Cadaveric Model of Pneumothorax (the GASP model): A Realistic, Reusable and Cost-Effective Simulator for Chest Drainage Training

Mon, 2 Nov 2026 00:00:00 +0000

Audience: The gastrostomy-assisted simulated pneumothorax (GASP) model is designed to train residents in emergency medicine, anesthesiology, pulmonology, cardiothoracic surgery, and paediatric surgery in the various techniques used to perform chest drainage (CD).

Introduction: Pneumothorax is a life-threatening emergency, particularly in the case of a tension pneumothorax. Failure to perform timely CD can rapidly result in cardiorespiratory arrest.¹ Needle decompression, chest tube insertion, and finger thoracostomy are the three main CD procedures that healthcare professionals must master. However, these are technically challenging procedures with potentially severe and sometimes fatal complications. The literature reports significant complication rates (19%) and failure rates (18-21%).^2,3

Acceptability of a Novel Prehospital Emergency Care System Evaluation Tool Among Southeast Asian Stakeholders: A Cross-Sectional Survey

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Prehospital emergency care (PEC) systems vary widely in structure, capacity, and stage of development, and existing evaluation tools are not tailored to the contextual needs of Southeast Asia. To address this gap, the Prehospital Emergency Care System Evaluation Tool (PECSET) was developed as a 32-element, consensus-derived framework to support system assessment, prioritization, and quality improvement. The objective of this study was to evaluate the prospective acceptability of the PECSET framework among Southeast Asian prehospital stakeholders using the theoretical framework of acceptability (TFA) and to identify regional variation in implementation priorities.

Methods: We conducted a cross-sectional survey of PEC professionals from the Philippines, Thailand, Vietnam, Indonesia, and Malaysia between April 2023 and June 2024. Participants were recruited from six resuscitation training conferences and attended a standardized...

A Low-Cost Rectal Foreign Body Removal Simulator

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This rectal foreign body removal model is designed to instruct emergency medicine residents. However, the innovation is appropriate for medical students, advanced practice providers (APPs), attending physicians, and clinicians in other medical specialties.

Introduction: Rectal foreign bodies are relatively uncommon emergency department presentations but are associated with significant morbidity and mortality.¹ These foreign bodies require prompt recognition and skilled management, which can be challenging due to stigma, patient discomfort, and procedural complexity. Learners often have limited opportunities for hands-on experience with rectal foreign body removal, and to our knowledge, no established simulation tool currently exists for training in this procedure. This task trainer was designed as an easily...

This Article Corrects: “The Bullets He Carried”

Mon, 2 Nov 2026 00:00:00 +0000

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Caring for Patients Anywhere, Anyhow: How Emergency Department Crowding and Boarding Shapes Professional Identity in Emergency Medicine Training

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency department (ED) boarding is a well-documented crisis associated with adverse patient outcomes, healthcare worker burnout, and moral injury. Although prior work has documented operational and educational impacts, including reductions in resident productivity and procedural exposure, less is known about how sustained boarding shapes professional identity formation. We sought to explore how sustained ED boarding shapes the learning experiences and professional identity formation of emergency medicine (EM) residents, as perceived by both residents and the attending physicians who train them.

Methods: Using a constructivist paradigm, we conducted a qualitative study using semi-structured interviews with residents and attending physicians from a 4-year EM residency program with rotations across 5 clinical sites, between July and August 2025. Two researchers independently coded transcripts and iteratively refined a shared...

Sickle Cell Crisis with Acute Chest Syndrome – Structured Certifying Exam Case

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This clinical decision-making case (CDM) is intended for emergency medicine residents (interns, juniors, seniors).

Introduction/Background: Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease and can be a common cause of ICU admission in these patients. Emergency physicians must rapidly identify, diagnose, and treat ACS to prevent deterioration. Acute chest syndrome is the most prevalent pulmonary disorder in individuals with sickle cell.1,2 Approximately 50% of patients with sickle cell disease will experience more than one episode of acute chest syndrome, with 78% of episodes secondary to vaso-occlusive pain episodes in adults. It is the most common cause of death in individuals with sickle cell, accounting for almost 25% of all deaths.3

Educational Objectives: By the end of this clinical decision-making case, learners will be able to: 1) demonstrate...

Transforming Emergency Medicine Mentorship: A Skill-Building Curriculum to Optimize Mentee Growth and Development

Mon, 2 Nov 2026 00:00:00 +0000

Audience and type of curriculum: This mentorship training curriculum is designed for faculty seeking to improve mentoring skills in an academic health system setting. The curriculum offers interactive small-group skill practice supported by brief didactic lectures, paired peer mentoring, and large group reflections.

Length of curriculum: The curriculum is designed as three one-hour interactive workshops to be delivered over three to six months to allow for spaced skill practice in between sessions.

Introduction/Background: This mentorship training curriculum addresses critical gaps in mentorship quality and availability for emergency medicine faculty and learners. Faculty rarely are trained to be mentors, limiting mentoring quality and accessibility for mentees. We addressed these scarcity and quality gaps by offering concise experiential workshops for mid-career and senior faculty mentors to shift their mentoring...

Meeting the Milestones through Simulation: Disclosing a Medical Error

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This simulation is intended for medical students, interns, junior residents, and senior residents.

Introduction: Patient safety event reporting and disclosure of medical errors to patients and families are critical components of high-quality, transparent care and a necessary skill for emergency medicine (EM) physicians. Accurate reporting of errors, near misses, and unsafe conditions provides institutions with the data needed to investigate vulnerabilities, implement system-based solutions, and prevent recurrence. Disclosure of medical errors fosters trust, supports just culture principles, and reinforces professional accountability.¹ Physicians have historically reported few adverse events, accounting for only 1–2% of all reports.² To address this gap, the Accreditation Council for Graduate...

Assessment of Combined Food and Nutrition Insecurity Screening in the Emergency Department: A Brief Report

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency department (ED) food insecurity (FI) screening traditionally identifies insufficient access to food but does not account for diet quality. We evaluated the incremental yield of adding a nutrition insecurity (NI) screener to routine FI screening.

Methods: This single-center observational study enrolled adult ED patients from April–September 2025. Participants completed the 2-item Hunger Vital Sign and a 1-item NI screener. Our primary measure was incremental yield of NI screening beyond FI screening, defined by the number of NI-positive/FI-negative patients identified. Secondary outcome measures included FI and NI prevalence, screening concordance, and number needed to screen. Screening fidelity was supported through structured training of research associates and standardized phrasing.

Results: Of 1,120 patients, 13.6% (95% CI, 11.6–15.7%) screened positive for FI and 11.4% (95% CI,...

Emergency Ultrasound Fellowship Match Outcomes: Unfilled Positions and Implications over Eight Years

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Advanced emergency ultrasound (AEMUS) fellowships recently experienced an unexpected decrease in the number of positions filled in the match. Our study aimed to characterize this trend over an eight-year period.

Methods: We performed a cross-sectional observational study of AEMUS fellowships participating in the National Resident Matching Program (NRMP) from the 2019–2026 match cycles, cross-referencing the publicly available database from the Society of Clinical Ultrasound Fellowships. The primary outcome was both the proportion of AEMUS fellowship positions filled and a program complement fill percentage. Secondary outcomes included stratification by geography and duration since program establishment.

Results: We included a total of 138 of the 141 programs listed in the NRMP Match. From 2019 to 2026, there was a 28.2% increase in the number of programs and a 34.5% increase in available positions....

English versus Non-English Language Preference and Computed Tomography Use in Pediatric Minor Head Trauma

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Whether the use of computed tomography (CT) in pediatric minor head trauma varies by documented language preference (English vs non-English), independent of race, is not well understood. Our objective was to identify factors associated with head CT use among children with minor head trauma in an institutional Pediatric Emergency Care Applied Research Network (PECARN)-based pathway.

Methods: This single-center retrospective cohort study included patients 2 to 14 years of age presenting with minor head trauma, January 2019 to June 2022, who were classified as low, intermediate, or high risk using PECARN criteria. Our primary outcome measure was a three-level clinical pathway: no CT and no traumatic brain injury (TBI); clinical TBI without CT; or CT performed. Secondary outcomes were CT positivity and short-term clinical outcomes. Multinomial logistic regression assessed associations between pathway and language preference,...

Case Report: Sonographic Detection of Chorionic Hemangiomas in Sturge-Weber Syndrome

Mon, 2 Nov 2026 00:00:00 +0000

Point-of-care ultrasound (POCUS) is used frequently in the emergency department (ED) as a non-invasive diagnostic tool. Ocular POCUS is utilized in patients with vision changes to detect pathologies including retinal detachment, vitreous hemorrhage and central retinal artery occlusion. This case demonstrates the capability of POCUS to detect choroidal hemangiomas, a pathology strongly associated with Sturge-Weber syndrome (SWS). A 31-year-old male with no significant medical history presented with two years of progressive vision changes and headaches. A large right-sided facial birthmark was noted, though the patient had no prior diagnosis. Examination revealed right eye blindness and an afferent pupillary defect. Ocular POCUS revealed retinal detachment and choroidal thickening, which were interpreted as choroidal hemangiomas. Findings were corroborated by MRI. Together with input from our ophthalmology and neurology specialists, a diagnosis of SWS was made. This case demonstrates...

Sex Differences in Outcome and Mortality in Urinary Tract Infections in the Emergency Department: The UTILY Study

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: In urinary tract infections (UTI) sex-related differences in comorbidities, antimicrobial resistance, and outcomes have been described, but it remains unclear whether these disparities reflect sex-related biological mechanisms or are primarily explained by age and comorbidity, especially in emergency settings. Our objective was to evaluate sex-related differences in microbiology, antimicrobial resistance, and outcomes among adults with potentially multidrug-resistant UTIs presenting to the emergency department (ED), and to determine whether sex independently predicts multidrug-resistant infections and outcomes after adjustment for age and comorbidity.

Methods: We conducted a prospective multicenter study enrolling all adult patients with suspected or confirmed UTIs admitted to one of the eight EDs involved from February 2023–July 2024. Our primary outcome was the prevalence of multidrug-resistant UTIs and whether sex independently...

High-efficiency Nebulizers Reduce Albuterol Administration Time in the Emergency Department

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Asthma exacerbations commonly require nebulized albuterol in the emergency department (ED). High-efficiency devices (vibrating mesh, breath-enhanced/actuated) may shorten treatment time compared with traditional jet nebulizers. We compared four commonly used nebulizer devices on treatment time and ED outcomes.

