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

Patwari Academy videos: Chest trauma

In the third and fourth video in the Trauma series (first two videos = primary and secondary survey), Dr. Rahul Patwari discusses about chest trauma, divided into blunt and penetrating mechanisms. What is “the box” that everyone keeps referring to?

(more…)

By Michelle Lin, MD|2019-01-28T22:04:15-08:00Mar 10, 2013|Patwari Videos, Trauma|

PE in pregnancy: which diagnostic tests do you use?

Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging.

(more…)

By Javier Benitez, MD|2026-06-16T16:01:58-07:00Mar 6, 2013|Cardiovascular, Ob/Gyn, Pulmonary|

Trick of the Trade: External jugular tourniquet

Paitents can be a challenge when trying to obtain peripheral IV access. The vein may be collapsed from dehydration or scarred because of IV drug use or repeated cannulation. Before thinking about an ultrasound-guided deep vein IV or a central line, take a look at the external jugular (EJ) vein.

There are, however, a few problems that exist when trying to cannulate this site:

There is no tourniquet for the neck.
To distend the vein, you often need to put the patient in Trendelenburg, which may be uncomfortable or intolerable for some

(more…)

By Timothy Peck, MD|2016-11-11T11:17:20-08:00Mar 5, 2013|Tricks of the Trade|

Patwari Academy videos: Trauma primary and secondary survey

What’s the primary and secondary survey in the assessment of the trauma patient? This is a great review of the methodical approach and insight in the thought processes by Dr. Rahul Patwari.

(more…)

By Michelle Lin, MD|2019-01-28T22:04:30-08:00Mar 3, 2013|Patwari Videos, Trauma|

Trick of the Trade: Use the angiocatheter for central lines

Central lines come packed with a long introducer needle (pink arrow) to feed the guidewire through AND a long angiocatheter (yellow arrow). Most people cannulate the vein by using the syringe and the introducer needle. What’s the angiocatheter for?

(more…)

By Michelle Lin, MD|2019-02-19T18:04:54-08:00Feb 26, 2013|Tricks of the Trade|

PV card: Bell’s Palsy Treatment

Bell’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

<span data-mce-type="bookmark" style="display: inline-block; width: 0px; overflow: hidden; line-height: 0;" class="mce_SELRES_start"></span>
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

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]
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]
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]
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 Michelle Lin, MD|2026-06-16T16:02:00-07:00Feb 21, 2013|ALiEM Cards, Neurology|