Recent uciem items

Atypical Presentation of Extensive Stanford Type A Aortic Dissection Initially Misattributed to Aspiration Pneumonia: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Acute aortic dissection is a life-threatening emergency that may present with nonspecific symptoms, particularly in older adults, leading clinicians to anchor on more common diagnoses.

Case Report: An 85-year-old man presented with four days of cough, weakness, and constipation after a recent emergency department (ED) visit due to food impaction after he choked on a carrot. A chest radiograph obtained the day before admission showed left basal consolidation, prompting referral for suspected aspiration pneumonia. In the ED, he appeared comfortable with no complaints of chest pain. Physical examination noted mild tachycardia and wheezes bilaterally and treatment was initiated with antibiotics and bronchodilators. A low-voltage electrocardiogram led to immediate point-of-care echocardiography, which demonstrated a large circumferential pericardial effusion, a markedly dilated aortic root, and right ventricular collapse. Computed...

Ultrasound-guided Emergency Pericardiocentesis Simulation on Human Cadavers: A Scoping Review

Sun, 20 Sep 2026 00:00:00 +0000

Objectives: Emergency pericardiocentesis is a critical but infrequently performed procedure in emergency medicine, necessitating effective training modalities for emergency physicians. In this scoping review we aimed to identify existing literature on simulation of ultrasound-guided pericardiocentesis in human cadavers.

Methods: We carried out a scoping review based on a search on the use of sonography on human cadavers. The following databases were searched: MEDLINE; EMBASE; CENTRAL; BIOSIS Previews; and Web of Science Core Collection. Additionally, we performed a gray literature search. Title and abstract screening were done by a single reviewer, and full-text review was performed by two independent reviewers. Studies included were limited to those published in English or German, focusing specifically on ultrasound-guided pericardiocentesis training models in human cadavers, with no restrictions on publication year or outcomes.

Results:...

Exercise-Induced Diaphragmatic Rupture with Intrathoracic Gastric Herniation: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: While abdominal pain is a common complaint in the emergency department (ED), it is key to obtain a diligent history and maintain a broad differential diagnosis. The development of exercise-induced diaphragmatic hernia is rare but can result in a high risk of morbidity and mortality.

Case Report: This is a case of a 24-year-old man who presented to the ED with acute-onset epigastric abdominal pain that began while performing “burpee” (squat thrust) exercises. Computed tomography of the abdomen and pelvis revealed diaphragmatic rupture with gastric herniation into the left hemithorax. The patient underwent emergent surgical intervention to reduce the intra-abdominal contents and repair the diaphragmatic defect.

Conclusion: There are no prior reports of diaphragmatic hernia due to burpee exercises in the emergency medicine literature. Consideration of exercise-induced diaphragmatic hernia is necessary...

Prehospital Ultrasound to Identify Endotracheal Tube Dislodgment in an Infant: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Point-of-care ultrasound (POCUS) is well established as a useful adjunct for airway management in both adult and pediatric patients, including confirmation of successful endotracheal intubation. While suprasternal ultrasound of the trachea is the most described method for confirming endotracheal tube (ETT) placement, a focused lung exam can be used to rapidly identify appropriate ventilation in otherwise apneic patients.

Case Report: This case involves a one-month-old male infant who experienced an out-of-hospital cardiac arrest secondary to suspected sudden infant death syndrome. During resuscitation, an accidental extubation occurred after an attempt at securing the ETT with a commercial pediatric tube holder. Loss of end-tidal carbon dioxide (ETCO2) waveform was recognized immediately; however, emergency medical services clinicians questioned the device’s accuracy due to earlier failures of the ETCO2 monitor and the...

Locked-In Syndrome from Delayed Vertebral Artery Dissection After Strangulation: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Vertebral artery dissection is a rare but life-threatening complication of strangulation. Symptoms are often nonspecific and may not manifest immediately, complicating diagnosis. If prior neck trauma is not elicited during assessment, clinicians may miss a mechanistic link to prompt vascular imaging, leaving patients at risk for irreversible outcomes, as illustrated in this case.

Case Report: A 24-year-old woman presented to a critical access emergency department (ED) with nonspecific neurological symptoms that had largely resolved upon arrival. Her only reported history was vague head and neck pain, which she attributed to stress after leaving an abusive relationship several weeks earlier. Hours later, while still in the ED, the patient experienced abrupt neurological deterioration. She was transferred to a regional medical center, where magnetic resonance imaging eventually revealed vertebral artery dissection...

Subacute Microperforation of Right Atrial Pacemaker Lead Presenting with Shock due to Cardiac Tamponade: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Delayed cardiac tamponade is a rare but life-threatening complication following permanent pacemaker placement and may present with non-specific symptoms.

Case Report: We report the case of a 66-year-old woman on oral anticoagulation who presented with generalized weakness, nausea, and profound hypotension four days after dual-chamber pacemaker placement. Initial evaluation demonstrated atrial fibrillation with rapid ventricular response, a normal chest radiographic findings, prerenal azotemia, and no evidence of device malfunction on interrogation. Point-of-care ultrasound (POCUS) performed in the emergency department revealed a large pericardial effusion with right atrial and right ventricular collapse and a plethoric inferior vena cava, consistent with cardiac tamponade. Emergent pericardiocentesis yielded 400 mL of sanguinous pericardial fluid with rapid hemodynamic improvement. Subsequent imaging revealed a 2-mm...