Methods: We conducted a prospective observational study of a convenience sample of patients at a high-volume, urban Level I trauma center ED (February 2019–March 2023; paused during COVID-19). Patients ≥ 3 years of age receiving clinician-ordered nebulized albuterol were eligible. Exclusions included patients with a history of chronic obstructive pulmonary disease or congestive heart failure, inability to follow commands or hold the device, and need for positive-pressure ventilation. Respiratory care practitioners used one of four devices already in use in this department: Westmed miniHEART Hi-Flo jet (Mini), Aerogen...

Shockingly Unreliable: A Case Report of Failure of Synchronized Cardioversion Device to Capture, Resulting in Ventricular Fibrillation and Cardiac Arrest

Mon, 2 Nov 2026 00:00:00 +0000

Synchronized cardioversion is a standard treatment for unstable ventricular tachycardia. While modern defibrillators are designed with safety mechanisms, synchronization failure can result in catastrophic complications. We present the case of a 65-year-old woman with unstable wide-complex tachycardia with a pulse who underwent emergent synchronized cardioversion. Despite activation of the “sync” mode, the device failed to capture appropriately and delivered a shock on the T-wave, precipitating ventricular fibrillation and cardiac arrest. After 26 minutes of resuscitation and multiple defibrillations, return of spontaneous circulation (ROSC) was achieved. The patient ultimately recovered and was discharged home in stable condition. This case underscores the rare but serious risk of synchronization failure, particularly in obese patients where pad placement and capture may be impaired,¹ and emphasizes the importance...

The Ethics of Night Shift Allocation

Mon, 2 Nov 2026 00:00:00 +0000

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Priapism got you down? A novel method to build your own moderate fidelity task trainer

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This task trainer was designed to instruct emergency medicine (EM) residents and faculty at all levels of training.

Introduction: Priapism management is time-sensitive, and the clinical opportunities to perform dorsal penile nerve block and corporal aspiration are seldom practiced. Despite knowledge of the importance of prompt recognition and management of priapism, many emergency physicians may not actually perform the recommended procedures to manage it for a variety of reasons.¹Due to the sensitive nature of the condition, physicians are eager to learn about and practice these intimate maneuvers in the safe setting of simulation; however, there is not a commercial task trainer available.²Some low-fidelity creations have been published as solutions, but they are less realistic and time...

Numerical Inconsistencies in “Physician-Staffed Ambulance Deployment: Comparative Response Time Analysis from a Slovak Pilot Project”

Mon, 2 Nov 2026 00:00:00 +0000

Numerical Inconsistencies in “Physician-Staffed Ambulance Deployment: Comparative Response Time Analysis from a Slovak Pilot Project”

Prehospital Buprenorphine: A National Cross-Sectional Analysis

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Initiation of buprenorphine reduces mortality in people with opioid use disorder. However, patients who decline hospital transport after overdose may not be connected to treatment. To augment treatment engagement, prehospital buprenorphine pilot programs began in 2019. To date, few studies have looked at these programs nationally. Our objective was to evaluate national prehospital buprenorphine usage.

Methods: We conducted a cross-sectional evaluation of emergency medical service (EMS) encounters involving prehospital buprenorphine administration using the 2020-2023 National EMS Information System Public Release Research datasets. Our primary outcome was trends in prehospital buprenorphine usage. Quarterly rates of prehospital buprenorphine were evaluated using joinpoint regression to identify inflection points. The secondary outcome was patient demographics and encounter characteristics, which were analyzed using descriptive...

Prehospital Facial Recognition Technology: Randomized Controlled Simulation Study

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: The risk of medical errors increases for the approximately 689,000 unidentified, noncommunicative patients who present to emergency departments annually. The concomitant rise in hospital admissions, lengths of stay, and mortality will likely persist unless approaches to identifying noncommunicative patients are developed and adopted. Facial recognition technology could provide a solution where scanning the face reliably provides access to identification and medical history of patients who self-enroll in the application database. Our objective was to compare paramedics’ ability to identify noncommunicative patients and make related clinical decisions using a cloud-based facial-recognition application vs standard practice.

Methods: We conducted a double-blind, randomized controlled study with 90 participating firefighterparamedics in a simulated patient encounter. Our primary outcome was patient identification. Secondary...

Impact of Away Rotations on Emergency Medicine Match Rates in the Virtual Residency Recruitment Era

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Since the COVID-19 pandemic, many emergency medicine (EM) residencies have transitioned to virtual interviews, providing less in-person exposure for applicants. Away rotations offer applicants the opportunity to gain in-person exposure to residency programs beyond the virtual interview environment. Whether the away rotation is more important now and leads to higher rotator match rates in the virtual recruitment era remains unclear and warrants investigation. Our objective was to determine the percentage of EM interns who completed an in-person rotation at the residency program in which they matched and compare this to pre-COVID-19 match rates.

Methods: This was a multicenter pilot study of EM residency programs. We recruited a convenience sample of academic programs from the eight Society for Academic Emergency Medicine (SAEM) US geographic regions. Inclusion criteria included academic EM programs that conducted virtual-only...

Anticipating Change: Local Attitudes Toward a New Community Emergency Medicine Residency Program

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: The Indiana University School of Medicine launched two new community-based residency programs at Indiana University Health Bloomington (IUH-B) in July 2026. Prior to the launch, this research explored community members’ attitudes, expectations, and concerns regarding the introduction of resident physicians to the emergency department (ED).

Methods: This study was conducted from June to July 2025 at IUH-B. Using a convergent mixed-methods design, we evaluated a convenience sample of adult patients and accompanying family members in the emergency department (ED). Data collection included a 16-item electronic survey and semi-structured interviews.

Results: The survey was completed by 39 adult participants, and 40 completed the qualitative interview. Most participants (59%) were aware of the residency programs, and nearly all (95%) agreed that residents would improve the quality, access,...

Case Report on Rare Presentation of Intravenous Leiomyomas with Intracardiac Leiomyomatosis

Mon, 2 Nov 2026 00:00:00 +0000

Uterine leiomyomas, or fibroids, are the most prevalent benign tumor pathology affecting women.¹ Fibroids are reportedly found in nearly 70% of Caucasian women and more than 80% of women with African ancestry.¹Rarely, fibroids progress to uterine intravenous leiomyomas (IVL), a neoplastic growth pattern characterized by intravascular proliferation of this smooth muscle cell tumor.² This tumor is typically confined to the pelvic vasculature but can occasionally spread with venous blood flowing to the heart, ultimately penetrating the inferior vena cava, right heart chambers, and pulmonary arteries.³ If the tumor reaches the heart, this intracardiac leiomyomatosis (ICL) can result in severe cardiac symptoms including arrythmias, murmurs, and sudden death.^3,4 The case presentation shows both IVL and ICL in a patient.

Mon, 2 Nov 2026 00:00:00 +0000

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Ruptured Hemorrhagic Ovarian Cyst Mimicking Ruptured Ectopic Pregnancy in a Post-Transplant Patient: A Case Report

Mon, 2 Nov 2026 00:00:00 +0000

The incidence of syncope in the setting of ruptured ectopic pregnancy can vary widely; however, data specifically focusing on syncope as the primary presenting symptom without accompanying abdominal pain or vaginal bleeding are scarce.^1,2 Our 23-year-old female patient, who is post-liver transplant and currently on immunosuppressive therapy, experienced syncope without significant pain or bleeding and presented to the ED with stable vital signs. Initial investigations revealed mild left lower quadrant tenderness, a serum beta-hCG of 95 mIU/mL, and moderate free pelvic fluid with a 28 mm left ovarian “cyst” on transvaginal ultrasound. These findings raised concerns for a ruptured ectopic pregnancy. Diagnostic laparoscopy, however, ultimately revealed a ruptured ovarian hemorrhagic cyst. Subsequent negative urine beta-hCG tests confirmed the initial serum beta-hCG as a false positive likely due to heterophile antibody...

A Case-Based Workshop to Enhance Leadership Self-Efficacy Among Women in Academic Emergency Medicine

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Women remain underrepresented in emergency medicine leadership roles, in part due to sex-based stereotypes that undervalue leadership traits traditionally associated with women, such as collaboration and empathy. Agentic traits like assertiveness are often perceived as requisite for leadership, while communal skills are overlooked. Leadership self-efficacy, an individual’s belief in their ability to successfully perform leadership roles, is a key predictor of leadership emergence.

Methods: Our team developed a 90-minute didactic session featuring a panel of diverse women leaders followed by an interactive case-based exercise, delivered at the Society for Academic Emergency Medicine 35th Annual Meeting in 2024. The intervention was evaluated using a pre- and postsurvey based on an adapted Leadership Self-Efficacy Scale measuring six domains of leadership self-efficacy. Eighteen participants completed both the pre- and postsession...

Emergency Department-Centered Digital Health Transformation: Narrative Review and Three-Pillar Implementation Framework

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency departments (EDs) face escalating pressures from rising patient volumes, workforce shortages, and documentation burdens. Digital health technologies have shown promise individually, but most are implemented in isolation, limiting their collective impact. This narrative review synthesizes evidence for six digital health technologies applicable to the ED and proposes a three-pillar framework for their coordinated implementation, positioning the ED as a convergence point for health system digital transformation.

Methods: We searched PubMed and Google Scholar for peer-reviewed literature published from 2018 through July 2026 on ambient artificial intelligence (AI) documentation, telehospitalist programs, virtual nursing, remote patient monitoring, virtual specialty consultation, and postdischarge transitional care, prioritizing systematic reviews and meta-analyses. Fifty-one sources met inclusion criteria and were...

Perspectives on Influenza Vaccination Among COVID-19 Unvaccinated Patients in US Emergency Departments: A Qualitative Study

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Efforts to increase influenza vaccine acceptance must consider the importance of patient education and familiarity with vaccinations and influenza in the emergency department (ED), particularly for populations without another primary source of healthcare. This is the first study, to our knowledge, to assess in-depth perceptions regarding the influenza vaccine and identify barriers and facilitators to influenza vaccination among COVID-19 unvaccinated adult ED patients.

Methods: We conducted a qualitative idiographic interview study from July 12, 2021, to September 24, 2021, at four EDs in urban cities across the United States. We recruited adult ED patients (18 years and older) unvaccinated for COVID-19, without a primary care clinician, who were fluent in either English or Spanish. The primary finding was a detailed understanding of patient perceptions regarding the influenza vaccine, with secondary findings assessing...

