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 card: Rapid Sequence Intubation

The key to success in performing procedures is preparation. This is especially true for endotracheal intubations in the Emergency Department where things are chaotic. Strategic planning and anticipation of obstacles during rapid sequence intubation (RSI) are key principles to avoiding complications.

PV Card: Rapid Sequence Intubation

Go to ALiEM (PV) Cards for more resources.

By Demian Szyld, MD EdM|2021-10-18T10:19:45-07:00Jul 16, 2010|ALiEM Cards, Tox & Medications|

Paucis Verbis card: Penetrating abdominal trauma

When I did my residency training in Emergency Medicine and in the first few years as an attending, we regularly performed diagnostic peritoneal lavages in patients with stab wounds injuries to the abdomen. Patients also routinely went to the operating room for exploration.

Now with the evolution of CT imaging technology and more clinical studies, there is now a role for a less invasive management approach. These are the Eastern Association for the Surgery of Trauma (EAST) guidelines.

PV Card: Penetrating Abdominal Trauma

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

Reference

Como JJ, Bokhari F, Chiu WC, et al. Practice Management Guidelines for Selective Nonoperative Management of Penetrating Abdominal Trauma. The Journal of Trauma: Injury, Infection, and Critical Care. 2010;68(3):721-733. doi: 10.1097/ta.0b013e3181cf7d07

By Michelle Lin, MD|2021-10-18T10:21:39-07:00Jul 9, 2010|ALiEM Cards, Trauma|

Paucis Verbis card: Burn Wounds

Burn classification and management are key skills for ED providers to remember. Depending on the prevalence of burns in your ED, it may be hard for forget the details. So here is a PV reference card on the rule of 9’s, different classifications of burns, and indications for burn unit referral.

Update (April 22, 2016): This card was updated by Dr. Christian Rose (UCSF-SFGH) to reflect current evidence that topical antibiotics and honey are IN, while silver sulfadiazine is OUT for partial-thickness burns.

PV Card: Burn Wounds

Adapted from [1-3]
Go to ALiEM (PV) Cards for more resources.

References

Gómez R, Cancio L. Management of burn wounds in the emergency department. Emerg Med Clin North Am. 2007;25(1):135-146. [PubMed]
Malik K, Malik M, Aslam A. Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns. Int Wound J. 2010;7(5):413-417. [PubMed]
Jull A, Cullum N, Dumville J, Westby M, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2015;(3):CD005083. [PubMed]

By Michelle Lin, MD|2021-10-18T10:23:37-07:00Jul 2, 2010|ALiEM Cards, Dermatology, Trauma|

Paucis Verbis card: Ascites assessment with paracentesis

A paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP).

Do you check coagulation studies before performing the procedure?
How comfortable do you feel that the patient has SBP with an ascites WBC > 500 cells/microliter or ascites PMN > 250 cells/microliter?

This installment of the Paucis Verbis (In a Few Words) e-card series provides an evidence-based review of the literature on topics related to the paracentesis procedure. Especially helpful is the pooled data of likelihood ratios. Like most everything in medicine, a lab test should be used in conjunction with your pretest probability in clinical decision making, and LR’s help with with this.

PV Card: Ascites and Paracentesis

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

Reference

Wilkerson RG, Sinert R. The Use of Paracentesis in the Assessment of the Patient With Ascites. Annals of Emergency Medicine. 2009;54(3):465-468. doi: 10.1016/j.annemergmed.2008.09.005

By Michelle Lin, MD|2021-10-18T10:26:22-07:00Jun 25, 2010|ALiEM Cards, Gastrointestinal|

Paucis Verbis card: Appendicitis – ACEP Clinical Policy

Appendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms and WBC lab results. Given the risk of ionizing radiation with CT scans, we should ideally minimize the number of CT scans ordered in these patients without mistakenly sending patients home with an early appendicitis. A perforated appendix places the patient at risk for bowel obstruction, infertility (in women), and sepsis.

Where does the American College of Emergency Physicians (ACEP) stand on the critical issues surrounding the evaluation of appendicitis?

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the ACEP Clinical Policy on Appendicitis. In the end, the policy conjures up more questions than answers, but a comprehensive presentation of the literature to date and helpful risk-stratification data are provided.

PV Card: ACEP Clinical Policy on Appendicitis

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

Reference

Howell J, Eddy O, Lukens T, et al. Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med. 2010;55(1):71-116. [PubMed]

By Michelle Lin, MD|2021-10-18T10:28:05-07:00Jun 18, 2010|ALiEM Cards, Gastrointestinal|

Paucis Verbis card: Septic Arthritis

In the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks “Does this patient have septic arthritis?” Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint.

I was surprised to learn that only about 50% of patients with septic joints have a fever. Note that a hip or knee prosthesis PLUS an overlying skin infection pretty much equals a septic joint (LR = 15.0).

Risk factors are listed in the table with the corresponding sensitivities, specificities, and likelihood ratios.

PV Card: Septic Arthritis

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-19T19:42:49-07:00Jun 11, 2010|ALiEM Cards, Infectious Disease, Orthopedic|

PV Card: Dermatomal and Myotomal Maps

There are some things in life which I just can’t memorize and dermatomal/myotomal maps are one of them. Weird cases of peripheral neurologic symptoms have presented to the ED in the setting of trauma and no trauma. So purely for selfish reasons, I’m making my own map to have on file.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews Sensory and Motor Function Testing by Levels.

PV Card: Dermatomal and Myotomal Maps

Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-08T09:42:25-07:00May 28, 2010|ALiEM Cards, Neurology, Orthopedic|

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