Porter M, Biel A, Turner-Lawrence D
… +4 more, Farhy E, Khalil L, Xing Y, Todd B
Am J Emerg Med
· 2026 Sep · PMID 42167131
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BACKGROUND: Clinician misidentification is a significant issue in the Emergency Department (ED), and improving patients' understanding of care team roles is critical for clear communication and effective patient care. We...BACKGROUND: Clinician misidentification is a significant issue in the Emergency Department (ED), and improving patients' understanding of care team roles is critical for clear communication and effective patient care. We aimed to measure clinician role misidentification rates in the ED and test if an educational intervention could improve patient identification, while exploring associations with patient and clinician characteristics. METHODS: This prospective controlled trial included 145 ED patients (70 control, 75 intervention). The intervention group received an educational sheet presenting clinician headshots with role descriptions. Participants were asked to identify one of their providers. Patient and clinician characteristics were recorded. The primary outcome was accuracy of clinician role identification. Secondary outcomes included changes after the intervention and associations with characteristics. Multivariable logistic regression was performed adjusting for patient age, gender, education level, and provider mask use. RESULTS: A total of 145 encounters were analyzed (67 attending, 39 resident, 39 advanced practice providers). At baseline, 28 of 70 patients (40.0%) correctly identified clinician roles. The intervention improved correct identification to 48 of 75 patients (64.0%) compared to 40.0% in controls (p = 0.005). On multivariable analysis, the intervention remained independently associated with higher odds of correct identification (aOR 6.00, 95% CI 2.31-16.80; p < 0.001). Improved identification was associated with patient age, race, and education level, along with clinician age, role, and mask use. CONCLUSION: Misidentification of ED clinician roles is influenced by patient and clinician characteristics. Our intervention significantly improved role identification and may help reduce misidentification in the ED.
Am J Emerg Med
· 2026 Sep · PMID 42155329
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BACKGROUND: Ultrasound phantoms, designed to mimic human tissue and anatomy, are important tools for training physicians. Commercial phantoms are expensive leading to the creation of do-it-yourself (DIY) phantoms. This s...BACKGROUND: Ultrasound phantoms, designed to mimic human tissue and anatomy, are important tools for training physicians. Commercial phantoms are expensive leading to the creation of do-it-yourself (DIY) phantoms. This study evaluates DIY fascia iliaca (FI) block phantoms made from different mediums compared to a commercial grade trainer to determine the best phantom material in terms of image quality, anatomical accuracy, and durability. METHODS: FI block phantoms were created using latex tubing to mimic vessels, bungee cord for nerve, and ballistics gel for muscle and fascia layers. Five mediums (agar, gelatin, konnyaku jelly, Dragon Skin™ silicone rubber, and ballistics gel) were poured over and between block components to create five different phantoms. Participants scanned each phantom and a commercial femoral trainer rating each on a five-point Likert scale. RESULTS: Two medical students and 17 emergency medicine residents participated. The gelatin phantom ranked the highest (median = 5) in all categories except durability (median = 4, IQR 3-5) and outperformed the commercial trainer in image quality, anatomic accuracy and overall impression. The agar model performed similarly to the commercial trainer (median = 4, p < 0.01) in all categories except durability (median = 3, IQR 3-4). The other mediums underperformed compared to the commercial trainer. The gelatin phantom was the top choice, favored by 79% of participants. CONCLUSIONS: DIY FI block phantoms are easily made and outperform commercial trainers in image quality and anatomic accuracy. DIY phantoms have the advantage of including more block specific landmarks and costing a fraction of the price of commercial trainers.