Acute Dystonia Following Ifosfamide Infusion in a Young Woman with Breast Angiosarcoma: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Ifosfamide is an alkylating chemotherapeutic agent commonly used in the treatment of sarcomas and other malignancies. Neurotoxicity is a recognized adverse effect, most often presenting as encephalopathy. Acute movement disorders such as dystonia are rare and may be underrecognized in the emergency department.

Case Report: We report a 22-year-old woman receiving combination chemotherapy with doxorubicin, ifosfamide, and mesna for breast angiosarcoma who developed acute right-sided neck spasms and involuntary movements within five minutes of initiating ifosfamide infusion. Vital signs were as follows: temperature, 98.0 degrees Fahrenheit; heart rate, 97 beats per minute; respiratory rate, 18 breaths per minute; blood pressure, 130/88 millimeters of mercury; and oxygen saturation, 99% on room air. Examination revealed sustained contraction of the right sternocleidomastoid and trapezius muscles with involuntary head deviation....

From Staple Removal to Startle—The Unexpected Discovery of a Scalp Pseudoaneurysm: A Case Report

Sun, 20 Sep 2026 00:00:00 +0000

Introduction: Point-of-care ultrasound (POCUS) allows emergency physicians to rapidly diagnose vascular abnormalities, including pseudoaneurysms. Although commonly identified following vascular catheterization, traumatic pseudoaneurysms of superficial scalp arteries are rare.

Case Report: An 85-year-old woman receiving anticoagulation presented to the emergency department (ED) for removal of a scalp staple placed during treatment of a previously bleeding scalp wound. Physical examination revealed a persistent scalp hematoma. Point-of-care ultrasound demonstrated a hypoechoic collection with Doppler flow consistent with a pseudoaneurysm. Computed tomography angiography confirmed the diagnosis. Ultrasound-guided compression attempted in the ED resulted only in transient thrombosis. The patient subsequently underwent elective percutaneous embolization.

Conclusion: Emergency physician–performed POCUS can rapidly identify...

WestJEM Full-Text Issue

Sun, 20 Sep 2026 00:00:00 +0000

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Hemodynamic Effects of Interfacility Dexmedetomidine Infusions During Transport of Patients with Alpha-2-adrenergic Agonist Withdrawal

Thu, 17 Sep 2026 00:00:00 +0000

Background: In the Philadelphia region, there has been an increase in the potency of illicit opioids as well as the addition of nonopioid adulterants. Currently, medetomidine, a veterinary anesthetic that acts as an alpha-2-adrenergic agonist, is a common adulterant in the illicit opioid supply, causing both unique overdose and withdrawal syndromes. Although opioid withdrawal alone is not deadly, with added adulterants, especially medetomidine, this is no longer the case. Dexmedetomidine is an alpha-2-adrenergic agonist frequently used for sedation in the emergency department and intensive care unit. Dexmedetomidine is also used off-label to treat the life-threatening withdrawal from alpha-2-agonists.

Objective: This study describes the dosing and hemodynamic effects associated with the interfacility administration of dexmedetomidine in patients with alpha-2 adrenergic agonist withdrawal. Secondarily, we describe the safety of dexmedetomidine...

Clinical and Financial Value of Cardiac Point-of-Care Ultrasound During Traumatic Cardiac Arrest

Thu, 10 Sep 2026 00:00:00 +0000

Introduction: Traumatic cardiac arrest is associated with poor survival and significant consumption of hospital resources. Determining which patients have survivable injuries allows for judicious use of resources. Our aim was to determine whether cardiac activity on point-of-care ultrasound (POCUS) during traumatic cardiac arrest was associated with increased patient survival and the charges of continued resuscitation in patients that do have cardiac activity on POCUS.

Methods: We conducted this single-center retrospective study at an urban, Level I trauma center of consecutive patients arriving in traumatic cardiac arrest from August 2016–December 2023 who had a cardiac POCUS performed during the initial resuscitation efforts. Our primary outcome was to determine whether cardiac activity on POCUS during the arrest was associated with increased patient survival to neurologically intact hospital discharge. Secondary objectives included...

Nurse and Physician Stakeholder Guidance on Improving Sexually Transmitted Infection Care in a Pediatric Emergency Department

Wed, 9 Sep 2026 00:00:00 +0000

Introduction: Pediatric emergency departments (PEDs) and general EDs in the United States (U.S.) do not consistently deliver sexually transmitted infection (STI) care that aligns with clinical guidelines. To inform the development of an implementation strategy plan aimed to improve STI care in a PED, we interviewed PED nurse and physician stakeholders to identify challenges and corresponding potential solutions aimed to improve STI care in a PED.

Methods: We conducted semi-structured interviews with 27 stakeholders consisting of emergency medicine (EM) residents, pediatrics residents, pediatric EM (PEM) fellows, attending pediatric emergency physicians, and PED nurses at an academic urban PED. Using the Tailored Implementation in Chronic Diseases (TICD) framework, we prepared semi-structured interview guides specific to stakeholder roles structured according to the usual six successive workflow stages of STI care in the PED (triage,...

Impact of Street Medicine on Emergency Department Use: A Three-Year Evaluation of People Experiencing Homelessness

Wed, 9 Sep 2026 00:00:00 +0000

Introduction: People experiencing homelessness (PEH) frequently utilize the emergency department (ED) for acute and primary healthcare needs. Loyola Street Medicine is a multidisciplinary team comprised of physicians, students, and other professionals who provide weekly healthcare services to PEH at a train station in Chicago. The objective of the study was to identify the specific patient demographics, chief complaints, and clinical interventions associated with increased odds of these patients reporting that they would have sought care at an ED had Loyola Street Medicine been unavailable.

