ALiEMCards.com

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” and moved away from the index-card templated PDF files. Check it out.

ALiEM Cards website screenshot

ALiEM Cards home page

Why transition to a new ALiEM Cards site?

We have always tried to keep the user and learner in mind. From a readability, design, and content delivery perspective, our index card look was becoming outdated.

  1. The limited text space negatively impacted our ability to easily convey the content in a clear fashion.
  2. The topics and keywords within each card were not searchable. You just had to know where things were.
  3. PDFs are often large-sized files and not easy to read on mobile devices.
  4. The new ALiEM Cards site incorporates the use of GitHub, which allows for better version control. We can more transparently update and incorporate crowdsourced feedback and peer review. This was not possible with the older PV Cards system.

What will we be stopping?

As part of this transition period, we are announcing the following:

  1. No more new content will be written in the PDF format.
  2. We are closing out the Evernote and Dropbox shared account options.

Index of Topics

TopicPDFMajor SubjectMinor SubjectBlog pageDate
Abdominal pain, diagnostic studiesPDFSurgery, traumaDiagnosticsBlog2011/07/22
Abdominal trauma, blunt (likelihood ratios)PDFSurgery, traumaBayesBlog2012/04/20
Abdominal trauma, penetratingPDFSurgery, traumaBlog2010/07/09
ABG interpretationPDFPulmonary, critical careDiagnosticsBlog2010/04/02
Acetaminophen toxicityPDFToxicology, pharmacologyBlog2011/11/04
Acute limb ischemiaPDFCardiovascularBlog2010/08/13
Acute vestibular syndrome and HINTS examPDFNeurologyBlog2011/12/02
Alcohol: Ethylene glycolPDFToxicology, pharmacologyBlog2012/06/08
Alcohol: Isopropyl alcoholPDFToxicology, pharmacologyBlog2012/06/22
Alcohol: MethanolPDFToxicology, pharmacologyBlog2012/06/15
AnaphylaxisPDFAllergy, ImmunologyBlog2012/02/24
AngioedemaPDFAllergy, ImmunologyBlog2010/03/26
Ankle and Hindfoot FracturesPDFOrthopedicsBlog2016/06/06
Ankle fracturesPDFOrthopedicsBlog2010/02/18
Anticoagulation for atrial fibrillationPDFCardiovascularBlog2010/04/09
Aortic dissection (IRAD)PDFCardiovascularBlog2011/05/20
Appendicitis: ACEP clinical policyPDFSurgery, traumaBlog2010/06/18
Asthma NIH classificationsPDFPulmonary, critical careBlog2011/04/29
Bayes nomogramPDFBayes2012/05/17
Bell’s Palsy: TreatmentPDFNeurologyBlog2013/02/21
Blood culture indicationsPDFInfectious diseaseBayesBlog2012/08/17
Blunt cardiac injuryPDFSurgery, traumaBlog2012/06/29
Brugada syndromePDFCardiovascularBlog2011/05/06
BurnsPDFSurgery, traumaBlog2016/04/22 update (original 7/2/2010)
C1-C2 fracturesPDFOrthopedicsBlog2010/09/24
C3-C7 fracturesPDFOrthopedicsBlog2010/10/01
Cardiac tamponadePDFCardiovascularBayesBlog2011/07/08
Cerebrovascular injury, bluntPDFSurgery, traumaBlog2011/07/01
Cervical spine rulesPDFSurgery, traumaBlog2010/12/10
Cervical spine, distracting injuryPDFSurgery, traumaBlog2011/09/09
Charting and CodingPDFAdministrativeBlog2016/08/15
Chemical sedationPDFToxicology, pharmacologyBlog2011/03/25
Chest pain, low risk ACSPDFCardiovascularBlog2010/01/29
CHF likelihood ratiosPDFCardiovascularBayesBlog2012/08/24
Cholecystitis testsPDFSurgery, traumaBayesBlog2011/03/18
Clostridium difficilePDFInfectious diseaseBlog2011/06/24
CNS infectionsPDFNeurologyBlog2009/12/29
Continuous end tidal CO2 monitoring in cardiac arrestPDFPulmonary, Critical CareBlog2015/10/20