Am J Emerg Med
· 2026 Sep · PMID 42139773
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PURPOSE: Understanding the nature and scope of fatal and nonfatal firearm injury in Texas is a necessary precursor to preventing firearm injuries statewide, however, Texas is frequently excluded from firearm injury resea...PURPOSE: Understanding the nature and scope of fatal and nonfatal firearm injury in Texas is a necessary precursor to preventing firearm injuries statewide, however, Texas is frequently excluded from firearm injury research due to limitations in commonly used data sources. METHODS: Outcomes of interest were (1) emergency department (ED) utilization for firearm injuries and (2) associated charges in Texas 2016-2022. For both outcomes, this study examined longitudinal trends by patient demographics, payer, admission status, and county characteristics; and generated estimates for the association with county firearm ownership tercile. All Texas ED visits 2016-2022 (regardless of patient survival) with at least one salient ICD-10 external cause code (W32-W33, X72-X74, X93-X95, Y22-Y24, Y35) were compiled. Longitudinal associations were estimated using time series negative binomial regressions, with Poisson models for robustness. RESULTS: Overall firearm injury ED utilization remained stable; however, injury severity may have increased, as the proportion of visits resulting in hospital admission rose and average total charges more than doubled in Texas 2016-2022. Each increase in county firearm ownership tercile was associated with more than a 10% increase in expected firearm injury ED visits. CONCLUSION: Firearm injuries are a growing health and fiscal burden for Texas patients and taxpayers.
Am J Emerg Med
· 2026 Sep · PMID 42139772
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BACKGROUND: HPV testing is an effective method of cervical cancer screening (CCS) for eligible individuals. Self-collection of specimens for HPV testing on-site at a healthcare facility received FDA approval in 2024 and...BACKGROUND: HPV testing is an effective method of cervical cancer screening (CCS) for eligible individuals. Self-collection of specimens for HPV testing on-site at a healthcare facility received FDA approval in 2024 and has been shown to increase participation in CCS among under-screened populations. OBJECTIVE: To determine the feasibility and rate of participation with HPV self-collection for CCS among eligible emergency department (ED) patients. METHODS: We conducted a prospective, interventional, single-arm trial of participants enrolled from an urban, academic ED (N = 200). Eligible participants were age 25-65 and in need of CCS based on American Cancer Society recommendations. Participants were offered the opportunity to self-collect for HPV testing during their ED visit. The primary outcome was participation in CCS via successful in-ED self-collection for HPV testing. RESULTS: Among the 200 ED patients included, 83% agreed to participate in HPV self-collection and 78.5% completed HPV self-collection. Less than 2% of self-collected specimens were deemed by the laboratory to be inadequate for testing. A total of 15.9% of HPV tests were positive for one or more high-risk HPV genotypes. CONCLUSION: This study demonstrates that ED-based HPV self-collection is operationally feasible and highly acceptable among ED patients in need of CCS. Nearly all self-collected specimens were adequate for laboratory processing.
Mondle J, De Leon A, Stryckman B
… +1 more, Wilkerson RG
Am J Emerg Med
· 2026 Sep · PMID 42139771
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BACKGROUND: Take-home naloxone distribution is a key harm-reduction strategy in emergency departments and community programs to prevent opioid overdose deaths. Intranasal naloxone is commonly provided as either single-st...BACKGROUND: Take-home naloxone distribution is a key harm-reduction strategy in emergency departments and community programs to prevent opioid overdose deaths. Intranasal naloxone is commonly provided as either single-step devices or multi-step kits requiring assembly. Device complexity may influence the effectiveness of take-home naloxone programs, particularly among lay responders without prior training, yet usability among individuals most likely to witness or experience overdose is not well characterized. METHODS: We conducted a randomized usability study in an urban emergency department. Participants without prior naloxone training were randomized to administer naloxone using either a commercially manufactured single-step intranasal device or an improvised multi-step kit during a standardized simulated overdose scenario designed to assess first use usability. The primary outcome was successful completion of predefined critical steps; secondary outcomes included time to administration and participant-reported usability. RESULTS: Forty participants were enrolled (20 per group). During the pre-education simulation, successful completion of all critical steps occurred in 17/20 (85%) participants assigned to the single-step device compared to 4/20 (20%) assigned to the multi-step device (risk difference 65 percentage points; 95% CI 42-83; p < .001). Median time to successful administration was shorter with the single-step device (30 s [IQR 24-38] vs 58 s [45-75]; p < .001). Following a brief structured educational intervention, success rates improved and no longer differed significantly (100% vs 90%; p = .29), although administration time remained shorter with the single-step device (22 s [18-29] vs 35 s [28-47]; p = .002). CONCLUSION: In this simulated overdose scenario among at-risk individuals, a single-step intranasal naloxone device produced higher first attempt success rates and faster administration than an improvised multi-step kit. Although brief structured education substantially improved performance with the multi-step device, administration times remained shorter with the single-step device. These findings suggest that device complexity may influence the real-world effectiveness of emergency department and community naloxone distribution programs, particularly when structured training is not consistently available.
