EM Pulse Podcast™

We’ve all seen it: the patient whose chart is “flagged” with a penicillin allergy, but when you dig into the history, the story doesn’t quite add up. Maybe it was a stomach ache in the 90s, or maybe they’re just carrying a “inherited” allergy from a parent. In this episode of EM Pulse, we sit down with ED Clinical Pharmacist Haley Burhans to discuss why these labels are more than just a nuisance—they’re a clinical liability—and how a simple tool can empower you to fix them on the fly. The Hidden Danger of the “Safe” Choice Choosing a non-beta-lactam antibiotic because of a questionable allergy label feels like the path of least resistance, but the data tells a different story. We explore how “playing it safe” can actually lead to: Worse Outcomes: Why second line antibiotics often mean higher treatment failure rates. The “Superbug” Factor: The surprising link between penicillin allergy labels and the rise of MRSA and VRE in our communities. The C. diff Connection: Why alternative choices might be setting your patient up for a much more difficult recovery. The Solution: The PEN-FAST Score How do you move from “I think this might not be a true allergy” to “I am confident this antibiotic is safe”? Haley introduces the PEN-FAST score, a validated scoring tool designed to risk-stratify patients based on a few key historical questions. The Mnemonic: We break down the PEN-FAST acronym so you know exactly which three questions to ask to risk-stratify your patient in seconds. IgE vs. The Rest: Learn to distinguish between the “true” dangerous hypersensitivity and the delayed reactions that shouldn’t stop you from using the best drug for the job. The “Amoxicillin Rash”: We dive into this common pediatric “gotcha.”, why many kids end up with a lifelong allergy label after a routine ear infection, and why it often has nothing to do with the drug itself. The Bottom Line: Patients with low PEN-FAST scores are considered low risk, making an oral challenge under observation in the ED a reasonable option. Higher scores may require shared decision-making or referral. Why the ED is the Perfect Place for a “Challenge” Delabeling isn’t just for the allergist’s office. We argue that the Emergency Department is actually the ideal setting to challenge these allergies. The “Oral Challenge”: Learn the practical steps for performing a trial dose in the department. Safety First: Why your environment and expertise make you uniquely qualified to handle the “what-ifs” better than anyone else. Key Takeaways Question the Label: The vast majority of reported penicillin allergies are inaccurate due to patients outgrowing the allergy or misinterpreting common side effects as allergic reactions. History is Everything: Dig deeper than just “rash.” Ask about the timing relative to the dose, specific appearance (hives vs. flat rash), and what treatment was required (epinephrine vs. antihistamines). Use PEN-FAST: Utilize this tool to objectify the risk. Document Tolerance: Even if you don’t fully delete the allergy label, if you successfully treat the patient with another beta-lactam (like ceftriaxone), document that tolerance clearly to aid future clinicians. Cephalosporins are likely safe: Later-generation cephalosporins generally have very low cross-reactivity and are usually safe options even in truly allergic patients How do you handle documented penicillin allergies? Do you use the PEN-FAST tool? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis Resources: PEN-FAST Score on MDCalc Penicillin Allergy Evaluation Should Be Performed Proactively in Patients with a Penicillin Allergy Label – A Position Statement of the American Academy of Allergy, Asthma & Immunology Staicu ML, Vyles D, Shenoy ES, Stone CA, Banks T, Alvarez KS, Blumenthal KG. Penicillin Allergy Delabeling: A Multidisciplinary Opportunity. J Allergy Clin Immunol Pract. 2020 Oct;8(9):2858-2868.e16. doi: 10.1016/j.jaip.2020.04.059. PMID: 33039010; PMCID: PMC8019188. Yang C, Graham JK, Vyles D, Leonard J, Agbim C, Mistry RD. Parental perspective on penicillin allergy delabeling in a pediatric emergency department. Ann Allergy Asthma Immunol. 2023 Jul;131(1):82-88. doi: 10.1016/j.anai.2023.03.023. Epub 2023 Mar 27. PMID: 36990206. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

