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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: Identifying toxidromes by vital signs

A middle-age woman presents to the Emergency Department with altered mental status after having ingested a drug. Is it an opioid? Is it an antihistamine?

The key is to pay close attention to the vital signs. They are often the clue to the mystery. I found this great table from EM Clinics of North America by Dr. Timothy Erickson from 2007. I can’t imagine how long it took for him to create all these mnemonics. I’ll never remember these mnemonics, but they’re fun to read nonetheless.

PV Card: Toxidromes by Vital Signs


Go to ALiEM (PV) Cards for more resources.

By |2021-10-17T09:22:42-07:00Nov 19, 2010|ALiEM Cards, Tox & Medications|
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Paucis Verbis: Sgarbossa’s Criteria with LBBB

EKG_LBBB

It is difficult to determine if a patient with a left bundle branch block (LBBB) has an acute myocardial infarction (AMI) because ST segments are “appropriately discordant” with the terminal portion of the QRS. That means if the QRS complex is negative (or downgoing), the ST segment normally will be positive (or elevated). Similarly if the QRS complex is positive (or upgoing), the ST segment will be negative (or depressed).

PV Card: Sgarbossa’s Criteria

In 1996, Sgarbossa et al looked through the GUSTO-1 trial patients with LBBB and AMI. They derived 3 criteria which may help diagnose the “hidden” AMI. The criteria are:

1. ST elevation ≥ 1 mm concordant with QRS complex (most predictive of AMI of the 3 criteria)
2. ST depression ≥ 1 mm in lead V1, V2, or V3
3. ST elevation ≥ 5 mm where discordant with QRS complex

Use these criteria with caution though. None of these criteria are perfect. They are to help you risk-stratify. For instance, criteria #3 (ST elevation ≥ 5 mm) can exist in asymptomatic patients with LBBB because of concurrent left ventricular hypertrophy and high voltages.

Thanks to Tom Bouthillet at ems12lead.com for the useful illustration above.
Go to ALiEM (PV) Cards for more resources.
By |2021-10-17T09:25:38-07:00Nov 5, 2010|ALiEM Cards, Cardiovascular, ECG|
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Paucis Verbis card: Algorithm for suspected pertussis in pediatrics

ChildCough

To treat for pertussis or not?

In the setting of the current pertussis epidemic in California, each kid with a cough sparks constant debate about whether to treat with azithromycin or not. Finally, thanks to my friends Dr. Andi Marmor and Dr. Shon Agarwal Jain (UCSF Pediatrics faculty), there’s a great algorithm to help you answer the question. I have found this algorithm extremely helpful.

You basically start by risk-stratifying by age and pertussis immunization status. For instance, if the patient is 6 months of age AND unimmunized), then follow the algorithm listed as “High Risk for Pertussis”.

PV Card: Suspected Pertussis in Pediatric Patients


Go to ALiEM (PV) Cards for more resources.

By |2021-10-17T09:28:20-07:00Oct 29, 2010|ALiEM Cards, Infectious Disease, Pediatrics|
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Paucis Verbis card: Pediatric weight-based reference (5-34 kg)

Broselow

The foundation in any pediatric resuscitation is the length-based estimation of the patient’s lean body weight. Once determined, equipments and medications are sized and dosed, respectively, according to that weight. You can use electronic resources such as PEMSoft (Pediatric Emergency Medicine Software) or the more traditional paper-based Broselow tape.

If you have neither of these at your easy disposal, I thought I would create a multi-card reference which works best in electronic pdf form on your mobile device. Even if you DO have other available references, it’s still nice to have some redundant back-up sources just in case.

This data was collected by merging data from the Broselow tape and PEMSoft.

  • I created 30 individual cards for patients weighing between 5 kg and 34 kg.
  • I didn’t include whether endotracheal tubes should be cuffed or uncuffed. This is controversial currently. The traditional teaching is that patients younger than 8 years old should receive UNcuffed tubes.
  • D10W glucose should be given in patients younger than 1 year old. D25W glucose should be given for patients 1-2 years old. D50W glucose can be given to patients 2 years and older.
  • Please use these cards with caution. I’ve proof-read these cards multiple times, but there still may be some typos. Please let me know if you see any discrepancies.

PV Card: Pediatric Weight-Based Resuscitation Reference


Go to ALiEM (PV) Cards for more resources.

 

By |2021-10-17T09:30:51-07:00Oct 22, 2010|ALiEM Cards, Pediatrics|
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Paucis Verbis card: C3-C7 spinal fractures

Fig9E Fx FlexTear anatomy cervical spine fracture

This is the second Paucis Verbis card on cervical spine fractures. Part 1 covered C1 and C2 fractures. This card covers the lower cervical spine fractures. These two tables are part of my chapter on “Spine and Spinal Cord Injury” in the textbook Emergency Medicine by Dr. Jim Adams (Northwestern EM Chair).

PV Card: C3-C7 Fractures and Injuries


Go to ALiEM (PV) Cards for more resources.

By |2021-10-18T09:59:44-07:00Oct 8, 2010|ALiEM Cards, Orthopedic|
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Paucis Verbis card: C1-C2 injuries

Cervical spine C1-C2 fracture

I’m starting to work on co-authoring the next edition of my chapter on “Spine and Spinal Cord Injury” within the textbook “Emergency Medicine” by Dr. Jim Adams (Northwestern EM Chair). There are some useful tables that I created that I thought you might find helpful. This is the first installment covering C1-C2 fractures. The next PV card will cover the lower cervical fractures.

I always forget which are stable and unstable. For instance, the above extension teardrop fracture looks innocuous but is an unstable fracture because the anterior longitudinal ligament is ruptured.

PV Card: C1 and C2 Fractures and Injuries


Go to ALiEM (PV) Cards for more resources.

By |2021-10-18T10:02:37-07:00Oct 1, 2010|ALiEM Cards, Orthopedic|
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Paucis Verbis card: When murmurs need echo evaluation

Cardiac Echocardiography

Have you been in a situation where you are the first to detect a cardiac murmur in a patient? If you are hearing it in a busy, loud Emergency Department, I find that it’s at least a grade III.

Should you order an echocardiogram for further outpatient evaluation? It depends on the grade and characteristic of the murmur, in addition to the patient’s symptoms. For instance, all diastolic murmurs require an echo. There is a useful ACC/AHA algorithm which helps you decide.

PV Card: When Murmurs Need Echocardiography Evaluation


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

Thanks to Amy Kinard, an Emergency RN and aspiring Family Nurse Practitioner, for drafting this useful Paucis Verbis card for me during her studies. Keep the great ideas coming, everyone!

Reference

  1. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118(15):e523-e661. doi: 10.1161/circulationaha.108.190748
By |2021-10-18T10:05:29-07:00Sep 17, 2010|ALiEM Cards, Cardiovascular|
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