Tularemia is a rare zoonotic disease caused by Francisella tularensis. It can often present with varied clinical presentations, but meningitis is extremely rare. In this case study, we describe a patient who presented to our emergency department with a Tularemic infection coupled with acute atypical meningitis, after he was exposed to aerosolized rabbit hair from lawn mowing. Prompt diagnosis of tularemic meningitis may be difficult without a known history of animal exposure. Despite what is taught in medical school, numerous studies have shown Kernig's sign, Brudzinski's sign, and nuchal rigidity do not have much diagnostic value in adults with meningitis. Yet, almost all patients with meningitis present with at least 2 of the 4 symptoms of fever, headache, altered mental status, and neck stiffness. For this reason, it is essential to stop using Kernig's sign and Brudzinski's sign as the only basis for diagnosing meningitis in every case. With the rampant population increase of rabbits in states like Colorado, Missouri, and Illinois, and a growing number of tularemic patients from lawn mowing incidents popping up across the country, it is also vital to consider the diagnosis of tularemia in your differential diagnosis and send for a cerebrospinal fluid culture, based on a more detailed historytaking of your patient, specifically noting his/her outdoor activities during the initial assessment in the emergency department (ED). This would immensely speed up the process of diagnosing the patient and would ensure a timely start of antibiotics for a full recovery. Research evaluating the relationship between vasopressor initiation timing and clinical outcomes is limited and conflicting. We investigated the association between time to vasopressors, worsening organ failure, and mortality in patients with septic shock. This was a retrospective study of patients with septic shock (2013-2016) within 24 hours of emergency department (ED) presentation. The primary outcome was worsening organ failure, defined as an increase in Sequential Organ Failure Assessment (SOFA) score ≥2 at 48 hours compared to baseline, or death within 48 hours. The secondary outcome was 28-day mortality. Time to vasopressor initiation was categorized into 6, 4-hour intervals from time of ED triage. Multiple logistic regression was used to identify predictors of worsening organ failure. We analyzed data from 428 patients with septic shock. There were 152 patients with the composite primary outcome (SOFA increase ≥2 or death at 48 hours). Of these, 77 patients died in the first 48 hours and 75 patients had a SOFA increase ≥2. Compared to the patients who received vasopressors in the first 4 hours, those with the longest time to vasopressors (20-24 hours) had increased odds of developing worsening organ failure (odds ratios [OR] = 4.34, 95% confidence intervals [CI] = 1.47-12.79, =0.008). For all others, the association between vasopressor timing and worsening organ failure was non-significant. There was no association between time to vasopressor initiation and 28-day mortality. Increased time to vasopressor initiation is an independent predictor of worsening organ failure for patients with vasopressor initiation delays >20 hours.20 hours. Evaluate an indication-based clinical decision support tool to improve antibiotic prescribing in the emergency department. Encounters where an antibiotic was prescribed between January 2015 and October 2017 were analyzed before and after the introduction of a clinical decision support tool to improve clinicians' selection of a guideline-approved antibiotic based on clinical indication. Evaluation was conducted on a pre-defined subset of conditions that included skin and soft tissue infections, respiratory infections, and urinary infections. The primary outcome was ordering of a guideline-approved antibiotic prescription at the drug and duration of therapy level. A mixed model following a binomial distribution with a logit link was used to model the difference in proportions of guideline-approved prescriptions before and after the intervention. For conditions evaluated, selection rate of a guideline-approved antibiotic for a given indication improved from 67.1% to 72.2% ( < 0.001). When duration of tduration of therapy guidelines into the antibiotic prescribing process. We sought to determine if a pictorial brochure improves HIV/AIDS and HIV testing knowledge and increases HIV testing motivation and behavioral skills as well as a video among adult emergency department patients, regardless of language spoken and health literacy level. ED patients were stratified by primary language spoken (English or Spanish) and health literacy level (lower or higher) and randomly assigned to watch the study video or review the content-matched pictorial brochure. click here HIV/AIDS and HIV testing knowledge, motivation for HIV testing, and behavioral skills for HIV testing were assessed using study instruments before and after watching the video or reviewing the pictorial brochure. Of the 712 English- and 655 Spanish-speaking ED patients, HIV/AIDS and HIV testing knowledge improved more among participants in the video than the pictorial brochure arm (∆ 0.43; 95% confidence interval [CI] 0.07, 0.79). This improvement was more pronounced among those with lower (∆ 0.60; 95% CI 0.06, 1.13) than higher health literacy (∆ 0.27; 95% CI -0.22, 0.76). HIV testing motivation was high before the intervention and did not increase differentially between arms. Confidence in recognizing when to be tested for HIV was slightly greater in the video than pictorial brochure arm (∆ 0.15; 95% CI 0.01, 0.28), but did not differ by language spoken or health literacy level. A video improved HIV/AIDS and HIV testing knowledge slightly more than a pictorial brochure. Other considerations (eg, patient volume, staffing, space, and video access) should guide EDs on how best to provide information about HIV testing to ED patients.A video improved HIV/AIDS and HIV testing knowledge slightly more than a pictorial brochure. Other considerations (eg, patient volume, staffing, space, and video access) should guide EDs on how best to provide information about HIV testing to ED patients.