The Journal Of Emergency Medicine[JOURNAL]
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200 papers
Mechanical Versus Manual Cardiopulmonary Resuscitation Causing Traumatic Cardiothoracic and Abdominal Injuries: A Meta-Analysis and Systematic Review of Randomized Trials.
El-Tahlawy Y, Mamum MA, Lubbad O … +3 more , Mahmood WU, Khera G, Sajid MS
J Emerg Med · 2026 May · PMID 42401171 · Publisher ↗
BACKGROUND: Mechanical cardiopulmonary resuscitation (CPR) devices are increasingly used during cardiac arrest to provide consistent chest compressions; however, concerns persist regarding their potential to cause trauma...
BACKGROUND: Mechanical cardiopulmonary resuscitation (CPR) devices are increasingly used during cardiac arrest to provide consistent chest compressions; however, concerns persist regarding their potential to cause traumatic injuries compared with manual CPR. OBJECTIVES: To compare the cardiothoracic and abdominal injuries caused by mechanical versus manual CPR. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. MEDLINE, EMBASE, PubMed, and the Cochrane Library were searched up to October 2025 for randomized controlled trials (RCTs) comparing mechanical with manual CPR in adults. Injury outcomes were grouped into clinically relevant categories and analyzed using Review Manager 5.4 with a random-effects model. RESULTS: Ten RCTs were included. There was no statistically significant difference between mechanical and manual CPR for liver injuries (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 0.47-5.31, Z = 0.75, p = 0.46), rib and sternal fractures (OR 0.99, 95% CI 0.57-1.71; Z = 0.05, p = 0.96), thoracic or pleural injuries (OR: 0.97, 95% CI: 0.80-1.19, Z = 0.28, p = 0.78), or vascular and hemorrhagic complications (OR: 1.02, 95% CI: 0.20-5.13, Z = 0.02, p = 0.98). Subgroup analysis showed no difference for rib fractures or sternal fractures individually. CONCLUSION: Across all pooled injury categories, mechanical CPR did not demonstrate a significantly different injury profile to manual CPR; however, the low to very low certainty of evidence and absence of any low risk of bias trials mean these findings should be interpreted with caution and do not confirm safety equivalence.
Drip-and-Ship versus Mothership Model in Acute Ischemic Stroke: A Meta-Analysis Stratified by Stroke System Integration.
Martins GS, de Santana Lima OG, Oliveira HP … +6 more , do Nascimento LR, de Oliveira Junior T, Günkan A, Ferreira MY, Bocanegra-Becerra JE, Serulle Y
J Emerg Med · 2026 May · PMID 42398230 · Publisher ↗
BACKGROUND: Although the mothership transport (MS) model (direct transport to a thrombectomy-capable center) has been associated with improved functional outcomes compared with the drip-and-ship (DS) model (initial trans...
BACKGROUND: Although the mothership transport (MS) model (direct transport to a thrombectomy-capable center) has been associated with improved functional outcomes compared with the drip-and-ship (DS) model (initial transport to a local center for thrombolysis followed by transfer) in acute ischemic stroke, the influence of stroke system integration on these outcomes remains unclear. OBJECTIVE: To compare clinical outcomes between DS and MS models and assess the impact of system integration. METHODS: This systematic review and meta-analysis involved a search of PubMed, Embase, and Cochrane (from inception up to March 2026) for studies comparing DS and MS in acute ischemic stroke. Inclusion required reporting of 90-day functional outcomes. Outcomes included the modified Rankin Scale (mRS), recanalization, hemorrhage, and mortality. Data were pooled using random-effects models, with analyses stratified by stroke system integration level. RESULTS: Thirty-seven studies encompassing 21,644 patients (mean age 70.1 (DS) and 70.7 (MS)) were included. MS was associated with significantly shorter symptom onset-to-recanalization times (251.0 ± 111.0 vs. 347.0 ± 128.0 minutes). MS patients had higher rates of functional independence (mRS, 0-2; OR, 0.78; 95% CI: 0.70-0.86) and lower rates of poor outcomes (mRS, 3-6; OR, 1.30; 95% CI: 1.17-1.45). No significant differences were found for successful recanalization, rates of symptomatic intracranial hemorrhage, or mortality. Stratified analyses showed no significant interaction between transport model outcomes and the level of system integration. CONCLUSIONS: The MS model provides shorter treatment times and superior functional outcomes compared to DS, regardless of stroke system integration level. Rates of recanalization, hemorrhage, and mortality were similar between models.