Methods: We conducted a retrospective review of patients seen by Loyola Street Medicine between September 2021 and September 2024, with 2,121 total encounters and a subset of 1,565 with identifying data. The primary outcome measure was whether the patient reported they would have gone to the ED for care, and the secondary outcome measures were patient...

Impact of Live Preferential Music on Pain in the Emergency Care Setting: A Randomized Controlled Trial

Wed, 9 Sep 2026 00:00:00 +0000

Introduction: Pain is the most prevalent complaint for the more than 155 million patients accessing emergency care in the United States. Appropriate and timely management of pain is a measure of quality emergency care. However, the opioid crisis has created a need for multimodal and alternative approaches to successful pain management. Models for integrating such approaches in emergency departments (ED) are understudied. Therefore, we chose to investigate the impact of live preferential music (LPM) in the management of acute musculoskeletal pain.

Methods: This prospective, randomized, double-blind intervention study was designed with block randomization clustered by day of the week to live preferred music versus usual care. To ensure blinding, patients were deceived that the study focus was on pain assessment without disclosure that there was an intervention. A total of 2,262 patients were screened, and 272 patients (94 interventions,...

A Decade Later: Trends in Fellowship Training and Secondary Board Certification Among Emergency Medicine Residency Leaders

Wed, 9 Sep 2026 00:00:00 +0000

Introduction: Residency program leaders shape the academic pipeline in emergency medicine (EM). We assessed current demographics and postgraduate training among EM residency leadership in the United States.

Methods: We conducted a national, cross-sectional survey of all Accreditation Council for Graduate Medical Education–accredited EM residency program leadership via an online, confidential questionnaire. Primary outcomes were the prevalence of any postgraduate fellowship training and any secondary board certification (ie, additional board certification beyond EM) as a complementary marker of advanced credentialing distinct from fellowship training. Programs were grouped by National Resident Matching Program (NRMP) region.

Results: We received 103 program responses (35.9%). Any fellowship training was reported by 25.5% of program directors (PD), 40.0% of associate program directors (APD), and 42.8% of assistant...

Impact of Ultrasound-Guided Peripheral Intravenous Training on Central Line Placement in the Emergency Department

Wed, 9 Sep 2026 00:00:00 +0000

Introduction: Central venous catheters are placed in the emergency department (ED) when difficult peripheral access limits care or when critical medications require central access because of their sclerotic nature or incompatibility with other drugs. Ultrasound-guided peripheral intravenous (IV) access offers a less invasive alternative. We evaluated whether implementation of a structured ultrasound-guided peripheral intravenous training program for ED nurses and technicians was associated with changes in ED central venous catheter use.

Methods: We performed a retrospective chart review at our 50-bed academic community ED, which holds a Level II trauma designation. This center has an ED census of 80,000 patients per year, a 4:1 nursing to patient ratio with an admission rate of 20-25% with expected monthly variation. A structured ultrasound-guided peripheral IV curriculum for nurses and technicians launched in November 2023. The primary...

Luxatio Erecta with Complex Medical Decision-Making Regarding Reduction: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: Luxatio erecta is a rare glenohumeral dislocation. The standard treatment is reduction under procedural sedation; however, decision-making becomes more nuanced in patients with comorbidities. This report describes a hyperglycemic patient with type 1 diabetes with luxatio erecta.

Case Report: An 18-year-old man resented with a traumatic inferior shoulder dislocation. Laboratory tests indicated severe hyperglycemia without diabetic ketoacidosis. The emergency department team performed a risk-benefit assessment before proceeding with procedural sedation. Closed reduction was successful, and hyperglycemia was managed with intravenous fluids.

Conclusion: Inferior shoulder dislocations are rare; severe hyperglycemia in diabetics is not an absolute contraindication to procedural sedation, but the patient may need individualized risk-benefit assessment.

Gaze-Evoked Vomiting After Minor Orbital Trauma: White-Eyed Blowout Fracture

Tue, 8 Sep 2026 00:00:00 +0000

Case Presentation: A 16-year-old girl presented to the emergency department after being struck in the right eye by another player’s elbow during a basketball game. She had only minimal periorbital swelling but developed persistent nausea, repeated vomiting, and diplopia with upward gaze. Visual acuity, visual fields, and pupillary light reflexes were normal. Extraocular movement testing showed mild limitation of upward gaze of the right eye, and upward gaze reproducibly provoked diplopia, marked nausea, and vomiting. Computed tomography (CT) showed no intracranial hemorrhage, and orbital CT was initially interpreted as showing no obvious orbital floor fracture or extraocular muscle entrapment. Given the discrepancy between the mild external appearance and the severe ocular symptoms, white-eyed blowout fracture with trapdoor-type entrapment and an oculocardiac reflex was suspected. She underwent emergent surgery, after which her vomiting, diplopia, and ocular...

Subarachnoid Pneumocephalus Following Endoscopic Transsphenoidal Surgery

Tue, 8 Sep 2026 00:00:00 +0000

Case Presentation: A 26-year-old man with past medical history of prolactinoma presented two weeks status post endoscopic transsphenoid prolactinoma excision with a positional headache and cerebrospinal fluid rhinorrhea; he was found to have diffuse subarachnoid air.

Discussion: There are few reports of subarachnoid pneumocephalus in the emergency medicine literature. Pneumocephalus, particularly tension pneumocephalus, typically occurs in the setting of traumatic skull fractures. However, emergency physicians should be aware of subarachnoid pneumocephalus in the setting of endoscopic skull base surgeries.