This episode of EM Pulse dives into one of the most stressful scenarios in the ED: the febrile infant in the first month of life. Traditionally, a fever in this age group has meant an automatic “full septic workup,” including the dreaded lumbar puncture (LP). But times are changing. We sit down with experts Dr. Nate Kuppermann and Dr. Brett Burstein to discuss a landmark JAMA study that suggests we might finally be able to safely skip the LP in many of our tiniest patients. The Study: A Game Changer for Neonates Our discussion centers on a massive international pooled study evaluating the PECARN Febrile Infant Rule specifically in infants aged 0–28 days. While previous guidelines were conservative due to a lack of data for this specific age bracket, this study provides the evidence we’ve been waiting for. The Cohort: A large pool of infants across multiple countries. The Findings: The PECARN rule demonstrated an exceptionally high negative predictive value for invasive bacterial infections. The Big Win: The rule missed zero cases of bacterial meningitis. Defining the Danger: SBI vs. IBI The experts break down why we are shifting our terminology and our clinical focus. Serious Bacterial Infection (SBI)  Historically, this was a “catch-all” term including Urinary Tract Infections (UTIs), bacteremia, and meningitis. However, UTIs are generally more common, easily identified via urinalysis, and typically less life-threatening than the other two. Invasive Bacterial Infection (IBI)  This term refers specifically to bacteremia and bacterial meningitis. These are the “high-stakes” infections the PECARN rule is designed to rule out. Dr. Kuppermann notes that we should ideally view bacteremia and meningitis as distinct entities, as the clinical implications of a missed meningitis case are far more severe. The HSV Elephant in the Room One of the primary reasons clinicians hesitate to skip an LP in a neonate is the fear of missing Herpes Simplex Virus (HSV) infection. Low Baseline Risk: While the overall risk of HSV in a febrile infant is low, the risk of “isolated” HSV (meningitis without other signs or symptoms) is even rarer. Screening Tools: Most infants with HSV appear clinically ill. Clinicians can also use ALT (liver function) testing as a secondary screen – transaminase elevation is a common marker for systemic HSV. Clinical Judgment: If the baby is well-appearing, has no maternal history of HSV, no vesicles, and no seizures, the risk of missing HSV by skipping the LP is exceptionally low. Practical Application: Shared Decision-Making This isn’t just about the numbers—it’s about the parents. “Families don’t mind their babies being admitted… They do not want the lumbar puncture. It is the single most anxiety-provoking aspect of care.” — Dr. Brett Burstein The PECARN “Low-Risk” Criteria:  (Remember, this rule applies only to infants who are not ill-appearing.) Urinalysis: Negative Absolute Neutrophil Count (ANC): ≤ 4,000/mm³ Procalcitonin (PCT): ≤ 0.5 ng/mL The Bottom Line: If an infant is well-appearing and meets these criteria, physicians can have a nuanced conversation with parents about the risks and benefits of forgoing the LP, while still admitting the child for observation (often without empiric antibiotics) while cultures brew. Key Takeaways The “Well-Appearing” Filter: If an infant looks ill, the rule does not apply. These patients require a full workup, including an LP, regardless of lab results. Meticulous Physical Exam: Assess for a strong suck, normal muscle tone, brisk capillary refill, and any rashes or vesicles. History is Key: Always ask about maternal GBS/HSV status, pregnancy or birth complications, prematurity, sick contacts, and any changes in feeding, stooling or activity. Procalcitonin: PCT is the superior inflammatory marker for this rule. If your facility only offers traditional markers like CRP, the PECARN negative predictive value cannot be strictly applied. In the words of Dr. Kuppermann: “If you don’t have it, for God’s sakes, just get it! ALT to Screen for HSV: While not part of the official PECARN rule, our experts suggest that significantly elevated liver enzymes should raise suspicion for systemic HSV. Observe, Don’t Discharge: Being “low risk” does not mean the infant goes home. All infants ≤ 28 days still require admission for 24-hour observation and blood/urine cultures. We want to hear from you! Does this change how you approach febrile neonates in the ED? How do you handle shared decision-making with parents? Connect with us on social media @empulsepodcast or on our website ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Brett Burstein, Clinician-Scientist and Pediatric Emergency Medicine Physician at Montreal Children’s Hospital, McGill University Resources: Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. 2026 Feb 3;335(5):425-433. doi: 10.1001/jama.2025.21454. PMID: 41359314; PMCID: PMC12687207 “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? PECARN Infant Fever Update: 61-90 Days Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. ****Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