Continuous infusionsPDFToxicology, pharmacologyBlog2012/03/09
CroupPDFPediatricsBlog2010/08/20
CT cancer riskPDFRadiologyBlog2011/06/10
Cystitis/Pyelonephritis Women AntibioticsPDFGenitourinaryBlog2011/09/02
D-dimerPDFHematology, oncologyDiagnosticsBlog2012/07/12
Delayed sequence intubationPDFAirway, pulmonaryBlog2012/08/31
Dental infectionsPDFENTBlog2011/04/22
Dental traumaPDFENTBlog2011/04/15
Dermatomes and myotomesPDFNeurologyAnatomyBlog2010/05/28
Diabetic foot osteomyelitisPDFOrthopedicsBayesBlog2011/09/23
Diverticulitis outpatientPDFSurgery, traumaBlog2011/05/27
Drug Card Emergency DepartmentPDFToxicology, pharmacologyBlog2013/09/11
DVT Diagnostic Guidelines (ACCP)PDFCardiovascularBlog2013/01/24
DysphagiaPDFENTBlog2010/02/03
Early goal directed therapy in sepsisPDFInfectious diseaseBlog2010/04/16
ECG: Early repolarization vs STEMIPDFCardiovascularBlog2013/05/16
ECG: Electrolyte imbalancePDFCardiovascular, EndocrineBlog2012/09/21
ECG: Geography of AMIPDFCardiovascularDiagnosticBlog2011/04/08
ECG: Lead aVRPDFCardiovascularDiagnosticBlog2011/11/18
ECG: Right and posterior leadsPDFCardiovascularDiagnosticBlog2011/03/11
Ectopic PregnancyPDFObstetrics/gynecologyBayesBlog2013/05/09
EMTALA rules in the transfer of ED patientsPDFAdministrativeBlog2012/09/14
Genital ulcersPDFGenitourinaryBlog2012/05/04
GRACE scorePDFCardiovascularBlog2012/04/13
Head CT before LPPDFNeurologyBlog2010/04/23
Head CT in trauma: Decision rulesPDFSurgery, traumaBlog2011/05/13
HyperkalemiaPDFEndocrine, metabolicBlog2010/03/12
Hypertension: First line treatmentPDFCardiovascularBlog2011/02/11
Hypothermia, accidentalPDFEnvironmentalBlog2011/02/04
Influenza treatmentPDFInfectious diseaseBlog2011/10/28
Intimate partner violencePDFTraumaBlog2013/07/31
Intraosseous lab interpretationPDFHematology, oncologyDiagnosticsBlog2012/01/13
IV fluid composition and Chloride-restrictive fluids in ICUPDFEndocrine, metabolicBlog2012/01/03
Kawasaki diseasePDFPediatricsBlog2012/03/23
Knee examPDFOrthopedicsBlog2010/03/19
Laceration repair and suturesPDFTraumaBlog2017/03/06
Legionnaires diseasePDFPulmonary, critical careBlog2011/09/16
Local anesthetic toxicityPDFToxicology, pharmacologyBlog2014/06/13
Metacarpal fracturePDFOrthopedicsBlog2013/12/13
Methotrexate and ectopic pregnancyPDFGynecology, obstetricsBlog2011/11/11
Murmurs and need for echocardiographyPDFCardiovascularBlog2010/09/17
Neutropenic fever and cancerPDFInfectious diseaseBlog2011/10/07
NSAID bleeding riskPDFToxicology, pharmacologyBlog2011/07/15
One minute preceptor: NERDS mnemonicPDFEducationBlog2015/08/01
Open fractures and antibioticsPDFOrthopedicsBlog2012/01/20
Osmolal gapPDFToxicology, pharmacologyBlog2012/06/01
Ottawa knee, ankle, foot rulesPDFOrthopedicsBlog2010/05/07
Overanticoagulation and supratherapeutic INRPDFHematology, oncologyBlog2012/08/10
Pain medications: Initial options in the EDPDFToxicologyBlog2015/10/23
Palliative Care Screening in the EDPDFPalliative CareBlog2015/07/27
Paracentesis and ascites assessmentPDFGastroenterologyBlog2010/06/25
PE clinical decision rulesPDFPulmonary, critical careBlog2011/06/03
PE indications for fibrinolysisPDFPulmonary, critical careBlog2011/07/29
Pediatric assessment trianglePDFPediatricsBlog2013/05/30
Pediatric fever (1-3 months old)PDFInfectious diseasePediatricsBlog2012/02/02
Pediatric fever (3 mo- 3 yrs old)PDFInfectious diseasePediatricsBlog2012/02/09