Medicolegal Pitfalls in Management of Shoulder Dislocations: A Case Series

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: Shoulder dislocations comprise approximately half of all major joint dislocations evaluated in the emergency department. Despite often being considered a simple injury, diagnosing a dislocation can be difficult, especially when accompanied by a fracture associated with unusual mechanism, or when the physical examination is limited. Missed and delayed diagnoses can result in poor patient outcomes and legal risks for clinicians, necessitating a high level of vigilance.

Case Series: We review three medical malpractice cases centered on the failure to recognize shoulder dislocations. Key issues included missed diagnosis, limited physical examination documentation, and inadequate discharge instructions.

Conclusion: Shoulder dislocations can be challenging to identify, and missed diagnoses give rise to subsequent clinical and legal risks. Emergency physicians must maintain a high index of suspicion...

Bezold Abscess: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: A Bezold abscess is a neck abscess characterized by inflammation and infection of the mastoid process that can invade deep into local anatomical musculature and vasculature.

Case Report: We highlight the case of a 62-year-old man who presented with ongoing left-sided neck pain, headache, and tinnitus that started two weeks prior to arriving at the emergency department. Physical examination showed tenderness to the left trapezius muscle, left-sided mastoid tenderness, and pearly tympanic membranes bilaterally. A computed tomography angiogram of the head and neck was performed due to concerns of vertebral dissection, which eventually led to a diagnosis of Bezold abscess.

Conclusion: Although Bezold abscess has been described in the medical literature, it is rarely encountered in modern clinical practice because the widespread use of antibiotic therapy prevents acute mastoiditis...

The Stellate Ganglion Nerve Block—A Novel Use for Electrical Storm in the Emergency Department: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: Electrical storm is an emergent medical condition in which a patient experiences recurrent episodes of ventricular tachycardia or ventricular fibrillation. Traditional management includes intravenous antiarrhythmics and/or electrical cardioversion. However, in some cases, cardiac arrhythmias may persist despite these interventions. In rare circumstances, traditional therapies in the emergency department (ED) may prove to be futile. In such cases, a stellate ganglion nerve block (SGNB) can be considered.

Case Report: We present a novel case in which a SGNB was performed in the ED on an awake patient experiencing recurrent cardioversions from his implantable cardioverter defibrillator shocks for ventricular tachycardia.

Conclusion: In the setting of refractory ventricular dysrhythmias, sympathetic blockade of the left stellate ganglion can be a useful adjunct to conventional management in the ED.

Inferior Vena Cava Cement Migration with Pulmonary Cement Embolism: A Case Report

Tue, 8 Sep 2026 00:00:00 +0000

Introduction: Vertebral augmentation procedures, including vertebroplasty and kyphoplasty, can result in cement extravasation, which is often clinically silent. Less commonly, cement may migrate intravascularly into the inferior vena cava (IVC) and pulmonary arterial circulation, resulting in pulmonary cement embolism, a potentially life-threatening complication. Early recognition in the emergency department (ED) is essential to guide appropriate imaging, specialty consultation, and timely management.

Case Report: A 76-year-old woman with recent third lumbar vertebral augmentation presented to the ED with acute worsening low back pain and burning bilateral radicular symptoms approximately one week after the procedure. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast demonstrated linear hyperdense material extending from the treated vertebral body into the IVC, concerning for intravascular cement migration....

Impact of a Decision-Support Interface on Mental Workload and Stress in Prehospital Stroke Triage: A Randomized Crossover Trial

Sat, 5 Sep 2026 00:00:00 +0000

Introduction: Prehospital triage challenges often lead to suboptimal choices and delayed treatment for stroke patients. The objective of the study was to evaluate whether a decision-support interface to assist in stroke triage to an appropriate hospital could reduce emergency medical technicians’ (EMT) mental workload.

Methods: This randomized crossover study was conducted between February and March 2025. Each participant completed two 12-minute simulated trials in randomized order: current dispatch orders without decision support and a decision-support interface. We assessed mental workload—the mental effort required to make hospital transport decisions under time pressure during prehospital stroke triage—using heart rate variability (HRV) metrics and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). System usability was assessed using the System Usability Scale. The primary outcome was the root mean square...

Rural-Urban Parity and Socioeconomic Gaps in Traumatic Brain Injury Outcomes

Sat, 5 Sep 2026 00:00:00 +0000

Background: Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Rural residence and low community income are independently associated with poorer health outcomes, mediated by variations in injury mechanism and healthcare access. We evaluated the impact of geographic location on injury patterns and acute‐care metrics in adults with TBI treated at Maryland’s statewide Level I trauma center.

Methods: Adults (≥18 years of age) with radiographically confirmed TBI admitted between 2017 and 2021 were identified retrospectively from the institutional trauma registry. Rural residence was defined using Rural-Urban Commuting Area codes. This single-center study included only patients surviving to hospital admission. Primary outcomes included hospital length of stay (LOS) and discharge to hospice or death. Secondary outcomes included intensive care unit (ICU) and ventilator days and discharge disposition.

Results:...

Partial Immersion Using Body Bags for Exertional Hyperthermia: A Randomized Crossover Study

Sat, 5 Sep 2026 00:00:00 +0000

Introduction: Recent recommendations suggest emergency medical personnel should consider rapid whole-body cooling for heat stroke patients. Cold-water immersion maximizes cooling rate and subsequent outcomes following heat stroke. Body bags filled with ice and water may provide portable, accessible partial cold-water immersion for this setting. The purpose of this study was to determine whole-body cooling rates when using body bags to facilitate partial cold-water immersion to treat exertional hyperthermia.