Response to: "Letter to the Editor Regarding Cervical Spine Clearance in Adult and Pediatric Trauma: A Systematic Review".
de Oliveira Manduca Palmiero H, Gadelha Figueiredo E
J Emerg Med · 2026 May · PMID 42392905 · Publisher ↗
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Ultrasound Characterization of the Distal Thigh Great Saphenous Vein Dimensions in Children and Adults: Implications for Peripheral Rescue Access.
Saadi Neto E, John-Pierce K, Khapov I … +3 more , Maldonado G, Shiue LT, Kummer T
J Emerg Med · 2026 May · PMID 42391823 · Publisher ↗
BACKGROUND: Peripheral intravenous (PIV) cannulation is the most common in-hospital procedure. In patients with difficult access, standard upper-extremity veins may be unsuitable, and alternative access sites need to be...
BACKGROUND: Peripheral intravenous (PIV) cannulation is the most common in-hospital procedure. In patients with difficult access, standard upper-extremity veins may be unsuitable, and alternative access sites need to be sought. The great saphenous vein (GSV) at the level of the distal medial thigh has been proposed as a potential alternative site for rescue access. Yet, the feasibility and reliability of targeting this site remain underexplored. OBJECTIVE: To assess the feasibility of ultrasound visualization and measurement of the GSV in the distal medial thigh as a reliable target for rescue PIV access. METHODS: This prospective, cross-sectional study enrolled 166 pediatric and adult emergency department participants at a tertiary academic medical center. The GSV was evaluated bilaterally using high-frequency linear ultrasound. Depth and diameter measurements were recorded at proximal, medial, and distal sites. Detection rates and vessel characteristics were compared across age, sex, comorbidity status, and history of difficult IV access. RESULTS: The GSV was visualized in ≥95% of participants across all thigh regions. Median depth was greatest proximally (11.7 mm) and shortest distally (9.9 mm), while median diameter was largest proximally (3.0 mm) and smallest distally (2.8 mm). Visualization was consistent across age groups, sex, and history of difficult IV access. CONCLUSION: The distal medial thigh GSV can be reliably visualized using ultrasound across pediatric and adult populations, including those with prior difficult intravenous access. Its consistent visualization and favorable anatomical characteristics support its potential as a rescue site for ultrasound-guided peripheral venous access in the emergency department.
A Shadow in the Right Ventricle.
Lin LZ, Lin FY, Chen CW
J Emerg Med · 2026 Apr · PMID 42391822 · Publisher ↗
BACKGROUND: Intracardiac cement embolism (ICE) is a rare but potentially lethal complication of percutaneous vertebroplasty (PVP), often misdiagnosed as conventional thrombotic pulmonary embolism (PE) due to similar clin...
BACKGROUND: Intracardiac cement embolism (ICE) is a rare but potentially lethal complication of percutaneous vertebroplasty (PVP), often misdiagnosed as conventional thrombotic pulmonary embolism (PE) due to similar clinical presentations and elevated D-dimer levels. CASE REPORT: A 65-year-old woman presented to the emergency department with chest tightness and dyspnea 15 days after undergoing multilevel PVP. Initial D-dimer elevation suggested acute PE. However, point-of-care ultrasound (POCUS) revealed a linear hyperechoic structure with dense posterior acoustic shadowing in the right ventricle, distinguishing it from a soft thrombus. A chest CT confirmed bone cement embolism. The patient underwent successful surgical embolectomy and was discharged without complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ICE must be considered in patients presenting with cardiopulmonary symptoms following spinal interventions. Unlike thrombotic PE, ICE carries unique risks, such as cardiac perforation, and often requires surgical or endovascular retrieval rather than standard anticoagulation. CONCLUSION: POCUS is a rapid and critical bedside tool for identifying mineralized foreign bodies like bone cement, facilitating prompt and appropriate management in the emergency department.
Structural Determinants of Telehealth Use Among Patients Presenting to an Urban Safety-Net Emergency Department.
Corbo J, Kabir F, Alcaraz G … +1 more , Miah S
J Emerg Med · 2026 May · PMID 42385350 · Publisher ↗
BACKGROUND: Telehealth expanded rapidly during and after the COVID-19 era. However, adoption remains uneven in safety-net populations, where structural barriers may limit use and worsen disparities. OBJECTIVE: To identif...
