http://www.rssboard.org/rss-specification 720 https://escholarship.org/uc/uciem/rss Recent eScholarship items from Department of Emergency Medicine (UCI) Wed, 5 Aug 2026 02:00:57 +0000 https://escholarship.org/uc/item/28v7b6tn <p><strong>Introduction:</strong> Agitation in the emergency department (ED) poses a significant safety concern for staff and patients. Multidisciplinary responses, such as Code Violet activations, are common but resource-intensive. Early identification and intervention may reduce escalation, but ED-specific data are limited. The objective of the study was to evaluate the implementation of a novel agitated behavior score (ABS) and assess whether higher ABS scores are associated with increased risk of Code Violet activation.</p> <p><strong>Case Series:</strong> This prospective observational study included adult patients admitted to a behavioral health unit in a community teaching hospital ED. Trained staff administered a novel 25-point ABS incorporating altered mentation, verbal agitation, and motor agitation. The primary outcome was Code Violet activation; secondary outcomes included pharmacologic interventions and substance use. Among 83 patients, 27 (33%) experienced ≥ 1 Code... https://escholarship.org/uc/item/28v7b6tn Mon, 3 Aug 2026 00:00:00 +0000 Ceraolo, Negin Sandine, Julianna Crouse, Bethany Krizo, Jessica Simon, Erin L https://escholarship.org/uc/item/1vb4c5q0 <p><strong>Introduction:</strong> Acute aortic dissection is a life-threatening emergency with a wide spectrum of clinical presentations. Neurological deficits as the initial manifestation of aortic dissection are uncommon and may result in delayed or missed diagnosis. This case describes aortic dissection presenting primarily as acute paraplegia without persistent chest pain or other classic features.</p> <p><strong>Case Report:</strong> We report a 52-year-old male who presented with sudden-onset paraplegia. Neurological examination revealed flaccid paralysis of both lower limbs, with loss of pain and temperature sensation below the first lumbar dermatome and preserved dorsal column modalities. The patient was hypertensive on presentation. A clinical diagnosis of anterior spinal artery syndrome was made. Contrast-enhanced computed tomography of the chest and abdomen demonstrated a Stanford type A aortic dissection. The patient was counseled regarding the need for urgent surgical... https://escholarship.org/uc/item/1vb4c5q0 Mon, 3 Aug 2026 00:00:00 +0000 Nagarajan, Sindujaa Ganessane, Ezhilkugan https://orcid.org/0000-0001-8541-5675 B G, Kowsthubha https://orcid.org/0009-0006-7909-7248 Somasundaram, Anukarthika Balamurugan, Nathan https://escholarship.org/uc/item/9j90r4vz <p>&nbsp; </p> <p style="text-align: justify;"><strong>Audience</strong>:&nbsp; The target audience for this small group session is post-graduate year (PGY) 1-4 emergency medicine (EM) residents and medical students.</p> <p style="text-align: justify;"><strong>Introduction</strong>: An electrocardiogram (ECG) is a crucial diagnostic tool in emergency medicine.¹ Accurate ECG interpretation by emergency physicians is crucial for diagnosing life-threatening conditions, making it essential for EM residents' training. The Accreditation Council for Graduate Medical Education (ACGME) lists ECG interpretation as a vital patient care milestone for residency graduation.² Despite this, research suggests that few EM programs have standardized ECG curricula or test for ECG interpretation competency.³ To address this gap, we created the “ECG Bootcamp,” which uses gamification to engage learners in key ECG concepts through group learning.</p> <p style="text-align:... https://escholarship.org/uc/item/9j90r4vz Fri, 31 Jul 2026 00:00:00 +0000 Sokol, Kimberly Lucero, Anthony David Kemp, Melissa Singh, Nayana Sprouse, Ian https://escholarship.org/uc/item/9d49k7bh <p><strong>Background: </strong>Asynchronous care has emerged as a promising approach to improving healthcare accessibility while potentially reducing costs, particularly for low-acuity conditions. Our objective was to describe the use patterns, patient characteristics, and short-term clinical outcomes of an emergency department (ED)–led asynchronous care platform managing low-acuity conditions in a large, academic health system.</p> <p><strong>Methods</strong><strong>:</strong> We conducted a retrospective cohort study evaluating the Mount Sinai Health System asynchronous care platform for managing urinary tract infections, conjunctivitis, cold sores, vaginal candidiasis, emergency contraception, and oral contraceptive prescriptions between December 2023–October 2024 during an initial rollout period. Individual charts were reviewed by two trained abstractors and two emergency physicians. The primary outcome was any subsequent ED or clinic visit within seven days. Secondary outcomes... https://escholarship.org/uc/item/9d49k7bh Fri, 31 Jul 2026 00:00:00 +0000 Shah, Shivam Suri, Ikaasa Gordan, Helen Schwartz, Nicole Hossain, Rubayet Apakama, Donald Khakhkhar, Rishi Marren, Taylor Abella, Benjamin S. Gavin, Nicholas Abbott, Ethan E https://escholarship.org/uc/item/9289h1wb <p style=" text-align: justify; "><strong>Audience:&nbsp;</strong>This simulation was designed primarily for emergency medicine residents and pediatric emergency medicine residents. Additionally, off-service residents, neurosurgical residents, pediatric residents, faculty, and medical students may benefit.</p> <p style=" text-align: justify;"><strong>&nbsp;</strong></p> <p style=" text-align: justify;"><strong>Introduction:&nbsp;</strong>Ventriculoperitoneal (VP) shunts are the treatment of choice for patients suffering from hydrocephalus.Hydrocephalus affects about 125,000 patients in the United States, and 33,000 VP shunts are implanted in patients every year.<a href="https://www.zotero.org/google-docs/?mUbKGi">¹</a>&nbsp;However, these devices can malfunction and can cause complications. It is important for the emergency department physician to recognize when these devices are not functioning correctly to prevent... https://escholarship.org/uc/item/9289h1wb Fri, 31 Jul 2026 00:00:00 +0000 Koda, Alexis Vawter, Kyle Thomas https://escholarship.org/uc/item/91f8s8fd <p><strong>Background:</strong> Prevalence of heart failure is increasing, with an associated rise in emergency department (ED)-related care. Social determinants of health (SDoH) are associated with adverse health outcomes, but the extent to which they influence ED use for heart failure care is poorly understood. We sought to describe the relationship between community-level social vulnerability and ED revisits and hospital admissions for heart failure within a single health system.</p> <p><strong>Methods:</strong> We conducted a retrospective review of Social Deprivation Index (SDI) scores (higher score = more deprivation) by ZIP code paired with administrative clinical data. Zero-hurdle regression was used to model the relationship between SDI and ED revisits within 90 days of a prior ED visit for heart failure (logistic model for &gt; 0 revisits; Poisson model for count of revisits). We used a mixed-effects logistic model—accounting for repeat visits—to test the association... https://escholarship.org/uc/item/91f8s8fd Fri, 31 Jul 2026 00:00:00 +0000 Ehrman, Robert R. Harrison, Nicholas E. Haber, Brian D. Korzeniewski, Steven J. Favot, Mark J. Khait, Lyudamila Levy, Phillip D. https://escholarship.org/uc/item/9067g1zz <p><strong>Introduction:</strong> Multi-day planned mass gatherings are prevalent in various forms of sports competitions, concerts, professional, political, and religious conferences. The largest, the World Cup competition, will be hosted by large cities of the United States, Canada, and Mexico in June and July, 2026. These can present risks to the health of spectators, participants, organizers, and host communities, which if discovered faster, facilitates more effective responses in preventing morbidity/mortality. This study demonstrates visually modeled 9-1-1 medical data that uniquely contributes to existing syndromic surveillance activities by its practicality and time sensitivity.<br>&nbsp; &nbsp; &nbsp;&nbsp;<br><strong>Objectives:</strong> Using data from the nine-day period of 2019 Super Bowl LIII festivities, this retrospective, quantitative, descriptive, population-based study was conducted to demonstrate how 9-1-1 emergency medical dispatch (EMD) data could be practically... https://escholarship.org/uc/item/9067g1zz Fri, 31 Jul 2026 00:00:00 +0000 Yancey, Arthur H https://orcid.org/0009-0002-0274-8517 Robinson, Elijah McMahan, Timothy Cotsonis, George A https://escholarship.org/uc/item/8z82b354 <p>Acute aortic dissection (AAD) typically presents with sudden, severe chest or back pain. This case highlights an atypical painless presentation that was rapidly progressive and lethal. A 55-year-old woman presented with generalized weakness, agitation, and shortness of breath, but without pain. Initial point-of-care ultrasound (POCUS) was reassuring, but persistent agitation and emerging abdominal tenderness prompted reexamination and repeat POCUS, which revealed evidence of aortic dissection. Computed tomography angiogram (CTA) confirmed the diagnosis of a Stanford Type A dissection. Despite aggressive resuscitative efforts, the patient’s condition deteriorated rapidly. This case emphasizes the importance of observant reassessment and repeating POCUS in atypical presentations of AAD because subtle clinical changes can reveal life-threatening conditions such as aortic dissection.</p> https://escholarship.org/uc/item/8z82b354 Fri, 31 Jul 2026 00:00:00 +0000 Yang, Justin Rigdon, Tyler Lewis, Kristin https://escholarship.org/uc/item/8z7577b8 <p><strong>Introduction:</strong> Our study objective was to share the experiences of four public emergency departments (ED) caring for patients with complications of gluteal autologous fat transfer (AFT), colloquially known as Brazilian butt lifts, to provide emergency physicians with a better understanding of these patients and potential complications associated with the procedure.</p> <p><strong>Methods:</strong> Jackson Health System in Miami, Florida, undertook an institutional initiative to prospectively collect data on patients presenting to any of the system’s EDs with gluteal AFT complications from October 2020–May 2023. We abstracted patient charts for demographics, disposition, lab values, diagnoses, and care-related charges to generate descriptive statistics. Our primary outcome measure was diagnostic code and diagnostic category. Secondary outcome measures were hemoglobin on presentation, units of blood transfused, admission level of care, hospital charge, length... https://escholarship.org/uc/item/8z7577b8 Fri, 31 Jul 2026 00:00:00 +0000 Lee, Mary Bridget Goldstein, Joshua Hercz, Daniel Pyle, Matt https://escholarship.org/uc/item/8sm5h5h8 <p><strong>Introduction:</strong> We incorporated an 8-hour standardized substance use disorder (SUD) curriculum and X-waiver training into our emergency medicine (EM) residency. We sought to assess whether the implementation of the standardized SUD curriculum and X-waiver training affected graduated EM residents’ comfort with treating SUD and prescribing practices, as well as their view of their future career paths.</p> <p><strong>Methods:&nbsp;</strong>Physicians who completed their EM residency at our hospital from 2016-2022 were invited to complete the survey in 2023. The primary outcome measure was the proportion of surveyed graduates who reported comfort and confidence in treating patients with SUD, measured by affirmative responses to survey items. The secondary outcome measure was the proportion of surveyed graduates reporting that participation in the SUD curriculum and X-waiver training during residency influenced their career plans, measured by affirmative responses... https://escholarship.org/uc/item/8sm5h5h8 Fri, 31 Jul 2026 00:00:00 +0000 Chukwunyere, Chigozie https://orcid.org/0000-0003-1294-6701 Heil, Jessica https://orcid.org/0000-0002-8876-0922 Salzman, Matthew Haroz, Rachel https://escholarship.org/uc/item/8fg1s80w <p style=" text-align: start; "><strong>Audience:</strong>&nbsp;This simulation is intended for emergency medicine residents.<br><br></p> <p style=" text-align: justify;"><strong>Background:&nbsp;</strong>Lateral canthotomy and cantholysis (LCC) is a sight-saving procedure for orbital compartment syndrome (OCS).¹&nbsp;Due to the rarity of OCS, emergency-medicine trainees often have limited exposure and low procedural confidence. In a questionnaire we found that trainees have low confidence levels in performing the procedure attributed to the low incidence of OCS and the scarcity of training opportunities. Existing literature describes LCC task trainers with creation of simulation models, but few provide a reproducible multimodal package adaptable for multiple training centres.