  Reimagining Care Beyond Hospital Walls Hospitals are a finite resource—but patient needs are not. This episode continues our multi-part series on taking medicine to where patients are—rather than making them come to us. From preventative care to pediatricians meeting families in their own environments, the series has explored how medicine is evolving beyond traditional settings. In this episode, we explore one of the most compelling—and long-overdue—ideas yet: care at home. What Is Home-Based Medical Care? Joined by Dr. Kelly Owen, Professor of Emergency Medicine at UC Davis and Medical Director for Express Care and Dispatch Health, the conversation dives into what home-based care really looks like—from urgent care at home to ED-to-home follow-ups and post-hospital discharge support designed to prevent readmissions. A Patient-Centered Solution That Works Through a powerful real-world case, the team illustrates how mobile medical units can deliver wraparound care—medications, follow-up appointments, and clinical evaluation—right in a patient’s living room, avoiding unnecessary hospital stays while improving outcomes and patient satisfaction. Why This Model Matters Now With emergency departments stretched thin, home-based care offers ways to: Reduce avoidable ED visits and hospitalizations Improve continuity of care after discharge Support vulnerable, homebound, or transportation-limited patients Deliver care that insurance covers and patients prefer The model is compelling: high patient satisfaction, low ED escalation rates, and health care dollars saved—all while keeping patients at the center. The Future of “Medicine on the Go” As technology and remote monitoring continue to evolve, this episode makes the case that home-based care isn’t a niche experiment—it’s a scalable, sustainable future for emergency and outpatient medicine. Tune in to hear how taking medicine to where patients are is transforming care—for the better. Was this series helpful for you? What other topics would you like to see us cover? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Kelly Owen, Professor of Emergency and Medical Director of Express Care and Dispatch Health at UC Davis Resources: ‘The next frontier of emergency medicine’: House calls following emergency room by Liam Connolly, April 30, 2024. UC Davis Health embarks on innovative care at home journey by Liam Connolly, July 18, 2023.  AMA’s Return on Health: Telehealth framework for practices. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

We’re stepping out of our Medicine on the Go series for a rapid-response episode on something hitting all of us hard right now: **influenza**. A lively debate among our colleagues sparked this conversation—especially around a newer flu antiviral, baloxavir (Xofluza). Who’s using it? When does it make sense? How much does it cost patients? And how does it really compare to the longtime staple oseltamivir (Tamiflu)? The questions came fast, the opinions were strong, and we knew it was time to dig in. With flu season in full swing, this episode is all about practical decision-making at the bedside. Back to Basics: How Flu Antivirals Work To help break it all down, we welcome back our trusted ED pharmacist, Haley Burhans. We begin with a quick review of how influenza antivirals have evolved. , approved in 1999, was the first widely used antiviral and works by blocking the neuraminidase enzyme. Over time, concerns about resistance led to the development of newer options. That brings us to baloxavir (Xofluza), approved in 2018. Xofluza works differently by stopping viral replication earlier in the virus life cycle. While both medications aim to shorten illness and reduce complications, they differ in how they work, how they are dosed, and which patients benefit most. Who Should Get What—and When? Next, we focus on real-world ED decision-making. Who should receive Tamiflu, and who is a good candidate for Xofluza? We review use in children, pregnant patients, hospitalized patients with severe or worsening illness, immunocompromised patients, and those at higher risk due to conditions like asthma, lung disease, diabetes, heart disease, obesity, or older age. Timing is critical. Both medications work best when started within 48 hours of symptom onset. However, oseltamivir is still recommended even after that window for patients who are hospitalized or severely ill. We also discuss when antivirals can be used for post-exposure prpphylaxis. What Does the Evidence Say? We then take a closer look at the data behind antiviral treatment. Both Tamiflu and Xofluza shorten the time to symptom improvement. Observational studies suggest oseltamivir may reduce hospital length of stay and in-hospital death in adults and shorten hospital stays in children. Trial data also suggest baloxavir may be more effective against influenza B. We compare dosing strategies—five days of twice-daily Tamiflu versus a single-dose Xofluza—and review side effects and pediatric considerations. Real-World Barriers: Access and Cost Finally, we tackle the practical issues clinicians face every day. Tamiflu is widely available and familiar to most providers. Xofluza, on the other hand, often requires prior authorization and may be harder for patients to obtain. We discuss insurance barriers, out-of-pocket costs, manufacturer coupons, and situations where Xofluza may or may not be a realistic option. Take-Home Message This episode is a practical, evidence-based conversation designed to help emergency clinicians make confident decisions during flu season. Whether you’re treating a high-risk patient, considering a single-dose option for uncomplicated flu, or simply trying to stay current, this discussion delivers clear, useful guidance you can use on your next shift! What’s your go to flu treatment? What other medications would you like to learn more about? Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis Resources: CDC: Influenza Antiviral Medications: Summary for Clinicians AAP: Recommendations for Prevention and Control of Influenza in Children, 2025–2026: Policy Statement ACEP Influenza Resources and Updates **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The next episode of our Medicine on the Go series features Dr. Serena Yang, Professor and Division Chief of General Pediatrics and Vice Chair of Community Engagement at UC Davis Health, as she shares how UC Davis Children’s Hospital’s Pediatric Mobile Clinic is bringing specialty care directly into schools and under-resourced communities across the Sacramento region. Learn how this innovative mobile model addresses urgent needs in child development, mental health, and asthma, removes barriers to care, and builds trust through strong school and community partnerships—offering an inspiring blueprint for delivering equitable pediatric care beyond the clinic walls. Does your health system have a mobile outreach clinic? Would you consider starting one? We’d love to hear from you! Share with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Serena Yang, Clinical Professor and Division Chief of General Pediatrics, and Vice Chair of Community Engagement at UC Davis Resources: UC Davis Pediatric Mobile Clinic Program **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In the second episode of our Medicine on the Go series, we step beyond the ED to explore how UC Davis Health and Sacramento County are partnering to deliver care directly to the community through the Wellness Without Walls (W3) street medicine program. We’re joined by Dr. MK Orsulak, Assistant Professor of Family Medicine at UC Davis. We discuss how a mobile clinic staffed by interdisciplinary teams brings primary care, wound care, mental health services, HIV/STI testing, vaccinations, and substance use treatment to people experiencing homelessness—meeting patients where they are and reducing preventable ED visits. This episode offers a powerful look at how innovative, cross-system collaboration can extend emergency care beyond hospital walls and improve access to the right care at the right time. Do you have a program similar to W3 in your area? We’d love to hear about it! Share with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. MK Orsulak, Assistant Professor of Family and Community Medicine at UC Davis Resources: Sacramento County Department of Health Services: Wellness Without Walls (W3) Street medicine team improves lives of unhoused patients, by Edwin Garcia, Feb 27 2024 *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this first installment of our Medicine on the Go series, we explore how care is moving beyond hospital walls and directly into the community through UC Davis Fire Department’s innovative mobile mental health crisis unit, Health 34. You’ll hear how this no-cost, 24/7 team—staffed by providers with paramedic backgrounds and lay counselor training—meets people where they are to prevent crises, support mental health needs, and connect patients to the right resources before problems escalate. Health 34 Provider, Blythe Clark, joins us to share the origins of the program, how it works, who it serves, and what other communities can learn from this model. We’ll explore how prehospital services can act as a powerful preventative tool and how collaborations like this could reshape the future of care far beyond campus. Do you have a program similar to Health 34 in your area? We’d love to hear how it’s working and what you’ve learned. Share with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Blythe Clark, Health 34 Provider, UC Davis Fire Department Resources: Health 34 *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode of EM Pulse, guest host Dr. Neelou Tabatabai joins Julia in a discussion with ED nurse and TeamSTEPPS advocate, Leigh Clary, to explore how structured communication tools can transform even the most high-stress medical and trauma resuscitations. Through a real-life story of conflict and resolution in the emergency department, Leigh illustrates how TeamSTEPPS strategies—like assertive communication, the Two-Challenge Rule, and CUS words—empower teams to speak up, de-escalate tension, and protect patient safety. Together, they unpack how calm, composed dialogue preserves respect, strengthens teamwork, and ensures every voice is heard when it matters most. Do you use TeamSTEPPS or a similar model in your ED? We’d love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis Guest: Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis Resources: TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN. TeamSTEPPS Pocket Guide – Agency for Healthcare Research and Quality EM Pulse: TeamSTEPPS, September 17, 2021  **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode, we dive into the charged world of Morbidity and Mortality conferences—where good intentions can collide with fear, shame, and silence. We’ve all felt that jolt of adrenaline sitting in the audience—or worse, standing at the podium. Our guest expert, Dr. Jaymin Patel, helps us unpack why the traditional M&M model no longer works and how we can rebuild it into something better: a space that turns mistakes into meaningful learning, supports both patient and provider healing, and helps us face our ghosts without fear. How do you think we can improve M&M? Share your ideas with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jaymin Patel, Assistant Professor of Emergency Medicine and Assistant Residency Program Director at UC Davis Resources: ALiEM: The M&M Shame Game; Case by Dr. Tamara McColl   Nussenbaum B, Chole RA. Rethinking Morbidity and Mortality Conference. Otolaryngol Clin North Am. 2019 Feb;52(1):47-53. doi: 10.1016/j.otc.2018.08.007. Epub 2018 Oct 5. PMID: 30297182. Wittels K, Aaronson E, Dwyer R, Nadel E, Gallahue F, Fee C, Tubbs R, Schuur J; EM M&M Culture of Safety Research Team. Emergency Medicine Morbidity and Mortality Conference and Culture of Safety: The Resident Perspective. AEM Educ Train. 2017 May 4;1(3):191-199. doi: 10.1002/aet2.10033. PMID: 30051034; PMCID: PMC6001737. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

What happens when a febrile infant presents at 61 days old? Are they suddenly low risk for invasive bacterial infections? In this episode, we explore the gray zone of managing febrile infants aged 61–90 days with the help of two new clinical prediction rules from PECARN. Joining us are two powerhouses in pediatric emergency medicine: Dr. Nate Kuppermann and Dr. Paul Aronson, who walk us through their recent study published in Pediatrics. We discuss why prior research has traditionally stopped at 60 days, what the new data shows about risk in this slightly older age group, and how these rules might help guide clinical decision-making. This study fills a long-standing gap—but should we start using the rules now? Tune in for a nuanced discussion on sensitivity, missed cases, practical application, and the future of risk stratification in young infants with fever. What is your practice in terms of work-up of 2-3 month old febrile infants? Will this change what you do? Hit us up social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Paul Aronson, Professor of Pediatrics (Emergency Medicine); Deputy Director, Pediatric Residency Program at Yale University School of Medicine Resources: “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? Aronson PL, Mahajan P, Meeks HD, Nielsen B, Olsen CS, Casper TC, Grundmeier RW, Kuppermann N; PECARN Registry Working Group. Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. 2025 Sep 1;156(3):e2025071666. doi: 10.1542/peds.2025-071666. PMID: 40854562; PMCID: PMC12432541. Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Dive into the second half of our envenomation series! Dr. Jonathan Ford, a UC Davis Medical Toxicologist and Professor of Emergency Medicine, returns to the podcast to tackle scorpions and spiders. We’re going beyond the basics to discuss the “why” and “how” of these bites and stings. Learn about the neurotoxic effects of bark scorpion venom and the life-threatening airway risks. Explore the mechanism behind black widow bites that leads to intense pain and spasms, and the crucial role of antivenom in severe cases. Plus, we’re setting the record straight on a common myth—the brown recluse—and the proper supportive care for its nasty bite. Join us to discover the latest evidence-based approaches that could change how you manage your next bite or sting. Have you had a patient with a serious or challenging envenomation?  How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Quan D. North American poisonous bites and stings. Crit Care Clin. 2012 Oct;28(4):633-59. doi: 10.1016/j.ccc.2012.07.010. PMID: 22998994. Levine M, Friedman N. Terrestrial envenomations in pediatric patients: identification and management in the emergency department. Pediatr Emerg Med Pract. 2021 Sep;18(9):1-24. Epub 2021 Sep 2. PMID: 34403224.. ***\ Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Summer hikes and backyard play mean we’re bound to see a few snakebites in the ED—and getting the first steps right makes all the difference. In the first half of this 2 part series, Medical Toxicologist Dr. Jonathan Ford joins us to walk through the key steps in caring for patients with snake envenomations. We’ll walk through what to do (and not to do) in terms of pre-hospital care, how to triage and assess patients when they arrive in the ED, and how to decide which patients need antivenom. Dr. Ford reviews dosing strategies, monitoring, and key considerations for children, elderly, and pregnant patients. And we discuss practical guidance on supportive care, from pain control to wound management. By the end of this episode, you’ll be ready to provide effective, evidence-based care for your next snakebite patient. Have you had a patient with a serious or challenging envenomation?  