Methods: A total of 9 healthy participants (8 male; mean [SD] age, 24 [4] years; height, 175 [7] cm; body mass, 83.6 [21.6] kg) completed our randomized-crossover field study. Following hydration verification, participants completed a self-paced 400 warm-up run, 1,609 m run, and 10-m sprints until rectal temperature (T-rec) reached 39.2 °C or volitional exhaustion. Following exercise, participants were cooled for a maximum of 30 minutes...

Effectiveness of a Nurse-Led Ambulatory Care Clinic in Reducing Emergency Department Visits and Hospitalizations

Sat, 5 Sep 2026 00:00:00 +0000

Introduction: Gaps in care integration and coordination contribute to emergency department (ED) crowding and preventable hospitalizations, necessitating innovative solutions to improve care transitions and reduce acute care use. This study evaluates whether attendance at a nurse-led ambulatory intermediate care clinic (AICC) reduces three-month ED visits and hospitalizations compared to missed AICC appointments.

Methods: This retrospective cohort study at a single academic center analyzed AICC appointments from the first three years of clinic operations using multivariable logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Our primary outcome measure was an ED visit within three months of the AICC appointment; our secondary outcome measure was hospitalization within three months. Robustness was assessed using Poisson, negative binomial, and zero-inflated models.

Results: Among...

Emergency Physicians Should Give Ketamine to Patients with Acute Suicidal Ideation

Fri, 4 Sep 2026 00:00:00 +0000

Acute suicidal ideation (SI) represents about 1% of all adult emergency department (ED) visits in the U.S. and has increased over the past few decades, especially in the wake of the COVID-19 pandemic.

FRONTIERS IN ADVANCED EMERGENCY CARE & THE MEDITERRANEAN ACADEMY OF EMERGENCY MEDICINE JOINT CONGRESSES - ABSTRACTS PART 2

Fri, 4 Sep 2026 00:00:00 +0000

Abstracts Presented in Tbilisi, Georgia July 17-18, 2026

FRONTIERS IN ADVANCED EMERGENCY CARE & THE MEDITERRANEAN ACADEMY OF EMERGENCY MEDICINE JOINT CONGRESSES - ABSTRACTS PART 1

Fri, 4 Sep 2026 00:00:00 +0000

Abstracts Presented in Tbilisi, Georgia July 17-18, 2026.

An Overview of the State of Emergency Medicine in Syria

Fri, 4 Sep 2026 00:00:00 +0000

Introduction: Emergency medicine is a developing specialty in low-to-middle income countries. The specialty was in its infancy in Syria when the war started a decade ago. Syria has since experienced civil war, unrest, famine, and financial collapse that has strained its healthcare system. There is limited research and information regarding Emergency Medicine residencies and training in Syria. Therefore, this article describes the growing and current state of Emergency Medicine and its training in Syria. Methods: A mixed methods approach using a systematic review and semi-structure interviews was utilized. MEDLINE, EMBASE and PsychINFO were searched from inception until March 9, 2022. Eligible studies were specific to emergency medicine and discussed the training of emergency medicine physicians in Syria. Semi-structured key informant interviews and a review of the Ministry of Health website were utilized to supplement information regarding the structure of emergency medicine...

A Case Report of Toxicity from Ingestion of a Hospital Antiseptic Solution Containing 1-Propanol and 2-Propanol

Fri, 4 Sep 2026 00:00:00 +0000

In the midst of the COVID-19 pandemic, the increased risk of exposure to 1-propanol has led the United States Food and Drug Administration to issue a warning about toxicity of 1-propanol-contaminated brands of hand sanitizers. We report a mixed intoxication with 1-propanol and 2-propanol in a patient who unintentionally ingested approximately 300 mL of hospital topical antiseptic solution and who presented to the emergency department with nausea, vomiting, and decreased level of consciousness. The patient developed an anion gap metabolic acidosis without an osmolar gap, elevated serum lactate, and undetectable serum beta-hydroxybutyrate. One hour later, he developed chest pain and was found to have an ST-segment elevation myocardial infarction. The patient underwent urgent coronary angiography and stenting of the totally occluded mid-segment of the Left Anterior Descending coronary artery. The patient recovered and was discharged home after 7 days.

Use National Early Warning Score In The Prognosis Of Stroke Patients In The Emergency Department

Fri, 4 Sep 2026 00:00:00 +0000

Introduction: Few scoring systems are used in the emergency department to identify critically ill patients and anticipate patients' deterioration such as National Early Warning Score (NEWS). This study aimed to evaluate NEWS in patients with acute stroke and its relationship with treatment and type of stroke and patient outcome. Methods: In this prospective cross-sectional descriptive-analytical study, all patients over 18 years of age with a diagnosis of ischemic stroke, who presented through the emergency department, were involved. The variables of interest were collected; the NEWs score was calculated for each patient. Results: In assessing NEWS and its relationship with outcome based on the ROC curve, the area under the curve was equal to 0.417. Considering the high intensity of NEWS above 7, sensitivity, specificity, positive predictive value, negative predictive value, PLR, and NLR were 16.67%, 98.77%, 83.33%, 74.45%, 13.5, 0.84 respectively. In assessing NEWS and...

