Toxicology Visual Pearls

About the Program

The Toxicology Visual Pearls series is a collaboration between ACMT and Academic Life in Emergency Medicine (ALiEM.) The pearls are open-access, expert peer-reviewed, toxicology-related visual stimuli followed by a question and discussion. The authors and editors volunteer their time and expertise to bring this well-regarded series to readers of the ALiEM blog. The series is led by Drs. Louise Kao and Bryan Judge from ACMT and Dr. Michelle Lin from ALiEM.

About ALiEM: ALiEM aims to enhance how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education. ALiEM strives to reshape medical education and academia in their evolution beyond the traditional classroom. 

How to Submit a Pearl

If you are interested in submitting a pearl for the series please see the submission guidelines below.

Full Submission Guidelines

Author information:

  • Name, Academic Title, Email address, Faculty Photo, Twitter handle
  • The email address will not be published but if ALiEM readers comment, you will be contacted via email
  • Multiple authors permitted

Visual Item:

  • An image or two such as a photo, EKG, radiology
  • No patient identifying information
  • You keep the rights to the photo. Use copyright free images (ACMT has a library available for this purpose. If interested, please write to: or place a copyright on your photo using Creative Commons

Question: Multiple choice question with 4-5 answer choices utilizing the image


  • Answer to the question with a brief one-two paragraph explanation
  • Please include 1-3 references with PMID

Bedside Pearls:

  • Brief bedside pearls for the clinician caring for this type of poisoning.
  • Please include a few references with PMID

Submit your item to Louise Kao: or Bryan Judge:

Please read the New Author Guidelines to prepare your pearl submission.

New Author Guidelines

Download PDF of Guidelines

ALiEM Blog: New Author Guide for Clinical Posts Welcome!

We’re thrilled to review your submission to the ALiEM blog. This guide will introduce you to our basic writing and design standards.

Inverted Pyramid Style: Approach to Blog Writing

There are a number of similarities between writing for a medical education blog and an academic journal. However, unlike journals, blogs are not bound to the traditional Introduction-Methods-Results-Discussion format. Instead, a classic journalism technique – the inverted pyramid – will help you structure your post and prioritize your learning points.

Imagine your post is an inverted triangle. The beginning of your post is the widest part at the top of the pyramid and represents your most important learning points. State these early. As you write, the blog post becomes more “narrow,” represented by the bottom of the pyramid. Here you provide supporting evidence, data, and detail. You may apply this technique to each individual section within your post too.

Unlike academic publications, in which the clinical implications are presented at the end of the study, blog posts are structured in a way that highlights the take-home points early, allowing readers to “scan” and gather the most important information.


Your title should be unique, descriptive, and specific. Avoid abbreviations and colloquial language. You can, however, get creative. For example, if your content answers a specific clinical question, you can incorporate that question into your title (e.g. “How Competitive was EM in the 2018 Match? The answer might surprise you”). Notice how this title instills curiosity, without giving away the answer to the question. Be sure to include the key term(s) that you want discoverable by Google search engines within the title.

First Paragraph

The first paragraph introduces your topic and tells the reader why it is important to their clinical practice. The best introductions spark curiosity, inform readers of a knowledge gap, and set the expectation that reading further will fill this void.

Take a moment to look at the blog, and you’ll see that the first paragraph sits on the homepage for several days. It functions as a “teaser,” providing the reader with some background information and outlining the learning objectives.

A few guidelines:

1. Length: 4-6 sentences.

2. Avoid headers, hyperlinks, or formatting in the first paragraph.

3. Make sure the first paragraph is related to your post’s main message.

4. Avoid unnecessarily long sentences, lists, or highly-detailed information (inverted pyramid!).

5. Please provide us with a high-resolution image related to your topic; we will right-align and embed this into the first paragraph.

Provide small bites of information. A high density of text does not favor readability and limits comprehension.


