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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PV Card: Ankle and Hindfoot Fractures | Quick Reference Guide

Orthopedic fractures and injuries are commonly managed in the emergency department. Often a quick bedside reference card is needed to remind the clinician about the acute management and follow-up instructions. Thanks to the efforts of a 2015-16 ALiEM Chief Resident Incubator team, we are pleased to announce the first of these reference cards. Ankle and hindfoot fractures covered include ankle malleolar fractures, talus, and calcaneus fractures. These cards were expert reviewed by Dr. Scott Sherman, co-editor of the Emergency Orthopedics textbook and illustrations were created by Dr. Mary Haas.

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By Layla Abubshait, MD|2021-10-04T09:45:52-07:00Jun 6, 2016|ALiEM Cards, Orthopedic|

PV Card: Adult scaphoid fracture

$snuffbox tenderness scaphoid fracture$ What is the most commonly fractured carpal bone in adults? It’s the scaphoid bone. As a bonus it has the dreaded complication of avascular necrosis. So how good are the physical exam and imaging modalities in diagnosing a fracture? What is the likelihood ratio (LR) that snuffbox tenderness predicts a fracture? Bottom lines: The exam is highly sensitive but poorly specific, such that one can only confidently state that a NON-tender snuffbox and scaphoid tubercle essentially rule out an acute scaphoid fracture. Also negative x-rays for patients with scaphoid tenderness still yield a fracture post-test probability of 25%. This PV card breaks down all the LRs.¹

PV Card: Scaphoid Fracture

Adapted from ¹

Reference

Carpenter C, Pines J, Schuur J, Muir M, Calfee R, Raja A. Adult scaphoid fracture. Acad Emerg Med. 2014;21(2):101-121. [PubMed]

By Sean Kivlehan, MD MPH|2021-10-04T09:47:50-07:00Feb 1, 2016|ALiEM Cards, Orthopedic|

PV Card: Initial Pain Medication Options in the Emergency Department

The emergency department (ED) manages acute pain on a daily basis, ranging from non-traumatic back pain to traumatic fractures. Some providers jump immediately to opioids without considering other non-opioid alternatives or start at incorrect doses. In the age of the opioid epidemic (ALiEM-Annals of EM journal club; bookclub discussing Dreamland) and medication errors, choosing the initial right agent(s) and dose(s) are important. Dr. Nick Koch and Dr. Sergey Motov (@PainFreeED) from Maimonides Medical Center present a thoughtful, evidence-based PV reference card on selecting and dosing initial pain medications for ED patients. Also congratulations to Dr. Motov and his team for their recent 2015 Annals of EM publication¹ on subdissociative dose ketamine for analgesia.

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By Michelle Lin, MD|2021-10-04T09:52:20-07:00Oct 23, 2015|ALiEM Cards, Tox & Medications|

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

For many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end tidal capnography, providers have access to so much more information during a cardiac arrest resuscitation, as summarized by the recently released 2015 American Heart Association (AHA) recommendations.¹ Thanks to Dr. Abdullah Bakhsh from Emory University for a great PV card to help remind us of these key cardiac resuscitation pearls.

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

Adapted from [1-4]

References

Link M, Berkow L, Kudenchuk P, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. [PubMed]
Ahrens T, Schallom L, Bettorf K, et al. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care. 2001;10(6):391-398. [PubMed]
Silvestri S, Ralls G, Krauss B, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005;45(5):497-503. [PubMed]
Kleinman M, Brennan E, Goldberger Z, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S414-35. [PubMed]

By Michelle Lin, MD|2021-10-19T19:25:31-07:00Oct 20, 2015|ALiEM Cards, Cardiovascular, Critical Care/ Resus|

PV Card: Normal Values for Ultrasound Measurements

As emergency medicine providers become more proficient in using bedside ultrasonography as a diagnostic tool, it can be difficult to remember all of the normal cutoff values. Is it 3 or 5 mm as the cutoff? Thanks to the team at UCSF (Dr. Maria Beylin, Dr. Scott Fischette, and Dr. Nate Teismann) for creating a succinct PV card listing the key numbers to remember. You can download this PV card into your mobile device as a reference guide, or you can even print and attach to each of your ultrasound machines!

PV Card: Normal Values for Ultrasound Measurements

Adapted from [1–4]

References

Horrow M. Ultrasound of the extrahepatic bile duct: issues of size. Ultrasound Q. 2010;26(2):67-74. [PubMed]
Beigel R, Cercek B, Luo H, Siegel R. Noninvasive evaluation of right atrial pressure. J Am Soc Echocardiogr. 2013;26(9):1033-1042. [PubMed]
Doubilet P, Benson C, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013;369(15):1443-1451. [PubMed]
Adhikari S, Zeger W, Thom C, Fields J. Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity. Ann Emerg Med. 2015;66(3):262-266. [PubMed]

By Michelle Lin, MD|2021-10-04T09:56:16-07:00Oct 15, 2015|ALiEM Cards, Ultrasound|

PV Card: Palliative Care Screening in the Emergency Department

What is Palliative Care? It is specialized medical care focusing on improving the care and quality of life for patients with advanced illness by decreasing suffering. It can be delivered concurrently with curative care. Early identification of patients who are likely to benefit is key. How do you decide whether your patient could benefit from a palliative care consult?

Hot off the presses

We just published in Academic Emergency Medicine a validated screening tool to identify ED patients who would benefit from palliative care [PubMed abstract].¹ In an effort to accelerate knowledge dissemination, the checklist is reproduced here in PV card form. Be sure to check out the thoughtful expert peer review below by Dr. Kate Aberger, who is the chair of the ACEP Palliative Care Section.

PV Card: Palliative Care Screening Tool

Adapted from ^1–3

George N, Barrett N, McPeake L, Goett R, Anderson K, Baird J. Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs. Acad Emerg Med. 2015;22(7):823-837. [PubMed]
Grudzen C, Richardson L, Morrison M, Cho E, Morrison R. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17(11):1253-1257. [PubMed]
Wu F, Newman J, Lasher A, Brody A. Effects of initiating palliative care consultation in the emergency department on inpatient length of stay. J Palliat Med. 2013;16(11):1362-1367. [PubMed]

By Naomi George, MD MPH|2022-01-10T16:49:39-08:00Aug 3, 2015|ALiEM Cards, Expert Peer Reviewed (Clinical), Geriatrics|

Poll : How do you use the PV cards?

In our effort to take the Paucis verbis (PV) card series to the next level, we are interested in knowing how YOU use the cards. We would appreciate your answers to the following 4 questions. Also if you have any comments/suggestions regarding the PV cards and how we can make them better please, use the Comments section.

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By Catherine Patocka, MD MHPE|2017-03-05T14:14:37-08:00Jul 24, 2015|ALiEM Cards|

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