteria used by the 3 studies. The overarching principle is that “high risk” infants get admitted with IV ceftriaxone and “low risk” infants get discharged with close follow-up +/- a ceftriaxone IV or IM dose. The line between these two risk categories is the grey area.

Where I practice, we tend to follow a modified version of the Rochester criteria, where a lumbar puncture and antibiotics aren’t always required for this age group (unlike the Boston criteria).

PV Card: Pediatric Fever Without a Source (29 Days-3 Months)

Go to ALiEM (PV) Cards for more resources.

Keep a lookout for future PV cards which will address fevers without a source in pediatric patients aged 3 months-3 years old.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.

By Michelle Lin, MD|2021-12-21T13:34:31-08:00Feb 3, 2012|ALiEM Cards, Pediatrics|

Paucis Verbis: Pediatric fever without a source (Birth-28 days)

Pediatric patients commonly are brought to the Emergency Department for a fever without a source. Management of these patients depends on the patient’s age. Today’s PV card focuses on the youngest age group: Birth-to-28 days.

QUESTION to everyone:

Do you correct your age calculation for prematurity? Premature neonates are more at risk for SBI, but I’ve seen varying practices.

PV Card: Pediatric Fever Without a Source (Birth-28 Days Old)

Go to ALiEM (PV) Cards for more resources.

Keep a lookout for future PV cards which will address fevers without a source in pediatric patients aged 29 days-3 months and 3 months-3 years old.

Thanks to Dr. Hemal Kanzaria (UCSF-SFGH resident) for helping design this PV card and Dr. Christine Cho, Dr. Andi Marmor, and Dr. Ellen Laves (UCSF Pediatrics) for the content.

By Michelle Lin, MD|2021-10-11T15:15:20-07:00Jan 27, 2012|ALiEM Cards, Pediatrics|

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