Impact of a Mentored Peer-Review Program on the Sponsoring Journal: Program Evaluation at Five Years

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: The number of peer-reviewed biomedical journals has more than tripled over the past 20–25 years increasing the demand for quality peer reviewers. This demand and the lack of available formal training in peer review have resulted in a shortage of qualified peer reviewers. In response to this shortage, the Western Journal of Emergency Medicine Special Issue in Education (Special Issue) developed a formal mentored peer-review (MPR) program that provides a learning experience in peer review to educate fellows through legitimate participation while contributing to the editorial process of the journal. The latter serves as the basis of this study.

Methods: The impact of the MPR program on the Special Issue’s reviewer pool served as the primary outcome of this study. This was accomplished by tracking the number of participating fellowships and their graduates who subsequently provided independent peer reviews for the sponsoring...

The Challenge of Critical Feedback: A simulation-based Advanced Residents as Teachers Module

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This is a simulation module intended to train residents at all levels in giving targeted, critical feedback to medical students on shift.

Introduction: Residents as teachers (RAT) curricula are an important component of graduate medical education for residents who teach medical students.¹ Developing residents’ skills in teaching, feedback, and supervision is therefore a critical component of training. Medical students receive a substantial portion of their clinical education from residents,^2,3and timely, specific feedback in the clinical setting improves learner performance and professional development.⁴ Despite the importance of these skills, residents have limited opportunities to practice delivering challenging feedback beyond introductory teaching...

Pediatric Unspecified Headache in the Emergency Department: Can We Do Better?

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Unspecified headache is a common discharge diagnosis in the pediatric emergency department (ED). While diagnostic uncertainty and limited access to specialty evaluation may contribute to repeat ED visits in this population, longitudinal utilization data are limited. Study objectives were both to determine the incidence of repeat headache-related ED visits in children discharged from the ED with unspecified headache and to identify predictors of ED return (eg, prior headache-related ED or neurology utilization).

Methods: This preliminary, prospective longitudinal cohort study included 76 children (ages 8–17 years) discharged from the ED with an unspecified headache diagnosis. We assessed headache-related ED and outpatient neurology visits both six months after the index visit (ie, ED enrollment) and, retrospectively, 12 months before the index visit. The sample included children insured through a Medi-Cal–based Physician-Hospital...

Emergency Medicine Reimagined: Development of the Patient Rights Index for Emergency Medicine

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency medicine has evolved beyond episodic acute care to encompass a growing range of clinical, social, and system-level responsibilities. This scholarly perspective proposes the Patient Rights Index in Emergency Medicine (PRI-ED), a conceptual framework designed to organize recurring domains through which emergency departments promote access to care, patient safety, relief of suffering, autonomy, and dignity.

Methods: The PRI-ED was developed through iterative domain generation informed by clinical observation, professional experience, and targeted review of peer-reviewed literature, policy analyses, and professional organizational reports. No primary data collection, systematic review, formal consensus process, or empirical validation was performed.

Results: We identified 12 domains that represent recurring clinical, operational, and system-level challenges encountered in emergency medicine....

Shoulder Dislocation Reduction Using Inhaled Nitrous Oxide in the Emergency Department: Retrospective Case Series

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Inhaled nitrous oxide (iNO) offers rapid onset analgesia with a favorable safety profile yet remains underused for shoulder dislocation reductions in the emergency department (ED). The objective of this study was to evaluate the use and outcomes of iNO for shoulder reduction in the ED, including whether intravenous (IV) access was required, whether successful reduction could be accomplished without additional analgesic or sedative medications under procedural sedation, and the rate of adverse effects from iNO.

Methods: We conducted a retrospective chart review of shoulder dislocation reductions using iNO at two high-volume EDs over three years (2019–2022). Data collected included age, sex, indication, procedural success, IV placement, medications administered, and adverse events and was stored in a password-protected database. The primary endpoint was successful reduction with iNO as the primary procedural analgesic;...

Ethics of Medical Students as Embedded Simulation Participants in Ultrasound Education

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Medical students are sometimes used as embedded simulation participants (ESP) to facilitate ultrasound training on live volunteers. There is little guidance on how to safeguard the autonomy and dignity of medical student ESPs serving in this role. Based on real student experiences, we used four cases to illustrate the ethical dilemmas that can arise when ESPs are used, including the examination of sensitive body areas, risk for coercion, discovery of incidental findings in a public and professional setting, and social media posting of training events. Through these cases, we explore and articulate the relevant ethical obligations educators have to obtain informed consent, sensitively address incidental findings, and ensure the psychological and physical safety of ESPs.

Methods: We developed interventions and procedures at our institution to address the obligation to promote ESP autonomy and bodily dignity, including...

Dedicated Vertical Physician Pilot in a Rotational Patient Assignment Emergency Department

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency department (ED) vertical patient pathways (VPP) assign patients to a dedicated care area with chairs, avoiding the use of traditional ED beds. The effect of reassigning a dedicated vertical emergency physician (EP) onto an established rotational patient assignment (RPA) system, which prospectively assigns arriving patients to EP queues, is unknown. We sought to describe operational outcomes and staff satisfaction with trialing this role.

Methods: We conducted a single-center, hypothesis-generating exploratory pilot at a 56-bed tertiary-care ED in which one 8.75-hour EP shift on five Mondays was repurposed into an 8.75-hour dedicated VPP role within a chair-based vertical patient care area while the rotational patient assignment system remained in place; three prior comparable Mondays served as comparison. Primary outcome was discharged-patient ED length of stay (LOS); secondary outcomes included VPP upgrades to...

WestJEM Full-Text Issue

Mon, 2 Nov 2026 00:00:00 +0000

WestJEM Full-Text Issue

How to Place a Central Line: Preparing Your Kit & Performing the Procedure

Mon, 2 Nov 2026 00:00:00 +0000

Audience: Senior Medical Students and Interns

Introduction: Central venous catheter (CVC) placement is a critical, high-risk procedure, and it is considered a core component of emergency medicine training.¹ Iatrogenic complications from improper technique—including arterial dilation, pneumothorax, and line-associated bloodstream infections—can significantly impact patient outcomes.^2-7Therefore, emergency medicine trainees should ideally demonstrate procedural competence and adherence to safety practices before performing CVC insertion in clinical settings. These videos serve as part of a mastery-based curriculum designed to reinforce standardized, evidence-based techniques and institutional safety protocols for internal jugular CVC placement.⁸ The procedural preparation video...

Sex Differences in Time to Triage in the Emergency Department: A Retrospective Cohort Study

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Efficient triage in emergency departments (ED) is crucial for timely patient care, as evidence indicates that time to triage could affect treatment outcomes. Sex differences have been observed in different healthcare areas. The objective of this study was to determine whether sex differences exist in a patient’s time to triage and the magnitude of any observed differences at presentation to the ED of a Jerusalem hospital.

Methods: This retrospective study used anonymized data from adult ED visits between January 1 to September 30, 2024, at an ED in Jerusalem. Our primary outcome measure was the mean time to triage, defined as the interval between documented patient arrival and the first encounter with a triage nurse. Our secondary outcome measures included the proportion of patients triaged within 15 minutes, stratified by sex, ED division, and Emergency Severity Index (ESI) level.

Results: The study...

Machine Learning Versus Traditional Statistical Models for Emergency Department Volume Forecasting

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency department (ED) crowding harms patient care and strains hospital operations. Forecasting daily patient arrivals can help ED medical directors, department chairs, and hospital administrators plan staffing and bed capacity in advance, rather than reacting after a surge has already occurred. This study compared five computer-based forecasting methods, including three machine learning models (eXtreme gradient boosting [XGBoost], light gradient boosting machine [LGBM], and long short-term memory [LSTM]) and two traditional statistical models (autoregressive integrated moving average [ARIMA] and seasonal ARIMA [SARIMA]), to determine which most accurately predicts ED patient volume seven days in advance, using eight years of daily visit data from an academic freestanding ED.

Methods: This retrospective study analyzed 3,202 consecutive days of daily patient volume (March 27, 2017, to December 31, 2025) from an academic...

Machine Learning Algorithms for Predicting Psychostimulant Intoxication in Emergency Department Patients: A Multicenter Study

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Psychostimulant detection rates among emergency department (ED) patients presenting with suspected substance intoxication are low and are influenced by limited access to confirmatory testing, insufficient clinical information, and variability in physician experience. These challenges often result in high false-positive rates and unnecessary resource use. We hypothesized that machine learning (ML) algorithms could maintain reliable diagnostic performance across a temporal validation cohort and perform comparably to physicians with varying experience levels.

Methods: This multicenter study prospectively enrolled ED patients with suspected substance intoxication between March 2019 and January 2020. We chronologically partitioned data into a training set (March–October 2019) and a temporal validation cohort (November 2019–January 2020) to assess model generalizability. After determining psychostimulant intoxication via liquid...

Awaiting Stress: An Interprofessional In-situ Simulation to Optimize Team Management of Cardiac Arrest in an Emergency Department Observation Unit

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This simulation is intended for interprofessional clinical decision unit (CDU) teams.

Introduction: Emergency department (ED) observation units or clinical decision units (CDU) are a common care model found in many hospitals due to their ability to provide high-quality care and reduce length of stay while also minimizing costs.^1,2,3 Despite initial clinical stability, deterioration while in the CDU may occur. Due to the unique environment of the CDU, it is essential that the interprofessional team is prepared to manage unstable patients; yet there is minimal literature on how to best train observation unit teams.

Educational Objectives: By the end of this simulation session, learners...

Factors Associated with Early ED Return Among Patients Discharged After Treatment for Alcohol Withdrawal Syndrome

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Alcohol withdrawal syndrome (AWS) is a frequent cause of emergency department (ED) visits, and some patients return soon after discharge. Identifying factors associated with short-term ED return may inform targeted interventions. Our primary objective was to identify factors associated with 72-hour ED return and 30-day hospital admission among patients discharged after treatment for AWS.

Methods: We conducted a retrospective review of 318 ED encounters for AWS at a single academic medical center from January 1, 2020, to December 31, 2023. Demographic, psychiatric, housing, insurance, and discharge pharmacology variables were collected. We evaluated ED pharmacologic treatment strategy and discharge taper prescriptions. The primary outcome measure was 72-hour ED return, and the secondary outcome measure was hospital admission within 30 days. We compared groups using chi-square, Shapiro-Wilk, Fisher exact, and Mann–Whitney...

Physical Frailty and End-of-Life Care Small Groups

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This module was developed for emergency medicine (EM) residents, though may also be used for medical students on an emergency medicine clerkship or attending physicians.

Length of Curriculum: This frailty and end-of-life care module consists of two 60-minute small group sessions.

