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

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


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PV Card: Contraindications to Thrombolytics in Stroke

thrombolytics stroke

This Paucis Verbis (PV) card is an updated version of the PV card on Contraindications to Thrombolytics for CVA from September 10, 2010, based on the Stroke 2013 AHA/ASA new guidelines that were just published.1 Some changes include…

  1. There is new mention of new anticoagulants in the market with additional absolute exclusion criteria.
  2. A blood glucose < 50 mg/dL has been upgraded from a relative exclusion to an absolute exclusion criteria. There is no more mention of glucose > 400 mg/dL as an exclusion criteria.
  3. Seizure at onset of presentation has moved from an absolute to a relative risk.
  4. Post-AMI pericarditis is no longer a relative exclusion criteria.

PV Card: Contraindications for Thrombolytics in Stroke


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

Reference

  1. Jauch E, Saver J, Adams H, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947. [PubMed]
By |2021-10-06T19:58:38-07:00May 23, 2013|ALiEM Cards, Neurology, Tox & Medications|

PV card: Early repolarization vs STEMI on ECG

You are handed an ECG for a 50 year old man with moderate chest pain for 2 hours now and no associated symptoms typical for ACS, PE, aortic dissection, or any other red flags of chest pain. He has no prior ECG’s on file.

  • Is this early repolarization or ST elevation MI?
  • Should I activate the cardiac catheterization lab?

Image courtesy of Dr. Steve Smith at HQMedEd-ecg.blogspot.com

Here are some great literature-based pearls compiled by Dr. Jason West (@JWestEM), an EM resident from Jacobi/Montefiore.

PV Card: ECG – Early Repolarization vs ST Elevation MI


Adapted from [1–7]
Go to ALiEM (PV) Cards for more resources.

Furthermore, there is a formula to differentiate early repolarization vs STEMI, per Dr. Smith’s publication6:

(1.196 x STE60V3) + (0.059 x QTc) – (0.326 x RA V4)

  • STE60V3 = STE elevation height at 60 msec (1.5 small boxes) after the J-point in lead V3 (mm)
  • QTc = The computer-read QTc interval
  • RA V4 = R wave amplitude in lead V4 (mm)

A result of > 23.4 is predictive of a LAD occlusion causing a STEMI, rather than early repolarization.

P.S. The above ECG image shows early repolarization.

References

  1. Brady W, Syverud S, Beagle C, et al. Electrocardiographic ST-segment elevation: the diagnosis of acute myocardial infarction by morphologic analysis of the ST segment. Acad Emerg Med. 2001;8(10):961-967. [PubMed]
  2. Brady W, Perron A, Syverud S, et al. Reciprocal ST segment depression: impact on the electrocardiographic diagnosis of ST segment elevation acute myocardial infarction. Am J Emerg Med. 2002;20(1):35-38. [PubMed]
  3. Smith S. Upwardly concave ST segment morphology is common in acute left anterior descending coronary occlusion. J Emerg Med. 2006;31(1):69-77. [PubMed]
  4. Larson D, Menssen K, Sharkey S, et al. “False-positive” cardiac catheterization laboratory activation among patients with suspected ST-segment elevation myocardial infarction. JAMA. 2007;298(23):2754-2760. [PubMed]
  5. Nfor T, Kostopoulos L, Hashim H, et al. Identifying false-positive ST-elevation myocardial infarction in emergency department patients. J Emerg Med. 2012;43(4):561-567. [PubMed]
  6. Smith S, Khalil A, Henry T, et al. Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction. Ann Emerg Med. 2012;60(1):45-56.e2. [PubMed]
  7. Chung S, Lei M, Chen C, Hsu Y, Yang C. Characteristics and prognosis in patients with false-positive ST-elevation myocardial infarction in the ED. Am J Emerg Med. 2013;31(5):825-829. [PubMed]
By |2021-10-08T09:16:44-07:00May 16, 2013|ALiEM Cards, Cardiovascular, ECG|

PV card: Ectopic pregnancy

Ectopic pregnancy is the leading cause of maternal death in the first trimester of pregnancy. A recent JAMA systematic review,1 from The Rational Clinical Examination series, looked to risk-stratify women in early pregnancy presenting with abdominal pain or vaginal bleeding for ectopic pregnancy. The authors set out to identify the accuracy and precision of elements in the history, physical examination, beta hCG, and ultrasound in ectopic pregnancy.