How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Seifert SA, Armitage JO, Sanchez EE. Snake Envenomation. N Engl J Med. 2022 Jan 6;386(1):68-78. doi: 10.1056/NEJMra2105228. PMID: 34986287; PMCID: PMC9854269. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In the second half of this two part episode, Dr. David Leon unpacks some of the most hotly debated topics in resuscitation—fluids, blood products, ECMO, and post-arrest care. He breaks down the pros and cons of crystalloids (yes, even the “pasta water” debate), explains why lactated Ringer’s is often preferred over normal saline, and dips into the use of albumin and colloids. Dr. Leon also discusses the promise and challenges of extracorporeal life support (ECLS), the evolving role of targeted temperature management (TTM), and even peeks into what advances the future might hold. It’s a thoughtful, forward-looking conversation every resuscitationist should hear. What do you think of Dr. Leon’s tips? Are you using these tools in your practice? We’d love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this high-yield two part episode, we dive into the evolving world of resuscitation with Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis. From the shift in priorities from ABC (Airway-Breathing-Circulation) to CAB (Circulation first) to the practical use of peripheral vasopressors and rapid infusion catheters, this episode breaks down how frontline ED care is adapting to sicker patients, longer ICU boarding times, and limited resources. Tune in for insights on advanced access strategies, pre-hospital blood products, and why old tools, like whole blood and vasopressin, are making a powerful comeback. What do you think of Dr. Leon’s tips? Are you using these tools in your practice? We’d love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

We’re back with another episode of Push Dose Pearls with ED Clinical Pharacist, Haley Burhans! In this episode, we break down the essentials of managing agitation in the ED—starting with why you should avoid diphenhydramine in the elderly and benzodiazepines in the 3 D’s: drunk, delirium, and dementia. We discuss how to quickly assess the cause, choose the right medication, and decide between IM and IV routes. And Haley offers some key safety tips and considerations for special populations, including kids and the elderly.  Was this episode helpful? What other medications would you like to learn more about? Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis Resources: ACEP’s New Clinical Policy on Severe Agitation. By Molly E.W. Thiessen, MD, FACEP | on February 12, 2024 Pediatric Education and Advocacy Kit (PEAK): Agitation Hoffmann JA, Pergjika A, Konicek CE, Reynolds SL. Pharmacologic Management of Acute Agitation in Youth in the Emergency Department. Pediatr Emerg Care. 2021 Aug 1;37(8):417-422. doi: 10.1097/PEC.0000000000002510. PMID: 34397677; PMCID: PMC8383287. Gerson R, Malas N, Feuer V, Silver GH, Prasad R, Mroczkowski MM. Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. West J Emerg Med. 2019 Mar;20(2):409-418. doi: 10.5811/westjem.2019.1.41344. Epub 2019 Feb 19. Erratum in: West J Emerg Med. 2019 May;20(3):537. doi: 10.5811/westjem.2019.4.43550. Erratum in: West J Emerg Med. 2019 Jul;20(4):688-689. doi: 10.5811/westjem.2019.4.44160. PMID: 30881565; PMCID: PMC6404720.. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode, we welcome back Dr. John Rose as cohost for a conversation with Dr. Gary Tamkin—Emergency Physician and Vice President of Provider Development at US Acute Care Solutions. Together, they explore what it really takes to find happiness and fulfillment in the high-stakes world of emergency medicine. From the trap of the arrival fallacy to the pressure of always chasing the next milestone, Dr. Tamkin shares personal insights and practical strategies tailored to the unique challenges EM clinicians face. You’ll come away with two actionable tools to help build more meaning, balance, and joy—both on shift and off. What are your tips for avoiding burnout and finding balance? Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest Host: Dr. John Rose, Professor of Emergency Medicine and EMS Medical Director at UC Davis Guest: Dr. Gary Tamkin, Emergency Physician and Vice President of Provider Development and US Acute Care Solutions Resources: Podcast: 10% Happier with Dan Harris Podcast: Hidden Brain with Shankar Vedantam Transitions by William Bridges, PhD with Susan Bridges The Happiness Advantage by Shawn Achor **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Hypoglycemia can be subtle—or dangerously obvious—and knowing when and how to treat it is critical. In her first episode as our new Push Dose Pearls expert, Emergency Medicine Clinical Pharmacist, Haley Burhans, joins us to break it down. We discuss glucose thresholds by age, when to draw critical labs, and how to choose the right treatment—whether it’s oral glucose, IV dextrose, or IM or intranasal glucagon. From neonates to older adults, Haley delivers practical, evidence-based pearls to help you manage low blood sugar safely and effectively in the ED. Was this episode helpful? What other medications would you like to learn more about? Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis Resources: Gandhi K. Approach to hypoglycemia in infants and children. Transl Pediatr. 2017 Oct;6(4):408-420. doi: 10.21037/tp.2017.10.05. PMID: 29184821; PMCID: PMC5682370. Rickels MR, Ruedy KJ, Foster NC, Piché CA, Dulude H, Sherr JL, Tamborlane WV, Bethin KE, DiMeglio LA, Wadwa RP, Ahmann AJ, Haller MJ, Nathan BM, Marcovina SM, Rampakakis E, Meng L, Beck RW; T1D Exchange Intranasal Glucagon Investigators. Intranasal Glucagon for Treatment of Insulin-Induced Hypoglycemia in Adults With Type 1 Diabetes: A Randomized Crossover Noninferiority Study. Diabetes Care. 2016 Feb;39(2):264-70. doi: 10.2337/dc15-1498. Epub 2015 Dec 17. PMID: 26681725; PMCID: PMC4722945.. MD Calc GIR (Glucose Infusion Rate) Calculator **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Summer travel is in full swing and, for physicians, that means more than just packing swimsuits and sunscreen. In this episode of EM Pulse, we sit down with wilderness medicine expert, Dr. Mary Bing, to unpack the real-world essentials of travel medical kits. From duct tape and whistles to epinephrine and steroids, you’ll learn what to bring, how to tailor your supplies based on destination and group, and why your role as a physician—formal or not—comes with extra responsibilities. Whether you’re headed to the Alps or the backyard, this episode is your go-to guide for staying medically prepared on the move. Don’t just travel light—travel smart. What’s in your first aid kit? Hit us op on on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Mary Bing, Professor of Emergency Medicine and Assistant EM Residency Program Director at UC Davis Resources: Surviving a Wilderness Emergency by Peter Kummerfeldt ACEP: First Aid Kit U.S. Customs and Border Protection: Traveling with medication ***  Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this follow-up to our artificial intelligence in EM series, we’re diving into how AI can enhance your professional life outside of clinical shifts. Joined by Dr. Jaymin Patel—Assistant Residency Program Director and tech-savvy educator—we explore three practical AI tools that can streamline teaching, content creation, communication, and even how you consume literature on your commute. From ChatGPT to DALL·E to NotebookLM, we break down what each tool does, how to use it effectively, what pitfalls to avoid, and how even non-educators can leverage them. Tune in to learn how to use AI intentionally, efficiently, and ethically in your day-to-day professional life.  Are you using AI in your professional life? What’s your favorite tool? Share your experience with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Jaymin Patel, Assistant Professor of Emergency Medicine and Assistant EM Residency Program Director at UC Davis Resources: Nivritti Gajanan Patil, Nga Lok Kou, Daniel T. Baptista-Hon, Olivia Monteiro. Artificial Intelligence in Medical Education: A Practical Guide for Educators. MedComm – Future MedicineVolume 4, Issue 2 e70018. First published: 02 April 2025 https://doi.org/10.1002/mef2.70018 ChatGPT DALL•E NotebookLM **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode of EM Pulse, Dr. Daniel Hernandez, an emergency medicine and addiction specialist at UC Davis, joins the team to spotlight methadone—one of the original and still powerful tools for treating opioid use disorder (OUD). While newer medications like buprenorphine often steal the spotlight, methadone remains a critical option, especially in the era of fentanyl. Tune in for a practical conversation on when and how to initiate methadone in the ED, navigating regulatory barriers, arranging follow-up at opioid treatment programs, and managing pain in patients already on methadone. Whether you’re new to methadone or looking to sharpen your approach, this episode offers real-world insights and actionable pearls  Have you started methadone from the ED? Share your experience with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Daniel Hernandez, Assistant Professor of Emergency Medicine and Assistant Director of the Addiction Medicine Fellowship at UC Davis Resources: CA Bridge ACEP/CA Bridge – Methadone Hospital Quick Start Liberate Methadone: An Introduction for the Emergency Medicine Physician By Terence M. Hughes, MD; Joan Chen, MD; and Utsha G. Khatri, MD, MSHP | on April 14, 2025 *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.