Introduction: Emergency medicine physicians often care for patients with significant comorbidities, physical frailty, and acute and chronic life-limiting conditions, including those at end-of-life. Over 60% of emergency department (ED) patients older than 65 years old meet established criteria for physical frailty, and at least half of older adults present to the ED in their final month of life.^1,2 Therefore, it is critical that EM physicians understand...

Intentional pencil ingestion – a case report of a sharp ingested foreign body

Mon, 2 Nov 2026 00:00:00 +0000

Treating foreign body ingestion in the emergency department (ED) is common; however, certain ingestions may be immediately life-threatening, depending on the object because sharp objects pose the greatest risk for gastrointestinal injury, including perforation and obstruction.1 This is a case of an adult male who arrived at the ED with suicidal ideation and reported ingesting a pencil two days prior. He presented with abdominal pain and hematochezia. A computed tomography (CT) scan of the abdomen and pelvis identified the pencil in the distal ileum. The patient was admitted for surgical evaluation and monitoring. Remarkably, the pencil was passed spontaneously in the stool on hospital day six without signs of colonic perforation. This case illustrates how selected cases of high-risk foreign body ingestion may be managed conservatively, though close monitoring is critical given the risks of perforation, obstruction, or failure of progression.

Simulation-Based Interprofessional Curriculum for Emergency Management of Snakebites

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This simulation is intended for Post-Graduate Level 1-4 Residents and Attending Physicians.

Introduction: Although uncommon in the Northeastern United States, emergency physicians may encounter exotic envenomation through zoological institutions, research facilities, or privately owned exotic reptiles.¹ These cases present unique diagnostic and logistical challenges because management frequently requires species-specific antivenom and early consultation with regional toxicology experts.^1,2,3 Emergency providers may be unfamiliar with such presentation, evaluation, and treatment steps. Simulation-based education can bridge this gap by allowing interprofessional teams, including residents, attendings, nurses, and pharmacists, to practice coordinated management in a safe...

Physical Wellbeing Scavenger Hunt

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This small group session is appropriate for any level of medical student, emergency medicine resident physicians, and faculty.

Introduction: Burnout is a major issue in medicine, with over half of physicians experiencing burnout at some point in their career.¹ Physicians who regularly participate in self-care activities, such as regularly exercising, having a well-balanced diet, and appropriate amount of sleep, experience less burnout.^2,3,4 As a resident, it is difficult to find time to practice self-care.² This session sought to combine education on how to implement appropriate self-care as a trainee and how to carry that forward after training in a way that was fun, provided a period of physical exercise, and provided time outdoors for those participating.

Infectious Flexor Tenosynovitis of the Lower Extremity: A Case Report

Mon, 2 Nov 2026 00:00:00 +0000

Infectious flexor tenosynovitis (IFT) of the lower extremity is rare but serious, requiring early recognition and aggressive management to prevent severe morbidity. Often associated with penetrating trauma or hematogenous spread, IFT can lead to devastating complications if not promptly identified and treated.

A 57-year-old female with cirrhosis, diabetes mellitus, and hypertension presented to the emergency department with progressive right ankle pain, swelling, and systemic symptoms. Despite prior emergency visits, her condition worsened. Imaging revealed infectious tenosynovitis involving the flexor hallucis longus and flexor digitorum longus tendons, with concerning signs of soft tissue necrosis. She received broad-spectrum antibiotics and underwent emergent surgery, ultimately requiring a below-the-knee amputation due to extensive necrosis. Blood cultures confirmed group B Streptococcus as the pathogen. Her postoperative course was complicated by hepatic encephalopathy...

Point-of-Care Ultrasound Findings of Ovarian Hyperstimulation Syndrome: A Case Report

Mon, 2 Nov 2026 00:00:00 +0000

Ovarian hyperstimulation syndrome (OHSS) is a rare but potentially life-threatening complication of assisted reproductive technology (ART). Prompt recognition and management are essential to reduce morbidity. This case describes a 30-year-old woman undergoing ART who presented to the emergency department (ED) with abdominal pain, distention, lightheadedness, nausea, vomiting, and shortness of breath following transvaginal oocyte retrieval. Physical examination revealed a tense, diffusely tender abdomen, and point-of-care ultrasound (POCUS) demonstrated enlarged ovaries bilaterally with multiple follicles and moderate peritoneal free fluid, confirming the diagnosis of OHSS. Laboratory findings included leukocytosis, hemoconcentration, and hypoproteinemia. The patient received supportive care with intravenous fluids and analgesia and, during admission, underwent therapeutic paracentesis, resulting in the removal of roughly three liters of ascitic fluid. Her symptoms resolved,...

Identification of Regional Wall Motion Abnormalities by Emergency Physicians in Acute Coronary Syndromes: Systematic Review and Meta-Analysis

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Chest pain accounts for approximately six million emergency department (ED) visits annually in the United States. Early detection of acute occlusive myocardial infarction (OMI) is challenging, especially in patients without classic ST-elevation on initial electrocardiography (ECG). Regional wall motion abnormalities (RWMA) often precede ECG changes and can be sensitive indicators of acute coronary occlusion on transthoracic echocardiography (TTE). However, the accuracy of emergency physician-performed TTE for RWMA detection has not been well defined. In this review we aim to determine how accurate emergency physicians are in detecting RWMAs.

Methods: We conducted a systematic review of studies including adult ED patients who underwent cardiac ultrasound performed or interpreted by emergency physicians, with test characteristics compared to cardiology-performed or interpreted echocardiography as the reference standard....

Reply to Letter to the Editor “Numerical Inconsistencies in ‘Physician-Staffed Ambulance Deployment: Comparative Response Time Analysis from a Slovak Pilot Project’”

Mon, 2 Nov 2026 00:00:00 +0000

Reply to Letter to the Editor “Numerical Inconsistencies in ‘Physician-Staffed Ambulance Deployment: Comparative Response Time Analysis from a Slovak Pilot Project’”

A Rapidly Expanding Neck Mass with Risk of Airway Compromise; A Case Report

Mon, 2 Nov 2026 00:00:00 +0000

Airway compromise and impending collapse should be considered in all patients presenting with a neck mass. This patient presented to the emergency department (ED) two weeks prior with concerns for rapid growth of a neck mass; after being sent home with an outpatient referral to specialty services, she re-presented when she developed progressive dyspnea and stridor. Imaging was concerning for anaplastic thyroid carcinoma that had grown over two centimeters (cm) in the past 15 days from 10.1 cm to 12.2 cm with new tracheal deviation and adjacent thrombus compression of the internal jugular vein and superior vena cava. Emergency medicine physicians should be cautious when discharging a patient with a neck mass. Outpatient referral should be considered only when the stability of the size of the mass can be reliably confirmed and close outpatient follow-up is guaranteed. Without these stipulations, ED physicians should advocate for...

Effects of Racial Concordance and Perceived Racism on Emergency Department Patient Satisfaction

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Racial disparities in healthcare persist, with evidence suggesting that bias contributes to inequities in care and outcomes for Black patients. Racial concordance between patients and clinicians has been proposed as one strategy to improve patient satisfaction and health outcomes, but its impact in acute care settings such as the emergency department (ED) remains underexplored. The objective of this study was to assess how racial concordance between patient and clinician, together with patient perceptions of how race affected their care, influence patient satisfaction with care in the ED.

Methods: This secondary analysis used data from a previously published text message–based survey of patients discharged from two EDs between August and September 2021. Patients were categorized as not completely discordant if at least one clinician (physician, advanced practice clinician, or nurse) shared their self-identified race. The...

Sweet Success: Using Candy Land to Explore Gamification in Medical Education

Mon, 2 Nov 2026 00:00:00 +0000

Audience: This session is intended for learners and educators interested in medical education, including medical students, residents, fellows, and faculty.

Introduction/Background: Gamification is increasingly recognized as an effective strategy to enhance engagement, motivation, and active learning in medical education. Despite its potential, many educators are unsure how to implement gamified strategies effectively. This session demonstrates a practical, interactive approach to applying gamification principles in a collaborative educational setting.

Educational Objectives: By the end of this session, learners will be able to (1) describe key principles of gamification in medical education, (2) identify resources and tools for implementing gamification, (3) actively participate in a gamified educational activity, and (4) design a simple plan to implement gamification in their own teaching, considering benefits...

Case Report: Atypical Presentation of Large Bowel Obstruction Due to Bezoar Formation in a Patient with a History of Colon Cancer

Mon, 2 Nov 2026 00:00:00 +0000

Abdominal pain is one of the most common presenting complaints in emergency medicine. This case report summarizes a 61-year-old male with worsening abdominal pain and no bowel movement for multiple days. Computer tomography (CT) scan demonstrated a large intraluminal mass at the anastomosis, concerning for a bezoar formation, with associated stercoral colitis and partial bowel obstruction. The patient was subsequently admitted to the general surgery service for further management. During hospitalization, the patient’s stool burden improved with osmotic laxatives, and he underwent a colonoscopy. The patient was discharged with outpatient follow-up. This report will help inform management in a patient with a history of colon cancer presenting with a large bowel obstruction post-colectomy.

Cumulative Weighted-Average Acuity Level: A Novel Clinician-Level Metric to Detect Emergency Department Surge Conditions in Real Time

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency department (ED) surge events, defined as the episodic clustering of high-acuity patients that transiently overwhelms available clinician capacity, are associated with delays in care and potential patient harm. Existing crowding metrics do not quantify real-time clinician-level workload. This paper describes the development and preliminary feasibility evaluation of a novel acuity-weighted metric—the cumulative weighted-average acuity level (CWAAL)—to detect physician-level surge conditions in real time.

Methods: This multiphase observational feasibility study was conducted at two rural community EDs. The CWAAL is defined as the sum of weighted acuity scores for all active patients under a single clinician’s management: it incorporates a feasibility threshold derived by combinatorial enumeration. The primary outcome was door-to-doctor time (DDT); secondary outcomes included length of stay (LOS) and CWAAL distribution....

Impact of an Overnight Stay in the Emergency Department Hallway on Admitted Geriatric Patients

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Patients frequently board overnight in the emergency department (ED) while awaiting medical admission, sometimes in hallway care spaces. Prior literature suggests that timing of boarding may matter; a single overnight stay in the ED may be associated with increased mortality and adverse events, especially for older adults. Given the deliriogenic ED environment, these effects may be magnified in the hallway. However, little is known about the effects of prolonged hallway stays. We evaluated whether an overnight stay in the ED hallway, compared to an ED room, was associated with increased delirium and adverse outcomes for geriatric patients.

Methods: We conducted a retrospective multisite cohort database study of patients aged 65 years and older admitted to a general medicine service January 1, 2022, to December 31, 2023, who spent an entire night (midnight to 8 am) in the ED prior to admission. We compared those who spent...