Pediatric fever (neonate)PDFInfectious diseasePediatricsBlog2012/01/27
Pediatric head trauma (PECARN)PDFSurgery, traumaPediatricsBlog2010/02/04
Pediatric ingestion dose thresholds for ED referralPDFToxicology, pharmacologyPediatricsBlog2014/07/09
Pediatric pertussis algorithmPDFPulmonary, critical carePediatricsBlog2010/10/29
Pediatric sizes and dosesPDFPediatricsBlog2010/10/23
PericarditisPDFCardiovascularBlog2015/02/05
PertussisPDFPulmonary, critical careBayesBlog2010/09/03
PESI score for pulmonary embolismPDFPulmonary, critical careBlog2012/11/17
Pneumonia scoresPDFPulmonary, critical careBlog2011/02/25
Post-exposure prophylaxis, non-occupPDFInfectious diseaseBlog2011/04/01
Procedural sedationPDFToxicology, pharmacologyBlog2010/08/06
Rapid sequence intubationPDFToxicology, pharmacologyBlog2010/07/16
Rashes, approach toPDFDermatologyBlog2011/08/26
Red eyePDFOphthalmologyBlog2010/01/22
Salicylate toxicityPDFToxicology, pharmacologyBlog2015/06/15
Scaphoid fracturePDFOrthopedicsBlog2016/02/01
Seizure, first timePDFNeurologyBlog2011/01/13
Seizure, status epilepticusPDFNeurologyBlog2011/01/20
Septic arthritisPDFOrthopedicsBayesBlog2010/06/11
Serotonin syndromePDFToxicology, pharmacologyBlog2012/01/06
Sgarbossa criteria for LBBBPDFCardiovascularBayesBlog2010/11/05
Shift feedback cardPDFEducationBlog2011/12/09
Shock and RUSH protocolPDFCardiovascularBlog2009/12/22
Shock, vasopressors and inotropesPDFCardiovascularBlog2010/04/30
Shoulder examPDFOrthopedicsBlog2011/01/28
Spinal epidural abscessPDFNeurologyBlog2011/08/05
Streptococcal pharyngitisPDFENTBlog2010/07/30
Stroke scale NIHPDFNeurologyBlog2010/02/26
Stroke: Contraindications for ThrombolyticsPDFNeurologyBlog2013/05/23
Subarachnoid hemorrhage, atraumaticPDFNeurologyBlog2010/03/05
Subarachnoid hemorrhage, high riskPDFNeurologyBlog2010/12/17
Suicide risk stratificationPDFPsychiatryBlog2011/02/18
Supraventricular Tachycardia (SVT) Aberrancy vs Ventricular Tachycardia (VT): Brugada CriteriaPDFCardiovascularBlog2013/02/27
Suture materialsPDFSurgery, traumaBlog2011/01/07
Tachycardia, approach toPDFCardiovascularBlog2011/08/19
TIMI scorePDFCardiovascularBlog2010/08/27
Toxidromes and vital signsPDFToxicology, pharmacologyBlog2010/11/19
Transient ischemic attack (TIA)PDFNeurologyBlog2010/01/05
Ultrasound: 1st Trimester Pregnancy (Transabdominal)PDFGynceology, obstetricsBlog2015/02/25
Ultrasound: 1st Trimester Pregnancy (Transvaginal)PDFGynceology, obstetricsBlog2015/03/04
Ultrasound: Abdominal AortaPDFRadiologyBlog2014/09/13
Ultrasound: Biliary ExamPDFGastroenterologyBlog2015/01/01
Ultrasound: Deep Vein Thrombosis (DVT)PDFCardiovascularBlog2015/02/18
Ultrasound: FASTPDFRadiologyBlog2014/09/14
Ultrasound: Focused EchocardiographyPDFCardiovascularBlog2015/02/11
Ultrasound: Lung ExamPDFPulmonary, critical careBlog2015/02/04
Ultrasound Measurements: Normal ValuesPDFRadiologyUltrasoundBlog2015/10/15
Ultrasound: Ocular ExamPDFOphthalmologyBlog2015/01/28
Ultrasound: Skin and Soft TissuePDFDermatologyBlog2015/01/07
Ultrasound: Testicular ExamPDFGenitourinaryBlog2015/01/21
Upper GI bleedPDFGastroenterologyBayesBlog2011/06/17
Urine toxicologyPDFToxicology, pharmacologyDiagnosticBlog2010/07/22
UTI, cystitisPDFGenitourinaryBlog2010/02/11
VBG versus ABGPDFPulmonary, critical careBlog2013/01/31
Ventilator settings: Lung protectionPDFPulmonary, critical careBlog2011/10/14
Ventilator settings: Obstructive diseasePDFPulmonary, critical careBlog2011/10/21