^2,3&nbsp;Our innovation combines presentation, instructional video, gamified quiz, and hands-on practicer with low fidelity models. Unlike previous studies... https://escholarship.org/uc/item/8fg1s80w Fri, 31 Jul 2026 00:00:00 +0000 Shoaib, Haris Hussain, Yunus K Shoaib, Shiza Hussain, Sulaiman Chaudhary, Haider A Ali, Muhammad Subed Jennings, Cara Smith, Tara https://escholarship.org/uc/item/86j47321 <p style=" text-align: justify;">Orbital compartment syndrome (OCS) is an ophthalmologic emergency due to an acute rise in intra-orbital pressure and can result in permanent vision loss, oftentimes requiring emergent surgical decompression. Orbital compartment syndrome most commonly occurs due to recent trauma and is often easily diagnosed by history and physical exam. However, there are other causes of OCS where a more subacute/chronic rise in pressure can lead to an atypical presentation. This is a case report of a 48-year-old male who presented with left eye pain and swelling for the past 6 months. The patient had seen two ophthalmologists prior to his emergency department (ED) presentation who had prescribed him an antibiotic ointment, oral steroids, and steroid eye drops. The physical exam in the ED was concerning for increased intra-ocular pressure (IOP) and decreased vision. Ophthalmology was consulted and requested magnetic resonance angiography (MRA)... https://escholarship.org/uc/item/86j47321 Fri, 31 Jul 2026 00:00:00 +0000 Ma, Rosalind Wu Harris, Dustin https://escholarship.org/uc/item/85f3w3xz <p>Children presenting to emergency departments who are found to have flat, round esophageal foreign bodies (FB) are often transferred to sites capable of foreign body removal. Coins are the most common FBs ingested in pediatric patients. However, button battery (BB) ingestions are a high-risk esophageal FB that can lead to severe injury. It is imperative to distinguish between these two radiographically similar objects to ensure expedited removal of BBs. The halo sign and step-off sign are characteristic of BBs. The presented case demonstrates an exception, where a coin stack (CS) mimicked a BB. A six-year-old female arrived at a tertiary care center as a transfer from an outside hospital with concern for BB ingestion. Her presenting symptoms were vomiting, gagging, and drooling. Her chest x-ray showed a radio-opaque, esophageal FB with halo and step-off signs. The circular FB was urgently removed and proved to be a nickel overlying a quarter. Due to the relative rarity of CSs... https://escholarship.org/uc/item/85f3w3xz Fri, 31 Jul 2026 00:00:00 +0000 Ware, Peyton Jacobsen https://orcid.org/0000-0002-0761-6751 Ware, Carter Bjornstad, Amanda Kuntz, Heather Young, Tim https://escholarship.org/uc/item/835359hd <p><strong>Introduction:</strong> It is not known whether skin color influences inclusion of substance use on medical students’ differential diagnoses for a simulated cardiac arrest. Our objective in this study was to investigate whether the presence of a dark-skinned or light-skinned manikin in the lab correlated with their decision to include substance use on the differential as a possible cause of cardiac arrest.</p> <p><strong>Methods:</strong> In this study at a single institution, all fourth-year medical students in an emergency medicine course participated in a manikin-based cardiac arrest simulation case. The simulation sessions alternated between the use of a light-skinned and a dark-skinned manikin. Both were adult sized. After the first shock was delivered, students individually documented their differential diagnosis for the cause of the cardiac arrest on deidentified, free-text research forms. We excluded forms if they were blank, had been completed by a non-medical... https://escholarship.org/uc/item/835359hd Fri, 31 Jul 2026 00:00:00 +0000 Miller, Hannah https://orcid.org/0000-0002-0541-1939 Tarrant, Claudia Lamberson, Miles https://orcid.org/0000-0002-0442-6995 Nicholas, Cate Dolbec, Katherine https://escholarship.org/uc/item/82t271r0 <p><strong>Introduction:</strong> The transition from resident to junior faculty in academic emergency medicine (EM) may be shaped not only by formal training and institutional policies but also by the “unwritten curriculum,” a set of norms and expectations embedded in institutional culture. However, the unwritten curriculum and its potential to impact junior faculty development remains largely unexplored. Little is known about how junior faculty perceive, experience, and navigate these informal expectations, or the formal and informal structures that influence this process. In this study we aimed to explore junior faculty members’ experiences with the unwritten curriculum in academic EM, with a focus on how they interpret and navigate institutional norms and identify supports and barriers encountered during their early faculty development.</p> <p><strong>Methods:</strong> Within their first five years, EM faculty at academic institutions distinct from their residency training... https://escholarship.org/uc/item/82t271r0 Fri, 31 Jul 2026 00:00:00 +0000 Bierowski, Abagayle https://orcid.org/0000-0001-5858-190X Morrone, Casey Hoag, Erin Ghei, Ridhima Pasirstein, Michael Blaszczak, Julie Papanagnou, Dimitrios https://escholarship.org/uc/item/7xh9z9dj <p><strong>Introduction: </strong>Intimate partner violence (IPV) represents a pervasive and costly public health issue. Many IPV victims seek care in the emergency department (ED) due to injuries or related medical complaints; yet a substantial number of cases remain undetected. The challenge lies in implementing effective screening tools within the demanding environment of an ED. In this study we aimed to assess the efficacy of two brief IPV screening tools— the single question, “Have you been hit, kicked, punched, or otherwise hurt by someone in the past year?” and the 4-item Ongoing Violence Assessment Tool—and to compare them to the more comprehensive Index of Spouse Abuse, a validated 30-item survey that is considered the gold standard for IPV assessment. Our objective was to identify improved strategies for IPV screening in the busy ED setting.</p> <p><strong>Methods: </strong>In this prospective study, every third English-speaking female patient 18-55 years of age presenting... https://escholarship.org/uc/item/7xh9z9dj Fri, 31 Jul 2026 00:00:00 +0000 Nonawzki, Gretchen Zhou, Zhengqiu Mohan, Maureen Slowey, Saria Carden, Donna Hoelle, Robyn https://escholarship.org/uc/item/7wz4w7v4 <p><strong>Introduction:</strong> Emergency department (ED) closures have become increasingly common across health systems worldwide, reflecting mounting pressures from staffing shortages, resource constraints, and rising patient demand. Closures, whether temporary or permanent, pose potential risks to timely access to emergency care and may significantly impact patient outcomes and healthcare system performance. Despite growing attention from policymakers and the public, academic evidence on real-world impacts of ED closures remains fragmented. In this scoping review we compiled and summarized the current literature directly addressing the impacts of ED closures.</p> <p><strong>Methods:&nbsp;</strong>Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews criteria, we conducted a search of PubMed.gov, the Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases for papers published in English after... https://escholarship.org/uc/item/7wz4w7v4 Fri, 31 Jul 2026 00:00:00 +0000 Ridha, Zahra Steiner, Adam Son, Helena Upadhye, Suneel https://orcid.org/0000-0002-6380-161X Strobel, Stephenson https://orcid.org/0000-0001-9408-7992 https://escholarship.org/uc/item/7p05g12g <p><strong>Audience</strong>:&nbsp; This guided small group exercise is suitable for medical students who have completed basic lectures on electrocardiogram (EKG) interpretation. This activity was created for use within a third year required Emergency Medicine (EM) clerkship but can be implemented in other undergraduate medical education settings as well.</p> <p style="text-align: justify; "><strong>Introduction</strong>: Electrocardiogram (EKG) interpretation is poorly understood by medical students,¹ and trainees display a concordant lack of confidence in their interpretation skills which can carry into fourth year of medical school and residency.^2,3,4 Improving learner confidence and competence in identification of arrhythmias is of paramount importance to improve patient care.^5,6 Our workshop targets the recognition and management of dangerous arrhythmias frequently seen in the Emergency Department&nbsp;<strong>&nbsp;</strong></p> <p style="text-align:... https://escholarship.org/uc/item/7p05g12g Fri, 31 Jul 2026 00:00:00 +0000 Ancmon, Jordan Feldman, Jacob https://escholarship.org/uc/item/7h7028v9 <p>Blunt cerebrovascular injury (BCVI) is defined as blunt traumatic injury to the carotid or vertebral vessels. Although rare, understanding risk factors and management of possible complications is vital in the emergency department (ED) setting since BCVI is associated with ischemic stroke and potential for poor neurologic outcome or death. In this case, a 27-year-old female patient presented with headache following a motor vehicle collision. Computed tomography angiography (CTA) of the neck revealed a right internal carotid artery dissection. Despite the injury, the patient was largely asymptomatic besides headache and discharged on acetylsalicylic acid (ASA) 81 mg to prevent stroke. Follow-up CTA one week later revealed worsening of the carotid dissection and a new vertebral artery dissection. The patient was admitted and received a diagnostic cerebral angiogram that elucidated the extent of her vascular injuries. The patient was discharged on ASA 325 mg and was followed for... https://escholarship.org/uc/item/7h7028v9 Fri, 31 Jul 2026 00:00:00 +0000 Hsu, Edmund Kinoshita, Andrew Takahiro https://orcid.org/0000-0001-6321-3642 Chu, Eleanor McCoy, Christopher Eric https://escholarship.org/uc/item/7gj9d33s Regarding Racial Disparities in Door-to-Clinician Time for Cardiac Chest Pain in the Emergency Department https://escholarship.org/uc/item/7gj9d33s Fri, 31 Jul 2026 00:00:00 +0000 Ventura, Christian Angelo I. https://orcid.org/0000-0002-4640-9421 Cabanilla, Ava D. Denton, Edward E. https://escholarship.org/uc/item/7dg5d3hf <p>A 75-year-old female with no prior history of bleeding disorders presented to the emergency department with spontaneous sublingual hematoma, hemarthrosis, hemotympanum, and cutaneous ecchymoses. She denied anticoagulant use, recent trauma, or underlying systemic disease. Initial laboratory findings revealed an isolated prolonged activated partial thromboplastin time (aPTT) that failed to correct with mixing studies. Factor VIII activity was markedly reduced, and the presence of factor VIII inhibitors was confirmed, leading to a diagnosis of acquired hemophilia A (AHA). Management included recombinant activated factor VII (rFVIIa) for hemostatic control, corticosteroids for immunosuppression, and weekly rituximab for inhibitor eradication. During her hospital course, serial monitoring demonstrated a decreasing inhibitor titer and improving coagulation profile. She was discharged and completed four weeks of rituximab and a steroid taper, with complete normalization of coagulation... https://escholarship.org/uc/item/7dg5d3hf Fri, 31 Jul 2026 00:00:00 +0000 Wolff, Andrea Dahlen, Ivy Singavi, Arun https://escholarship.org/uc/item/7bj7j26f <p><strong>Audience</strong>:&nbsp; This innovation is designed for first- and second-year medical students seeking early exposure to core procedural skills relevant to emergency medicine.</p> <p style="text-align: justify;"><strong>Introduction</strong>: Early procedural training opportunities are limited in preclinical medical education, leaving students underprepared and lacking confidence in essential clinical skills.¹ Simulation-based procedural instruction has proven effective for residents and senior students, but preclinical learners often lack similar access.² Procedurepalooza was developed to address this gap by providing a scalable, low-cost, hands-on workshop introducing foundational procedural techniques in a supportive, high-engagement environment.&nbsp; Prior studies demonstrate that early procedural exposure improves confidence and skill acquisition; however, structured opportunities for preclinical learners remain limited.³</p> <p... https://escholarship.org/uc/item/7bj7j26f Fri, 31 Jul 2026 00:00:00 +0000 Ryan, Matthew https://escholarship.org/uc/item/79j953js <p>A 49-year-old male presented to the emergency department (ED) with bilateral knee pain that began after a mechanical fall down several steps.&nbsp; He states that he fell in such a way that both knees were flexed while he was in the air, which he described as a “flying prayer” position, and he landed with all his weight onto his flexed knees. He did not immediately seek medical care but instead wore knee braces and used crutches to ambulate. This resulted in multiple other falls due to persistent pain and lack of mobility. He was seen at an outside facility prior to presenting to our ED and was reportedly diagnosed with severe arthritis based on x-ray imaging and told he may have a minor quadriceps tendon injury. No other imaging was performed at that time. Due to continued pain, he presented to our ED where we utilized point-of-care ultrasound (POCUS) which revealed the presence of bilateral full-thickness quadricep muscle and tendon tears. He was treated with surgical repair... https://escholarship.org/uc/item/79j953js Fri, 31 Jul 2026 00:00:00 +0000 Hines, Joel Blanton, Christopher Jones, Jodi Mehta, Prayag https://escholarship.org/uc/item/77q6p449 <p><strong>Audience:&nbsp;</strong>This simulation is intended for emergency medicine residents, PGY 1-4.</p> <p style="text-align: justify;"><strong>Introduction:</strong> Postpartum hemorrhage (PPH) is defined as cumulative blood loss ≥1000 mL or any postpartum bleeding with signs of hypovolemia within 24 hours of delivery. Post-abortion hemorrhage (PAH) has no single universally adopted numeric definition but clinically is defined as excessive bleeding following spontaneous or induced abortion that results in hemodynamic instability, need for transfusion, hospital admission, or procedural intervention. Due to its rarity, PAH may be underrecognized and thus is the target of this simulation. The emergency department is the country's reproductive health safety net. With the decline of labor and delivery units and on-call, in-house OB/GYN consultants, emergency clinicians must be equipped to recognize and manage these cases.