Cannabis Use versus Cigarette Smoking in Emergency Department Patients: Comparative Outcomes

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Cannabis is one of the most commonly used psychoactive substances worldwide, with 20% of adults in the U.S. reporting using cannabis at least once in the past year. Nicotine dependence is reported in 9% to 10% of adults in the U.S.1 This study aims to investigate the relationship between cannabis use and cigarette smoking on mortality, cardiovascular outcomes, suicide, cancer of the lung and bronchus, and reactive airway disease in emergency department (ED) patients.

Methods: This retrospective, propensity score–matched study used the TriNetX database to analyze records of 120,689,106 patients from 69 healthcare organizations in the U.S. between 2005 and 2022. The first cohort consisted of adult patients and was grouped based on diagnosis of cannabis-related disorders (CRD) within five years before or one month after an ED visit. The second cohort consisted of adult patients with a diagnosis of “nicotine dependence, cigarettes”...

Off Service, with Purpose: Creating Learner-Centered Experiences for Off-Service Residents

Mon, 2 Nov 2026 00:00:00 +0000

Academic emergency departments (EDs) host off-service residents (OSRs) from various specialties. While OSRs contribute meaningfully to patient care, they often face unique challenges during their ED rotations, including limited preparation, heightened stress, and unmet personal expectations. Despite a standardized curriculum endorsed by the American College of Emergency Physicians, guidance on how to foster meaningful educational experiences for OSRs remains sparse. This perspective offers a structured approach grounded in self-determination theory (SDT), which emphasizes autonomy, competence, and relatedness as essential to intrinsic motivation and effective learning. By aligning educational strategies with SDT principles, emergency medicine educators can enhance engagement, support learner development, and create lasting interprofessional collaboration. Ultimately, this learner-centered approach not only enriches the OSR experience but also strengthens the role of the ED...

Emergency Department Operational Measures Associated with EMS Redirection Activation and Duration

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Emergency medical services (EMS) redirection is used to manage emergency department (ED) strain, but whether it reflects operational conditions is unclear. We compared associations of prespecified ED operational measures, including visit volume, patient flow times, admissions, boarding, and left-early measures, with redirection activation and total daily redirection minutes.

Methods: We performed a retrospective study at a single urban tertiary care center over 392 consecutive days from April 7, 2021 through May 3, 2022. Redirection temporarily routed ambulances away from the study hospital and was activated centrally by EMS. New York City’s 9-1-1 system included about 500 ambulance units and over 60 hospitals. The primary outcome was activation, defined as any redirection during a calendar day. The secondary outcome was total redirection minutes among days with redirection. Multivariable logistic regression evaluated...

All In: A Casino-Themed Emergency Medicine Conference Day

Mon, 2 Nov 2026 00:00:00 +0000

Audience: The target audience includes individuals involved in the education and training of emergency medicine (EM) residents, such as program directors, assistant program directors, core faculty, and academic attendings, as well as learners including residents, physician assistant (PA) fellows, and medical students (MS).

Introduction: Gamification has increasingly been incorporated into emergency medicine (EM) residency education to enhance learner engagement, motivation, and active participation. Prior studies have demonstrated benefits of game-based learning across multiple areas of medical education, including improved knowledge retention, teamwork, communication, and learner satisfaction.^1-4 However, most gamification interventions in EM involve isolated activities rather than comprehensive, multi-station conference...

Trends in Mushroom Exposures Reported to the Florida Poison Information Center Network, 2014–2024

Mon, 2 Nov 2026 00:00:00 +0000

Introduction: Toxic mushroom exposures can occur through multiple mechanisms, including consumption as a delicacy, foraging, and use for psychoactive properties. Recent evidence suggests that psylocibin mushroom use is increasing in the United States. However, information on trends in mushroom poisonings in Florida is limited. This study aims to characterize trends in psychoactive and nonpsychoactive mushroom exposures reported to the Florida Poison Information Center Network (FPICN) over an 11-year period.

Methods: This is a retrospective review of all mushroom exposures reported to the FPICN between 2014 to 2024. Our primary outcome was to evaluate the annual trend of psychoactive and nonpsychoactive exposures. Secondary outcomes included identifying patient demographics, exposure intent, clinical effects, and medical outcomes associated with each exposure type. Psychoactive mushrooms were defined as belonging to groups 2 (muscimol),...

Diagnosing a Fractured Pedunculated Osteochondroma Using Point-of-Care Ultrasound in the Emergency Department: A Case Report

Sat, 31 Oct 2026 00:00:00 +0000

Introduction: This case report discusses the use of point-of-care ultrasound (POCUS) in the diagnosis of a fractured pedunculated osteochondroma in an 8-year-old boy after minor trauma. Although osteochondromas are the most common benign bone tumors, especially in this age, historically only radiographs have been obtained in the emergency department to diagnose these benign bone tumors.

Case Report: An 8-year-old boy reported ongoing pain for 2 months but had an acute onset worsening of his pain after minor trauma to the medial distal right femur. Point-of-care ultrasound was used to diagnose a fractured pedunculated osteochondroma prior to radiographic imaging.

Conclusion: We demonstrated the practicality and ease of POCUS in assisting with the diagnosis of an osteochondroma and the subtle fracture of the base. Both POCUS and radiographic imaging may be beneficial when used in conjunction for the...

Drug-Induced Immune Thrombocytopenia Caused by Sulfamethoxazole-Trimethoprim: A Case Report

Fri, 30 Oct 2026 00:00:00 +0000

Introduction: Drug-induced immune thrombocytopenia (DITP) is a rare process in which specific drugs induce antibodies against platelet antigens, resulting in the destruction, consumption, or impaired production of platelets.1,3 Sulfamethoxazole-trimethoprim can result in DITP.2

Case Report: This is a case of a 64-year-old man who developed severe thrombocytopenia after sulfamethoxazole-trimethoprim use. He presented to the emergency department with oral hemorrhagic lesions, mucositis, and petechiae. Laboratory evaluation revealed a low platelet count. Drug-induced immune thrombocytopenia was suspected, and the sulfamethoxazole-trimethoprim was discontinued. The patient’s platelet count responded rapidly after discontinuation of the offending drug and administration of dexamethasone.

Conclusion: This case highlights the importance of early recognition of DITP and the avoidance of re-exposure to the causative agent....

A 30-Year-Old Man With Rapid Floor-of-Mouth Swelling After Facial Trauma

Fri, 30 Oct 2026 00:00:00 +0000

Case Presentation: A 30-year-old man presented to the emergency department with severe blunt facial trauma following a fall from height. Examination revealed extensive floor-of-mouth ecchymosis and a large tense sublingual hematoma causing tongue elevation, dysarthria, and swelling mimicking Ludwig’s angina, producing a traumatic pseudo-Ludwig appearance with marked airway crowding. Three-dimensional computed tomography demonstrated severely displaced bilateral mandibular fractures. Owing to pronounced segmental instability with mobile dentoalveolar fragments, temporary interdental bridle wire stabilization was performed in the emergency department. Despite the dramatic anatomical findings, serial airway reassessments confirmed sustained airway stability, permitting delayed definitive open reduction and internal fixation.

Discussion: Traumatic pseudo-Ludwig angina secondary to bilateral mandibular fractures is an uncommon presentation...

Nitrous Oxide “Whippet” Induced Subacute Combined Degeneration of the Spinal Cord: A Case Report

Fri, 30 Oct 2026 00:00:00 +0000

Introduction: Subacute combined degeneration (SCD) is an uncommon neurologic complication of vitamin B12 deficiency characterized by demyelination of the dorsal and lateral columns of the spinal cord, resulting in weakness, paresthesias, sensory deficits, and gait ataxia. Recreational nitrous oxide inhalation has emerged as an important cause of functional vitamin B12 deficiency and may precipitate SCD, particularly in otherwise healthy individuals.

Case Report: We report a case of nitrous oxide-associated SCD in a patient who presented to the emergency department with progressive neurologic symptoms. This case illustrates a rare but increasingly recognized complication of recreational nitrous oxide use.

Conclusion: Nitrous oxide-induced SCD should be considered in patients presenting with subacute weakness, paresthesia, and ataxia, particularly when there is a history of recreational inhalant use. Early recognition...

Bougie-Assisted Blakemore Tube Insertion: A Case Series

Fri, 30 Oct 2026 00:00:00 +0000

Introduction: Variceal hemorrhage is a life-threatening complication of portal hypertension that requires rapid hemorrhage control. Gastroesophageal balloon tamponade devices are effective temporizing measures when endoscopic or definitive therapies are delayed or unsuccessful, but placement can be technically challenging during active bleeding. A bougie-assisted technique has been proposed to improve ease and success of placement.

Case Series: We describe three patients with cirrhosis and varices who presented with massive upper gastrointestinal bleeding and hemorrhagic shock. All received standard medical therapy and required escalation due to ongoing bleeding. In each case, a Sengstaken-Blakemore tube was placed using a bougie tracheal tube introducer as a semirigid stylet. The device was advanced under laryngoscopy through the esophagus and into the stomach without procedural complications. Hemostasis was achieved in all cases following...

Use of Point-of-Care Ultrasound to Confirm and Manage a Morel-Lavallée Lesion in the Emergency Department: A Case Report

Fri, 30 Oct 2026 00:00:00 +0000

Introduction: Morel-Lavallée lesions are closed, soft tissue degloving injuries that occur when shearing forces separate the subcutaneous tissue from the underlying fascia. This creates a potential space for hemolymphatic fluid accumulation. Morel-Lavallée lesions are frequently under-reported and often misdiagnosed as hematomas or abscesses, leading to potential mismanagement. While magnetic resonance imaging (MRI) is considered the gold standard for diagnosis, point-of-care ultrasound (POCUS) has been shown to be an effective adjunct that can rapidly confirm sonographic features consistent with Morel-Lavallée lesions, support MRI-established findings, and guide procedural intervention in the emergency department (ED) setting.

Case Report: We describe a 20-year-old woman presenting to the ED with persistent right-sided hip pain two months after a pedestrian–motor vehicle collision. Initially misdiagnosed as a hematoma, an outpatient...

Emergency Department Use of Genicular Nerve Block for Sickle Cell Pain Crisis: A Case Report

Mon, 26 Oct 2026 00:00:00 +0000

Introduction: Acute pain crises are a common emergency department presentation in patients with sickle cell disease. Pain management typically relies on multimodal analgesia, with opioids often playing a central role. We propose incorporating regional anesthesia techniques into the pain management regimen.