BACKGROUND: Telehealth expanded rapidly during and after the COVID-19 era. However, adoption remains uneven in safety-net populations, where structural barriers may limit use and worsen disparities. OBJECTIVE: To identify structural and healthcare access factors associated with telehealth use among adults presenting to an urban safety-net emergency department (ED) and evaluate whether telehealth use was associated with ED utilization. METHODS: We conducted a cross-sectional survey of adults presenting to an urban safety-net ED in the Bronx, New York, between July and November 2025. The survey assessed prior telehealth use, primary care provider (PCP) status, home internet access, technology comfort, and ED visit frequency. Multivariable logistic regression identified factors associated with telehealth use. Adjusted Poisson regression assessed associations with ED visit frequency. RESULTS: Of 326 patients screened, 301 completed the survey (92% response rate). The median age was 45.5 years (IQR 34-61), 52.8% were female, and 42.9% reported prior telehealth use. In adjusted analyses, no primary care provider (aOR 0.32, 95% CI 0.18-0.58), no home internet access (aOR 0.33, 95% CI 0.12-0.88), and male sex (aOR 0.42, 95% CI 0.25-0.70) were independently associated with lower telehealth use. Age, race/ethnicity, Medicaid insurance, and technology comfort were not associated with telehealth use. Prior telehealth use was not associated with ED visit frequency (aIRR 1.05, 95% CI 0.92-1.20). CONCLUSIONS: Telehealth use in this safety-net ED population was driven by primary care linkage and internet access. Efforts to promote equitable telehealth adoption should prioritize improvements in primary care access and digital connectivity.
Comparison of Over-the-Head and Standard Lateral Cardiopulmonary Resuscitation: A Prospective Crossover Simulation Study.
Koca Y, Bozan Ö, Ferhatlar ME … +2 more , Doğruyol S, Kalkan A
J Emerg Med · 2026 May · PMID 42379131 · Publisher ↗
BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) is fundamental to survival. Standard training emphasizes the lateral position, but confined spaces (e.g., airplane aisles, ambulances, narrow hallways) often n...
BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) is fundamental to survival. Standard training emphasizes the lateral position, but confined spaces (e.g., airplane aisles, ambulances, narrow hallways) often necessitate the over-the-head (OTH) technique. The effect of this position on compression biomechanics remains unclear. STUDY OBJECTIVES: To compare OTH and standard lateral CPR techniques in a manikin simulation regarding the quality of chest compression and rescuer fatigue. METHODS: This prospective, crossover simulation study included 45 experienced health care professionals. Participants performed 2 min of continuous chest compressions in both lateral and OTH positions, separated by a 24-h washout period. Compression depth, rate, and fraction were recorded using a CPR feedback-capable defibrillator, with real-time audiovisual feedback disabled during data collection. Fatigue was assessed using a numeric rating scale. RESULTS: A total of 41 participants completed the protocol. The mean compression rate (121.7 vs. 120.5/min, p = 0.306) and mean depth (49.5 vs. 49.5 mm, p = 0.897) were similar between the OTH and lateral positions, indicating comparable average depth adequacy. However, reflecting lower consistency, the percentage of compressions within the target depth range (50-60 mm) was considerably lower in the OTH position (35.2% vs. 49.4%, p = 0.027). Self-reported fatigue scores did not differ considerably (2.5 vs. 2.8, p = 0.132). CONCLUSION: Although OTH CPR achieved a similar average depth and rate to the lateral position, it resulted in a lower proportion of compressions within the optimal depth range. Therefore, OTH CPR seems to be a feasible situational alternative in confined environments when lateral access is limited. Dedicated training may be needed to optimize depth in the OTH position. © 2026 Elsevier Inc.
Time-Critical Diagnosis of Pediatric Testicular Torsion in a Tertiary Pediatric Emergency Setting: Integrating Clinical Predictors With Selective Doppler Ultrasound.
Zouari M, Belhajmansour M, Hbaieb M … +4 more , Laadhar M, Issaoui A, Dhaou MB, Mhiri R
J Emerg Med · 2026 May · PMID 42379130 · Publisher ↗
BACKGROUND: Acute scrotum is a frequent pediatric emergency encompassing a heterogeneous spectrum of conditions, among which testicular torsion (TT) represents the most time-critical diagnosis. OBJECTIVES: The aim of thi...
