• The rainy East coast spring has increased tick populations in endemic areas such as Maryland resulting in more tick bites.
• ED visits for known tick bites present acutely, often with parents bringing in the tick to be identified/tested.
• Routine serologic testing and antibiotic prophylaxis is not recommended after every tick bite.
• If an attached tick is engorged, identified as I. scapularis, and has been attached for >36 hours, then antibiotic prophylaxis for Lyme can be prescribed if started within 72 hours of tick removal in those patients > 8 years of age
• Prophylaxis: Single dose of doxycycline 4 mg/kg or 200mg max 
• If early Lyme Disese is present in the form of the classic rash of Erythema migrans, then treatment is doxycycline, 4 mg/kg or 100mg max BID for patients > 8 years of age or amoxicillin 50 mg/kg per day divided TID with 500 mg max TID in those < 8 years of age for 14 days 
• Serologic testing is false negative in the first month of testing, and unnecessary in the ED  for acute presentations.