Case Report: We present a case of a young patient with sickle cell disease experiencing an acute pain crisis with severe knee pain. A genicular nerve block was performed, resulting in significant pain reduction in the affected knee.

Conclusion: Regional anesthesia, including isolated nerve blocks, may be safe and effective as part of a multimodal pain approach for patients suffering from acute pain crises due to sickle cell disease. This may help reduce the need for opioid or other sedating pain medications, as well as the inherent risks associated with increasing doses, such as respiratory depression.&...

59-year-old Woman with Acute Blindness

Mon, 26 Oct 2026 00:00:00 +0000

When a patient with acute blindness presents to the emergency department (ED), the evaluation typically suggests one of the “can’t miss” diagnoses ingrained in emergency physicians during training. How does the differential change when the patient’s presentation does not neatly reveal an expected pathology? A 59-year-old woman presented to the ED with acute binocular blindness in the setting of three days of a flu-like illness. This case offers a practical approach to opening the lens on the presentation of acute blindness.

Retrocaval Ureter Diagnosed Following Point-of-Care Ultrasound Detection of Hydronephrosis: A Case Report

Mon, 26 Oct 2026 00:00:00 +0000

Introduction: Retrocaval ureter (RCU) is a rare congenital anomaly resulting from abnormal development of the inferior vena cava, leading to ureteral obstruction and hydronephrosis. Patients often present with nonspecific symptoms, making diagnosis challenging. Point-of-care ultrasound (POCUS) is frequently used in the emergency department (ED) to evaluate abdominal pain and may identify clinically important abnormalities requiring further investigation.

Case Report: A 30-year-old woman presented to the ED with a two-day history of nonspecific abdominal pain. Physical examination was notable only for mild epigastric tenderness. Abdominal POCUS performed by the emergency physician demonstrated moderate right-sided hydronephrosis. The patient had no urinary symptoms and normal renal function. Follow-up renal ultrasound confirmed hydronephrosis and proximal hydroureter without nephrolithiasis. Contrast-enhanced computed tomography subsequently...

Carotid Artery Dissection After Cervical Traction Device Use: A Case Report

Mon, 26 Oct 2026 00:00:00 +0000

Introduction: Internal carotid artery (ICA) dissection is a time-sensitive vascular emergency that may present with subtle findings, most notably painful Horner syndrome. Mechanical stress to the cervical vasculature is a recognized trigger for this condition.

Case Report: We report a 56-year-old man who developed ipsilateral ptosis, miosis, and head and neck pain after using a home cervical traction device. Computed tomography angiography showed focal critical stenosis of the distal cervical left ICA consistent with dissection, along with a contralateral pseudoaneurysm suggesting prior injury. He was treated with dual antiplatelet therapy.

Conclusion: This case highlights a potential association between cervical traction device use and carotid dissection and underscores the importance of recognizing painful Horner syndrome and bilateral carotid pathology, while prompting clinicians to specifically inquire about...

Parainfectious Urticarial Rash in a Young Female with Epstein-Barr Virus Infection: A Case Report

Tue, 20 Oct 2026 00:00:00 +0000

Introduction: Urticarial rash is a common condition but can present atypically, making it difficult to clinically diagnose. Thorough assessment with awareness and exclusion of differentials is crucial for definitive treatment.

Case Report: This is a case of a 23-year-old woman who presented with signs and symptoms suggestive of streptococcal pharyngitis and was treated with clarithromycin by primary care. Two weeks later, the patient was referred to the emergency department for malaise and an acute, rapidly progressing pruritic rash. Further evaluation revealed an Epstein-Barr virus (EBV) infection.

Conclusion: This case highlights the differential diagnoses and diagnostic reasoning required for a patient with a rash and concurrent respiratory symptoms. Differential considerations include viral exanthem, delayed drug-induced reaction, EBV-associated antibiotic rash, scarlet fever, and urticarial vasculitis....

Delayed Revascularization in Rural Acute STEMI Patient on Direct Oral Anticoagulation: A Case Report

Tue, 20 Oct 2026 00:00:00 +0000

Introduction: Acute ST-elevated myocardial infarction (STEMI) is a medical emergency requiring timely revascularization to preserve myocardial injury. Rural populations often experience delays in treatment leading to increased risk of complications and mortality. Emergent treatment of STEMI in a patient on long-term direct oral anticoagulation facing delays to revascularization is a complex scenario for rural physicians.

Case Report: A 55-year-old male presented to the emergency department in rural Alaska and was diagnosed with acute inferior STEMI. The patient’s history was notable for pulmonary embolism with long-term direct oral anticoagulation. Thrombolytic therapy was not recommended and prompt revascularization via percutaneous coronary intervention (PCI) was needed; however, the nearest PCI-capable hospital was hundreds of miles away, increasing the risk of ischemic cardiomyopathy and death. The patient achieved revascularization...

From Frenulum Tear to Transfusion—An Unexpected Diagnosis of Hemophilia in a Toddler: A Case Report

Tue, 20 Oct 2026 00:00:00 +0000

Introduction: Labial frenulum tears in infants are commonly associated with minor trauma but may raise concern for nonaccidental injury. These injuries are typically benign and self-limiting; however, persistent or excessive bleeding should prompt evaluation for an underlying bleeding disorder. Hemophilia A is an X-linked factor VIII deficiency with clinical symptoms that vary based on the level of severity.

Case Report: A previously healthy 14-month-old male presented to the pediatric emergency department three times within 10 days for persistent bleeding from a superior labial frenulum tear sustained after minor trauma. Initial examination was reassuring, and he was discharged without laboratory evaluation. On repeat presentation, he was found to have normocytic anemia and isolated prolonged activated partial thromboplastin time. Despite topical and oral antifibrinolytic therapy, he returned with worsening anemia, melena, hematemesis,...

Spontaneous Cardiac Tamponade in a Patient with Severe Hemophilia A: A Case Report

Tue, 20 Oct 2026 00:00:00 +0000

Introduction: Hemophilia A is an X-linked recessive bleeding disorder characterized by deficiency of factor VIII. The clinical features of this disease are hemorrhage and can be life-threatening when major organ systems are involved.

Case Report: We report the case of a 13-year-old boy with severe hemophilia A and factor VIII inhibitors who presented with fever and septic arthritis, later developing refractory shock with tachyarrhythmia. Despite initial suspicion of sepsis-related myocarditis, point-of-care ultrasound (POCUS) revealed massive hemorrhagic pericardial effusion with tamponade physiology. Recombinant factor VIIa was transfused as hemostatic rescue therapy; the patient was subsequently started on fresh frozen plasma and emicizumab. Ultrasound-guided pericardiocentesis resulted in rapid hemodynamic recovery.

Conclusion: This case highlights the importance of considering obstructive shock in unstable...

Inguinal Bladder Herniation in the Emergency Department: A Report of Two Cases

Tue, 20 Oct 2026 00:00:00 +0000

Introduction: Inguinal bladder herniation is a rare subtype of inguinal hernia in which the urinary bladder protrudes into the inguinal canal. It is often asymptomatic but can present with a range of clinical severity in the emergency department (ED).

Case Report: We present a case report of two patients with inguinal bladder hernias. The first case describes a stable patient with bladder herniation without urinary obstruction, successfully managed with outpatient follow-up. The second case illustrates a more severe presentation with bladder involvement causing bilateral hydroureteronephrosis, requiring admission after failed reduction. This patient subsequently re-presented with urosepsis and developed multiple complications, including bacteremia and infective endocarditis.

Conclusion: Inguinal bladder herniation can present with a wide clinical spectrum in the ED. Early recognition, appropriate imaging, and...

Before Hyperemesis Gravidarum Is Blamed for Thiamine Deficiency, Alternative Causes Should Be Ruled Out

Tue, 20 Oct 2026 00:00:00 +0000

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Acute Myocardial Infarction Following Tenecteplase: A Case Report of Complex Dual Pathology

Tue, 20 Oct 2026 00:00:00 +0000

Introduction: Acute ischemic stroke is a leading cause of morbidity and mortality, with tenecteplase being a cornerstone of acute management. While tenecteplase carries a known risk of bleeding, major thrombotic events such as acute myocardial infarction (AMI) after stroke reperfusion are less commonly described.

Case Report: We present the case of a 67-year-old man who presented with acute stroke symptoms. After ruling out intracranial hemorrhage and managing blood pressure, he received tenecteplase, and all neurological deficits resolved. Soon after, he developed acute chest pain, and his repeat electrocardiogram confirmed a ST-elevation myocardial infarction. He underwent emergent cardiac catheterization, revealing 100% occlusion of the left circumflex artery, which was successfully revascularized with thrombectomy and angioplasty. Intravascular ultrasound further supported the presence of embolic phenomenon. Pathology of the retrieved...

Focal Hepatic Hot Spot Sign Mimicking Active Extravasation on CT Angiography in Superior Vena Cava Syndrome: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Caused by portosystemic venous shunting, the focal hepatic hot spot sign (or hot quadrate sign) is a radiologic finding most commonly associated with superior vena cava (SVC) obstruction. On contrast-enhanced imaging, this finding may mimic active hepatic extravasation or focal hepatic pathology, posing a diagnostic challenge in the emergency department (ED).

Case Report: We report a case of a 70-year-old man with progressive cognitive decline and hypoxemic respiratory failure requiring intubation. Computed tomography (CT) angiography of the chest demonstrated a focal area of intense contrast enhancement in the left hepatic lobe, initially concerning for active extravasation. Further review of the imaging revealed a right upper lobe lung mass and a large mediastinal mass causing high-grade SVC stenosis. The hepatic finding was subsequently identified by the reading radiologist as a focal hepatic hot spot sign representing...

Atypical Emergency Department Presentation of Acute Motor and Sensory Axonal Neuropathy: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Acute motor and sensory axonal neuropathy is a rare, severe axonal variant of Guillain–Barré syndrome characterized by rapidly progressive motor and sensory dysfunction. Early recognition in the emergency department (ED) is challenging because patients may initially present with subtle neurologic findings, preserved reflexes, and normal cerebrospinal fluid (CSF) studies.

Case Report: A 29-year-old woman with a history of generalized anxiety disorder presented to the ED with progressive distal numbness and mild weakness, with weakness being her chief complaint. Neurologic examination demonstrated preserved reflexes without focal deficits, and she was noted to be anxious. Given the reassuring examination, the patient was discharged with strict return precautions, including instructions to seek immediate reevaluation for worsening weakness, numbness, or progression of neurologic symptoms. She returned 48 hours later...