¹ Effective management of these cases includes... https://escholarship.org/uc/item/77q6p449 Fri, 31 Jul 2026 00:00:00 +0000 Freeman, Brendan Gudhe, Ritika Kong, Rodrigo Levy, Eric Swaminathan, Anand https://escholarship.org/uc/item/7425245k <p>Fournier’s gangrene is a well-established surgical emergency as patients can decompensate rapidly, resulting in significant morbidity and mortality. We describe a case in which a 54-year-old medically complex male presented to the emergency department (ED) with a primary complaint of abdominal pain after a therapeutic paracentesis was performed by interventional radiology just prior to arrival. Upon further questioning, the patient reported scrotal pain that had developed over three to four days. On exam, the patient was well-appearing although he did have scattered scrotal masses with chalky white purulence. Given the relatively quick development, an atypical presentation of Fournier’s gangrene was suspected, and the patient was started on antibiotics with urology immediately consulted. Imaging was concerning for subcutaneous gas. The patient was subsequently taken to the operating room (OR) for debridement, where Fournier’s gangrene was confirmed by surgical investigation... https://escholarship.org/uc/item/7425245k Fri, 31 Jul 2026 00:00:00 +0000 Noori, Elaha Davis, Konnor Rigdon, Tyler Spiegelman, Lindsey https://escholarship.org/uc/item/72j3k9rs <p>An adult female presents for chronic eye complaints refractory to outpatient ophthalmology management, as well as purpuric rash, Reynaud’s symptoms, and reported nodules. She received ophthalmology and rheumatology consultations while in the emergency department (ED) and was subsequently admitted. Expedited rheumatologic workup revealed evidence of granulomatosis with polyangiitis, a rare and potentially debilitating autoimmune vasculitis. She was ultimately discharged after an eight-day hospital course on a long prednisone taper with plan for outpatient management and transition to long-term therapy. This report documents a case warranting high clinical suspicion for an undiagnosed condition in a patient with demonstrably poor access to longitudinal care and the subsequent, in-hospital diagnosis of a rare disease facilitated by ED clinician action.</p> <p></p> https://escholarship.org/uc/item/72j3k9rs Fri, 31 Jul 2026 00:00:00 +0000 Martin, Daniel https://orcid.org/0000-0001-8678-3023 https://escholarship.org/uc/item/7156c0pv <p>This case report highlights the rapid and sensitive diagnostic capabilities of a right upper quadrant (RUQ) ultrasound to diagnose pneumoperitoneum secondary to a hollow viscus rupture. The patient was a 55-year-old male with sudden onset epigastric and right upper quadrant pain. Symptoms were concerning for either acute cholecystitis and gastric ulcer or perforation. Immediate point of care ultrasound (POCUS) of the RUQ showed no signs of acute cholecystitis but showed concerning findings of intraabdominal free air given the enhanced peritoneal stripe sign, reverberation, and ring down artifacts. The radiologist did not note any signs of free air on the interpretation of the formal ultrasound. Eventually, the chest X-ray and computed tomography (CT) of the abdomen and pelvis showed air under the right diaphragm, fluid in the porta hepatis, and multiple foci of pneumoperitoneum. Broad spectrum antibiotics and fluid resuscitation were given. General surgery performed an emergency... https://escholarship.org/uc/item/7156c0pv Fri, 31 Jul 2026 00:00:00 +0000 Lee, Yonghoon Dalley, Michael https://escholarship.org/uc/item/6zd4j2tr <p><strong>Background:</strong> Incidentalomas—unexpected neoplastic lesions discovered during imaging for unrelated complaints—represent a growing clinical and ethical challenge in emergency medicine. Their detection has increased due to widespread use of advanced imaging, particularly in patients who may otherwise escape thorough diagnostic evaluation.</p> <p><strong>Objective:&nbsp;</strong>We sought to determine the frequency, anatomical distribution, and clinical management gaps of neoplastic incidentalomas &nbsp;observed in patients presenting with non-specific, low-severity complaints at the emergency department (ED). (In this paper, neoplastic incidentalomas include both lesions discovered incidentally during imaging for unrelated conditions and newly diagnosed malignancies plausibly related to the patient’s presenting symptoms,)</p> <p><strong>Methods:</strong> Data collection covered the period January 1–December 31, 2023. We conducted a retrospective observational study... https://escholarship.org/uc/item/6zd4j2tr Fri, 31 Jul 2026 00:00:00 +0000 Nasta, Carmine https://orcid.org/0009-0009-7977-2233 Morelli, Romeo Facciuto, Antonia Ida Palumbo, Francesca Finelli, Martina Brunelli, Vincenzo Puoti, Mario Palumbo, Alfredo Voza, Antonio Paolisso, Giuseppe Giordano, Mauro https://escholarship.org/uc/item/6tq0s3zm <p><strong>Introduction: </strong>Despite expectations that emergency medical services (EMS) transport following a gunshot wound (GSW) would improve 30-day mortality compared to transport by private vehicle, the opposite has been found in several studies. In response, EMS has adopted interventions over the past decade to reduce patient mortality. We compared mortality of GSW patients transported by EMS versus private vehicle as these field practice advancements became widespread.&nbsp;</p> <p><strong>Methods:</strong> We conducted a retrospective cohort study using data from the National Trauma Data Bank (NTDB) from 2007–2021. We included adults (≥ 16 years of age) with GSW injuries transported solely by ground EMS (≤ 2 hours) or by personal vehicle to a Level I or Level II trauma center. The primary outcome was 30-day in-hospital mortality. We also aimed to describe demographic changes over time in these patient populations. A multivariable logistic regression model was developed... https://escholarship.org/uc/item/6tq0s3zm Fri, 31 Jul 2026 00:00:00 +0000 Muller, Gregory Miller, Kate Matheson, Loretta Wang, Xinhang Gharahbaghian, Laleh D'Souza, Peter Gautreau, Marc Yiadom, Maame Yaa A.B. https://escholarship.org/uc/item/6h14n4ts <p style=" text-align: justify; "><strong>Audience:&nbsp;</strong>This virtual escape room (VER) serves as a didactic activity tailored for learners specializing in emergency medicine, pediatrics, and family medicine across all postgraduate years. The VER can be undertaken collaboratively in teams or individually, leveraging virtual platforms and adaptable to various educational settings.</p> <p style=" text-align: justify; "><strong>&nbsp;</strong></p> <p style=" text-align: justify; "><strong>Introduction:</strong>&nbsp;Iron tablets appeal to children due to their vibrant color and sugar coating, resembling candy. Nearly 11,000 cases of iron exposure in children under six are reported annually in the US.¹&nbsp;More severe incidents involve prenatal vitamins and iron preparations containing ferrous sulfate, which has a significantly higher concentration of elemental iron per tablet than other formulations.²&nbsp;Virtual... https://escholarship.org/uc/item/6h14n4ts Fri, 31 Jul 2026 00:00:00 +0000 Boggs, Kaitlyn Madhok, Manu Ahluwalia, Tania https://escholarship.org/uc/item/6cv87835 <p><strong>Introduction: </strong>During endotracheal intubation, equipment setup typically includes the patient monitor fixed at the head of the bed behind the back of the operator. Inability to directly visualize the patient monitor may result in delayed recognition of desaturation. Our primary aim in this study was to measure the association between patient monitor position and the time to recognition of a desaturation event during endotracheal intubation.</p> <p><strong>Methods: </strong>We performed a randomized crossover trial of emergency medicine residents across two Accreditation Council for Graduate Medical Education-accredited programs. Subjects were asked to perform direct and video-assisted laryngoscopy once on a difficult airway trainer in a simulation. The sequence of laryngoscopy modality (direct vs video-assisted) and monitor position (head vs left vs right of bed) were randomized prior to each attempt. The simulated patient’s peripheral capillary oxygen saturation... https://escholarship.org/uc/item/6cv87835 Fri, 31 Jul 2026 00:00:00 +0000 Boccio, Eric Perkins, Rachelle Bonz, James https://escholarship.org/uc/item/6b536830 <p><strong>Introduction: </strong>Emergency front-of-neck access may serve as a life-saving intervention when facing patients with difficult airways. Cricothyrotomy consists of needle and surgical techniques and is performed in approximately 0.2-0.5% of all airway management attempts. Our primary aim in this study was to compare procedural completion time and first-pass success of needle and surgical approaches to cricothyrotomy by civilian and military practitioners using a human cadaver model.</p> <p><strong>Methods: </strong>Emergency medicine (EM) attendings and residents and U.S. Air Force Pararescue specialists were randomized to perform either a needle or surgical cricothyrotomy on an unfixed human cadaver a single time following a 30-minute didactic session about both procedure types. We recorded procedural completion time, first-pass success, frequency and type of observed complications, and subject level of training. Our primary outcome measure was procedural completion... https://escholarship.org/uc/item/6b536830 Fri, 31 Jul 2026 00:00:00 +0000 Boccio, Eric Levi, Daniel Bonz, James Belsky, Justin D'Amore, Jason https://escholarship.org/uc/item/6197w2hs <p><strong>Introduction:</strong> Emergency physicians frequently care for patients with serious or terminal illnesses, yet they often lack formal palliative care training. Our primary objective was to develop a structured, multimodal palliative care curriculum for emergency medicine (EM) residents and evaluate whether this curriculum improved residents’ knowledge, comfort level, and perceived application of skills to care for patients with chronic or terminal illness in the emergency department (ED). Our secondary objective was to determine whether EM residents found palliative care education important and to identify which educational modalities are most effective for acquiring palliative care knowledge and skills.</p> <p><strong>Methods:&nbsp;</strong>We implemented an eight-hour multimodal curriculum for EM residents at a single, large Level I trauma center (four hours of didactics, a three-hour simulated patient communication skills lab, and one hour of high-fidelity simulation).... https://escholarship.org/uc/item/6197w2hs Fri, 31 Jul 2026 00:00:00 +0000 Hase, Travis Ndiaye, Cindy Putman, Margaret https://escholarship.org/uc/item/5zb9155n <p style=" text-align: justify;"><strong>Audience:&nbsp;</strong>This session is intended for first- and second-year medical students, or any pre-clinical medical students.</p> <p style=" text-align: justify;">&nbsp;</p> <p style=" text-align: justify;"><strong>Introduction:</strong>&nbsp;Preclinical learners build skills and confidence when they practice first responder tasks early in training, and simulation helps them to perform basic procedures better.^1,2&nbsp;A small group case competition uses a game format to reinforce rapid assessment, clear team roles, and closed-loop communication.^3,4</p> <p style=" text-align: justify;">&nbsp;</p> <p style=" text-align: justify;">Out-of-hospital cardiac arrest affects hundreds of thousands of people in the United States each year, and survival to discharge is low. Bystander cardiopulmonary resuscitation (CPR) and early use of an... https://escholarship.org/uc/item/5zb9155n Fri, 31 Jul 2026 00:00:00 +0000 Fillmore, Harrison Heisler, Thomas Nadeau, Marissa Worley, Emmagene Titone, Lauren M. Murano, Tiffany Truong, Jimmy https://escholarship.org/uc/item/5x13r5zk <p><strong>Audience:&nbsp;</strong>This clinical decision-making (CDM) case is intended for emergency medicine (EM) residents of all levels.</p> <p style="text-align: justify; "><strong>Introduction:</strong> About 700,000 patients every year in the United States experience an acute ischemic stroke.¹ Morbidity and mortality from an ischemic stroke may be limited from timely diagnosis and acute management, including specialist involvement, appropriate blood pressure control, and evaluation for possible thrombolytic therapy. EM residents should be familiar with stroke management principles whether they work in an academic, community, or rural setting.</p> <p style="text-align: justify;"><strong>Educational Objectives</strong>: By the end of this clinical decision-making case, learners will be able to: 1) demonstrate familiarity with the CDM case format and case play, 2) describe important historical information to obtain when suspecting an acute stroke, 3) outline key... https://escholarship.org/uc/item/5x13r5zk Fri, 31 Jul 2026 00:00:00 +0000 Yee, Jennifer San Miguel, Christopher Mitzman, Jennifer Li-Sauerwine, Simiao Emerson, Geremiha Leung, Cynthia G. Miller, Krystin N Jordan, Kelsey Khandelwal, Sorabh https://escholarship.org/uc/item/5sx7440s <p style=" text-align: justify;"><strong>Audience:&nbsp;</strong>This small-group simulation workshop is designed for pediatric emergency medicine fellows but can also be offered to emergency medicine residents or faculty.</p> <p style=" text-align: justify;">&nbsp;</p> <p style=" text-align: justify;"><strong>Introduction:</strong>&nbsp;Pediatric intubation is a high-acuity, low-frequency event. Specific patient scenarios that may lead to a difficult pediatric airway, such as airway edema, airway contamination (hemorrhage, emesis), prematurity, obesity, shock, and inhalational injuries, compound an already challenging and emergent situation. Previous studies have investigated simulation-based airway education for emergency medicine (EM), anesthesia, and critical care trainees. To our knowledge, there has been no study reporting the development and outcomes of a difficult airway course for pediatric emergency medicine (PEM) fellows... https://escholarship.org/uc/item/5sx7440s Fri, 31 Jul 2026 00:00:00 +0000 Chen, Sarah Athale, Abha Runkle, Anne https://escholarship.org/uc/item/5rm2853t <p><strong>Introduction: </strong>Understanding changes in opioid overdose-related emergency department (ED) visits and ED-based opioid use disorder (OUD) treatment post-coronavirus disease 2019 (COVID-19) pandemic can inform ongoing efforts to address the opioid crisis. We aimed to examine trends in opioid overdose-related ED visits, ED-based medication for OUD (MOUD) treatment, and appendicitis-related ED visits (as a control) before and after the initial COVID-19 peak in April 2020.