Am J Emerg Med
· 2026 Sep · PMID 42134097
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Hypertension is a major modifiable risk factor for cardiovascular disease. Asymptomatic hypertension is a common presenting chief concern and incidentally noted vital sign abnormality in the emergency department. Elevate...Hypertension is a major modifiable risk factor for cardiovascular disease. Asymptomatic hypertension is a common presenting chief concern and incidentally noted vital sign abnormality in the emergency department. Elevated blood pressure readings in the ED may be inappropriately attributed to pain, or other factors. Although there are clear dangers of rapidly lowering blood pressure in patients with asymptomatic hypertension, recent literature demonstrates the potential benefits associated with prescriptions for antihypertensive medications at the time of emergency department discharge. This article reviews relevant literature and clinical policy statements regarding diagnosis and treatment of asymptomatic hypertension in the ED and highlights clinically useful information for emergency physicians from recently published guidelines regarding best practices in the care of patients with hypertensive disorders.
Am J Emerg Med
· 2026 Sep · PMID 42127879
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Community-acquired pneumonia (CAP) is a common condition evaluated and managed in the emergency department (ED) setting. Guidelines published in 2007 and 2019 from the American Thoracic Society (ATS) and Infectious Disea...Community-acquired pneumonia (CAP) is a common condition evaluated and managed in the emergency department (ED) setting. Guidelines published in 2007 and 2019 from the American Thoracic Society (ATS) and Infectious Diseases Society of America provide recommendations for CAP, but there are a variety of studies that have been published since the release of these guidelines. The ATS published updated guidelines in 2025, which discuss imaging, antibiotic therapy, and corticosteroids. The updated guidelines support the use of lung ultrasound for diagnosis of CAP when used by experienced clinicians. For patients with CAP and positive viral testing who are otherwise healthy, the 2025 guidelines suggest not prescribing antibiotics based on very low-quality evidence, though there are several factors that should be considered (e.g., imaging findings). Antibiotics should be administered in those with comorbidities or admitted patients, as well as those with imaging findings consistent with pneumonia. Duration of antibiotic therapy less than 5 days (minimum 3 days) in outpatients and admitted patients with nonsevere CAP who reach clinical stability is recommended, rather than ≥5 days of therapy. In patients admitted with severe CAP, the guideline recommend 5 or more days of antibiotics. Corticosteroids may be used in patients with severe CAP, but the guidelines recommend against their use in nonsevere pneumonia. This review summarizes the 2025 guideline recommendations with an emphasis on their impact on emergency medicine.
Am J Emerg Med
· 2026 Sep · PMID 42127878
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OBJECTIVES: To evaluate the prognostic role of initial band percentages in adults presenting to the emergency department (ED) with bacteremia. METHODS: This 8-year retrospective cohort study included treatment-naïve adul...OBJECTIVES: To evaluate the prognostic role of initial band percentages in adults presenting to the emergency department (ED) with bacteremia. METHODS: This 8-year retrospective cohort study included treatment-naïve adults with bacteremia who underwent a manual differential hemogram. The primary outcome was 30-day mortality after ED arrival. The association between initial band percentages and mortality was analyzed using a logistic regression model adjusted for independent prognostic factors. RESULTS: Of the total 5558 patients, patients were stratified into five groups by the initial percentage of band cells (neutrophils): 0%-10% (3358 patients), 10%-19% (849), 20%-29% (618), 30%-39% (347), and ≥ 40% (386). The groups varied significantly in terms of clinicodemographic characteristics, bacteremia profiles, and mortality rates at 3, 15, and 30 days. Overall, each 10% increase in the initial band percentage was independently associated with an average 12% increase in 30-day mortality rates. The positive association between initial band percentages and 30-day mortality rates remained consistent across predefined patient subgroups. CONCLUSIONS: A higher initial percentage of band cells is independently associated with a higher risk of short-term mortality in adults presenting to the ED with bacteremia.