BACKGROUND: Acute scrotum is a frequent pediatric emergency encompassing a heterogeneous spectrum of conditions, among which testicular torsion (TT) represents the most time-critical diagnosis. OBJECTIVES: The aim of this study was to evaluate the diagnostic performance of clinical predictors and ultrasound in children presenting with acute scrotum, and to identify factors associated with TT. METHODS: We conducted a prospective observational cohort study including consecutive children presenting with non-traumatic acute scrotum between January 2022 and December 2025 at a tertiary pediatric surgical center. RESULTS: During the 4-year study period, 189 children were prospectively enrolled. The median age was 11 years. Testicular torsion was confirmed in 41 patients. Scrotal Doppler ultrasound was performed in 72 patients (38.1%) with an overall accuracy of 94%. The accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score was 82%. On multivariable analysis, three independent predictors of TT were identified: pain duration < 24 h (OR = 19.251, 95% CI 5.355-69.210, p < 0.001), TWIST score ≥ 3 (OR = 35.987, 95% CI 2.49-370.7, p < 0.001), and scrotal erythema (OR = 6.277, 95% CI 1.572-25.061, p = 0.009). CONCLUSIONS: In pediatric acute scrotum, scrotal Doppler ultrasound demonstrates excellent diagnostic accuracy when performed, while structured clinical assessment remains crucial for early risk stratification and time-critical decision-making. These findings support an integrated, probability-based diagnostic approach in which clinical predictors guide the selective and timely use of ultrasound, without delaying surgical exploration.
The Role of Radiological Imaging in Pediatric Nasal Fractures: Too Much, Too Often?
Trenta I, Rossi FP, Crea F … +6 more , Lambiase C, Leccese B, Tripodi F, Sitzia E, Magistrelli A, Marchesani S
J Emerg Med · 2026 May · PMID 42372418 · Publisher ↗
BACKGROUND: Nasal fractures are the most common facial fractures in the pediatric population. Imaging is usually not necessary for isolated nasal trauma, but nasal X-ray and facial computed tomography (CT) are still freq...
BACKGROUND: Nasal fractures are the most common facial fractures in the pediatric population. Imaging is usually not necessary for isolated nasal trauma, but nasal X-ray and facial computed tomography (CT) are still frequently performed. OBJECTIVES: The aim of this study is to evaluate the appropriateness of radiological imaging in the management of nasal fractures. METHODS: We collected data on patients with a history of nasal trauma who underwent radiological imaging (X-ray or facial CT) from the electronic medical records of our hospital over a 3-year period. RESULTS: We analyzed data from 534 patients who were admitted to our Emergency Department for nasal trauma and underwent radiological imaging (38% female, 62% male, median age 8.5 years, range 1-17 years). 293 patients (55%) underwent nasal X-ray, and 344 patients underwent facial CT (64%). For 302 patients (56%) a nasal fracture was identified on X-ray or CT and 18% of patients underwent surgery. For all patients who required nasal surgery, a facial CT was performed. Facial CT scans detected a nasal fracture more frequently than a nasal X-ray (74% vs. 43% p-value 0.00001). Patients who underwent surgery were more often male and more frequently presented with epistaxis at onset. CONCLUSIONS: Our data confirmed that nasal X-rays may be of limited use after facial trauma. Furthermore, we highlighted that radiological imaging for nasal trauma could potentially be reduced given that a substantial number of patients underwent nasal X-ray or facial CT without presenting a nasal fracture or requiring surgical intervention.
Paid Time Off Pressure in Emergency Medicine: Vacation Conflict Risk in the Context of Group Size, and Shift Coverage.
Sebro R
J Emerg Med · 2026 Jun · PMID 42361787 · Publisher ↗
BACKGROUND: Emergency departments (EDs) are confronting steadily rising patient visit volumes, ongoing workforce shortages, and the continuous requirement for uninterrupted 24/7/365 coverage. These pressures create subst...