Observation Unit Management of Older Adults with Rib Fractures: A Case Series

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Rib fractures in older adults carry high morbidity and mortality, leading many hospitals to admit patients based on age alone. The Rib Injury Guidelines (RIG) offer a triage system; under RIG 2, patients are typically admitted to inpatient care.

Case Series: This study evaluated whether older adults categorized as RIG 2 solely due to age could be safely managed in an emergency department observation unit. We conducted a 14-month case series at an academic trauma center, reviewing 23 patients 60 years and older with rib fractures. Twenty met RIG 2 criteria, including those later admitted for nontrauma reasons. The mean observation stay was 26.6 hours, and the total hospital stay was 1.8 days. Seventeen patients (85%) were discharged directly from observation, three (15%) were admitted to medicine, and none returned within 72 hours.

Conclusion: Carefully selected older adults with rib fractures...

Prehospital Cold-Water Immersion for Undifferentiated Heat Stroke: A Case Series

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Heat stroke is a time-sensitive condition that requires early intervention to prevent morbidity and mortality. Heat-related deaths are also increasing. Multiple studies have evaluated various cooling methods and assessed their effectiveness, safety, and practicality across diverse settings and populations. Earlier and faster cooling leads to improved patient outcomes. The National Association of Emergency Medical Services Physicians recommends initiating prehospital cold-water immersion before emergency medical services (EMS) transport.

Case Series: This case series evaluated the feasibility and effectiveness of prehospital cold-water immersion initiated before and continued during EMS transportation from the scene to emergency department arrival in this critically ill patient population.

Conclusion: Rapid initiation and maintenance of prehospital cold-water immersion in undifferentiated...

Tension Pneumopericardium from a Gastrojejunal-Pericardial Fistula Causing Tamponade: A Case Report

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Cardiac tamponade typically develops from the accumulation of blood and other fluids, although it can occur from pneumopericardium.

Case Report: A 62-year-old man presented to the emergency department with chest pain and was found to have a pneumopericardium on computed tomography. He developed signs of obstructive shock with hypotension refractory to intravenous fluids and vasopressors. The patient stabilized with bedside pericardiocentesis and pericardial drain placement.

Conclusion: Gastrointestinal-pericardial fistulae are a rare cause of pneumopericardium. Emergency physicians typically rely on cardiac point-of-care ultrasound to evaluate for tamponade and guide pericardiocentesis. However, air artifacts interfere with images, complicating diagnosis and procedures.

Unna Boot Therapy Reduces Emergency Department Use in an Unhoused Patient: A Case Report

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Venous leg ulcers disproportionately affect people experiencing homelessness and contribute to recurrent emergency department (ED) use. Standard wound care protocols often require daily dressing changes and leg elevation, which are unrealistic in unstable housing environments.

Case Report: A 71-year-old male with a 10-year history of venous leg ulcers and 15 ED visits achieved complete wound epithelialization after four months of weekly Unna boot compression therapy, despite eviction during treatment. He has not returned to the ED for this condition.

Conclusion: Emergency department-initiated compression therapy with structured wound care referral may reduce recurrent ED use among unhoused patients with venous leg ulcers.

Amphetamine-induced Reverse Takotsubo Syndrome: Further Implications

Mon, 31 Aug 2026 00:00:00 +0000

Amphetamine-induced Reverse Takotsubo Syndrome: Further Implications

Soft Palate Perforation with Endotracheal Tube During Video Laryngoscopy

Mon, 31 Aug 2026 00:00:00 +0000

Case presentation: A 57-year-old man with a history of obesity-hypoventilation syndrome, diabetes mellitus, and chronic renal insufficiency was intubated with an 8.0-mm endotracheal tube under video laryngoscopy in the emergency department due to respiratory failure. After successful intubation, bloody secretions were noted in the patient’s mouth. Subsequent examination revealed that the endotracheal tube had caused a through-and-through perforation at the junction of the soft palate and the anterior tonsillar pillar. Because the intubation had been successful, the endotracheal tube was not removed, and the soft palate was transected to free the tube. The patient made an uneventful recovery.

Discussion: Soft palate perforation is an uncommon injury that has been reported more frequently with video laryngoscopy than direct laryngoscopy. To prevent this injury and ensure its rapid recognition, it is recommended that the clinician sequentially...

Impact of a Residency-Run Emergency Medicine Podcast Summary on Learning Retention and Engagement

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Podcasts have become a widely used educational tool in emergency medicine. In this study, a podcast was used as the intervention. This podcast consisted of a brief audio summary of weekly in-person conference content produced by residents and faculty. We assessed whether a resident-led, curriculum-based podcast summary improved knowledge retention and learner engagement compared to a standard written summary format.

Methods: This mixed-methods prospective cohort study conducted at a single urban academic hospital included 54 emergency medicine residents and approximately 66 attending physicians. The study unfolded in three phases: eight weeks of standard written conference summaries (control); followed by eight weeks of written plus podcast conference summaries (intervention); and a four-week post-intervention period with surveys. The primary outcome was knowledge retention, measured by weekly postconference quiz scores...

Primary Group A Streptococcus Peritonitis in a Healthy Child: A Case Report

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Group A streptococcus (GAS, Streptococcus pyogenes) is commonly associated with pharyngitis and skin and soft tissue infections, but invasive infection can occur. Primary bacterial peritonitis due to GAS is rare, especially in healthy children without nephrotic syndrome or immunocompromise.