Am J Emerg Med
· 2026 Sep · PMID 42119277
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Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide, with a survival to discharge rate of less than 20% in most communities. The "chain of survival" framework has served as the foundation of OHCA...Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide, with a survival to discharge rate of less than 20% in most communities. The "chain of survival" framework has served as the foundation of OHCA care for decades. This framework emphasizes early recognition, prompt bystander cardiopulmonary resuscitation (CPR), and rapid defibrillation as critical determinants of outcomes. Despite expanded CPR training initiatives and increasing automated external defibrillator (AED) use, bystander intervention remains infrequent, reflecting persistent gaps between training, device availability, and real-world action. Barriers to action include unequal access to CPR training across socioeconomic, age, and racial groups, social and gender-related hesitations, fear of harm or legal liability, and limited awareness or accessibility of AEDs. Although bystander AED use markedly improves survival to hospital discharge, it is applied in only a small fraction of public OHCA cases, emphasizing a persistent gap between effectiveness and utilization. Emerging strategies such as volunteer responder networks, GIS-guided AED placement, connected device registries, video-assisted telecommunicator CPR, and automated cardiac arrest detection are promising initiatives but require further evaluation and equitable implementation. Bridging the gap between training, access, and action through community-centered and system-level approaches is essential to improving OHCA outcomes. This narrative review synthesizes barriers to effective bystander response and examines emerging strategies to bridge the gap between training, access, and action to improve OHCA outcomes.
Am J Emerg Med
· 2026 Sep · PMID 42119276
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Seizures are a common reason for emergency medical service (EMS) activation. Among various etiologies, hypoglycemia is relatively rare in prehospital settings, and blood glucose measurements at symptom onset are often un...Seizures are a common reason for emergency medical service (EMS) activation. Among various etiologies, hypoglycemia is relatively rare in prehospital settings, and blood glucose measurements at symptom onset are often unavailable. Continuous glucose monitoring (CGM) devices synchronized with smartphone applications can provide real-time or retrospective glucose data, potentially supporting prehospital clinical assessment. This case report describes a 37-year-old man with type 1 diabetes mellitus who experienced a generalized tonic-clonic seizure while shopping with his seven-year-old son. Using a smartphone application linked to the patient's CGM device, the child identified a critically low glucose level at seizure onset. Based on this information, emergency medical services were promptly contacted. Upon EMS arrival, the seizure had resolved; however, the patient remained mildly agitated. Oral carbohydrate was administered, and subsequent point-of-care testing showed improvement in blood glucose levels. On arrival at the emergency department, no focal neurological deficits were observed. Clinical findings, together with CGM data, supported a diagnosis of hypoglycemia-induced seizure. This case highlights two important aspects of both prehospital care and emergency settings. First, smartphone applications linked to CGM devices can provide valuable information regarding glucose trends during transient neurological events. Second, such applications can be effectively used even by individuals without medical training, including children, to recognize abnormal glucose patterns and facilitate appropriate emergency response. Awareness of this novel use of CGM technology may help both prehospital and hospital-based providers better interpret prehospital information.
Am J Emerg Med
· 2026 Aug · PMID 42119226
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Nausea and vomiting in pregnancy is a common affliction, especially in the early trimesters. This is typically managed at home with doxylamine-pralidoxime or other home remedies. Many women, however, require additional a...Nausea and vomiting in pregnancy is a common affliction, especially in the early trimesters. This is typically managed at home with doxylamine-pralidoxime or other home remedies. Many women, however, require additional adjuncts to control their symptoms. In this case we present a G2P0 female at 7 weeks gestation who arrived in the emergency department with persistent vomiting for several days. This patient already had a home medication regimen of multiple antiemetics. Additional treatment with ondansetron, prochlorperazine, and metoclopramide via IV administration as well as fluid administration resulted in minimal improvement in her symptoms in the emergency department. After stepwise escalation of antiemetic therapy and fluid resuscitation failed to provide relief, droperidol administration resulted in the rapid and complete resolution of her symptoms. This allowed for a safe discharge rather than admission for hyperemesis gravidarum. This case highlights the utility of droperidol as a rescue antiemetic in pregnancy when conventional therapies prove to be ineffective. This adds to the evidence supporting consideration of droperidol for refractory cases of nausea and vomiting and hyperemesis gravidarum in pregnancy. The purpose of this case report is to describe the safety and efficacy of droperidol in the treatment in refractory nausea and vomiting in pregnancy.