The rest of your text will be divided by 3-4 section headers. Think of these headers early when writing your post; this will help the rest of your writing unfold. Headers provide focus points for the reader and direct their attention to the information you want them to learn. Consider headers with words like “How” and “Why” (these have been shown to snag readers’ attention) and don’t be afraid to make a main point in the header itself.

Spelling, Grammar, and Formatting

Some rules to keep things consistent:

● Use American English spellings.

● Be careful about using non-traditional abbreviations for the sake of brevity. When in doubt, spell out the word in its first instance.

● Use serial commas.

● Use only 1 space after periods, not 2.

● Be sure to place a period at the end of a bullet if it is a complete sentence.

○ Period? YES: There is a 25% chance of perforation.○ Period? NO: 25% chance of perforation

● As long as the sentence doesn’t start with a number, use the actual numeric form (1, 2, 3).

● Include units after numbers. Stick with the metric system. Make sure to include a space.

○ YES: 45 mg/dL ○ NO: 45mg/dL

● Avoid underlining text (this implies a hyperlink).


For most submissions, your target audience is your politically correct friend from medical training. You are a content expert, and your friend from medical training is asking you to bring them up to speed. Your friend will appreciate direct, succinct explanations with punchy descriptions and memorable examples. Ensure that your post welcomes all readers and promotes inclusive learning. Overall tone should be professional, friendly, and engaging.

Pro-Tips: Bulleted Lists & Tables

If you find yourself listing ≥3 items, consider bullet points or numbers. This improves readability especially for digital media. If you have a dense paragraph with data or research numbers, you may also consider a bulleted list.

If you identify a common denominator or theme across multiple sections or your post or paragraphs within a section, consider presenting the information as a table instead of text. We don’t expect you to develop this table – we’ll help you with that! But as you write, always be on the look-out for opportunities to present your content as an organized graphic (e.g. table, graph, or bulleted list), and if it crosses your mind, reach out to us and pitch the idea. This will save all of us time later when we copy-edit your work.


In your post, number your references and place these numbers within brackets at the end of a sentence, before the period.

● YES: Most aneurysms have a SBP goal of <140 mmHg [1, 2].

● NO: Most aneurysms have a SBP goal of <140 mmHg. (Brown, Anderson).

At the end of your post, list your numbered references in order of appearance in the post. Please use AMA citation format and put the PMID or DOI next to each citation with a hyperlink to the associated web page. If there is no PMID/DOI, please write the reference in AMA format.


1. Kraus CK, Weaver KR. Traumatic Dislocation of the First Carpometacarpal Joint. Am J Emerg Med. 2014;32(12):1561. PMID: 24993682

2. Lahiji F, Zandi R, Maleki A. First Carpometacarpal Joint Dislocation and Review of Literatures. The Archives of Bone and Joint Surgery. 2015;3(4):300-303. PMID: 26550598

3. No PMID; Anderson, C. The impact of blood pressure on stroke risk. N Eng J Med. 2016;(368)25:1453-1458.


Try to use high resolution copyright-free images. If you have a question about this, let us know. We take all HIPAA violations very seriously, so please try to remove all potential identifiers before submitting your post. These are often hiding in the corner of Ultrasound videos or ECGs.

Pictures of a physical exam finding may include identifies such as tattoos or name bands – these must be cropped out.

Below are links to all toxicology visual pearls. Click the button to view the photos, prompt, answers, and access the full post (some include other media including charts and videos.)

June 6, 2022

Pretty (and Deadly) in Purple

By: Charles Harris III, MD and Ann-Jeannette Geib, MD

May 6, 2022

Substance-Induced Crystalluria: All That Glitters Is Not Gold

By: Alex Ponce, PharmD and Kris Nañagas, MD

April 4, 2021

Hypertension and Rash

By: Michael Semple, DO; Johana Lopez, MD; and Evan Schwarz, MD

February 16, 2022

Sink or Swim

By: Elzada Sercus, MD and Kathryn T. Kopec, DO

May 26, 2021

Questions About Green Pee? Urine Luck!