Case Report: We present a 21-month-old previously healthy male with four days of fever, irritability, and refusal to walk. Examination revealed abdominal distention and peritonitis. Computed tomography showed ascites and a normal appendix. Diagnostic laparoscopy revealed copious purulent peritoneal fluid; both peritoneal fluid and blood cultures were positive for GAS. He was treated with ampicillin-sulbactam followed by oral amoxicillin-clavulanate with complete recovery.

Conclusion: This case highlights a rare presentation of invasive GAS as primary peritonitis in a healthy child. Clinicians should consider this...

Efficiency of Early Warning Scores in Adult Emergency Department and Inpatient Populations: Overview of Reviews

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Early Warning Scores (EWS) are used to support decisions regarding triage and early intervention of patient deterioration in emergency departments (ED) and other clinical environments. We synthesized evidence from systematic reviews on the predictive performance and clinical impact of EWS and their modifications in adult in-hospital populations.

Methods: We conducted and reported an overview of reviews following the Joanna Briggs Institute (JBI) methodology, PRIOR statement, and our predefined protocol. A systematic search of MEDLINE (Ovid) and Epistemonikos was performed in May 2025. Two reviewers independently screened studies, extracted data, and critically appraised systematic reviews. We included systematic reviews of adult in-hospital populations evaluating EWS as either prognostic tools for deterioration or mortality, or as interventions implemented within track-and-trigger or rapid response systems. Primary study...

A Case Report of Spontaneous Pneumomediastinum Following Chest Massage: A Rare Clinical Presentation

Mon, 31 Aug 2026 00:00:00 +0000

Introduction: Spontaneous pneumomediastinum is a rare condition characterized by the presence of air in the mediastinum without preceding trauma. It is often triggered by minor events such as coughing, physical exertion, or traditional therapies.

Case Report: A 52-year-old male with a history of pulmonary tuberculosis developed sudden left-sided chest pain and swelling following traditional chest massage therapy. Examination revealed subcutaneous emphysema with palpable crepitus. Imaging showed characteristic signs of pneumomediastinum with bilateral lung opacities. As a complication of pneumomediastinum the patient developed mediastinitis and a mediastinal abscess, requiring open thoracotomy and drainage. He recovered with multidisciplinary care.

Conclusion: Early recognition of spontaneous pneumomediastinum in emergency settings is crucial, especially when chest pain is accompanied by subcutaneous...

From De-escalation to Restraint: A Qualitative Study of Emergency Clinician Decision-Making in Patient Agitation

Sat, 29 Aug 2026 00:00:00 +0000

Introduction: Managing agitation in the emergency department (ED) is challenging and frequently involves decisions about physical restraints and emergent medications. While institutional protocols and behavioral response teams exist, little is known about how individual clinicians make decisions about restraint use—decisions with significant implications for safety, ethics, and equity. The objective of the study was to explore how emergency physicians, residents, and nurses make decisions about physical restraint and emergent medication use during episodes of patient agitation in the ED.

Methods: We conducted a qualitative study using semi-structured interviews with 35 emergency clinicians (18 attending physicians, 7 senior residents, and 10 nurses) at an urban academic ED. Interviews were transcribed and analyzed using inductive thematic analysis.

Results: Clinicians described three key factors informing restraint...

Efficiency and Humanism: The Impact of the Humanistic Charting Tool on Patient Experience in the Emergency Department

Sat, 29 Aug 2026 00:00:00 +0000

Introduction: Emphasis on documentation challenges clinicians to strike a balance between efficiency and individualized care, often leading to the depersonalization of patient interactions. The Humanistic Charting Tool (HCT) addresses this by integrating the patient’s voice into the electronic medical record (EHR). The objective of this study was to examine whether use of the HCT during emergency department (ED) visits is feasible and improves key patient experience metrics.

Methods: The study took place in an urban, academic hospital. Patients in the ED completed the HCT while waiting to see a clinician. The patient’s responses were condensed into a two-page summary and uploaded into their EHR. Clinicians were asked whether they used the HCT for each patient at the end of the encounter, and patients completed precare and postcare surveys assessing key experience metrics. Our primary outcome measure was changes in patient experience...

Traumatic Extremity Amputations in Children: Causes and Outcomes Based on a Regional Experience

Sat, 29 Aug 2026 00:00:00 +0000

Introduction: Pediatric traumatic extremity or digit amputations are preventable causes of morbidity. The object of this study was to evaluate the etiology and outcomes of these injuries in our region. We used the Childhood Opportunity Index to explore the role of social determinants of health.

Methods: We performed a retrospective cohort study at an academic children’s hospital on all pediatric patients younger than 18 years who presented with a traumatic digit or extremity amputation between January 1, 2014, to July 31, 2024. Metrics such as patient demographics, injury severity, prehospital course, hospital events and follow-up were abstracted. The Childhood Opportunity Index assigns a 0-100 composite score of region-based childhood opportunity determined from home ZIP codes. Our primary outcome measure was mechanism of injury. Secondary outcomes included length of stay, need for initial surgical intervention, subsequent operations,...

Changes in Outpatient and Telehealth Visits Among Undocumented Patients.

Thu, 27 Aug 2026 00:00:00 +0000

Importance

Anti-immigration policies in 2025 may influence outpatient care and telehealth among immigrant communities. Understanding visit patterns is essential for health systems leaders to prepare for shifts in health care use and ensure preventive care.

Objective

To compare outpatient in-person and telehealth visit completion rates among patients classified as likely undocumented and those likely with legal status, before and after 2025 federal immigration policy changes.