Am J Emerg Med
· 2026 Aug · PMID 42119225
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Although uncommon, scurvy can still occur in developed contries and can cause substantial morbidity and be life threatening if untreated. An impoverished 68-year-old woman with a low intake of fruit and vegetables presen...Although uncommon, scurvy can still occur in developed contries and can cause substantial morbidity and be life threatening if untreated. An impoverished 68-year-old woman with a low intake of fruit and vegetables presented with weakness and painful purpura on both legs, having experienced a similar episode 3 years previously. Laboratory tests revealed anemia, coagulopathy, a low folic acid concentration, and serum vitamin C concentration below the limit of detection. She was admitted and treated with transfusions of packed red blood cells and fresh frozen plasma owing to the coagulopathy, and vitamin C and folic acid were administered to correct the micronutrient deficiencies. Her clinical condition improved within a few days, and she was discharged ambulatory on hospital day 14. Clinicians should maintain a high index of suspicion for scurvy in patients with unexplained purpura and social risk factors.
Rice DR, Pallaci MJ, Weinstock MB
… +6 more, Cray SS, Foster KM, Oskvarek JJ, Bedolla JJ, Aldeen AZ, Pines JM
Am J Emerg Med
· 2026 Aug · PMID 42114386
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OBJECTIVE: We describe the prevalence of seven life-threatening diagnoses in Emergency Department (ED) patients with chest pain in a national ED group. METHODS: Using data from 141 EDs staffed by US Acute Care Solutions...OBJECTIVE: We describe the prevalence of seven life-threatening diagnoses in Emergency Department (ED) patients with chest pain in a national ED group. METHODS: Using data from 141 EDs staffed by US Acute Care Solutions (USACS) from January 2021 to December 2024 in 17 U.S. states, we used descriptive statistics to tabulate prevalences of seven life-threatening conditions in ED patients with atraumatic chest pain: acute coronary syndrome (ACS), pulmonary embolism (PE), pneumothorax, thoracic aortic dissection (TAD), esophageal rupture, pericardial tamponade, and ruptured aortic aneurysm. We used logistic regression to estimate the association between ACS, PE, or any life-threatening diagnosis with ED visit and site characteristics. RESULTS: In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs. CONCLUSION: Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.
Am J Emerg Med
· 2026 Aug · PMID 42114385
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INTRODUCTION: Rib fractures are common in blunt chest trauma and are associated with significant morbidity. Although increasing rib fracture count has been linked to worse outcomes, a clear and clinically applicable thre...INTRODUCTION: Rib fractures are common in blunt chest trauma and are associated with significant morbidity. Although increasing rib fracture count has been linked to worse outcomes, a clear and clinically applicable threshold for complication risk remains uncertain. This study aimed to evaluate the predictive value of rib fracture burden in patients with isolated blunt chest trauma and to identify a clinically meaningful cut-off. METHODS: This retrospective observational study included adult patients with isolated blunt chest trauma presenting between January 2021 and December 2025 at a tertiary care center. Patients with radiologically confirmed rib fractures were analyzed. The primary outcome was the development of thoracic complications. Multivariable logistic regression was performed to identify factors independently associated with complications. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value of rib fracture count. RESULTS: A total of 184 patients were included. The median number of rib fractures was 3.0 (IQR: 2.0-4.0). Complications were significantly associated with a higher number of rib fractures (median 4 vs 2, p < 0.001). In multivariable analysis, age (OR = 1.07, 95% CI: 1.03-1.12), rib fracture count (OR = 33.23, 95% CI: 11.13-99.18), and displaced fractures (OR = 161.48, 95% CI: 21.24-1227.78) were independently associated with complications. ROC analysis demonstrated strong predictive performance (AUC = 0.872, 95% CI: 0.814-0.920). The optimal threshold was ≥4 rib fractures, with 65% sensitivity and 98% specificity. CONCLUSION: Rib fracture count is strongly associated with complications in isolated blunt chest trauma. A threshold of ≥4 rib fractures may provide a simple and clinically useful tool for early risk stratification.