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 From a readability, design, and content delivery perspective, our index card look was becoming outdated.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




Paucis Verbis: Blunt cardiac injury

blunt cardiac injuryDo you always get a troponin for patients who sustain blunt chest trauma?

Hopefully your answer is no. Of note, it is also NOT indicated as a screening test for those in whom you suspect a blunt cardiac injury (BCI). It can be normal in the setting of arrhythmias and it can be falsely elevated in the setting of catecholamine release or reperfusion injury from hypovolemic shock.

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2019-01-28T22:18:42-08:00

Paucis Verbis: Toxic alcohols – Isopropyl alcohol

isopropyl alcohol Rubbing AlcoholContinuing on the theme of Toxic Alcohols (osmolal gapethylene glycol, methanol), this Paucis Verbis card focuses on isopropyl alcohol toxicity, which is commonly found in rubbing alcohols. In this toxic alcohol, fomipezole is actually NOT indicated because you want to have alcohol dehydrogenase convert the toxic parent compound (isopropyl alcohol) into the nontoxic metabolite (acetone).

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2017-08-01T19:21:16-07:00

Paucis Verbis: Toxic alcohols – Ethylene glycol

Ethylene glycolFollowing last week’s Paucis Verbis card on calculating the osmolal gap, here is the first installment of the Toxic Alcohols cards. First up — ethylene glycol. There are useful American Academy of Clinical Toxicologists recommendations on when to administer an antidote (fomipezole) and when to perform hemodialysis.

Here’s a quick review of the metabolism of the different toxic alcohols. The parent compounds for ethylene glycol and methanol are innocuous and the metabolites are toxic.

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2019-01-28T22:21:00-08:00

Paucis Verbis: Approach to increased osmolal gap

MindTheGapWe often talk about calculating the anion gap in the evaluation of patients. What about the osmolal gap? When do you calculate this? What’s the differential diagnosis for an increased osmolal gap?

I recently came upon a nice 2011 review in the American Journal of Kidney Disease called “Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis”. It’s always nice to revisit and review this concept. You’ll always learn something new. For instance, I didn’t know that salicylates cause anion gaps as well as osmolal gaps.

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2019-01-28T22:20:50-08:00

Paucis Verbis: Upper GI bleeding

BloodTransfusionDripSM

Do you know what the Blatchford clinical prediction score is for upper GI bleeding? It can help you predict whether a patient with an upper GI bleed is severe and requires urgent intervention.

Hot off the presses, JAMA just came out with a great Clinical Rational Examination article on this topic. Thanks to Dr. Ryan Radecki (EMLitOfNote) for the heads up. The likelihood ratios and Blatchford risk stratification score are so useful that I’m breaking my PV rule to keep things down to the size of one index card. Note the absence of a NG lavage result to help you risk stratify for an upper GI bleed requiring urgent intervention using the Blanchard score.

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2019-01-28T22:20:01-08:00

Paucis Verbis: Genital Ulcers

A few months ago, American Family Physician published a nice review article on the diagnosis and management of genital ulcers. How do you remember the classic appearances of the lesions? I often quickly check references to confirm my suspicions.

I find the two following tables helpful to remember. The table of differential diagnoses is from AFP. The article also reviews the confirmatory diagnostic testing and treatment protocols. The table of the clinical characteristics for the main infectious causes is from “The Practitioner’s Handbook for the Management of Sexually Transmitted Disease”.

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2019-02-19T18:51:32-08:00

Paucis Verbis: Blunt Abdominal Injury, Likelihood Ratios

blunt abdominal injuryThis month’s issue of JAMA addresses the question “Does this patient have a blunt intra-abdominal injury?” as part of the always-popular Rational Clinical Examination series.

The systematic review of the literature summarizes the accuracy of findings for your blunt trauma patient in diagnosing intra-abdominal injuries. Specifically, likelihood ratios (LR) are summarized. These LRs can be used to plot on the Bayes nomogram below. You draw a straight line connecting your pretest probability and the LR. This yields your posttest probability.

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2019-01-28T22:22:31-08:00