BACKGROUND: Emergency departments (EDs) are confronting steadily rising patient visit volumes, ongoing workforce shortages, and the continuous requirement for uninterrupted 24/7/365 coverage. These pressures create substantial tension between maintaining operational efficiency and supporting physician work-life balance, with paid time off (PTO) emerging as a particularly challenging area of conflict. OBJECTIVES: The aim of this study was to introduce and define "PTO pressure" (PTOP), a novel probabilistic metric that quantifies the minimum likelihood that an emergency physician's requested vacation week will conflict with the department's maximum allowable number of concurrent absences. METHODS: Using combinatorial probability modeling, we evaluated PTOP across varying department sizes. The model assumes uniform random selection of vacation weeks and systematically examines how group size (P physicians), annual PTO entitlement (k weeks), and the maximum number of allowable concurrent absences interact to influence scheduling conflict risk. RESULTS: PTOP rises significantly with smaller group sizes, higher PTO entitlements, and stricter limits on concurrent absences. For example, in a 12-physician group with 6 weeks of annual PTO and only 4 allowable concurrent absences, the minimum PTOP was approximately 0.357. While larger groups naturally reduce PTOP, they still require deliberate calibration of shift equity, backup staffing resources, and productivity expectations to ensure safe coverage and maintain fairness among physicians. CONCLUSION: Unresolved PTO scheduling conflicts contribute meaningfully to physician dissatisfaction, moral distress, and burnout risk in a specialty already reporting among the highest burnout rates. Emergency medicine leaders should incorporate PTOP modeling into workforce planning strategies. Doing so will better align staffing expansion with equitable and sustainable vacation policies, ultimately supporting physician well-being, retention, and long-term workforce resilience.
Reducing Hyperoxemia in Mechanically Ventilated Emergency Department Patients: A Before-and-After Study.
Davis ML, Gunaje N, Hall J … +6 more , Doerning R, Lin F, Hall MK, Carlbom D, Johnson NJ, Klemisch R
J Emerg Med · 2026 May · PMID 42348932 · Publisher ↗
BACKGROUND: Supplemental oxygen is a common therapy for emergency department (ED) patients undergoing invasive mechanical ventilation. Both hyperoxemia and hypoxemia carry potential risks. However, little is known about...
BACKGROUND: Supplemental oxygen is a common therapy for emergency department (ED) patients undergoing invasive mechanical ventilation. Both hyperoxemia and hypoxemia carry potential risks. However, little is known about ideal oxygenation targets or ED based interventions. OBJECTIVE: To evaluate the effectiveness and safety of implementing an oxygen titration guideline to reduce hyperoxemia in mechanically ventilated ED patients. METHODS: We performed a single-center retrospective cohort study of mechanically ventilated ED patients pre- and postimplementation of a quality improvement (QI) intervention aimed at reducing hyperoxemia. The primary outcome was incidence of severe hyperoxemia (partial pressure of oxygen [PaO > 300 mmHg), with safety outcomes including the incidences of hypoxemia (PaO < 60 mmHg) and severe hypoxemia (PaO < 50 mmHg). Additional secondary outcomes included in-hospital mortality, intensive care unit (ICU) length of stay, hospital length of stay, and median time on the ventilator. RESULTS: The cohort included 1111 patients: 625 preintervention and 486 postintervention. The incidence of severe hyperoxemia decreased from 39.4% preintervention to 30% postintervention, adjusted odds ratio (aOR) 0.68, 95% confidence interval (CI), 0.51-0.91; p = 0.01. The incidence of hypoxemia increased from 7.5% to 13%, aOR 1.87, 95% CI, 1.22-2.88; p < 0.01, severe hypoxemia did not significantly change (3.4% preintervention and 3.1% postintervention). No significant differences were noted in ICU length of stay, hospital length of stay, or in-hospital mortality. Median time on the ventilator increased slightly postintervention. CONCLUSIONS: Implementation of an oxygen titration guideline decreased severe hyperoxemia but increased hypoxemia, without affecting severe hypoxemia. Further research is needed to define ideal oxygenation targets and interventions to maintain patients within range.
Emergency Department and Hospitalization Processes After the February 6 Earthquake: Resource Utilization and Patient Outcomes.
Emrecik A, Gulen M, Satar S … +5 more , Acehan S, Unlu N, Nigiz K, Sevdimbas S, Gorur M
J Emerg Med · 2026 May · PMID 42348931 · Publisher ↗
BACKGROUND: Major earthquakes place a substantial and evolving burden on emergency departments, yet data on temporal changes in patient profiles, resource utilization, and outcomes remain limited. OBJECTIVE: To evaluate...