</p> <p><strong>Methods:</strong> We conducted an interrupted time series analysis of monthly ED visits from January 2017–December 2022 at three hospitals in California. We modeled pre- and post-COVID-19 visit trends and the change in trend from pre- to post-COVID-19 peak using linear regression controlling for study site. Our primary outcome included monthly rates of opioid overdose-related ED visits, with monthly rates of ED visits with MOUD treatment as a secondary outcome. Appendicitis-related... https://escholarship.org/uc/item/5rm2853t Fri, 31 Jul 2026 00:00:00 +0000 Molina, Melanie F. Pimentel, Samuel D. Raven, Maria C. LeSaint, Kathy T. Dillon, David G. https://escholarship.org/uc/item/5rf4k3q5 <p><strong>Introduction:</strong> High-quality cardiopulmonary resuscitation (CPR) is essential to improve survival in cases of cardiac arrest. However, skill acquisition based solely on instructor observation has proven to be limited. In this context, real-time feedback devices emerge as promising tools to optimize CPR training.<br>Objective: In this study our goal was to evaluate the effect of using a real-time feedback device on the quality of CPR performed by medical students at a public university in Colombia.</p> <p><strong>Methods:</strong> This was an experimental study with fourth-year medical students, randomly assigned to two groups. Both groups received the same initial theoretical and practical training in basic CPR. Subsequently, the intervention group practiced with a real-time feedback device, while the control group trained without technological feedback. The primary outcome measure was the target of chest compressions, simultaneously meeting both a rate of 100-120... https://escholarship.org/uc/item/5rf4k3q5 Fri, 31 Jul 2026 00:00:00 +0000 Piñeros-Alvarez, Jose Luis Portuguez-Jaramillo, Nelson Esteban https://orcid.org/0009-0001-3552-5574 Urbano-Cano, Astrid Lorena https://orcid.org/0000-0001-9902-9185 https://escholarship.org/uc/item/5mc0d249 <p>Abstracts Presented in Tbilisi, Georgia July 17-18, 2026&nbsp;</p> https://escholarship.org/uc/item/5mc0d249 Fri, 31 Jul 2026 00:00:00 +0000 https://escholarship.org/uc/item/5hb6f7ss <p><strong>Introduction:</strong> Emergency department (ED) encounters are common for pregnant individuals in the United States. Radiological imaging is frequently ordered for diagnostics in the ED but generally avoided during pregnancy. This study examines missed pregnancy documentation and the association of pregnancy documentation with radiological imaging among individuals who have an ED encounter while pregnant.</p> <p><strong>Methods:</strong> We used a retrospective cohort of pregnant individuals who had a live birth in an urban county in Indiana 2022–2023. We pulled all ED encounters occurring between 42-279 days of gestation (N = 4,597) that did not occur within five days of delivery. Our primary outcome measure was pregnancy documentation in the patient’s electronic health record and receipt of radiological imaging (radiograph and computed tomography) of the chest, abdomen or spine. We used descriptive statistics and logistic regressions for the analysis.&nbsp;</p> <p><strong>Results:&nbsp;</strong>Pregnancy... https://escholarship.org/uc/item/5hb6f7ss Fri, 31 Jul 2026 00:00:00 +0000 Campbell, Angela G. https://orcid.org/0000-0002-1547-7595 Knies, Austin https://orcid.org/0000-0002-1109-5864 Musey, Paul Ryckman, Kelli K. https://orcid.org/0000-0002-9496-4147 Gharbi, Sami Wiehe, Sarah https://orcid.org/0000-0002-8148-0848 https://escholarship.org/uc/item/5g96632f <p>This case report discusses a 36-year-old male who presented to the emergency department with an atypical story for acute coronary syndrome (ACS). Initially, the patient was felt to have a &nbsp;non-diagnostic electrocardiogram (ECG). Once the laboratory test results were obtained and the initial high-sensitivity troponin was noted to be elevated, the initial ECG was again reviewed. The patient was felt this time to have an abnormal ECG, demonstrating borderline ST elevation in leads I, aVL, and V2-V5. The interventional cardiologist on call was contacted, and the cardiac catheterization lab was activated. Upon left heart catheterization, the patient was found to have a spontaneous coronary artery dissection (SCAD) of the distal left anterior descending (LAD) artery. Post-catheterization, the patient was observed on cardiac telemetry and started on dual antiplatelet therapy. Echocardiogram revealed a preserved ejection fraction (EF), but hypokinesis of the apical anterior, anterolateral,... https://escholarship.org/uc/item/5g96632f Fri, 31 Jul 2026 00:00:00 +0000 DeWitt, Stephen McClinton, Jacob Jarrell, Daniel https://escholarship.org/uc/item/55h6110q <p style=" text-align: start; "><strong>Audience and Type of Curriculum:&nbsp;</strong>This electrocardiogram (ECG) curriculum was designed for residents of all levels.</p> <p style=" text-align: start; "><strong>Length of Curriculum:&nbsp;</strong>The curriculum runs over 1.5 years and is repeated, so that there will be repetition during a resident’s training.</p> <p style=" text-align: start; "><strong>Introduction:</strong>&nbsp;Electrocardiogram interpretation is a vital skill for emergency physicians. Formal ECG education in emergency medicine (EM) often consists of a few conference lectures, with the majority of education relegated to the clinical environment. However, this often leaves significant gaps in education, as a full curriculum cannot be implemented within limited conference time.</p> <p style=" text-align: start; "><strong>Educational Goals</strong>: The goals of the curriculum were to establish an asynchronous ECG... https://escholarship.org/uc/item/55h6110q Fri, 31 Jul 2026 00:00:00 +0000 West, Tyler Adam, Jarren Watkins, Kevin https://escholarship.org/uc/item/5460301g <p><strong>Introduction: </strong>Maintaining competence in high-acuity, low-occurrence (HALO) procedures poses a challenge for emergency physicians as they progress past residency training or practice in lower-acuity settings. Simulation-based deliberate practice offers a feasible method to sustain procedural competence. We developed and evaluated a blended, faculty development procedural curriculum designed to improve confidence and clinical application of HALO skills across a five-hospital emergency medicine (EM) network.</p> <p><strong>Methods:&nbsp;</strong>A faculty needs assessment and departmental quality data informed the creation of a 4-hour procedural curriculum course. The blended curriculum included asynchronous precourse procedural guides and videos followed by a 4-hour, in-person deliberate practice session led by peer EM faculty instructors. Year one procedures included cricothyroidotomy, transvenous pacing, catheter thoracostomy, neonatal resuscitation, and peritonsillar... https://escholarship.org/uc/item/5460301g Fri, 31 Jul 2026 00:00:00 +0000 Walsh, Ryan Lei, Charles Williams, Saralyn R. Smith, Kurt Lesnick, Jason Boaglio, Sean Smith, Amanda Olushoga, Michael Andereck, Jonathan Boyd, Jeremy S. https://escholarship.org/uc/item/513277ct <p><strong>Background: </strong>Intravenous (IV) fluids are commonly used in emergency departments (ED), but their supply can be vulnerable to national shortages. In September 2024, Tropical Storm Helene disrupted production at a major manufacturing facility, triggering a nationwide IV fluid shortage. In response, our ED implemented a multiphase intervention aimed at reducing non-essential fluid utilization. We aimed to reduce total IV fluid use in the ED by at least 25% through a staged, systems-based conservation strategy.</p> <p><strong>Methods:&nbsp;</strong>We conducted a single-center, retrospective, pre-post quality improvement initiative in a tertiary academic ED with approximately 57,000 annual visits. Interventions were deployed across three Plan–Do–Study–Act cycles: 1) clinician education on fluid stewardship (7 days); 2) protocol modifications to reduce routine IV placement (11 days); and 3) electronic health record (EHR) clinical decision support tools, including... https://escholarship.org/uc/item/513277ct Fri, 31 Jul 2026 00:00:00 +0000 Jenkins, Phillip D Xu, Obert https://orcid.org/0009-0005-6453-9739 DeVane, Kenneth Hartenstein, Melinda Manella, Haley Burns, Beech https://escholarship.org/uc/item/4pb27817 <p style=" text-align: justify;"><strong>Audience:&nbsp;</strong>This&nbsp;auricular hematoma task trainer&nbsp;is designed to instruct emergency medicine (EM) residents,&nbsp;fellows, and medical students.<em>&nbsp;</em>Otolaryngology trainees may also benefit from this simulator.</p> <p style=" text-align: justify;">&nbsp;</p> <p style=" text-align: justify;"><strong>Introduction:</strong>&nbsp;Auricular hematomas are relatively infrequent but require timely intervention to prevent complications such as infection, cartilage necrosis, or permanent ear deformity (“cauliflower ear”).¹&nbsp;Although these injuries make up only a small part of all otologic complaints in the emergency department, they are one of the most frequent ear injuries in contact sports, with wrestlers, boxers, and rugby players being the most at-risk.^{2&nbsp;&nbsp;}Not only can they occur in sports, one urban level I trauma review found... https://escholarship.org/uc/item/4pb27817 Fri, 31 Jul 2026 00:00:00 +0000 Bailey, Laura Shaffer, William Thatcher, Byron Bethel-Schmitz, Aubrey https://escholarship.org/uc/item/4d847616 <p style=" text-align: justify;"><strong>Audience:&nbsp;</strong>This card game is designed to cultivate educational discussion among emergency medicine resident physicians about the assessment, treatment, and disposition of key pediatric and adult&nbsp;thoracic-respiratory&nbsp;diagnoses in a fun, casual environment. It&nbsp;could also be played by emergency medicine-bound medical students.</p> <p style=" text-align: justify;">&nbsp;</p> <p style=" text-align: justify;"><strong>Introduction:</strong>&nbsp;Emergency department visits related to the thoracic-respiratory system are common complaints in both the pediatric and adult populations. In the United States, for several years prior to the Covid-19 pandemic, respiratory system diseases accounted for about 10.6% of ED visits.¹&nbsp;In children, respiratory complaints make up the largest percentage of their ED visits, particularly in the fall and winter seasons.²&nbsp;This... https://escholarship.org/uc/item/4d847616 Fri, 31 Jul 2026 00:00:00 +0000 Lamparter, Lauren Wray, Alisa https://escholarship.org/uc/item/43m5g3nm <p style=" text-align: justify; ">ABSTRACT:</p> <p style=" text-align: justify;"><strong>Audience and type of curriculum:&nbsp;</strong>This curriculum is designed to prime pre-medical-field undergraduate students with medical research concepts and skills necessary to assist Emergency Medicine (EM) residents on clinical research projects in a community hospital setting.</p> <p style=" text-align: justify;"><strong>&nbsp;</strong></p> <p style=" text-align: justify;"><strong>Length of curriculum:&nbsp;</strong>The PRIMER lecture series should run two to three days with six hours of lecture content to be covered. Project completion and poster presentation should take 8-16 weeks depending on time constraints, resources, and project scope.</p> <p style=" text-align: justify; "><strong>&nbsp;</strong></p> <p style=" text-align: justify; "><strong>Introduction:</strong>&nbsp;Scholarly... https://escholarship.org/uc/item/43m5g3nm Fri, 31 Jul 2026 00:00:00 +0000 Parks, M. Kaitlin https://orcid.org/0000-0001-7588-0792 Cupps, Justin L Meador, Jessica Kashef, Melody Kirsch, Danielle R Settle, Sonja https://escholarship.org/uc/item/3x46t432 <p><strong>Introduction:</strong> Hypoventilation and hypercapnia are the primary physiological indicators of opioid-induced respiratory depression (OIRD), while hypoxia is typically a later manifestation. However, use of pulse oximetry to measure oxygen saturation (SpO₂) level remains the most widely available and commonly used monitoring modality in both clinical and community settings, whereas capnography is not routinely accessible. Given this reality, it is important to evaluate hypoxia thresholds reported in the literature to inform practical detection and intervention strategies. Oxygen saturation monitoring may serve as a valuable support tool to help determine when individuals experiencing opioid toxicity require intervention; however, there is limited consensus on SpO₂ thresholds that indicate OIRD. Our objective in this study was to evaluate existing evidence on SpO₂ thresholds for OIRD as a physiological marker to incorporate with clinical assessment to potentially... https://escholarship.org/uc/item/3x46t432 Fri, 31 Jul 2026 00:00:00 +0000 Manes, Akash Sran, Joban Samra, Ivjot Dhaliwal, Balkaran Soliman, Adam Puri, Nitasha https://escholarship.org/uc/item/3t3276w7 <p>Midgut volvulus is a rare finding in adults, especially those without a known history of congenital gastrointestinal abnormalities. This is a case of a 78-year-old man who presented to the Emergency Department (ED) with two weeks of intermittent, postprandial abdominal bloating and pain. His examination was notable for tachycardia and mild abdominal distention. On computed tomography angiography (CTA), he was found to have midgut volvulus and underwent emergent exploratory laparotomy with Emergency General Surgery (EGS) where his bowel was found to be twisted clockwise around the mesentery. This case report highlights the diagnosis and treatment of a patient with the relatively uncommon diagnosis of midgut volvulus. In this report, we describe the patient’s presentation, important imaging findings, and key management principles for midgut volvulus.&nbsp;</p> <p></p> https://escholarship.org/uc/item/3t3276w7 Fri, 31 Jul 2026 00:00:00 +0000 Khurana, Surina Lu, Tien Dangberg, Carson Lewis, Kristin https://escholarship.org/uc/item/3pq0g7xw <p><strong>Audience:&nbsp;</strong>The target audience for this video is any provider who is likely to experience patient death. We have demonstrated this method to medical students, residents, and faculty and across departments and disciplines of health care including physician assistants and nurses.