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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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Paucis Verbis: International Registry on Aortic Dissection (IRAD)

What do these 3 people have in common?

  • Lucille Ball (comedienne)
  • Jonathan Larson (wrote the musical “Rent”)
  • John Ritter (comedian)

They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with dissections.

I find this list helpful, because it illustrates the fact that the classic signs and symptoms aren’t actually very common. Here are some scary examples:

  • A pulse deficit in the carotid, brachial, and femoral arteries is only present 15% of the time.
  • A tearing or ripping quality of pain is present in only 50% of patients.
  • Not all patients have a widened mediastinum or abnormal aortic contour (only 78.7%).

PV Card: Aortic Dissection


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

Reference

  1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD). JAMA. 2000;283(7):897. doi: 10.1001/jama.283.7.897
By |2021-10-13T08:51:53-07:00May 20, 2011|ALiEM Cards, Cardiovascular|
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Paucis Verbis: Head CT clinical decision rules in trauma

HeadCTbleedThe ideal clinical decision tool has a sensitivity and specificity of 100%.

You need a high sensitivity to be sure that your negative result indeed predicts a true negative. That means if your clinical decision tool suggests that you don’t need to get a head CT, then your head CT would have been normal.

On the flip side, this realistically means there is a low-moderate specificity. That means a clinical decision tool with at least 1 positive criterion does not always mean that there will be an abnormal finding on head CT.

There are 3 major clinical decision rules that I’ve heard tossed around in the literature:

  • Canadian CT Head Rules (CCHR)
  • New Orleans Criteria (NOC)
  • National Emergency X-Radiography Utilization Study (NEXUS)-II

There is no perfect tool.

Take a look at these decision rules and their inclusion criteria.

  • The CCHR included patients with GCS 13-15. The NOC initially enrolled only patients with a GCS of 15.
  • All factor in age (≥65 years for CCHR and NEXUS-II; ≥60 years for NOC).
  • Interestingly only the CCHR, for better or worse, take into account mechanism of injury. I’m not sure I would obtain a head CT on a pedestrian with a graze wound on the foot from a slow-moving vehicle.

Which do you use? I use a combination of all 3 and my clinical gestalt.

PV Card: Head CT in Trauma – Clinical Decision Tools


Go to ALiEM (PV) Cards for more resources.

By |2021-10-15T10:59:57-07:00May 13, 2011|ALiEM Cards, Radiology, Trauma|
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Paucis Verbis: Brugada syndrome

Brugada Syndrome

You always hear about it when working up syncope and sudden cardiac arrest in young patients, but it’s so easy to forget what it looks like on ECG. We so rarely see it… or DO we?!

This Paucis Verbis card on Brugada Syndrome is to help emblazon these ECG tracings in our mind, so that we don’t miss the subtle findings which place a patient at risk for sudden cardiac death. Pay special attention to Type 1, which is most specific for Brugada Syndrome.

PV Card: Brugada Syndrome

* Update 8/2/18: Only Type 1 and Type 2 are recognized for Brugada syndrome. The type 3 pattern is likely a normal variant.

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

Reference

  1. Antzelevitch C. Brugada Syndrome: Report of the Second Consensus Conference: Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation. 2005;111(5):659-670. doi:10.1161/01.cir.0000152479.54298.51
By |2021-10-15T11:04:55-07:00May 6, 2011|ALiEM Cards, Cardiovascular, ECG|
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Paucis Verbis: Asthma classification

asthma classification MDI
Emergency physicians have the opportunity to educate patients and prescribe chronic inhaled corticosteroids to patients who should be on these medications chronically. Patients may be more receptive to education and advice given immediately after an asthma exacerbation, managed in the ED.  Using the National Institute of Health/ National Asthma Education and Prevention Program classification system, physicians can quickly determine if the patient is a candidate for inhaled corticosteroids and initiate therapy accordingly.

PV Card: Asthma Classification system

In short, patients can be classified into one of 4 classes: intermittent, mild persistent, moderate persistent, and severe persistent asthma. Patients in these classes should receive either Step 1, 2, 3, or 4/5 medications, respectively. I remember that patient using daily short-acting beta agonists (SABA) belong to the moderate persistent asthma category.


Go to ALiEM (PV) Cards for more resources.

By |2021-10-15T11:08:17-07:00Apr 29, 2011|ALiEM Cards, Pulmonary|
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Paucis Verbis: Dental infections

PeriapicalAbscessTo follow up with the wildly popular Paucis Verbis card made by Dr. Hans Rosenberg (University of Ottawa), here is his card on Dental Infections. This card summarizes common dental infection complaints (like the periapical abscess seen to the right) that we see in the Emergency Department.

PV Card: Dental Infections


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

Reference

  1. Nguyen D, Martin J. Common dental infections in the primary care setting. Am Fam Physician. 2008;77(6):797-802. [PubMed]
By |2021-10-15T11:10:29-07:00Apr 22, 2011|ALiEM Cards, Dental|
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Paucis Verbis: Dental trauma

OLYMPUS DIGITAL CAMERAHow cool is this — I have talented emergency physicians contributing Paucis Verbis card content! This week features excellent pearls on Dental Trauma by Dr. Hans Rosenberg (University of Ottawa). Here’s his recent article in Annals of EM on reimplantation of avulsed teeth.1

PV Card: Dental Trauma


Go to ALiEM (PV) Cards for more resources.

Reference

  1. Rosenberg H, Rosenberg H, Hickey M. Emergency management of a traumatic tooth avulsion. Ann Emerg Med. 2011;57(4):375-377. [PubMed]
By |2021-10-15T11:15:07-07:00Apr 15, 2011|ALiEM Cards, Dental|
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Paucis Verbis: AMI and ECG Geography

Sometimes a picture is worth MORE than a 1000 words. Such is the case of the above illustration that I saw on the Life In The Fast Lane blog. When I first saw it, I knew that I immediately had to find out who made the graphic. It turns out it is the multitalented Dr. Tor Ercleve, who is an emergency physician at Sir Charles Gairdner Hospital and an established medical illustrator.

ECG anatomy illustration AMI

This graphic demonstrates the EKG findings for the various types of acute MI’s as broken down by coronary vascular anatomy (right coronary artery, left circumflex artery, left anterior descending artery). This detailed illustration won’t be readable in print form but is great in digital format on your mobile device.

Thanks, Tor!

[PDF]

Go to ALiEM (PV) Cards for more resources.
By |2021-10-15T11:17:43-07:00Apr 8, 2011|ALiEM Cards, Cardiovascular, ECG|
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