BACKGROUND: Major earthquakes place a substantial and evolving burden on emergency departments, yet data on temporal changes in patient profiles, resource utilization, and outcomes remain limited. OBJECTIVE: To evaluate temporal changes in patient characteristics, diagnostic resource utilization, treatment approaches, and clinical outcomes among patients hospitalized after the February 6, 2023, earthquakes. METHODS: This retrospective observational cohort study was conducted at a tertiary care hospital in the disaster region. Adult patients hospitalized via the emergency department within 7 days were included. Demographics, diagnostic resource use, treatments, early warning scores (modified early warning score [MEWS] and rapid emergency medicine score [REMS]), and mortality were analyzed. RESULTS: A total of 1050 hospitalized patients were analyzed. Trauma-related admissions accounted for 80.8%, while medical conditions comprised 19.2%. Trauma admissions were concentrated in the first 3 days (71.4%), whereas medical admissions predominated later (52.4%, p < 0.001). Medical patients were older and had higher intensive care unit admission rates (61.9%) and mortality (16.8%). Laboratory testing was performed in 98.1% of patients, x-ray in 68.1%, computed tomography in 59.0%, and magnetic resonance imaging in 2.3%. Diagnostic turnaround times were longer in trauma patients (p < 0.05). Surgical intervention was required in 55.4%, mostly within the first 3 days. Both MEWS and REMS were associated with mortality and demonstrated good discriminatory performance (area under the curve 0.87 and 0.82). CONCLUSION: Patient characteristics, resource use, and outcomes vary over time after a major earthquake. Early phases are dominated by trauma and surgical demand, whereas later phases involve medically complex patients with higher mortality risk. Early warning scores may support risk stratification; however, their role in real-time triage requires prospective validation.
Spontaneous Pulmonary Herniation: A Case Report.
Johnson D, Graves P, Good B
J Emerg Med · 2026 May · PMID 42348930 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Case of Abdominal Pain with Aching Legs.
Qi X, Monette DL, Wittels KA
J Emerg Med · 2026 May · PMID 42341539 · Publisher ↗
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Up to Date Status and Acceptance of the Influenza Vaccine among a National Sample of Emergency Department Patients.
Dhama S, Gulati R, Ge S … +9 more , Torres J, Chinnock B, Gottlieb M, Kumar VA, Rising KL, Eucker S, Molina MF, Kean ER, Rodriguez RM
J Emerg Med · 2026 May · PMID 42296645 · Publisher ↗
BACKGROUND: Influenza vaccination is a core public health measure but uptake rates in underserved populations are largely unknown. OBJECTIVE: In a national sample of emergency department (ED) patients we sought to determ...
BACKGROUND: Influenza vaccination is a core public health measure but uptake rates in underserved populations are largely unknown. OBJECTIVE: In a national sample of emergency department (ED) patients we sought to determine knowledge and up-to-date status of the influenza vaccine; acceptance of influenza vaccination if offered in the ED; and reasons for not being up-to-date and declining vaccination. METHODS: We conducted this cross-sectional study of adult patients at ten US EDs from April-December 2024. Research personnel asked participants standardized questions about their knowledge, uptake and willingness to accept the influenza vaccine if offered during their ED visit. We report primary outcomes as frequency percentages with 95% confidence intervals (CIs) and performed multivariable logistic regression to identify factors associated with outcomes. RESULTS: Of 4326 patients approached, 3285 (75.9%) participated; 96.0% (95%CI, 95.5-96.3%) had heard of the influenza vaccine, 77.6% (76.2-79.0%) reported having ever received it, and 58.4% (56.7-60.1%) were not up to date. Factors associated with not being up-to-date included African American race (adjusted odds ratio [aOR] 1.28), lack of primary care (aOR 2.61), and lack of insurance (aOR 1.54). Among participants who were not up-to-date, 37.0% (95%CI, 34.7-39.3%) reported they would accept influenza vaccination if offered. CONCLUSIONS: Although awareness of the influenza vaccine was high among ED patients, more than half were not up-to-date. Over one-third of those not up-to-date would accept influenza vaccination if offered during their ED visit. These findings highlight the potential for ED-based influenza vaccination surveillance, messaging and delivery programs.
Predictors of Adenosine-Induced Sinus Pause Duration for Supraventricular Tachycardia in the Emergency Department: The Role of Body Mass Index and Symptom Duration.
Ozatak AT, Sonmez E, Ozatak P … +1 more , Ozcan AB
J Emerg Med · 2026 May · PMID 42296644 · Publisher ↗
BACKGROUND: Intravenous adenosine is the standard first-line therapy for stable supraventricular tachycardia (SVT). However, transient post-cardioversion sinus pauses frequently complicate its use, causing clinical anxie...