&nbsp;</p> <p style="text-align: justify;"><strong>Introduction:</strong> Emergency medicine (EM) physicians frequently encounter patient death, requiring effective coping strategies. Brief mindfulness practices, including focused breathing, can promote emotional regulation and reduce perceived stress. These techniques are particularly relevant in acute care settings where rapid cognitive and emotional transitions are required.¹ While techniques such as “The Pause”—a moment of silence after death—have been proposed, their impact remains understudied.^2-4 In addition to the Pause Method, many physicians at our institution utilize the “Three-Breath Guided Meditation”... https://escholarship.org/uc/item/3pq0g7xw Fri, 31 Jul 2026 00:00:00 +0000 Petelinsek, Sarah https://orcid.org/0009-0005-9733-7674 Christensen, Genae Franke, Alexander Raps, Christine Beaulieu, Allison Fix, Megan Langmann, Gabrielle Hughes, Patrick G. https://escholarship.org/uc/item/3mv231np <p style=" text-align: justify;">This case highlights a rare and complex occurrence of an open chest wound with a pathologic sternal fracture. This resulted from a combination of remote chest trauma, chronic chest wall infection, malignancy, and ultimately, sternal osteomyelitis. A 69-year-old male presented with a large, open anterior chest wound, chronic ulceration, and weight loss. Thirty years earlier, the patient had sustained trauma from a firecracker, which led to a chronic wound for which he did not seek medical attention. Physical exam revealed a large open chest wound with an open sternal fracture and exposed pericardium. The patient underwent surgical resection, followed by chest wall reconstruction using a rectus myocutaneous flap. Tissue pathology confirmed squamous cell carcinoma and osteomyelitis of the sternum.</p> <p style=" text-align: justify;">&nbsp;</p> <p style=" text-align: justify;">The case demonstrates... https://escholarship.org/uc/item/3mv231np Fri, 31 Jul 2026 00:00:00 +0000 Ortego, Alexandra Sharma, Vivek https://escholarship.org/uc/item/3bt40667 Reply: Regarding Racial Disparities in Door-to Clinician Time for Cardiac Chest Pain https://escholarship.org/uc/item/3bt40667 Fri, 31 Jul 2026 00:00:00 +0000 Awad, Emad https://escholarship.org/uc/item/38m6d4bp Introduction: Emergency medicine is a developing specialty in low-to-middle income countries. The specialty was in its infancy in Syria when the war started a decade ago. Syria has since experienced civil war, unrest, famine, and financial collapse that has strained its healthcare system. There is limited research and information regarding Emergency Medicine residencies and training in Syria. Therefore, this article describes the growing and current state of Emergency Medicine and its training in Syria. Methods: A mixed methods approach using a systematic review and semi-structure interviews was utilized. MEDLINE, EMBASE and PsychINFO were searched from inception until March 9, 2022. Eligible studies were specific to emergency medicine and discussed the training of emergency medicine physicians in Syria. Semi-structured key informant interviews and a review of the Ministry of Health website were utilized to supplement information regarding the structure of emergency medicine... https://escholarship.org/uc/item/38m6d4bp Fri, 31 Jul 2026 00:00:00 +0000 Mughal, Anisa Y Dadoush, Hashem Akkad, Rana Hougeir, Serge https://escholarship.org/uc/item/2dg4t2rn <p><strong>Introduction:</strong> Penicillin allergy is one of the most reported drug allergies, but studies have shown that patients who report an allergy frequently do not have a significant reaction when challenged. Avoidance of penicillin or beta-lactam antibiotics in these patients results in increased hospitalization costs, suboptimal antibiotic therapy, and risk for subsequent infection with multidrug resistant organisms.&nbsp;</p> <p><strong>Methods:&nbsp;</strong>This was a single-center, retrospective chart review that included patients ≥ 18 years of age with documented penicillin allergy who presented to the emergency department (ED) over a one-year period. Clinical pharmacy specialists in the ED reviewed and stratified patient allergy risk. Patients with low-risk allergy histories who were to be admitted and gave formal consent were given an oral amoxicillin challenge and then observed in the ED for at least one hour. Patients who were eligible for challenge but were... https://escholarship.org/uc/item/2dg4t2rn Fri, 31 Jul 2026 00:00:00 +0000 Chen, Brian Nguyen, Phuong Khanh T. Pham, My-Phuong Koh, Cynthia Graber, Christopher J. https://escholarship.org/uc/item/29t582zg <p><strong>Introduction:</strong> Alcohol use disorder (AUD) contributes to significant healthcare costs, disease, emergency department (ED) crowding, and recidivism. Naltrexone is a treatment for AUD that has been approved by the U.S. Food and Drug Administration and holds promise as a pharmacologic intervention for ED patients with AUD. We hypothesized that subjects who received naltrexone in the ED would have associated reduced recidivism in the 30 days after treatment.</p> <p><strong>Methods:</strong> This was a retrospective chart review of an AUD quality program comparing ED visits in the 30 days before with 30 days after initiation of naltrexone in the ED. We performed this study at two academic hospitals (one a Level I trauma center) and one community hospital.</p> <p><strong>Results:</strong> A total of 297 subjects (median age 43 years, 69.5% male) made 331 naltrexone index visits during the study period. There was no difference in the number of ED visits before versus... https://escholarship.org/uc/item/29t582zg Fri, 31 Jul 2026 00:00:00 +0000 Warren, Otis Gress, Jeremiah Lin, Timmy Lippmann, Melanie Bubly, Gary https://escholarship.org/uc/item/23j2906q In the midst of the COVID-19 pandemic, the increased risk of exposure to 1-propanol has led the United States Food and Drug Administration to issue a warning about toxicity of 1-propanol-contaminated brands of hand sanitizers. We report a mixed intoxication with 1-propanol and 2-propanol in a patient who unintentionally ingested approximately 300 mL of hospital topical antiseptic solution and who presented to the emergency department with nausea, vomiting, and decreased level of consciousness. The patient developed an anion gap metabolic acidosis without an osmolar gap, elevated serum lactate, and undetectable serum beta-hydroxybutyrate. One hour later, he developed chest pain and was found to have an ST-segment elevation myocardial infarction. The patient underwent urgent coronary&nbsp; angiography and stenting of the totally occluded mid-segment of the Left Anterior Descending coronary artery. The patient recovered and was discharged home after 7 days. https://escholarship.org/uc/item/23j2906q Fri, 31 Jul 2026 00:00:00 +0000 Farah, Rita Muffarij, Afif ElZahran, Tharwat Kazzi, Ziad Mrad, Sandra https://escholarship.org/uc/item/1mf3k155 <p>&nbsp;This case report highlights a unique presentation of a prosthetic joint infection. A 63-year-old female presented to the emergency department for right knee pain after falling three months earlier, shortly after a total knee arthroplasty. On exam, she was found to have a chronically dehisced wound with exposure of her femur, prosthetic, and overlying cellulitis. She was started on intravenous antibiotics and admitted to the orthopedic surgery service for an above-the-knee amputation. Her unusually delayed presentation and repeated refusal of operative management were heavily influenced by social determinants of health, including polysubstance use, lack of caregiver support, and housing instability.” This uncommon presentation of chronic dehiscence and prosthetic joint infection provides an opportunity to review the management of prosthetic joint infections compared to native joint septic arthritis, how socioeconomic factors drive patient outcomes, and a discussion on... https://escholarship.org/uc/item/1mf3k155 Fri, 31 Jul 2026 00:00:00 +0000 Chao, Kevin Matonis, Danielle Wray, Alisa https://escholarship.org/uc/item/1kx2f9mh <p><strong>Background: </strong>Emergency physicians frequently transfer patients with spine pathology to tertiary- care centers, although research suggests many are discharged without requiring a procedure or specialized imaging. Such transfers consume resources and remove patients from their families and communities. Better understanding these transfers might help identify which patients can receive care without transfer.&nbsp;</p> <p><strong>Methods:</strong> This was a retrospective cohort study of transfers for spine evaluation to an urban, tertiary-care, Level I trauma center from October 1, 2017–October 1, 2022. Transfers were defined as necessary if the patient a) went to the operating room (OR) within 12 hours of arrival, b) had a neurologic magnetic resonance image (MRI), c) was admitted to an intensive care unit from the emergency department (ED), or d) was admitted to either neurology or a surgical service (including neurosurgery and orthopedics, which share spine... https://escholarship.org/uc/item/1kx2f9mh Fri, 31 Jul 2026 00:00:00 +0000 Marks, Clifford M. https://orcid.org/0009-0004-0867-1164 Burke, Ryan C. Rasner, Cody Stippler, Martina Rosen, Carlo L. https://orcid.org/0000-0002-9876-4476 https://escholarship.org/uc/item/1fb8570c Introduction: Few scoring systems are used in the emergency department to identify critically ill patients and anticipate patients' deterioration such as National Early Warning Score (NEWS). This study aimed to evaluate NEWS in patients with acute stroke and its relationship with treatment and type of stroke and patient outcome. Methods: In this prospective cross-sectional descriptive-analytical study, all patients over 18 years of age with a diagnosis of ischemic stroke, who presented through the emergency department, were involved. The variables of interest were collected; the NEWs score was calculated for each patient. Results: In assessing NEWS and its relationship with outcome based on the ROC curve, the area under the curve was equal to 0.417. Considering the high intensity of NEWS above 7, sensitivity, specificity, positive predictive value, negative predictive value, PLR, and NLR were 16.67%, 98.77%, 83.33%, 74.45%, 13.5, 0.84 respectively. In assessing NEWS and... https://escholarship.org/uc/item/1fb8570c Fri, 31 Jul 2026 00:00:00 +0000 Poureskandari, Masoumeh Rajaie Ghafouri, Rouzbeh Sadeghi Hokmabadi, Elyar Hosseinzadeh, Naiemeh Mohammad Rezaie, Sevda Shams Vahdati, Samad https://escholarship.org/uc/item/16657297 <p>Cerebral venous thrombosis (CVT) is an uncommon occurrence, but it carries significant morbidity.¹&nbsp; CVT symptoms overlap with other common emergency department conditions, and it requires a specific neuroimaging for accurate detection, making this diagnosis a significant challenge for emergency clinicians. We present a case of a 20-year-old postpartum woman with a history of a post-dural puncture headache following a spinal block with worsening headache and disequilibrium.&nbsp; She was found to have a cerebral venous thrombosis on non-contrast head CT and CT venogram of the head.&nbsp; Her course was uncomplicated with appropriate symptom control while on anticoagulation.&nbsp; We review her CT imaging findings and provide a brief review of the current recommendations and literature on CVT.</p> https://escholarship.org/uc/item/16657297 Fri, 31 Jul 2026 00:00:00 +0000 Koo, Alex Y Shulimson, Samuel Borhart, Joelle https://escholarship.org/uc/item/0tj2h2n7 <p style=" text-align: justify;"><strong>Audience:&nbsp;</strong>This clinical decision-making (CDM) case is intended for emergency medicine residents of all levels, medical students, and fellows preparing for standardized oral board exams.</p> <p style=" text-align: justify;"><strong>Introduction:&nbsp;</strong>Fever in a neonate (infant &lt;28 days old) is a medical emergency due to the high risk of serious bacterial infections (SBIs) like meningitis, sepsis, or urinary tract infections (UTIs).^1-3&nbsp;Compared with older infants and children, neonates have immature immune responses, reduced ability to localize infection, and limited physiologic reserve, which contribute to rapid clinical deterioration and increased morbidity and mortality when invasive infection is present.^1,3</p> <p style=" text-align: justify;">Importantly, clinical presentation in this age group is often subtle and nonspecific. Neonates... https://escholarship.org/uc/item/0tj2h2n7 Fri, 31 Jul 2026 00:00:00 +0000 Maupin, Carrie Anand, Ambika Hickam, Grace Nesbit, Danielle https://escholarship.org/uc/item/0sw5g3k9 <p style=" text-align: justify;">We present a case of a 75-year-old female with a history of congestive heart failure who developed a large edema bulla on her right shin after running out of her home medications. The patient presented with swelling and a rapidly enlarging bulla that reached the size of a grapefruit. Physical examination revealed bilateral pitting edema and a 10 x 10 cm bulla filled with serous fluid. Dermatology was consulted, confirming the diagnosis of edema bulla secondary to acute volume overload. The bulla was drained in the emergency department, and the patient was discharged with wound care instructions, including the application of petroleum jelly and vinegar compresses. Follow-up three months later showed significant healing. This case highlights the importance of recognizing edema bullae in patients and managing the underlying fluid overload. This case report specifically demonstrates that edema bullae can present at sizes larger than... https://escholarship.org/uc/item/0sw5g3k9 Fri, 31 Jul 2026 00:00:00 +0000 Morris, Jarom https://orcid.org/0009-0007-2574-5892 Sommer, Matthew Braun, Felix Klapthor, Brent Beaulieu, Allison Fix, Megan https://escholarship.org/uc/item/0nx0k83t <p><strong>Introduction: </strong>Emergency department (ED) boarding of critically ill patients awaiting intensive care unit (ICU) admission has been associated with delays in time-sensitive interventions, prolonged lengths of stay (LOS), increased crowding, and higher incidence of morbidity and mortality. To address this, our institution implemented an ED critical care consult team in 2020 and established a resuscitation and emergency critical care fellowship in 2022. The critical care consult team, staffed by emergency physicians with additional resuscitation or critical care training, provides consultative support for resuscitations and the management of boarding critically ill patients 10 hours per day, with the dual goals of improving clinical care and optimizing patient flow. The primary outcome of this study was to evaluate the rate of patients downgraded from their initial admission level of care (ICU, Intermediate care) to a lesser intensity of care (intermediate, ward,... https://escholarship.org/uc/item/0nx0k83t Fri, 31 Jul 2026 00:00:00 +0000 Johnson, Matthew https://orcid.org/0000-0002-3581-9038 Bracey, Alexander Ata, Ashar DaSilva, William Geary, Sean Patrick Aly, Iman Hayashi, Warren Leavitt, Rachel Mantas, James Hanowitz, Christopher Duncan, Luke J Pauze, Denis Wu, Gregory P https://escholarship.org/uc/item/0n52v8sb <p><strong>Introduction: </strong>Historically, flumazenil was employed as both a diagnostic aid in unresponsive patients and as an antidote for suspected benzodiazepine overdose in both emergency departments and out-of-hospital settings. However, its prehospital application has been historically constrained by long-standing concerns regarding adverse events, leading many emergency medical service (EMS) systems to restrict or avoid its use. The use of flumazenil in the prehospital setting remains underreported in the literature, despite its inclusion in the treatment protocols of various EMS agencies. We conducted a descriptive analysis of the use of flumazenil by EMS in the out-of-hospital setting across the state of Kansas over a five-year period. We characterize the frequency, indications, patient outcomes, and associated adverse events of flumazenil administration, thereby contributing to a better understanding of its role, safety, and clinical relevance in prehospital care.