Spontaneous Spinal Epidural Hematoma as a Manifestation of Hypertensive Emergency: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Uncontrolled hypertension is frequently evaluated in the emergency department (ED), with the goal of identifying those patients with hypertensive emergencies. Spontaneous spinal epidural hematoma is rare and not considered a typical manifestation of hypertensive emergency.

Case Report: A 31-year-old man presenting to the ED with chest pain and hypertension subsequently developed lower extremity neurologic deficits and was diagnosed with a spontaneous spinal epidural hematoma. After thorough testing, no other risk factors for this medical condition were identified, and the hemorrhage was attributed to hypertensive emergency.

Conclusion: Spontaneous spinal epidural hematoma is a rare complication of hypertensive emergency and should be considered when evaluating patients with hypertension, back pain, and neurologic deficits.

Partial Segmental Thrombosis of the Corpus Cavernosum Following Valsalva Maneuver: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Partial segmental thrombosis of the corpus cavernosum is a rare vascular condition that may present with nonspecific groin or pelvic pain and mimic more common surgical or urologic emergencies.

Case Report: A 33-year-old man presented to the emergency department with acute left-sided groin and pelvic pain after straining during defecation. Initial history and evaluation raised concern for incarcerated inguinal hernia, epididymo-orchitis, renal colic, lymphadenopathy, and soft tissue infection. Computed tomography demonstrated asymmetric enlargement of the left corpus cavernosum, while penile ultrasound showed diminished cavernosal flow. Magnetic resonance imaging confirmed segmental thrombosis of the left corpus cavernosum. The patient was treated conservatively with rivaroxaban and analgesia, resulting in symptomatic improvement.

Conclusion: Partial segmental thrombosis of the corpus cavernosum...

Behavioral Trigger Identification in Recurrent Postpartum Chest Pain After Negative Cardiopulmonary Evaluation: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Recurrent chest pain in postpartum patients frequently results in repeated emergency department (ED) visits despite negative cardiopulmonary investigations, creating diagnostic uncertainty and increasing healthcare resource utilization. We report a case highlighting the value of a structured postexclusion assessment to identify clinically relevant behavioral triggers after life-threatening causes have been excluded.

Case Report: A 33-year-old woman, six weeks postpartum, presented repeatedly with nocturnal chest pain, palpitations, and dyspnea. Serial electrocardiograms, cardiac biomarkers, chest imaging, and transthoracic echocardiography were consistently normal, excluding acute cardiopulmonary pathology. Careful reassessment of symptom chronology and behavioral history identified a reproducible temporal association between symptom onset and nocturnal binge-eating episodes. Following outpatient psychiatric and clinical...

Transient Electrocardiographic Changes in Anaphylaxis Mimicking Acute Coronary Syndrome: A Case Series

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Anaphylaxis is a life-threatening emergency that can involve significant cardiovascular manifestations. Transient electrocardiographic (ECG) changes during anaphylaxis and following epinephrine administration may closely mimic acute coronary syndrome, creating a diagnostic dilemma in the emergency department (ED). Failure to recognize these reversible patterns can result in delayed anaphylaxis treatment or unnecessary activation of invasive cardiac pathways.

Case Series: We report a case series of three adult patients presenting to the ED with anaphylaxis who developed alarming ECG changes, including ST-segment elevation, ST-segment depression, and hyperacute T waves. One patient demonstrated transient ECG changes temporally related to intramuscular epinephrine administration, while two patients exhibited features suggestive of hypersensitivity-associated coronary vasospasm or thrombosis manifesting as ECG changes. In all...

Bedside Sonography Brings the Weiss Ring into Focus: Rapid Diagnosis of Posterior Vitreous Detachment

Tue, 13 Oct 2026 00:00:00 +0000

Case Presentation: A 51-year-old woman presented to the emergency department with blurred vision and a large, dark floater in her right eye. Point-of-care ultrasound (POCUS) revealed a Weiss ring, strongly suggesting a diagnosis of a posterior vitreous detachment.

Discussion: Identifying a Weiss ring with POCUS may be a reasonable and easier alternative for emergency clinicians when used in conjunction with a slit-lamp examination and may aid in timely ophthalmologic management of posterior vitreous detachments.

Hemopericardium After Cardiopulmonary Resuscitation—Bedside Drainage with a Triple-Lumen Catheter: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Hemopericardium from chest compression-related cardiac injury is an underrecognized complication of cardiopulmonary resuscitation, with bleeding risk amplified in anticoagulated patients.

Case Report: A 66-year-old man on apixaban and hemodialysis presented in cardiac arrest. Post resuscitation ultrasound revealed pericardial tamponade. With no pericardiocentesis kit available, a seven French triple-lumen central venous catheter was placed under ultrasound guidance via a subxiphoid approach. Approximately one liter of bloody fluid was drained; the patient died within 24 hours.

Conclusion: Hemopericardium is an underrecognized complication of resuscitation in anticoagulated patients. A triple-lumen central venous catheter offers a familiar bedside drainage alternative when a commercial kit is unavailable.

A Rare Presentation of Pneumococcal Meningitis with Acute Bilateral Vision Loss: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Bacterial meningitis affects about 1.2 million people worldwide each year. Streptococcus pneumoniae is responsible for the majority of cases of bacterial meningitis in the United States and Europe, with visual impairment seen in 6.3% of patients. The etiology of acute vision loss in the setting of bacterial meningitis remains wide-ranging, most often occurring in the setting of endogenous endophthalmitis, optic neuropathy, and cortical blindness. Retinal necrosis is rare, and typically associated with viral meningitis, but has not been reported in bacterial meningitis.

Case report: A 66-year-old man with headache, malaise, and intermittent blurry vision, initially diagnosed with viral upper respiratory infection and presumed trigeminal neuralgia, presented to the emergency department with altered mental status, meningismus, and progressive bilateral vision loss. He was diagnosed with bacterial meningitis, and subsequent...

Cauda Equina Syndrome Secondary to Seizure-Induced Spinal Fracture During Hyperbaric Oxygen Therapy: A Case Report

Tue, 13 Oct 2026 00:00:00 +0000

Introduction: Hyperbaric oxygen therapy carries a risk of central nervous system oxygen toxicity, which can result in seizures. Seizure-induced spinal fractures are uncommon complications that occur during generalized convulsive activity. While often benign, lumbar vertebral body burst fractures may result in cauda equina syndrome. Additionally, patients with beta-thalassemia may have decreased bone mineral density due to ineffective erythropoiesis and bone marrow expansion increasing the risk for pathologic and traumatic fractures.

Case Report: A 35-year-old man with beta-thalassemia major presented to the emergency department after a witnessed, first-time generalized tonic-clonic seizure during hyperbaric oxygen therapy for chronic venous ulcers. Initial evaluation revealed severe low back pain and midline lumbar tenderness. Computed tomography revealed an acute third lumbar vertebra (L3) burst fracture with retropulsion. The patient...

Impact of Increasing Ambient Temperatures on Emergency Department Trauma Presentations at a Level I Trauma Center

Sun, 11 Oct 2026 00:00:00 +0000

Introduction: Global temperatures are increasing because of climate change, affecting human health. Elevated ambient temperature has been shown to increase rates of trauma presentations in emergency departments and to increase antisocial behavior, such as violent crime. To better understand how to reduce the burden on trauma hospitals, we must better understand the relationship between ambient temperature, trauma patients, and intentional injury. We sought to examine the relationship between trauma rates and minimum and maximum daily temperatures and assess whether the assault trauma mechanism had the strongest association between weather and trauma rates.

Methods: We conducted a retrospective cohort study of full and partial trauma team activations that presented to a Level I trauma center in New York from 2012 to 2019, inclusive. Daily maximum and minimum temperatures were divided into quintile ranges. Traumas were classified by injury...

WestJEM Full-Text Issue

Sat, 10 Oct 2026 00:00:00 +0000

WestJEM Full-Text Issue

Intubation Practices and Outcomes in Diverse Emergency Departments Within a Single Health System

Fri, 9 Oct 2026 00:00:00 +0000

Introduction: 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.

Methods: 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...

Type I Choledochal Cyst in a Three-Year-Old with Recurrent Vomiting and Pancreatitis: A Case Report

Wed, 7 Oct 2026 00:00:00 +0000

Introduction: Choledochal cysts are rare congenital dilatations of the biliary tree that may present with nonspecific gastrointestinal symptoms in children, posing diagnostic challenges.

Case Report: We report a 3-year-old girl who presented with recurrent vomiting and abdominal pain. Initial laboratory testing revealed a mildly elevated lipase. An abdominal ultrasound demonstrated a pancreatic cyst; the patient was discharged with outpatient follow-up. She returned with worsening symptoms and a markedly elevated lipase of 2,247 U/L (reference range, < 160 U/L). Computed tomography subsequently revealed a type I choledochal cyst. She underwent operative resection with an uncomplicated postoperative course.

Conclusion: Persistent gastrointestinal symptoms with uptrending lipase in children should prompt consideration of hepatobiliary etiologies. Choledochal cysts may be missed on initial presentation as...

Status Epilepticus in a Patient Prescribed Theophylline: A Case Report

Tue, 6 Oct 2026 00:00:00 +0000

Introduction: Seizures are a frequent reason for emergency department (ED) evaluation, and new-onset events carry a wide differential in which medication toxicity can be overlooked. Toxicity from seldomly prescribed drugs, such as theophylline, can be particularly challenging to recognize because they can cause nonspecific adverse effects, including palpitations, nausea, vomiting, and seizures. Although theophylline use was widespread in the 1980s, current prescribing patterns are unknown. Nevertheless, theophylline toxicity continues to result in ED visits and poison center calls. Because adverse effects may be acute or chronic, identifying theophylline toxicity remains difficult.

Case Report: A 74-year-old woman presented to the ED with status epilepticus. After thorough history and extensive medical work-up, medication toxicity was suspected as the cause of her seizures. Upon further investigation, the patient was found...

Intracardiac Placement of Needle Thoracostomy Catheter by Paramedics Due to Anatomic Variation: A Case Report

Tue, 6 Oct 2026 00:00:00 +0000

Introduction: Needle thoracostomy is the only procedure in the United States for paramedic treatment of suspected tension pneumothorax within the most recent emergency medical services (EMS) national scope of practice model. We present a rare complication of an out-of-hospital left needle thoracostomy performed by paramedics after intracardiac placement of the catheter. The patient’s imaging studies in the receiving emergency department (ED) confirmed that the needle thoracostomy insertion location was correct, but the catheter entered the heart due to the patient’s existing atypical anatomy.