PV Card: Algorithm for acute bronchiolitis management

baby-cough-canstockphoto5283520Bronchiolitis is a common lower respiratory tract infection in children less than 2 years old, and especially in those 3-6 months old. In a collaboration with the American Academy of Pediatrics’ (AAP) Section on Emergency Medicine Committee on Quality Transformation, we present a PV card summarizing the Section’s “Clinical Algorithm for Bronchiolitis in the Emergency Department Setting” (reproduced with permission).1 Dr. Shabnam Jain sums it up best in her expert peer review below: “In bronchiolitis, less is more.”
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PV Card: Introduction to ED Charting and Coding

ED charting and coding computer-charting-TEXT-canstockphoto17902161What makes a good chart? How do you write a good chart quickly? How about a good, efficient, billable chart? On average, residents and practicing physicians report they did not receive adequate training in charting and coding1–3 and resident charts are more often down-coded due to documentation failures than those of attendings and PAs.4 Thankfully, resident education in charting has improved over the past 15 years,5 and a little learning goes a long way to improve confidence6 and competence.7

In the spirit of #FOAMed, we would like to provide some pearls and pitfalls for EM documentation, starting with a PV card that addresses the basic elements of coding a chart. We hope it’s a handy on-shift reference.

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PV Card: Ankle and Hindfoot Fractures | Quick Reference Guide

Ankle and Hindfoot Fractures Talar Neck Hawkins Classification IVOrthopedic 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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PV Card: Adult scaphoid fracture

snuffbox tendernessWhat 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

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2017-08-03T00:34:20-08:00

PV Card: Initial Pain Medication Options in the Emergency Department

backpain_pc_400_clr_2144The 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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2019-01-28T21:42:50-08:00

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

capnographyFor 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.

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2019-01-28T21:43:05-08:00

PV Card: Normal Values for Ultrasound Measurements

Ultrasound-PV-Card-smAs 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!

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2019-01-28T21:43:45-08:00