</p> <p><strong>Methods:</strong>... https://escholarship.org/uc/item/0n52v8sb Fri, 31 Jul 2026 00:00:00 +0000 Hanson, Cameron G. https://orcid.org/0000-0002-8245-5337 Beaver, Bryan P. Frantz, Eric Dunn, Thomas Thornton, Stephen Cava, Isabel Jacobsen, Ryan C. https://escholarship.org/uc/item/0fb6x7mh <p><strong>Introduction:</strong> Emergency departments (ED) are a primary site of blood culture collection in the United States. High rates of blood culture contamination, commonly seen in EDs, are associated with diagnostic inaccuracy, unnecessary antibiotic use, and increased costs. In this structured literature review, we evaluated the effectiveness of initial specimen diversion devices (ISSDs), which are attached to the needle tip and discard the initial 0.15-1.5 mL of blood. We paid particular attention to their applicability in reducing blood culture contamination in adult ED patients in rural healthcare settings. The average cost of an ISDD is $15–$30, and this upfront cost creates a significant barrier in rural EDs, which face resource scarcity. &nbsp;</p> <p><strong>Methods:</strong> In this review of primary literature from 2021–2025, we evaluated the efficacy of ISDD in lowering blood culture contamination rates in adult patients in the ED. Our primary outcome was... https://escholarship.org/uc/item/0fb6x7mh Fri, 31 Jul 2026 00:00:00 +0000 Ayres, Makayla D. https://orcid.org/0009-0000-9013-7809 Johnson, Maria C. Andersen, Megan E. Lewis, Alyson P. Farrow, Lucas S. Vopat, Amelia M. Spears, Kathleen M. https://escholarship.org/uc/item/09g699kp <p><strong>Introduction:</strong> Rural areas in the United States have higher mortality rates than urban regions, particularly from emergency care-sensitive conditions. Air medical ambulances (medevacs) are critical to emergency care access in the rural U.S., but limited data hinder the ability to study this critical system. In Alaska, medevac services often represent the sole method for connecting Alaska Native patients in remote clinics to physician emergency medical care. This study characterizes medevac use and timing between tribally administered village clinics and hospitals in Northwest Alaska. Our objective in this study was to describe the use and timing of medevacs and investigate how medevac decision-making impacts medevac transport times.</p> <p><strong>Methods:</strong> We conducted a retrospective cohort analysis of medevac transfers between 2020–2024 from 11 Alaskan village clinics within the Maniilaq Association, which serves ~8,000 people over 35,862 square miles.We... https://escholarship.org/uc/item/09g699kp Fri, 31 Jul 2026 00:00:00 +0000 Rice, Brian https://orcid.org/0000-0002-9093-1831 Williams, Chelsea Chang, Cindy Y Wood, Jeremy Saul, Henry https://orcid.org/0009-0009-5604-0582 Pritchard, Angelica Day, Gretchen Thomas, Timothy https://orcid.org/0000-0001-9958-8411 Hao, David Britton, Carla Onders, Robert Hernandez-Boussard, Tina https://escholarship.org/uc/item/04b3j2cc <p><strong>Introduction:</strong> Diagnostic efficiency in the emergency department (ED) is crucial for workflow. Among these, urinalysis (UA) is a key test for abdominopelvic complaints. Prolonged UA turnaround times can extend patient length of stay and reduce patient satisfaction, highlighting the need for improvement. In this study qw sought to measure the correlation between UA turnaround times and time to disposition.</p> <p><strong>Methods:</strong> We conducted a retrospective analysis of discharged ED patients with abdominopelvic complaints who had a UA ordered between January–August 2022. Electronic health records data included UA order-to-result time, urine human chorionic gonadotropin (hCG), time to disposition, and complete blood count (CBC) turnaround time as a venipuncture comparator. Spearman correlation coefficients assessed associations between lab processing times and time to disposition.</p> <p><strong>Results:&nbsp;</strong>Among 6,708 discharged patients... https://escholarship.org/uc/item/04b3j2cc Fri, 31 Jul 2026 00:00:00 +0000 Baymon, DaMarcus E. Hernandez, Patricia https://orcid.org/0000-0003-1576-0443 Chen, Paul Sanchez, Leon D. https://orcid.org/0000-0002-8807-0913 Im, Dana Bukhman, Alice Joseph, Josh W. https://escholarship.org/uc/item/6zj310sk WestJEM Full-text Issue https://escholarship.org/uc/item/6zj310sk Thu, 30 Jul 2026 00:00:00 +0000 Saucedo, Cassandra Choi, Isabella Zhang, Annie https://escholarship.org/uc/item/2xb7r5tg <p><strong>Introduction: </strong>ST-elevation myocardial infarctions (STEMI) represent complete occlusion of a coronary artery. An electrocardiogram (ECG) is a method of diagnosis; however, on rare occasions clues of myocardial infarction are first noted on imaging. This is a case of myocardial infarction first noted on computed tomography (CT).</p> <p><strong>Case Report:&nbsp;</strong>A 62-year-old man was brought to the emergency department after being found unresponsive with multiple burns. An ECG performed on arrival did not show changes consistent with myocardial ischemia. Due to reported trauma, a CT incidentally found a heterogeneous low-attenuation area in the posterior wall of the left ventricle of the heart. A repeat ECG subsequently showed an inferior STEMI.&nbsp;</p> <p><strong>Conclusion:</strong> Computed tomography of the chest obtained in the evaluation of trauma may demonstrate evidence of myocardial ischemia. This case highlights the ability of CT to detect... https://escholarship.org/uc/item/2xb7r5tg Wed, 29 Jul 2026 00:00:00 +0000 Araujo, Maria Jose Sandhu, Eknoor https://orcid.org/0009-0001-9258-890X Romero, Angel Randhawa, Jugraj https://orcid.org/0009-0000-7235-8659 O’Donnell, Rachel https://escholarship.org/uc/item/9mj7z5p8 <p><strong>Introduction:</strong> Endotracheal intubation (ETI) is a life-saving procedure commonly performed in emergency departments (ED). Prior research has demonstrated significant variability in ETI experience, practices, and outcomes across EDs. Health systems often include a mix of ED environments, from large academic hospitals to community-based and freestanding EDs. However, little is known about how ETI experiences and outcomes vary within a single health system. Our objective in this study was to compare first-attempt success across three EDs representing different practice environments but within one health system.</p> <p><strong>Methods: </strong>This retrospective observational study used institutional data from 1,659 ETI events between November 2021–January 2025 to compare ETI-related outcomes across three EDs representing a spectrum of settings: an academic Level I trauma center (A); a community teaching hospital (B); and a nonteaching community site (C). Our primary... https://escholarship.org/uc/item/9mj7z5p8 Tue, 28 Jul 2026 00:00:00 +0000 Gonzalez-Bankich, Sarah Sterrett, Emily C Crittenden, Tim Burrows, Brian Borawski, Joseph Kapadia, Neel Liu, Beiyu Greenwald, Emily https://escholarship.org/uc/item/9316241d <p><strong>Introduction:</strong> Virtual care is expected to play an increasingly important role in the Canadian healthcare system, with the 2023-2024 Health Canada Departmental Plan outlining the advancement of digital health solutions as a focal point. However, key outcomes of transitioning from traditional in-person healthcare appointments to a virtual model of care are not yet well-described. Here, we apply the Sustainability in Quality Improvement (SusQI) framework to patients seen in a novel pediatric virtual urgent care (VUC) program to quantify the environmental, economic, and social impacts of virtual care.</p> <p><strong>Methods:</strong> We conducted a retrospective analysis of provincial pediatric VUC visits staffed by pediatric emergency physicians and nurse practitioners during the 2020-2025 fiscal years. We focused on three key metrics: (1) economic value, measured as travel costs avoided; (2) environmental value, measured in fuel saved (L) and carbon emissions... https://escholarship.org/uc/item/9316241d Tue, 28 Jul 2026 00:00:00 +0000 Lim, Emma Strychowsky, Julie Gunz, Anna C Belisle, Sheena https://escholarship.org/uc/item/7248v1dh <p><strong>Introduction:</strong> Frequent emergency department (ED) users, particularly those with high rates of use, often experience complex social determinants of health (SDOH) that contribute to their repeated visits and may lead to adverse health outcomes. Our objective in this study was to characterize the needs most commonly affecting this population, which may support the creation of tailored interventions with a higher chance of success.</p> <p><strong>Methods:</strong> This was a retrospective analysis of patients evaluated by an ED social medicine team in a large urban academic ED from May 2021–December 2023. Patients were identified either via frequent ED use (patients with the 10 highest number of visits each month) or referred by ED staff. We assigned 11 categories of medical, mental health, and social needs through chart review and team documentation. The primary outcome was the identification of distinct need-based subgroups among patients with high ED use, using... https://escholarship.org/uc/item/7248v1dh Tue, 28 Jul 2026 00:00:00 +0000 Kumaravel, Shwath Parker, Emily Friedman, Eleanor Stanford, Kimberly A https://escholarship.org/uc/item/68g1v3hg <p><strong>Case Presentation: </strong>An 83-year-old man with a history of left corneal transplant presented to the emergency department with several days of left eye pain, redness, and tearing. Visual acuity was 20/50 in the right eye and bare light perception in the left eye. Intraocular pressure was 15 millimeters fo mercury in the right eye and unobtainable in the left. The left conjunctiva and sclera were injected, and slit-lamp examination revealed a full-thickness corneal perforation with corneal haze in the transplanted cornea. We placed a rigid eye shield, provided systemic analgesia, kept the patient nil per os, and obtained urgent ophthalmology consultation.</p> <p><strong>Discussion:</strong> Corneal perforation is a full-thickness corneal defect that disrupts globe integrity and allows aqueous leakage. It may result from infection, ocular surface disease, autoimmune disorders, trauma, or prior keratoplasty, with graft–host junction instability representing a key... https://escholarship.org/uc/item/68g1v3hg Tue, 28 Jul 2026 00:00:00 +0000 Dahdal, Diala Nama, Ahmad Deng, Wenyu Hahn, Barry https://orcid.org/0000-0001-9035-5603 https://escholarship.org/uc/item/5tn883t4 <p><strong>Introduction:</strong> Adolescents frequently seek care in the emergency department (ED) for behavioral health emergencies. Due to national shortages in staffing, limited opportunities to begin treatment on site in most centers and, thus, the frequent default to elusive inpatient psychiatric beds as a means of stabilization, adolescents may spend prolonged amounts of time boarding in the ED, often without treatment. Ketamine is a rapid-acting antidepressant with emerging evidence in adults, but data are limited on its effectiveness in suicidal youth. We aimed to evaluate the effectiveness of a single dose of intravenous (IV) ketamine on depression and suicidality scores compared to placebo in adolescents with treatment-resistant depression presenting to the ED with suicidal ideation.</p> <p><strong>Methods:</strong> We conducted a two-arm randomized double-blind placebo controlled trial on a convenience sample of adolescents 12–17 years of age with treatment-resistant... https://escholarship.org/uc/item/5tn883t4 Tue, 28 Jul 2026 00:00:00 +0000 Vayngortin, Tatyana Patel, Ekta Seneviratne, Shamilka Lowet, Daniel Saavedra-Chavez, Christian D Chau, Christine Hollenbach, Kathryn Saleh, Fareed Kanegaye, John https://escholarship.org/uc/item/5jf8p2sx <p><strong>Introduction: </strong>Lidocaine toxicity is a rare but potentially dangerous consequence of a frequently used medication. Most commonly, it has generalized neurologic and cardiac effects. Discontinuation of lidocaine is sufficient with less severe symptoms. With more severe symptoms, such as seizures and arrhythmia, intravenous (IV) lipid emulsion therapy can be used. To date, lidocaine toxicity presenting as focal neurologic deficits has rarely been documented in the literature. In the case reported here, the patient was receiving lidocaine injections when she developed palpitations and left arm and facial weakness and numbness, which resolved after IV lipid emulsion therapy.