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EM Pulse Podcast™

EM Pulse Podcast™

De: UC Davis Department of Emergency Medicine
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Bringing research and expert opinion to the bedside2023 UC Davis Emergency Department Educación Enfermedades Físicas Higiene y Vida Saludable
Episodios
  • Tiny Hot Patients And The PECARN Febrile Infant Rule

    Tiny Hot Patients And The PECARN Febrile Infant Rule
    Feb 4 2026
    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: NegativeAbsolute Neutrophil Count (ANC): ≤ 4,000/mm³Procalcitonin (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 ...
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    33 m
  • Medicine on the Go: Care at Home

    Medicine on the Go: Care at Home
    Jan 21 2026

    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.
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    19 m
  • Push Dose Pearls: Tamiflu vs Xofluza

    Push Dose Pearls: Tamiflu vs Xofluza
    Jan 16 2026
    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.
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    18 m
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