BACKGROUND: Intravenous adenosine is the standard first-line therapy for stable supraventricular tachycardia (SVT). However, transient post-cardioversion sinus pauses frequently complicate its use, causing clinical anxiety. Patient-specific factors driving this variable duration remain poorly defined. OBJECTIVE: To evaluate how specific patient characteristics-namely age, body mass index (BMI), and symptom duration-independently predict adenosine-induced sinus pause duration. METHODS: We retrospectively analyzed adult emergency department patients with SVT successfully cardioverted with adenosine. Demographics, BMI, symptom duration, and dosing were recorded. Longest post-cardioversion sinus pauses were measured electronically. Multivariate linear regression identified independent predictors of pause duration. RESULTS: Among 89 included patients (mean age 53.7 ± 14.7 years), multivariate analysis identified age (p = 0.022), BMI (p = 0.031), and symptom duration (p = 0.048) as significant independent predictors. Advanced age and prolonged symptoms correlated with longer pauses. Conversely, obese patients (BMI ≥ 30 kg/m²) exhibited significantly shorter pauses than non-obese patients (1176 ± 530 vs. 1770 ± 970 ms; p = 0.004). Initial versus cumulative adenosine doses showed no significant difference in pause duration. CONCLUSION: Post-adenosine sinus pause duration is physiologically driven. Advanced age and prolonged tachycardia predispose patients to extended asystole, whereas obesity shortens pauses, likely due to intravascular dilution. Emergency physicians should anticipate longer pauses in elderly, lean patients with prolonged symptoms and offer appropriate pre-procedural counseling.
Ventricular Tachycardia Terminated by Vagal Maneuvers.
Germany JL, Cabrejas J, Ross S … +1 more , Eilbert W
J Emerg Med · 2026 May · PMID 42287883 · Publisher ↗
BACKGROUND: The majority of patients presenting to the emergency department with a stable, regular, monomorphic, wide complex tachycardia will be diagnosed with ventricular tachycardia, with a minority of these patients...
BACKGROUND: The majority of patients presenting to the emergency department with a stable, regular, monomorphic, wide complex tachycardia will be diagnosed with ventricular tachycardia, with a minority of these patients being diagnosed with supraventricular tachycardia (SVT) with aberrant conduction. Vagal maneuvers may be performed as a first-line treatment for these patients, primarily for the treatment of potential SVT with aberrant conduction. CASE REPORT: A 62-year-old woman presented to the emergency department with syncope and palpitations. Her electrocardiogram revealed a regular tachycardic rhythm with a widened monomorphic QRS pattern. The patient converted to a sinus rhythm with a narrow QRS pattern with a modified Valsalva maneuver. Further work up of the patient revealed it was ventricular tachycardia as the presenting rhythm. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given their benign nature, vagal maneuvers may be a useful initial therapeutic option for the treatment of stable, regular, monomorphic wide complex tachycardia. They may be effective at terminating not only SVT with aberrant conduction, but also some types of ventricular tachycardia.
Erector Spinae Plane Block as an Analgesic Strategy for Hepatopancreaticobiliary Pain: A Systematic Review.
Neto ES, Scapin M, de Menezes TA … +5 more , Valente LF, Marques de Freitas NT, Salomão IFA, Brogan A, Dreyfuss A
J Emerg Med · 2026 May · PMID 42284689 · Publisher ↗
BACKGROUND: Hepatopancreaticobiliary (HPB) pain is a common cause of emergency department (ED) and intensive care unit (ICU) presentation and is frequently managed with opioid analgesics. In the setting of the ongoing op...
BACKGROUND: Hepatopancreaticobiliary (HPB) pain is a common cause of emergency department (ED) and intensive care unit (ICU) presentation and is frequently managed with opioid analgesics. In the setting of the ongoing opioid crisis, effective non-opioid analgesic strategies are urgently needed. The erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique. OBJECTIVES: To systematically review and synthesize existing evidence on the feasibility, effectiveness, and safety of ESPB for HPB-related pain in acute care settings. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and the Cochrane Library were searched for studies reporting ESPB use in patients aged ≥16 years with HPB-related pain. Eligible studies included randomized trials, case series, case reports, and letters. Data on clinical setting, block technique, analgesic outcomes, and safety were extracted. Risk of bias was assessed using ROB 2 and Joanna Briggs Institute tools. Due to limited sample size and heterogeneity, results were synthesized qualitatively. RESULTS: Thirteen studies were included, reporting outcomes in 55 patients within 1 hour and 64 patients within 24 hours. Most ESPBs were performed in the ED. Indications included pancreatitis, cholecystitis, and pancreatic malignancy. ESPB was associated with rapid pain reduction, often within 15-60 minutes, and reduced rescue opioid requirements. No block-related complications were reported. CONCLUSIONS: Current case-based evidence suggests ESPB is a feasible, safe, and rapidly effective analgesic option for HPB-related pain in acute care settings, with potential opioid-sparing benefits. Higher-quality prospective studies are needed to confirm efficacy and standardize practice.