By: Clare Gunn, MD and Kathryn T. Kopec, DO

April 7, 2021

In “Spore” Taste

By: Bryan Ross, MD and Kris Nañagas, MD

February 10, 2021

Necrotic Spider Bite

By: Michael Simpson, MD and Rebecca Bruccoleri, MD

January 20, 2021

A Poke in the Belly

By: Caitlin Baldwin, DO; Alexis Cates, DO; and Steven J. Walsh, MD

November 9, 2020

Case of a Toxic Tea

By: Nicholas Titelbaum, MD; Vir Singh, MD; and Daniel Nogee, MD

October 5, 2020

“I Have a Nagging Feeling About This”

By: Brian Lewis, MD; Gilbert Nelson, DO; Thomas Vu, DO; and Bryan Judge, MD, FACMT

September 14, 2020

Awake Seizures

By: Kregg Laundon, MD and Christine Murphy, MD

July 27, 2020

Perineal Skin Burns

By: Kregg Laundon, MD and Christine Murphy, MD

July 13, 2020

Caterpillar Envenomation

By: Nicholas Titelbaum, MD and Robert Avera, MD

June 22, 2020

I’ll Huff and I’ll Puff…

By: Kathryn T. Kopec, DO and Blake Bauer, MD

June 8, 2020

A Foraging Experience to Die For

By: Robert Goodnough, MD; Karla Canseco, MD; and Eddie Garcia, MD

May 11, 2020

The Doom from Down Under

By: Christopher Gardner, MD and Kathryn T. Kopec, DO

May 4, 2020

Tox Never Smelled So Good

By: Jessica Hoglund, MD and Kathryn T. Kopec, DO

February 17, 2020

Painful Foot

By: Ethen Ellington and Kathryn T. Kopec, DO

February 10, 2020

The Blood Sample Doesn’t Look Right

By: Austin Costa, MD and Kathryn T. Kopec, DO

January 20, 2020

Look, Don’t Touch

By: Ashley Mazo, MD and Christine Murphy, MD

January 1, 2020

Painful Hand

By: Angela Rombola, MD and Kathryn T. Kopec, DO

October 2, 2019

Getting Caught Yellow Handed

By: Francisco Javier Andrade Jr., MD and Kathryn T. Kopec, DO

August 16, 2019

Mushroom Mania

By: Mary Grady, MD and Christine Murphy, MD

June 26, 2019

Abnormal ECG

By: Colin O’Neill, MD and Kathryn T. Kopec, DO

May 27, 2019

Eating Foraged Wild Mushrooms

By: Alayna Prest, MD and Kris Nañagas, MD

February 18, 2019

Don’t Go Breaking My Heart

By: Jennifer Pallansch, MD; Margaret R. Lewis, MD; and Kathryn T. Kopec, DO

January 21, 2019

Abnormal Brain Imaging

By: Laura Tormoehlen, MD, FACMT, FAAN and Jeff C. Miller, MD

December 3, 2018

Blue Urine

By: Jennifer K. Potter, MD and Kathryn T. Kopec, DO

August 30, 2018

Toxic Mouth Pain

By: Heather A. Borek, MD and Matthew Eisenstat, MD

April 9, 2018

Spider Bite

By: Adrienne Hughes, MD and Robert G. Hendrickson, MD

February 21, 2018

Drug-Induced Rash

By: Jennifer S. Love, MD and Louise Kao, MD, FACMT

December 18, 2017

Toxic “Weed”

By: Leslie R. Dye, MD, FACMT

July 10, 2017

Discolored Skin/Urine

By: Hannah Malashock, MD

May 1, 2017

Exotic Viper Envenomation

By: Bryan Judge, MD, FACMT

April 3, 2017

Suicide Plant

By: Louise Kao, MD, FACMT

October 16, 2017

Drug-Induced QT Prolongation

By: Ryan Marino, MD and Anthony Pizon, MD, FACMT