Pediatric Trick of the Trade: Finger Immobilization Technique

A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is crying, anxious, and uncooperative. How do you make this situation easier to evaluate and repair?

Nail bed and finger laceration repairs can be challenging, and even more challenging in young patients. Preparation is key to getting a good outcome. Here we present a pediatric trick of the trade on immobilizing a finger for digit or nail bed procedures.

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By Josh Bukowski, MD|2017-11-13T10:18:47-08:00Nov 13, 2017|Orthopedic, PEM Pearls, Trauma, Tricks of the Trade|

ALiEM’s Greatest Hits for Interns: A Curated Collection of High-Yield Topics

Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine residents. It was a particularly competitive year for Emergency Medicine, with 99.7% of first-year spots filled despite a whopping 2,047 positions being offered in 2017 (up by 152 spots compared to last year).¹ Now begins the most crucial 3 or 4 years of your medical training that will prepare you for the rest of your career in Emergency Medicine.

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By Jeffrey Shih, MD, RDMS|2026-06-16T16:11:58-07:00Jul 21, 2017|Cardiovascular, Critical Care/ Resus, Gastrointestinal, Medical Education, Neurology, Ophthalmology, Pediatrics, Tox & Medications, Ultrasound for the Win|

PEM Pearls: Treatment of Pediatric Diabetic Ketoacidosis and the Two-Bag Method

Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up glucose from the blood stream, inhibits liver glucose production, increases glycogen storage, and increases lipid production. When insulin is not present, such as in patients with Type 1 diabetes mellitus (DM), all of the opposite effects occur.

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By Jason Woods, MD|2018-04-02T02:54:56-07:00Jul 3, 2017|Endocrine-Metabolic, Pediatrics, PEM Pearls|

PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians

The Pediatric Emergency Care Applied Research Network (PECARN) collaborative has teamed up with the ALiEM and CanadiEM teams to introduce the official PECARN visual decision rule aid for pediatric blunt head trauma! This has been a 6 month collaboration focused on bringing evidence-based research to the bedside in pediatric emergency medicine (EM).

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By Gabe Sudario, MD|2024-06-01T10:49:21-07:00Jun 27, 2017|Pediatrics, Trauma|

Little Patients, Big Medicine Podcast: Lactate in Pediatric Sepsis

The first recording from Little Patients, Big Medicine: the Pediatric Emergency Medicine (PEM) Podcast. This is an exciting interview with Dr. Halden Scott, a PEM physician at Children’s Hospital Colorado, about the use of lactate measurement in pediatric sepsis. Dr. Scott is one of the premier pediatric sepsis researchers, with a specific focus on the use of lactate measurement in the ED. We talk about the Sepsis-3 definitions and whether pediatrics will eventually follow them, Dr. Scott’s previous work on lactate use in the pediatric ED, and her new article published in March of 2017 on the association between elevated lactate in the ED and 30-day mortality in children. ^1–6
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By Jason Woods, MD|2026-06-16T16:11:51-07:00Jun 7, 2017|Infectious Disease, Pediatrics|

PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool

While ear foreign bodies can happen at any age, the majority occur in children less than 7 years of age.¹ The younger the patient, the less likely they are cooperative with the exam and, therefore, the less chance of successful foreign body removal. The first attempt at removal is the best, so it is important to make it count. Similarly, different types of foreign bodies call for different “tools” for removal. It is important to understand when to attempt removal in the emergency department (ED) and what tools are available. This blog post will help you optimize your first pass success at foreign body removal by understanding what tools are at your disposal.

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By Josh Bukowski, MD|2017-10-26T14:32:51-07:00May 8, 2017|ENT, Pediatrics, PEM Pearls|

PEM Pearls: 2017 AAP Section of EM’s Guide to Pediatric Community Acquired Pneumonia

Pediatric community-acquired pneumonia (CAP) is an acute, common, and potentially serious infection of the pulmonary parenchyma in children. In November 2010, the American Academy of Pediatrics endorsed “The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.” [PDF]¹Based on this guideline, the American Academy of Pediatrics (AAP) Section on Emergency Medicine’s Committee on Quality Transformation developed a clinical algorithm for CAP in the ED setting.

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By Shabnam Jain, MD, MPH|2019-09-05T17:28:22-07:00Mar 16, 2017|Pediatrics, PEM Pearls, Pulmonary|