Challenging the Paradigm: Fascia Iliaca Blocks May Not be Necessary for All Neck of Femur Fractures.
Boylan CT, Yousuf ZA, Samarakoon G … +4 more , Bulut H, Lam C, Moss M, Verstraten L
J Emerg Med · 2026 May · PMID 42275900 · Publisher ↗
BACKGROUND: Fascia iliaca blocks (FIB) are recommended by national guidelines for analgesia in neck of femur (NOF) fractures to reduce opioid burden. However, evidence supporting universal administration is largely deriv...
BACKGROUND: Fascia iliaca blocks (FIB) are recommended by national guidelines for analgesia in neck of femur (NOF) fractures to reduce opioid burden. However, evidence supporting universal administration is largely derived from patients with moderate-to-severe pain. It remains unclear whether ``blanket'' FIB protocols benefit the heterogeneous population presenting to emergency departments. OBJECTIVES: To evaluate real-world analgesic efficacy of FIBs across baseline pain severities and to assess whether a targeted approach is justified. METHODS: Single-centre, retrospective case-control study of adults presenting to a UK Major Trauma Centre with radiologically confirmed NOF fractures. Changes in pain scores and opioid consumption (Morphine Milligram Equivalents [MME]) were analyzed pre- and post-intervention. Outcomes were compared between FIB and standard analgesia, and between ultrasound-guided and landmark techniques. RESULTS: Of 112 included patients (80.2 ± 9.4 years; 74.1% female), 87 (77.7%) received a FIB. While FIB resulted in a statistically significant reduction in pain scores (4.7 ± 3.8 to 2.0 ± 2.8; p = 0.003), it did not significantly alter opioid consumption (median 0.00 vs 0.47 MME/h; p = 0.961). Subgroup analysis revealed that analgesic benefit was strongly correlated with baseline pain (r = 0.771, p < 0.001); patients with rest pain <4 derived minimal benefit. No significant difference in efficacy was observed between ultrasound-guided and landmark techniques. CONCLUSION: Universal FIBs for NOF fractures may represent an inefficient use of resources for patients with low baseline pain. A stratified protocol prioritising patients with moderate-to-severe pain (Visual Analogue Scale [VAS]/Numerical Rating Scale [NSR] ≥ 4) is recommended.
Repeat Intravenous Tenecteplase for Posterior Circulation Stroke Without Completed Infarction.
Burnham K, Saherwala A, Singh M … +1 more , Pieniazek N
J Emerg Med · 2026 Apr · PMID 42275899 · Publisher ↗
BACKGROUND: Intravenous thrombolysis is traditionally avoided in patients with early recurrent acute ischemic stroke due to concerns for increased hemorrhagic risk. Although emerging evidence suggests that repeat intrave...
BACKGROUND: Intravenous thrombolysis is traditionally avoided in patients with early recurrent acute ischemic stroke due to concerns for increased hemorrhagic risk. Although emerging evidence suggests that repeat intravenous thrombolysis may be safe in selected patients, nearly all published cases involve alteplase, with limited data on repeated use of tenecteplase. CASE REPORT: A 39-year-old woman with no prior medical history presented with acute posterior circulation stroke symptoms following cervical chiropractic manipulation and was found to have a right vertebral artery dissection. She received intravenous tenecteplase with rapid neurologic improvement and no evidence of completed infarction on magnetic resonance imaging. Five days later, she re-presented with sudden-onset diplopia, obtundation, and signs concerning for brainstem ischemia. Imaging demonstrated diminished basilar artery flow concerning for occlusion. Given disabling symptoms and absence of established infarction, repeat intravenous tenecteplase was administered approximately 140 h after the initial dose, resulting in rapid neurologic recovery and restoration of posterior circulation flow. She experienced no thrombolysis-related complications and was discharged neurologically intact. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early recurrent stroke presents a diagnostic and therapeutic challenge in the emergency department, particularly in patients with posterior circulation symptoms and recent thrombolytic exposure. This case demonstrates that, in carefully selected patients with disabling symptoms and no completed infarction, repeat intravenous tenecteplase may be a viable treatment option, highlighting the importance of timely neurologic assessment, vascular imaging, and multidisciplinary decision-making.
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