The systematic review consisted of 14 studies (n=12,101). The search consisted only of English language studies from 1965 to 2012 in which ectopic pregnancy was the final diagnosis with 100 or more patients per article. The summary prevalence of ectopic pregnancy was 15% (95% CI, 10-22%) in women presenting with abdominal pain or vaginal bleeding.

History and Physical

  • Patients symptoms had limited clinical value. Most symptoms had an unhelpful positive LR of less than 1.5.
  • The absence of cervical motion tenderness, peritoneal signs, adnexal mass, or adnexal tenderness did not significantly decrease likelihood of ectopic pregnancy.
  • In descending order, the most significant physical exam findings were:
    • Cervical motion tenderness (Positive LR = 4.9)
    • Peritoneal findings (Positive LR = 4.2-4.5)
    • Adnexal mass (Positive LR = 2.4)
Ultrasound showing normal IUP as shown by the double decidual rings and presence of a yolk sac in a gestational sac

Ultrasound showing normal IUP as shown by the double decidual rings and presence of a yolk sac in a gestational sac

Ultrasound

  • Findings of an intrauterine pregnancy (IUP) such as gestational sac or fetal pole ruled out ectopic pregnancy, except in rare cases of heterotropic prengnacy.
  • Bedside ultrasound is the single most useful diagnostic test. Positive LR = 111. 

Beta-hCG

  • The “discriminatory zone” continues to be debated – no consensus on the number.
  • A one-time hCG level does not rule out ectopic pregnancy.

PV Card: JAMA Review on Ectopic Pregnancy


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

Reference

  1. Crochet J, Bastian L, Chireau M. Does this woman have an ectopic pregnancy?: the rational clinical examination systematic review. JAMA. 2013;309(16):1722-1729. [PubMed]
By |2021-10-08T09:20:50-07:00May 9, 2013|ALiEM Cards, Ob/Gyn|

Need your input! PV cards becoming an app

It’s all about luck, opportunity, and timing.

I will be releasing the blog’s first ever Paucis Verbis (PV) native app this year. After a few years of brainstorming and lots of reader inquiries about an app, we were approached by two different app-building companies in the same week. I’m incredibly humbled to be approached by organizations, who can see the potential of these pocket cards (which started as actual index cards while I was in residency). It is an incredibly exciting time to be in the world of education and social media!

I need your help with step 1.

(more…)

By |2017-03-05T14:14:30-08:00Mar 12, 2013|ALiEM Cards, Social Media & Tech|

PV card: Bell’s Palsy Treatment

Bells PalsyBell’s Palsy is an idiopathic unilateral facial nerve paralysis.

Since the 2009 Cochrane review1 showing that antivirals added no benefit to corticosteroids in Bell’s Palsy, I stopped prescribing them. The NNT.com site has concluded the same. Looking at the literature a little more, the recommendations are a little murkier. Some groups are still advocating for antivirals for severe cases, because there may be a very small but questionably positive benefit.

  • “Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best”2
  • UpToDate: “For the subgroup of patients with severe facial palsy at presentation, defined as House-Brackmann grade IV or higher, we suggest early combined therapy with prednisone (60 to 80 mg per day) plus valacyclovir (1000 mg three times daily) for one week rather than glucocorticoids alone (Grade 2B).”
  • “The authors conclude that although a strong recommendation for adding antiviral agents to corticosteroids to further improve the recovery of patients with severe Bell palsy is precluded by the lack of robust evidence, it should be discussed with the patient.”3
  • “Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.”4

PV Card: Treatment of Bell’s Palsy


Adapted from [1, 2, 4]
Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Kristin Berona (UCSF-SFGH EM resident) for the idea and notes!

