New PECARN Febrile Infant Rule: A 3-Variable Approach for Ages 29-60 Days | Interview with Dr. Kuppermann

The diagnosis and risk stratification of febrile young infants continues to present a clinical challenge. Serious bacterial infection (SBI) rates in infants ≤60 days have continued to be reported between 8-13%. Despite several different classification rules and pathways, we continue to struggle to accurately delineate which infants have SBI and which do not. A paper titled “A Clinical Prediction Rule to Identify Febrile Infants 60 days and Younger at Low Risk for Serious Bacterial Infections” was published in JAMA Pediatrics in February of 2019.¹ The authors sought to derive a new clinical prediction rule for infants with fever. The research was conducted as part of the Pediatric Emergency Care Applied Research Network (PECARN). We discussed this publication with lead author Dr. Nathan Kuppermann on a podcast and summarize our discussion below.

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By Jason Woods, MD|2021-07-01T21:15:48-07:00Jun 19, 2019|Pediatrics|

ACMT Toxicology Visual Pearls: Eating Foraged Wild Mushrooms

What clinical symptoms would be expected after eating a meal made with the pictured foraged wild mushrooms?

Bradycardia, urinary incontinence, and bronchospasm
Hallucinations
Seizures and rhabdomyolysis
Skin flushing and palpitations (more…)

By Alayna Prest, MD|2019-11-12T19:03:03-08:00May 27, 2019|ACMT Visual Pearls, Expert Peer Reviewed (Clinical), Tox & Medications|

SplintER Series: A Case of Severe Shoulder Pain

A 45 year old woman presents with several days of gradually worsening right shoulder pain and stiffness. Her shoulder is very warm to the touch but not erythematous. You obtain shoulder x-rays and see a linear density in the AP view (photo credit).

What is the most likely diagnosis, the differential diagnosis, and management plan?

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By William Denq, MD CAQ-SM|2026-06-16T16:14:28-07:00May 20, 2019|Orthopedic, SplintER|

Ultrasound Gel Warmers in the Emergency Department?

How many times have you told a patient “The gel will be cold?” How many times have you watched a patient retract from the transducer because of the cold gel? How about a pediatric patient? Could warm gel improve your rate of clinically successful scans? It seems easy enough to install gel warmers alongside our ultrasound machines. But, should we do this?

SplintER Series: Case of a First Metacarpal Fracture

$first metacarpal fracture$

Click image to enlarge view

A 22 year-old male was playing football when he fell, landing on his outstretched left arm with his thumb flexed. He now has pain at the base of his thumb. This AP view of the hand best demonstrates the injury (photo credit).

What is this fracture, what additional imaging is needed, and what should be the management plan?

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By Tabitha Ford, MD|2019-05-09T18:07:02-07:00May 13, 2019|Orthopedic, SplintER|

ALiEM AIR | Neurology 2019 Module

Welcome to the Neurology 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 online content related to neurological emergencies. 6 blog posts within the past 12 months (as of January 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. (more…)

By Chris Belcher, MD|2020-09-04T11:11:58-07:00May 3, 2019|ALiEMU, Approved Instructional Resources (AIR series), Neurology|

DIY Ultrasound Model Compendium in Emergency Medicine

As the use of point-of-care ultrasound expands in emergency medicine, phantoms offer an attractive training solution for new learners and continuing education. Unfortunately, commercially available products are expensive and likely cost-prohibitive for individual practitioners to purchase. Luckily, there are a number of quality, low cost do-it-yourself (DIY) models published in journals and on the Internet. To help you navigate your options, I have created a compendium of DIY ultrasound models relevant to emergency medicine. The models are divided by system or application with a cost estimate for each model, if provided, as well as a list of materials and a short description. Links are provided for further reading.

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By Dallas Holladay, DO|2019-04-26T15:26:28-07:00Apr 24, 2019|Ultrasound|