Design, setting, and participants

This cross-sectional study analyzed electronic health record data from outpatient encounters in a public safety-net system. Documentation status was approximated using non-English primary language without a Social Security number (SSN) to classify patients with likely undocumented status and using English primary language with SSN for patients likely with legal status. Analyses compared visits from January to June 2024 and January to June 2025.

Main...

Changing Risk Factors in Patients Diagnosed with Human Immunodeficiency Virus

Wed, 26 Aug 2026 00:00:00 +0000

Introduction: Since 2019, transmission risk factors among patients diagnosed with HIV have changed, although the trends and reasons behind them have not been fully elucidated. The objective of this study was to assess changes in HIV transmission risk factors among patients newly diagnosed with HIV to inform future targeted HIV testing programs.

Methods: This study site is New England’s largest essential hospital and a major reporter of new HIV cases in Massachusetts. We performed a retrospective chart review of patients diagnosed with HIV infection at our medical center between January 2019 and December 2023. Demographic and clinical variables were collected and analyzed using descriptive and comparative statistics to evaluate trends in primary risk factor for HIV. Our primary outcome measure was incident HIV diagnosis with a primary risk factor of injection drug use (IDU), men who have sex with men (MSM), or heterosexual contact. A...

Purulent Pericarditis Identified with Point-of-Care Echocardiography: A Case Report

Mon, 24 Aug 2026 00:00:00 +0000

Introduction: Purulent pericarditis is a rare subset of pericarditis that can result in serious morbidity and mortality. Presenting symptoms are often nonspecific, and a high index of suspicion must be maintained to reach an early diagnosis. Point-of-care ultrasound can be pivotal in the emergency department evaluation of purulent pericarditis, providing key information including characteristics of the effusion and a sonographic assessment for signs of tamponade. We present a case of purulent pericarditis first detected using point-of-care ultrasound in the emergency department.

Case Report: A 55-year-old male presented with chest pain and dyspnea and was found to have cardiac tamponade secondary to purulent pericarditis.

Conclusion: Cases of purulent pericarditis are rare but should be recognized by emergency clinicians. Point-of-care ultrasound is a powerful tool to assist in early diagnosis of pericardial...

Emergency Severity Index Stratified by Post-Triage Lactate: Association with In-Hospital Mortality in Admitted Patients

Sun, 23 Aug 2026 00:00:00 +0000

Introduction: The Emergency Severity Index (ESI) is a widely used triage tool in emergency departments (EDs) and is associated with adverse outcomes. Lactate has also been associated with mortality in various ED populations. This study evaluated whether lactate levels measured after triage at the treating physician’s discretion are associated with in-hospital mortality across ESI levels in admitted ED patients.

Methods: This study is a secondary analysis of prospectively collected data from adult patients presenting to the ED of a Swiss tertiary care center in 2013, 2015, 2017, and 2019. The study included admitted patients who underwent post-triage lactate measurement at the treating physician’s discretion. Only the first lactate value measured in the ED was analyzed and categorized as < 2.0, 2.0–3.9, and ≥ 4.0 mmol/L. The primary outcome was in-hospital mortality; secondary outcomes were 30-day mortality and intensive care unit...

From Stress to Strength: Fostering a Positive Learning Climate to Promote Learning, Performance, and Well-Being

Fri, 21 Aug 2026 00:00:00 +0000

From Stress to Strength: Fostering a Positive Learning Climate to Promote Learning, Performance, and Well-Being

From AUC to Action: AI Sepsis Alerts as Quality Improvement Tools in the Emergency Department

Fri, 21 Aug 2026 00:00:00 +0000

From AUC to Action: AI Sepsis Alerts as Quality Improvement Tools in the Emergency Department

Climate Change and Heat-related Illness in Older Adults: Implications for Emergency Medicine

Mon, 17 Aug 2026 00:00:00 +0000

Climate change is increasing the frequency, duration, and intensity of extreme heat events, creating a growing public health threat for older adults. Age-related physiologic decline, comorbid chronic diseases, polypharmacy, and social vulnerability all contribute to reduced heat tolerance and higher rates of heat-related morbidity and mortality. Emergency departments (ED) are increasingly encountering older adults presenting with minor heat illness, heat stroke, and exacerbations of chronic illnesses triggered by heat exposure. This review synthesizes current evidence describing why older adults are disproportionately affected by extreme heat, highlights key social and environmental determinants of vulnerability, and outlines clinical and public health strategies that emergency clinicians and EDs can assist with to reduce risk. As global temperatures rise, proactive prevention, early recognition, and coordinated community interventions are essential to protect this high-risk...

Emergency Department Evaluation and Care of Hepatic Encephalopathy: ACEP Expert Panel Recommendations

Mon, 17 Aug 2026 00:00:00 +0000

Introduction: Patients with hepatic encephalopathy frequently visit the emergency department, and these visits are expected to rise in the coming years due to an increased prevalence of liver disease in the United States. Accordingly, we sought to define a comprehensive and efficient approach for emergency physicians to evaluate, treat, and determine the optimal disposition of patients presenting with possible or confirmed hepatic encephalopathy and its complications.

Methods: We reached consensus recommendations through a structured literature review and a modified Delphi technique, informing an expert panel of academic and community emergency physicians convened by the American College of Emergency Physicians.

Results: We created the assess, look, treat, evaluate risk, reassess, disposition (ALTERD) framework as a digital point-of-care tool to support clinicians in guiding key bedside steps involved in the diagnosis...

Retrograde Intubation in a Severe Fixed Spinal Deformity: A Case Report