Case Report: A 64-year-old unrestrained male driver in a roll-over motor vehicle accident was found in respiratory distress with difficulty auscultating left-sided lung sounds, left chest wall pain on palpation, and confusion. The first-arriving paramedics performed a left needle thoracostomy for suspected tension pneumothorax in advance of...

Case Report of Orthopedic Screw Migration Presenting as Abdominal Pain in the Emergency Department

Tue, 6 Oct 2026 00:00:00 +0000

Introduction: Hip fractures are a concern in older adults, with incidence expected to rise as the population ages. Despite advances in surgical technique and hardware design, complications remain, influenced by patient factors and surgical choices. Rarely, hardware migration into the pelvis occurs, which poses serious risks. In the emergency setting, abdominal pain is a common complaint, and when evaluating patients with complex histories or prior orthopedic surgeries, clinicians must maintain a broad differential. This case details the discovery of a medially displaced hip screw into the pelvis as the cause of abdominal pain in a patient in the emergency department (ED).

Case Report: A 44-year-old female with end stage renal disease on hemodialysis, anemia, and osteoporosis presented to the ED with sudden-onset, bilateral lower quadrant abdominal pain, vomiting, and diarrhea. The patient reported undergoing left hip open reduction and...

Acute Headache Management and Emergency Department Throughput: A Multicenter Retrospective Analysis

Sun, 4 Oct 2026 00:00:00 +0000

Introduction: Headache is a common presentation to the emergency department (ED), requiring both accurate diagnosis and efficient management. Although consensus guidelines exist, real-world treatment practices and their associations with operational outcomes remain variable. We evaluated the association between acute headache management strategies—including medications, diagnostic imaging, and consultations—and ED length of stay (LOS), using both unadjusted and multivariable-adjusted analyses.

Methods: We conducted a multicenter retrospective observational study using data from 79,527 adult ED encounters for headache across 22 EDs in the southwestern and upper Midwestern United States between 2018 and 2024. The primary outcome was ED LOS. Secondary outcomes included LOS differences associated with medication classes, imaging modalities, procedures, and specialty consultations. Length of stay differences by treatment strategy were compared...

Impact of Physician Patient Load on Imaging Use in the Emergency Department

Sun, 4 Oct 2026 00:00:00 +0000

Introduction: Emergency department (ED) crowding may alter physician decision-making, yet little is known about how real-time physician workload affects diagnostic imaging use. We examined the association between physician patient load and the proportion of patients who received diagnostic imaging, including computed tomography (CT), CT with intravenous (IV) contrast, CT without contrast, plain radiography, magnetic resonance imaging (MRI), and ultrasound (US).

Methods: We conducted a retrospective cohort study of all ED visits at an academic tertiary care center (January 2019–December 2024). Physician workload was defined as the sequential patient assignment order per physician per day (range 1–17). Our primary outcome measures were binary indicators of whether each imaging modality was ordered during the ED visit: CT (any); CT with IV contrast; CT without IV contrast; radiograph, MRI; and US. Multivariable logistic regression with...

Recent uciem items

Special Issue on Climate Change

Introducing the Climate Change Special Issue

Acute Neurologic Decline in the ED: A Case Report on Recognizing ARIA in the Age of Anti-Amyloid Therapy

Cadaveric Model of Pneumothorax (the GASP model): A Realistic, Reusable and Cost-Effective Simulator for Chest Drainage Training

Acceptability of a Novel Prehospital Emergency Care System Evaluation Tool Among Southeast Asian Stakeholders: A Cross-Sectional Survey

A Low-Cost Rectal Foreign Body Removal Simulator

This Article Corrects: “The Bullets He Carried”

Caring for Patients Anywhere, Anyhow: How Emergency Department Crowding and Boarding Shapes Professional Identity in Emergency Medicine Training

Sickle Cell Crisis with Acute Chest Syndrome – Structured Certifying Exam Case

Transforming Emergency Medicine Mentorship: A Skill-Building Curriculum to Optimize Mentee Growth and Development

Meeting the Milestones through Simulation: Disclosing a Medical Error

Assessment of Combined Food and Nutrition Insecurity Screening in the Emergency Department: A Brief Report

Emergency Ultrasound Fellowship Match Outcomes: Unfilled Positions and Implications over Eight Years

English versus Non-English Language Preference and Computed Tomography Use in Pediatric Minor Head Trauma

Case Report: Sonographic Detection of Chorionic Hemangiomas in Sturge-Weber Syndrome

Sex Differences in Outcome and Mortality in Urinary Tract Infections in the Emergency Department: The UTILY Study

High-efficiency Nebulizers Reduce Albuterol Administration Time in the Emergency Department

Shockingly Unreliable: A Case Report of Failure of Synchronized Cardioversion Device to Capture, Resulting in Ventricular Fibrillation and Cardiac Arrest

The Ethics of Night Shift Allocation

Priapism got you down? A novel method to build your own moderate fidelity task trainer

Numerical Inconsistencies in “Physician-Staffed Ambulance Deployment: Comparative Response Time Analysis from a Slovak Pilot Project”

Prehospital Buprenorphine: A National Cross-Sectional Analysis

Prehospital Facial Recognition Technology: Randomized Controlled Simulation Study

Impact of Away Rotations on Emergency Medicine Match Rates in the Virtual Residency Recruitment Era

Anticipating Change: Local Attitudes Toward a New Community Emergency Medicine Residency Program

Case Report on Rare Presentation of Intravenous Leiomyomas with Intracardiac Leiomyomatosis

Ruptured Hemorrhagic Ovarian Cyst Mimicking Ruptured Ectopic Pregnancy in a Post-Transplant Patient: A Case Report

A Case-Based Workshop to Enhance Leadership Self-Efficacy Among Women in Academic Emergency Medicine

Emergency Department-Centered Digital Health Transformation: Narrative Review and Three-Pillar Implementation Framework

Perspectives on Influenza Vaccination Among COVID-19 Unvaccinated Patients in US Emergency Departments: A Qualitative Study

Impact of a Mentored Peer-Review Program on the Sponsoring Journal: Program Evaluation at Five Years

The Challenge of Critical Feedback: A simulation-based Advanced Residents as Teachers Module

Pediatric Unspecified Headache in the Emergency Department: Can We Do Better?

Emergency Medicine Reimagined: Development of the Patient Rights Index for Emergency Medicine

Shoulder Dislocation Reduction Using Inhaled Nitrous Oxide in the Emergency Department: Retrospective Case Series

Ethics of Medical Students as Embedded Simulation Participants in Ultrasound Education

Dedicated Vertical Physician Pilot in a Rotational Patient Assignment Emergency Department

WestJEM Full-Text Issue

How to Place a Central Line: Preparing Your Kit & Performing the Procedure

Sex Differences in Time to Triage in the Emergency Department: A Retrospective Cohort Study

Machine Learning Versus Traditional Statistical Models for Emergency Department Volume Forecasting

Machine Learning Algorithms for Predicting Psychostimulant Intoxication in Emergency Department Patients: A Multicenter Study

Awaiting Stress: An Interprofessional In-situ Simulation to Optimize Team Management of Cardiac Arrest in an Emergency Department Observation Unit

Factors Associated with Early ED Return Among Patients Discharged After Treatment for Alcohol Withdrawal Syndrome

Physical Frailty and End-of-Life Care Small Groups

Intentional pencil ingestion – a case report of a sharp ingested foreign body

Simulation-Based Interprofessional Curriculum for Emergency Management of Snakebites

Physical Wellbeing Scavenger Hunt

Infectious Flexor Tenosynovitis of the Lower Extremity: A Case Report

Point-of-Care Ultrasound Findings of Ovarian Hyperstimulation Syndrome: A Case Report

Identification of Regional Wall Motion Abnormalities by Emergency Physicians in Acute Coronary Syndromes: Systematic Review and Meta-Analysis

Reply to Letter to the Editor “Numerical Inconsistencies in ‘Physician-Staffed Ambulance Deployment: Comparative Response Time Analysis from a Slovak Pilot Project’”

A Rapidly Expanding Neck Mass with Risk of Airway Compromise; A Case Report

Effects of Racial Concordance and Perceived Racism on Emergency Department Patient Satisfaction

Sweet Success: Using Candy Land to Explore Gamification in Medical Education

Case Report: Atypical Presentation of Large Bowel Obstruction Due to Bezoar Formation in a Patient with a History of Colon Cancer

Cumulative Weighted-Average Acuity Level: A Novel Clinician-Level Metric to Detect Emergency Department Surge Conditions in Real Time

Impact of an Overnight Stay in the Emergency Department Hallway on Admitted Geriatric Patients

Cannabis Use versus Cigarette Smoking in Emergency Department Patients: Comparative Outcomes

Off Service, with Purpose: Creating Learner-Centered Experiences for Off-Service Residents

Emergency Department Operational Measures Associated with EMS Redirection Activation and Duration

All In: A Casino-Themed Emergency Medicine Conference Day

Trends in Mushroom Exposures Reported to the Florida Poison Information Center Network, 2014–2024

Diagnosing a Fractured Pedunculated Osteochondroma Using Point-of-Care Ultrasound in the Emergency Department: A Case Report

Drug-Induced Immune Thrombocytopenia Caused by Sulfamethoxazole-Trimethoprim: A Case Report

A 30-Year-Old Man With Rapid Floor-of-Mouth Swelling After Facial Trauma

Nitrous Oxide “Whippet” Induced Subacute Combined Degeneration of the Spinal Cord: A Case Report

Bougie-Assisted Blakemore Tube Insertion: A Case Series

Use of Point-of-Care Ultrasound to Confirm and Manage a Morel-Lavallée Lesion in the Emergency Department: A Case Report

Emergency Department Use of Genicular Nerve Block for Sickle Cell Pain Crisis: A Case Report

59-year-old Woman with Acute Blindness

Retrocaval Ureter Diagnosed Following Point-of-Care Ultrasound Detection of Hydronephrosis: A Case Report

Carotid Artery Dissection After Cervical Traction Device Use: A Case Report

Parainfectious Urticarial Rash in a Young Female with Epstein-Barr Virus Infection: A Case Report

Delayed Revascularization in Rural Acute STEMI Patient on Direct Oral Anticoagulation: A Case Report

From Frenulum Tear to Transfusion—An Unexpected Diagnosis of Hemophilia in a Toddler: A Case Report

Spontaneous Cardiac Tamponade in a Patient with Severe Hemophilia A: A Case Report

Inguinal Bladder Herniation in the Emergency Department: A Report of Two Cases

Before Hyperemesis Gravidarum Is Blamed for Thiamine Deficiency, Alternative Causes Should Be Ruled Out