&nbsp;</p> <p><strong>Case Report:</strong> A 52-year-old female with a past medical history of migraines, cholecystectomy, nephrolithiasis, and hypothyroidism presented to the emergency department (ED) via ambulance from her dental office with acute neurologic symptoms. While receiving an injection... https://escholarship.org/uc/item/5jf8p2sx Tue, 28 Jul 2026 00:00:00 +0000 Yeung, Timothy Estrada, Isaac Phan, Tammy H. Samones, Emmelyn J. Kalam, Sharmin https://escholarship.org/uc/item/5383h1hh <p><strong>Introduction: </strong>Magnet ingestions are a growing pediatric emergency due to the use of widely available stronger magnets in toys. A legislative ban briefly reduced injuries, but cases rose after its reversal in federal court. Magnet ingestions are resulting in increasing morbidity and mortality, specifically due to bowel obstruction and perforation.&nbsp;</p> <p><strong>Case Report:</strong> We present a complex case involving a child with global developmental delay presenting to the emergency department for evaluation of abdominal pain. While the initial evaluation focused on working up appendicitis, which he was found to have, he was also found to have ingested multiple magnets causing small bowel obstruction and perforation.&nbsp;</p> <p><strong>Conclusion:&nbsp;</strong>This case highlights the need for emergency physicians to maintain a high level of suspicion when evaluating pediatric patients with abdominal pain, especially those with developmental delay.... https://escholarship.org/uc/item/5383h1hh Tue, 28 Jul 2026 00:00:00 +0000 Ball, Seth Wierzbicki, Marissa https://escholarship.org/uc/item/34x717qk <p><strong>Introduction: </strong>Exfoliative dermatitis, also known as erythroderma, represents an infrequent clinical presentation in emergency departments (ED) and often contributes to considerable diagnostic uncertainty. The differential diagnosis is broad, and the condition may arise from a wide variety of etiologies. We report a case of severe exfoliative dermatitis characterized by gradual progression and resistance to multiple therapeutic interventions over several weeks, ultimately resulting in significant systemic complications and marked hematological abnormalities.</p> <p><strong>Case Report:</strong> A 57-year-old man presented to the ED with severe pain, pruritus, and widespread skin peeling involving more than 90% of his body surface area. The patient developed a rash following a trip to Korea about six months prior to presentation, which progressively worsened despite multiple prior diagnoses and treatments including corticosteroids, immunosuppressive therapy,... https://escholarship.org/uc/item/34x717qk Tue, 28 Jul 2026 00:00:00 +0000 Boukouris, Jennifer https://orcid.org/0009-0001-2349-7203 Elsherif, Sherif https://orcid.org/0009000834650032 https://escholarship.org/uc/item/01j6p3vt <p><strong>Introduction:</strong> Chest pain patients presenting to the emergency department (ED) often require risk stratification through stress testing, which may necessitate hospitalization. This practice contributes to ED crowding by occupying beds with low-risk patients who may derive limited benefit from testing, thereby increasing bed occupancy, prolonging ED boarding times, amplifying crowding, and resource strain. Use of an artificial intelligence (AI)-driven clinical decision support tool improves the detection of obstructive coronary artery disease and focuses diagnostic testing on those most likely to benefit.</p> <p><strong>Methods: </strong>We created a Monte Carlo simulation informed by available published inputs and ran 1,000 trials to estimate the national impact of using an AI-driven decision-support tool to reduce avoidable downstream cardiac testing among eligible U.S. ED patients with chest pain. Model inputs included patient demographics, chest pain history,... https://escholarship.org/uc/item/01j6p3vt Tue, 28 Jul 2026 00:00:00 +0000 Baugh, Christopher William https://orcid.org/0000-0002-2360-1891 Luo, Andrew D Zeuthen, Christopher Samadian, Kian Daniel https://orcid.org/0009-0008-5289-9325 De Armas, Ricardo E. Senter-Zapata, Michael Zellweger, Michael J. Brunner-LaRocca, Hans-Peter https://escholarship.org/uc/item/8bm1p3wp Since the fall of 2019, Lebanon has been facing an economic crisis that has imposed many challenges on its healthcare system in its entirety. In this review, we propose a methodology to inform healthcare policy and apply it on cardiovascular disease (CVD) healthcare with emphasis on ischemic heart disease (IHD). The main goal of this methodology is reducing unnecessary expenditure while maintaining quality and access. CVD, and particularly IHD, is the most common reason for hospitalizations in Lebanon. Lebanon also has a high density of catheterization labs, higher than countries with higher prevalence of disease. Additionally, we found coronary to be are more expensive in comparison to other countries. To reduce healthcare costs without compromising quality and access we propose solutions targeting healthcare financing, payment for services, healthcare organizations, behaviors of providers, payers, and patients, and above all government regulation. https://escholarship.org/uc/item/8bm1p3wp Fri, 24 Jul 2026 00:00:00 +0000 Isma'eel, Hussain El Jamal, Nadim Al-Chaer, Elie Haj-Ali, Wissam Hamadeh, Ghassan https://escholarship.org/uc/item/7k75p79g <p>The cholinesterase activity (AcCh) assay finds an important place in the diagnosis of acute poisoning by cholinesterase inhibitor pesticides, allowing the indication and the efficacy evaluation of antidote treatment with atropine and oximes. AcCh is also a biomarker of effect in occupational exposure to cholinesterase inhibitor pesticides. However, some factors may disrupt AcCh levels and distort the interpretation of the assay results. Hence, the present review aimed to summarize the factors and the variations that may have an impact on the interpretation of AcCh. Indeed, butyrylcholinesterase and acetylcholinesterase are subject to wide physiological individual variations, such as to age, weight and height. Genetic and pathological state may also be factors influencing AcCh levels. The consumption of drugs and daily exposure to some toxicants may also disrupt the AcCh levels, either by direct action on the enzyme or by disrupting its synthesis. In addition, analytical variations... https://escholarship.org/uc/item/7k75p79g Fri, 24 Jul 2026 00:00:00 +0000 Chefirat, Bilel Rezk-kallah, Haciba Beldjilali, Slimane Zergui, Anissa https://escholarship.org/uc/item/6zn9z1j9 Over the past year, Beirut has witnessed a civil revolution, the COVID-19 pandemic, its worst economic crisis in decades, and most recently one of the largest non-nuclear explosions in history.&nbsp;This explosion had devastating effects on the city’s social, economic, and health infrastructure. https://escholarship.org/uc/item/6zn9z1j9 Fri, 24 Jul 2026 00:00:00 +0000 Cheaito, Mohamad Ali Al-Hajj, Samar https://escholarship.org/uc/item/4fv2k09r Introduction: Non-invasive ventilation (NIV) could be a good alternative in elderly people with acute respiratory failure (ARF), to procure them a respiratory support while avoiding as much as possible the complications of invasive ventilation. Methods: This is an observational retrospective study conducted at the emergency department (ED) of a tertiary care, university-based teaching hospital. Data of elderly patients (≥ 65 years) admitted to ED between January 2017 and April 2018 for ARF and requiring NIV were collected and analyzed using SPSS 22 software. Results: Sixty six patients (≥ 65 years) requiring NIV for acute respiratory failure (ARF) were included. The mean age was 76 years (± 7), the median Charlson index was 5. Acute respiratory failure was related to acute heart failure in 68%, acute exacerbation of chronic obstructive pulmonary disease in 53% and pneumonia in 39% of cases. Forty eight percent had more than one etiologic diagnosis. Hypercapnic acute respiratory... https://escholarship.org/uc/item/4fv2k09r Fri, 24 Jul 2026 00:00:00 +0000 Yahia, Yosra Maghraoui, Hamida Zaouche, Khedija Mghirbi, Abdelwahab Slama, Amani Kilani, Mohamed Achouri, Abderrahim Kallel, Manel Gnenna, Hedia Majed, Kamel https://escholarship.org/uc/item/1nw9c836 Monoarticular joint pain is commonly encountered in the emergency department (ED) with a broad differential diagnosis. Septic arthritis represents a “can’t miss” diagnosis while gout represents a chronic, painful arthropathy. Traditionally these diagnoses are made with arthrocentesis in addition to history, physical exam, imaging and laboratory studies. Ultrasound (US) represents a novel modality that may aid in the diagnosis of gout without requiring arthrocentesis. Furthermore, the sonographic features of gout may exclude the diagnosis of septic arthritis. Additional research is required in the ED setting to better clarify the role of US in these two disease states. https://escholarship.org/uc/item/1nw9c836 Fri, 24 Jul 2026 00:00:00 +0000 Kiel, John M Kaeley, Gurjit https://escholarship.org/uc/item/7wj6k504 Background: In the field of scientific research, it is well recognized that the starting point for such efforts necessitates a proper and thorough literature search using reliable databases.&nbsp;Objectives: The aim of this article is to present future researchers with a guide that provides a well-defined set of search terms (MeSH terms and keywords) for the Middle East and North Africa (MENA) region, the Arab world, and countries within them.&nbsp;Methods: Selecting the proper search terms for the 26 countries and COVID-19 required a systematic approach for building a search strategy. MeSH and keyword searching was initially conducted in Medline (OVID) and replicated in PubMed.&nbsp;Discussion: Based on the described methodology, we extracted and compiled an extensive and comprehensive collection of search terms pertaining to the countries of the Arab world, MENA region, and COVID-19.&nbsp;Conclusions: This guide will facilitate conducting systematic and scoping reviews, using... https://escholarship.org/uc/item/7wj6k504 Wed, 22 Jul 2026 00:00:00 +0000 Zmerli, Omar Hneiny, Layal Kreidieh, Khalil Bou Fakhreddine, Hisham https://escholarship.org/uc/item/6bb731gw Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections, or PANDAS, is a diagnosis of children with an acute and fast onset of obsessions, compulsions or tics succeeding a Group A beta-hemolytic streptococcal infection. Coprolalia is a form of tics where the patient involuntarily says obscene and inappropriate words. We report a case of a 15-year old girl with a history of suspected PANDAS presenting to the emergency department with recurrent coprolalia without signs of a streptococcus infection. PANDAS and other neuropsychiatric syndromes can have different acute presentations. The ED physicians should be familiar with such disorders and presentations. https://escholarship.org/uc/item/6bb731gw Wed, 22 Jul 2026 00:00:00 +0000 El Tawil, Chady Richard, Andre Kassir, Ghida Bank, Ilana https://escholarship.org/uc/item/5r87m7zw Introduction: The coronavirus 2019 (COVID 19) is an ongoing pandemic that brought significant changes in the healthcare sector, including healthcare-seeking behaviours, population movement, and daily activities. The COVID 19 has significantly affected the influx of paediatric patients attending the emergency department at a tertiary hospital level. This paper aims to measure and study the magnitude and reasons behind the reducing number of children attendances. COVID-19 compares with the disappearing number of children attending PED's to Pied Piper of Hamelin, attracting kids away from their homes as in our old bedtime stories. Methods: Our paper is a single-centre, retrospective, observational study in the Paediatric Emergency Department (PED) and data obtained from Electronic Medical Records and ED Dashboard. We included all paediatric patients who registered in our PED during April, May, and June over three years (2018, 2019, and 2020), including their level of triage and... https://escholarship.org/uc/item/5r87m7zw Wed, 22 Jul 2026 00:00:00 +0000 Al-Kaisy, Maythem Abdulhassan Abraham, Sneha Al-Shaibani, Noura Ishaq Jaiganesh, Thiagarajan https://escholarship.org/uc/item/45t3g1mp <p><strong>Introduction:</strong> While computed tomography (CT) is invaluable for detecting life-threatening injuries in the emergency department (ED), the literature shows increasing use of head CT and cervical spine CT in low-risk trauma patients without a corresponding rise in injuries identified. These low-yield exams expose patients to avoidable radiation, increase costs, and contribute to inefficiencies in already overburdened EDs. In this study we evaluated the impact of a multimodal quality improvement (QI) campaign to reduce the use of head and cervical spine CT in low-risk trauma patients.</p> <p><strong>Methods:</strong> This prospective QI intervention involved two EDs within one healthcare network: an academic trauma center and a community hospital. We collected data on baseline CT use for six months, followed by a 23-month intervention period. Primary outcomes were monthly rates of low-risk trauma head and cervical spine CT per 100 ED patients; secondary outcome... https://escholarship.org/uc/item/45t3g1mp Tue, 21 Jul 2026 00:00:00 +0000 Luke, Jude C. Kubick, Rebecca N. Sucharew, Heidi J. Winkler, Kayla Giles, Mary L. Kreitzer, Natalie E. Goel, Anita L. Thompson, David O. https://escholarship.org/uc/item/67n326s9 <p><strong>Introduction:</strong> Tension hydrocele is a rare but serious complication that can threaten testicular viability. This case report describes how testicular point-of-care ultrasound (POCUS) enabled timely recognition of a large hydrocele compromising testicular perfusion and guided management.