References

  1. Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F. Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2009;(4):CD001869. [PubMed]
  2. Gronseth G, Paduga R, American A. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012;79(22):2209-2213. [PubMed]
  3. van der, Rovers M, de R, van der. A small effect of adding antiviral agents in treating patients with severe Bell palsy. Otolaryngol Head Neck Surg. 2012;146(3):353-357. [PubMed]
  4. de A, Al K, Guyatt G, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009;302(9):985-993. [PubMed]
By |2021-10-08T09:23:49-07:00Feb 21, 2013|ALiEM Cards, Neurology|

PV card: VBG versus ABG

abg vbgYou obtain a venous blood gas (VBG) on a patient with a COPD exacerbation because you are concerned about hypercarbia. You get a value of 55 mmHg. How correlative is that compared to an arterial blood gas (ABG). There has been a lot of literature on how well the pH correlates between the ABG and VBG but what about pCO2?

A small study (n=89) from 20121 found that with a cutoff of pCO2 < 45 mmHg, the venous pCO2 is 100% sensitive in ruling out arterial hypercarbia. When the pCO2 was ≥ 45 mmHg, the VBG was less correlative.

Below is a review by Dr. Michelle Reina (EM resident at Univ of Utah) and Dr. Rob Bryant (Intermountain Medical Center in Utah) of the VBG vs ABG correlative data, along with a proposed algorithm on what to do with patients with COPD exacerbation.

What is your practice with an elevated pCO2 value on VBG?


Adapted from [1–5]
Go to ALiEM (PV) Cards for more resources.

Updated 1/31/13 at 2 pm PST:

  • Changed range of pH correlation between VBG and ABG = 0.03-0.04
  • Was typo in abstract of Kelly et al article.2 Stated difference between pHs was 0.4, rather than 0.04 as described in main results text.

References

  1. McCanny P, Bennett K, Staunton P, McMahon G. Venous vs arterial blood gases in the assessment of patients presenting with an exacerbation of chronic obstructive pulmonary disease. Am J Emerg Med. 2012;30(6):896-900. [PubMed]
  2. Kelly A, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001;18(5):340-342. [PubMed]
  3. Ma O, Rush M, Godfrey M, Gaddis G. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Acad Emerg Med. 2003;10(8):836-841. [PubMed]
  4. Middleton P, Kelly A, Brown J, Robertson M. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Emerg Med J. 2006;23(8):622-624. [PubMed]
  5. Koul P, Khan U, Wani A, et al. Comparison and agreement between venous and arterial gas analysis in cardiopulmonary patients in Kashmir valley of the Indian subcontinent. Ann Thorac Med. 2011;6(1):33-37. [PubMed]
By |2021-10-08T09:26:47-07:00Jan 31, 2013|ALiEM Cards, Endocrine-Metabolic, Pulmonary|

PV card: Diagnosis of DVT (ACCP guidelines)

DVT

A patient presents with an asymmetric leg with trace pitting edema in the affected leg. What is your diagnostic approach to such a patient? What is the role of D-dimer and ultrasound (U/S)? Does this match the 2012 American College of Chest Physicians (ACCP) guidelines?

The first step is to determine your patient’s pretest probability because the recommendations vary based on risk. I can tell you that many ED patients come in with a Wells score of 1-2, which places them in the “moderate pretest probability” category. There are 2 approaches you can take based on the availability of resources at your site (high-sensitivity D-dimer or U/S) and the patient’s comorbidities. Are you referring your patient for a repeat outpatient ultrasound, if warranted?Walk through various patient scenarios to see how the D-Dimer and U/S come into play.

PV Card: Diagnosting DVT – ACCP Evidence Based Guidelines


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

Thanks to Dr. Jason West (EM resident at Jacobi/Montefiore) for this card idea and deciphering the complex recommendations from the publication.

Reference

  1. Bates S, Jaeschke R, Stevens S, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e351S-418S. [PubMed]
By |2021-10-08T09:29:18-07:00Jan 24, 2013|ALiEM Cards, Cardiovascular|
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