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: International Registry on Aortic Dissection (IRAD)

What do these 3 people have in common?

Lucille Ball (comedienne)
Jonathan Larson (wrote the musical “Rent”)
John Ritter (comedian)

They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with dissections.

I find this list helpful, because it illustrates the fact that the classic signs and symptoms aren’t actually very common. Here are some scary examples:

A pulse deficit in the carotid, brachial, and femoral arteries is only present 15% of the time.
A tearing or ripping quality of pain is present in only 50% of patients.
Not all patients have a widened mediastinum or abnormal aortic contour (only 78.7%).

PV Card: Aortic Dissection

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

Reference

Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD). JAMA. 2000;283(7):897. doi: 10.1001/jama.283.7.897

By Michelle Lin, MD|2021-10-13T08:51:53-07:00May 20, 2011|ALiEM Cards, Cardiovascular|

Paucis Verbis: Head CT clinical decision rules in trauma

The ideal clinical decision tool has a sensitivity and specificity of 100%.

You need a high sensitivity to be sure that your negative result indeed predicts a true negative. That means if your clinical decision tool suggests that you don’t need to get a head CT, then your head CT would have been normal.

On the flip side, this realistically means there is a low-moderate specificity. That means a clinical decision tool with at least 1 positive criterion does not always mean that there will be an abnormal finding on head CT.

There are 3 major clinical decision rules that I’ve heard tossed around in the literature:

Canadian CT Head Rules (CCHR)
New Orleans Criteria (NOC)
National Emergency X-Radiography Utilization Study (NEXUS)-II

There is no perfect tool.

Take a look at these decision rules and their inclusion criteria.

The CCHR included patients with GCS 13-15. The NOC initially enrolled only patients with a GCS of 15.
All factor in age (≥65 years for CCHR and NEXUS-II; ≥60 years for NOC).
Interestingly only the CCHR, for better or worse, take into account mechanism of injury. I’m not sure I would obtain a head CT on a pedestrian with a graze wound on the foot from a slow-moving vehicle.

Which do you use? I use a combination of all 3 and my clinical gestalt.

PV Card: Head CT in Trauma – Clinical Decision Tools

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-15T10:59:57-07:00May 13, 2011|ALiEM Cards, Radiology, Trauma|

Paucis Verbis: Brugada syndrome

You always hear about it when working up syncope and sudden cardiac arrest in young patients, but it’s so easy to forget what it looks like on ECG. We so rarely see it… or DO we?!

This Paucis Verbis card on Brugada Syndrome is to help emblazon these ECG tracings in our mind, so that we don’t miss the subtle findings which place a patient at risk for sudden cardiac death. Pay special attention to Type 1, which is most specific for Brugada Syndrome.

PV Card: Brugada Syndrome

* Update 8/2/18: Only Type 1 and Type 2 are recognized for Brugada syndrome. The type 3 pattern is likely a normal variant.

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

Reference

Antzelevitch C. Brugada Syndrome: Report of the Second Consensus Conference: Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation. 2005;111(5):659-670. doi:10.1161/01.cir.0000152479.54298.51

By Michelle Lin, MD|2021-10-15T11:04:55-07:00May 6, 2011|ALiEM Cards, Cardiovascular, ECG|

Paucis Verbis: Asthma classification

Emergency physicians have the opportunity to educate patients and prescribe chronic inhaled corticosteroids to patients who should be on these medications chronically. Patients may be more receptive to education and advice given immediately after an asthma exacerbation, managed in the ED. Using the National Institute of Health/ National Asthma Education and Prevention Program classification system, physicians can quickly determine if the patient is a candidate for inhaled corticosteroids and initiate therapy accordingly.

PV Card: Asthma Classification system

In short, patients can be classified into one of 4 classes: intermittent, mild persistent, moderate persistent, and severe persistent asthma. Patients in these classes should receive either Step 1, 2, 3, or 4/5 medications, respectively. I remember that patient using daily short-acting beta agonists (SABA) belong to the moderate persistent asthma category.

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-15T11:08:17-07:00Apr 29, 2011|ALiEM Cards, Pulmonary|

Paucis Verbis: Dental infections

To follow up with the wildly popular Paucis Verbis card made by Dr. Hans Rosenberg (University of Ottawa), here is his card on Dental Infections. This card summarizes common dental infection complaints (like the periapical abscess seen to the right) that we see in the Emergency Department.

PV Card: Dental Infections

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

Reference

Nguyen D, Martin J. Common dental infections in the primary care setting. Am Fam Physician. 2008;77(6):797-802. [PubMed]

By Michelle Lin, MD|2021-10-15T11:10:29-07:00Apr 22, 2011|ALiEM Cards, Dental|

Paucis Verbis: Dental trauma

How cool is this — I have talented emergency physicians contributing Paucis Verbis card content! This week features excellent pearls on Dental Trauma by Dr. Hans Rosenberg (University of Ottawa). Here’s his recent article in Annals of EM on reimplantation of avulsed teeth.¹

PV Card: Dental Trauma

Go to ALiEM (PV) Cards for more resources.

Reference

Rosenberg H, Rosenberg H, Hickey M. Emergency management of a traumatic tooth avulsion. Ann Emerg Med. 2011;57(4):375-377. [PubMed]

By Michelle Lin, MD|2021-10-15T11:15:07-07:00Apr 15, 2011|ALiEM Cards, Dental|

Paucis Verbis: AMI and ECG Geography

Sometimes a picture is worth MORE than a 1000 words. Such is the case of the above illustration that I saw on the Life In The Fast Lane blog. When I first saw it, I knew that I immediately had to find out who made the graphic. It turns out it is the multitalented Dr. Tor Ercleve, who is an emergency physician at Sir Charles Gairdner Hospital and an established medical illustrator.

This graphic demonstrates the EKG findings for the various types of acute MI’s as broken down by coronary vascular anatomy (right coronary artery, left circumflex artery, left anterior descending artery). This detailed illustration won’t be readable in print form but is great in digital format on your mobile device.

Thanks, Tor!

[PDF]

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-15T11:17:43-07:00Apr 8, 2011|ALiEM Cards, Cardiovascular, ECG|

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