<br>Case Report: A 57-year-old male presented to the emergency department (ED) with painful right scrotal swelling. Testicular POCUS demonstrated a large hydrocele with reduced intratesticular blood flow. A scrotal centesis performed by the emergency physician led to symptom resolution and restoration of normal flow.</p> <p><strong>Conclusion:</strong> Testicular POCUS can rapidly identify impaired perfusion and guide scrotal centesis in the ED, a temporary yet potentially testis-saving intervention.</p> https://escholarship.org/uc/item/67n326s9 Mon, 20 Jul 2026 00:00:00 +0000 Potalivo, Sophia Fornbacher, Sophia Abadilla, Joey Goubert, Ron Tovar Hirashima, Eva https://escholarship.org/uc/item/6785283v <p><strong>Case Presentation: </strong>A 28-year-old woman was brought to the emergency department after being found collapsed at home. Because she was unable to provide a history, contextual bedside clues were important during the initial assessment. Bright yellow granular material with a medicinal odor was noted adherent to her hair. This unusual finding raised suspicion of overdose with an acetaminophen-containing over-the-counter (OTC) cold medication. Her serum acetaminophen concentration was elevated at 135 micrograms per milliliter, and N-acetylcysteine was promptly administered. She did not develop hepatic injury and was discharged after recovery.</p> <p><strong>D</strong><strong>iscussion:</strong> This case highlights the diagnostic value of visible bedside clues when history is initially unavailable. The yellow residue was not pathognomonic, and no chemical analysis of the material was performed. However, in the context of the increasing incidence of overdoses involving... https://escholarship.org/uc/item/6785283v Mon, 20 Jul 2026 00:00:00 +0000 Sakamoto, So https://orcid.org/0000-0002-0921-7375 https://escholarship.org/uc/item/5rw263cs <p><strong>Introduction: </strong>High-risk pulmonary embolism (PE) is an uncommon but potentially reversible cause of out-of-hospital cardiac arrest, frequently presenting as pulseless electrical activity (PEA). Early identification and multidisciplinary intervention are critical, yet confirmatory imaging is often delayed. Current guidelines recommend consideration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in specialized centers when high-risk PE is suspected and the patient presents with cardiogenic shock or cardiac arrest.&nbsp;</p> <p><strong>Case Report:</strong> We describe a 50-year-old woman with a remote history of deep vein thrombosis who arrested after acute-onset dyspnea. Emergency medical services documented PEA arrest and initiated advanced cardiac life support. On arrival to the emergency department (ED), the patient remained in PEA arrest without cardiac motion on point-of-care ultrasound. Pulmonary embolism was strongly suspected but... https://escholarship.org/uc/item/5rw263cs Mon, 20 Jul 2026 00:00:00 +0000 Chopra, Tananshi Dahlke, Lea Salinas, Nancy Shabbir, Moizza Gunn, Tyler Torbati, Sam https://escholarship.org/uc/item/4r85p7bq <p><strong>Introduction: </strong>Blunt thoracic aortic injury is a rare but potentially fatal consequence of motor vehicle collisions. While commonly associated with hemodynamic instability, some cases present with normal vital signs, delaying diagnosis and treatment. We present the case of a 42-year-old unrestrained backseat passenger who sustained a blunt thoracic aortic injury following a motor vehicle collision and underwent emergent endovascular repair. This case emphasizes the critical role of early imaging and multidisciplinary coordination in the management of high-risk trauma patients.</p> <p><strong>Case Report:&nbsp;</strong>A 42-year-old female presented to the emergency department (ED) following a high-risk motor vehicle collision. She was an unbelted passenger in a vehicle traveling at approximately 35 miles per hour that collided with a telephone pole. The patient was unconscious at the scene but regained consciousness en route. Upon arrival at the ED she was alert,... https://escholarship.org/uc/item/4r85p7bq Mon, 20 Jul 2026 00:00:00 +0000 Knudsen, Joseph Lucas, Stephen Mangano, James https://escholarship.org/uc/item/4fc1v72d <p><strong>Introduction: </strong>Hernias are a common presenting complaint in the emergency department. If they are not promptly identified and reduced, patients may need urgent surgery, which entails an increase in morbidity and mortality. The diagnosis and reduction of hernias can be challenging due to a patient’s large body habitus. In this case, we demonstrate the utility of using point-of-care ultrasound (POCUS) to detect an abdominal wall defect and provide real-time guidance to reduce a hernia and avoid surgery in a patient who was a poor surgical candidate.&nbsp;</p> <p><strong>Case Report:&nbsp;</strong>A 48-year-old morbidly obese male with multiple comorbidities presented with abdominal pain at the location of a known ventral hernia. Computed tomography (CT) of the abdomen confirmed a ventral hernia; however, three different physicians attempted reduction and were unsuccessful. We then used POCUS to identify the ventral hernia and the abdominal wall defect and to guide... https://escholarship.org/uc/item/4fc1v72d Mon, 20 Jul 2026 00:00:00 +0000 Lochner, Arion Stovicek, Elizabeth Kman, Nicholas Petelinsek, Sarah https://orcid.org/0009-0005-9733-7674 Cotton, Jennifer https://escholarship.org/uc/item/1ct7231h <p><strong>Case Presentation:</strong> A one-year-old girl presented with acute-onset dyspnea persistent for two days and recurrent choking episodes. Physical examination revealed stridor and sub-costal retractions. Despite initial treatment with inhaled nebulized epinephrine, stridor persisted. Lateral chest radiography finding indicated tracheal stenosis. Contrast-enhanced neck and chest computed tomography (CT) showed an aberrant right subclavian artery compressing the esophagus posteriorly, causing esophageal stenosis with associated food residue accumulation. The proximally dilated portion of the esophagus caused mass effect with compression of the trachea, resulting in tracheal stenosis. Despite medical management, the patient experienced recurrent stridor and could only swallow liquids. Therefore, surgical translocation of the right subclavian artery to the right common carotid artery was performed. Postoperatively, the patient swallowed age-appropriate food, and the stridor... https://escholarship.org/uc/item/1ct7231h Mon, 20 Jul 2026 00:00:00 +0000 Yasuda, Masato Ito, Tomoya https://escholarship.org/uc/item/9273p2mt <p><strong>Importance: </strong>Distal radius fractures and distal ulna fractures are common orthopedic injuries treated in emergency departments (ED). Our goal in this narrative review was to present emergency physicians with a single source that covers the evaluation and treatment of distal radius fractures and distal ulna fractures across the lifetime of our patients. There are differences in the treatment algorithms for distal radius fractures between pediatric, young adult, and geriatric patients.</p> <p><strong>Observations:</strong> Pediatric distal radius fractures are defined by their relation to the growth plate and are influenced by the gradual calcification of the developing bone. Some pediatric distal radius fractures can heal through significant displacement, while others require anatomical reduction to limit the risk of growth arrest. For adult patients with a distal radius fracture, there are established guidelines for both appropriate reduction goals and for when... https://escholarship.org/uc/item/9273p2mt Fri, 17 Jul 2026 00:00:00 +0000 Kirchberg, Tyler Nolan, Robert Tomberg, Spencer https://escholarship.org/uc/item/8n75z5fz <p><strong>Introduction: </strong>Toxic alcohol poisoning (methanol or ethylene glycol) can cause severe metabolic disturbances, end-organ damage, and death. Timely diagnosis is paramount and predicated on history, lab markers, and confirmatory laboratory testing, which inform antidote use and/or hemodialysis. Confirmatory toxic alcohol testing capabilities and turnaround times vary by geographic region. Our objective in this study was to evaluate how differences in toxic alcohol testing turnaround times impact our primary outcome of hospital length of stay and secondary outcomes of antidote (fomepizole) administration and medical outcomes (including death, major, moderate, and minor effects) among patients with suspected toxic alcohol poisoning.</p> <p><strong>Methods:</strong> This is a retrospective cohort study of toxic alcohol poisoning cases reported to two U.S. poison centers, Michigan Poison and Drug Information Center (MiPDC) and Florida’s Poison Information Network (FPIN),... https://escholarship.org/uc/item/8n75z5fz Fri, 17 Jul 2026 00:00:00 +0000 Chen, Steven https://orcid.org/0009-0001-4005-4703 Yudiono, Jacob https://orcid.org/0009-0002-0494-2604 Vohra, Varun https://orcid.org/0000-0001-9471-2348 Lipscomb, Rebecca https://orcid.org/0009-0003-6920-989X Mhaskar, Rahul Arnold, Justin K. Dean, Diana https://orcid.org/0000-0003-2073-8005 https://escholarship.org/uc/item/7sk394np <p><strong>Introduction:</strong> Collective leadership within healthcare is critical if we are to deliver on net zero targets and provide high-value, low-carbon care to our patients. However, driving change in systems under considerable strain from crowding, limited resources, and increasingly complex caseloads can be a daunting task and often feels out of reach. In July 2023, the Royal College of Emergency Medicine (RCEM) launched a sustainability initiative to support environmentally sustainable healthcare within emergency departments (ED). This 12-month support and accreditation scheme centers around a framework of 36 actions and has been designed to make sustainability interventions accessible to staff, enabling individuals, groups, and networks to become leaders within their own spheres of influence and elicit measurable changes. The objective of this study was to evaluate the impact of the accreditation scheme over a 2-year period.</p> <p><strong>Methods:</strong> The primary... https://escholarship.org/uc/item/7sk394np Fri, 17 Jul 2026 00:00:00 +0000 Wood, Jennifer L. Robertson, Alexander Spruell, Tim Steley, Zoe https://escholarship.org/uc/item/6v2362s2 <p><strong>Introduction:</strong> Point-of-care ultrasound (POCUS) can expedite patient diagnoses and improve procedural safety in emergency department (ED) patients. Nevertheless, clinical POCUS use lags in many ED sites nationwide, with only 40% of community physicians using POCUS according to a study from 2019-2021. We studied the impact of a multifaceted clinical POCUS intervention to address barriers and increase clinical POCUS use.&nbsp;</p> <p><strong>Methods:&nbsp;</strong>We conducted a prospective cohort study at a single academic hospital that included ED attendings, residents, and advance practice clinicians (APC). A multifaceted four-week intervention for emergency clinicians from December 2023–January 2024 addressed barriers to POCUS use identified on a pre- and post-intervention survey. The intervention included POCUS education during clinical shifts by ultrasound faculty, clinical POCUS workflow demonstration during resident conference/faculty meetings, and QR... https://escholarship.org/uc/item/6v2362s2 Fri, 17 Jul 2026 00:00:00 +0000 Platt, Alyssa Peterson, Timothy Peethumnongsin, Erica Kuchibhatla, Maragatha Theophanous, Rebecca G https://orcid.org/0000-0003-0697-3703 https://escholarship.org/uc/item/4q494179 <p>Abstracts Presented in Tbilisi, Georgia July 17-18, 2026.</p> https://escholarship.org/uc/item/4q494179 Fri, 17 Jul 2026 00:00:00 +0000 https://escholarship.org/uc/item/3nj7r2b4 <p><strong>Introduction:</strong> Video methods used in medicine have been described as the “gold standard” because they show events as they occurred and with a level of detail unattainable when events are reconstructed using other methods. In stimulated recall, video or pictures during interviews prompt discussion about participants’ thoughts or feelings when images were captured. Coupled with video, stimulated recall can deepen researchers’ understanding of a participant’s thinking at the time. However, conducting video-based stimulated recall interviews with participants is poorly described in the literature because of word count limits in today’s journals. In this paper we describe how we used video with stimulated recall interviews to learn how the diagnostic process evolves for emergency physicians.&nbsp;</p> <p><strong>Methods:</strong> We used the theory of distributed cognition to describe how information processing develops over time and occurs across physicians, the... https://escholarship.org/uc/item/3nj7r2b4 Fri, 17 Jul 2026 00:00:00 +0000 Manojlovich, Milisa https://orcid.org/0000-0002-6101-5535 Cassady, Caitlin Parker, Sarah J. Davis, Ellie Ahr, Charlotte Ryamukuru, David Wang, Anna Pasupathy, Kalyan Singh, Hardeep Mahajan, Prashant https://escholarship.org/uc/item/21m205ps <p><strong>Introduction:</strong> Methamphetamine-associated heart failure with reduced ejection fraction is a serious consequence of methamphetamine use often underrecognized in the emergency department (ED). Point-of-care ultrasound (POCUS) offers rapid, non-invasive cardiac screening for high-risk populations. This study evaluated the diagnostic yield of POCUS for detecting methamphetamine-associated heart failure with reduced ejection fraction in ED patients who use methamphetamine.</p> <p><strong>Methods:</strong> We conducted this prospective cohort study between December 2020–February 2024 at an urban Level I trauma center ED. The primary outcome was diagnostic yield of cardiac POCUS for abnormal left ventricular ejection fraction (LVEF) and abnormal sex-specific left ventricular end-diastolic diameter in patients with methamphetamine use, with secondary analyses assessing associations with use duration and frequency. Diagnostic yield was calculated as the proportion of... https://escholarship.org/uc/item/21m205ps Fri, 17 Jul 2026 00:00:00 +0000 Nashu, Madison Lam, Jordan Khan, Zarak Saadat, Soheil Almog, Roy Goubert, Ron Wasmund, Joshua Choi, Heesun Lahham, Shadi Hsu, Edmund Guy, Megan Fox, John C.