1 03, 2017

PEM Pearls: Pediatric Sepsis Management – Understanding the Basics

pediatric sepsis managementJust as in adults, pediatric sepsis is a complex topic with continued research. In the United States, there are an estimated 75,000 cases per year of pediatric severe sepsis with an in-hospital mortality of 5-10%.1,2 This is one of the deadliest conditions treated in children. In addition, after the Rory Staunton case, New York State passed regulations requiring all hospitals to have pediatric specific recognition, treatment, and data reporting systems. Several other states have adopted, or are considering, similar requirements. Thus it is critical that emergency physicians understand at least the basics of pediatric sepsis management.


1 12, 2016

AIR Series: Infectious Disease Module (2016)

Welcome to the Infectious Disease Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team is proud to present the highest quality procedure content. Below we have listed our selection of the 18 highest quality blog posts within the past 12 months (as of August 2016) related to Infectious Disease emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 2 AIRs and 16 Honorable Mentions. We recommend programs give 6 hours (about 20 minutes per article) of III credit for this module.


20 06, 2016

Ultrasound For The Win! – 63M with an Erythematous Abdomen #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 63-year-old man presents with a painful, warm, and erythematous area of his abdomen.


15 02, 2016

Zika Virus: What emergency department providers need to know

Zika virusThe Zika virus outbreak has recently been put on “Level 1” activation status by the Emergency Operations Center at the U.S. Centers for Disease Control and Prevention (CDC). If you haven’t already thought about this affecting your emergency department, you should starting now. A Level 1 status has been triggered only 3 times in the recent years: Ebola (2014), H1N1 (2009), Hurricane Katrina (2005). The following are some key facts and resources.


29 07, 2015

60-Second Soapbox: New podcast series featuring Drs. Lin, Riddell, Shaikh

aliem_soapboxWe are excited to announce our new podcast series, 60-Second Soapbox! Each episode, one lucky individual gets exactly 1 whole minute to present their rant-of-choice to the world. Any topic is on the table – clinical, academic, economic, or whatever else may interest an EM-centric audience. Don’t worry if your are microphone-shy. We will carefully remix your audio to add an extra splash of drama and excitement. Even more exciting, participants get to challenge 3 of their peers to stand on a soapbox of their own!


29 06, 2015

Blast From the Past: Occult Sepsis, Lactic Acid, and Mortality

Occult Sepsis, Lactic Acid, & Mortality-3Severe sepsis and septic shock affect millions of patients worldwide and have high rates of morbidity and mortality as well as high resource utilization. The way we manage sepsis has changed quite a bit since the Rivers et al randomized controlled trial of early goal-directed therapy (EGDT) 1 , which had an absolute decrease in mortality from 46% with “usual care” to 31% with EGDT. What we now know is that a proactive approach to septic patients will result in lower mortality rates and better outcomes (i.e. early identification, early intravenous fluids, and early antibiotics). Patients with sepsis are still missed despite the fact that we understand the benefits to morbidity and mortality with early recognition. In this blast from the past study from 2007, Howell et al 2 answered the important question of does elevated lactic acid simply reflect a patient’s hemodynamic status or can it independently predict 28 day in-hospital mortality after controlling for other potential confounders in patients with sepsis. (more…)

27 04, 2015

Four reasons not to order a Rapid Flu test

Rapid flu testEvery year emergency departments are inundated with cases of influenza-like illness. Rapid flu testing (RFT) offers the promise of a quick and relatively noninvasive rapid diagnostic test. However, the use of this test has significant limitations that can lead to increased risk for both the patient and the provider.