The Journal Of Emergency Medicine[JOURNAL]
Sun
200 papers
Can Real-Time Prehospital Medical Record Data Presented on A Screen Enhance Team Readiness in the Emergency Department? A Pilot Study.
Bleeg RC, Poulsen NR, Pedersen MK … +2 more , Skrejborg P, Søvsø MB
J Emerg Med · 2026 Jan · PMID 41297110 · Publisher ↗
BACKGROUND: Emergency Medical Services (EMS) continuously document treatment and patient condition information in the electronic prehospital medical record (ePMR) during care. Only selected information is communicated vi...
BACKGROUND: Emergency Medical Services (EMS) continuously document treatment and patient condition information in the electronic prehospital medical record (ePMR) during care. Only selected information is communicated via telephone to the emergency department (ED) and the waiting ED team, potentially leading to loss of valuable information. OBJECTIVES: To pilot-test whether implementing real-time, screen-based access to prehospital medical records before patient arrival enhances the ED team's readiness. METHODS: Pilot study of implementing wall-mounted screens connected to the ePMR system in the ED trauma rooms in the North Denmark Regional Hospital. Three months before and four months after implementation, we measured the overall self-reported readiness of the ED team by questionnaires. The readiness rating was based on a visual analogue scale (VAS 0-15) and three sub-questions. RESULTS: We included 393 questionnaires (traumas N = 199, medical emergencies N = 194) corresponding to capture of 46% (141/307) of all events. For all questionnaires combined, overall readiness increased from a median of 7.1 (IQR 6.5-12.9) to 12.8 (IQR 9.7-14), p < 0.001. Stratified by event type, results persisted. Trauma: 7.1 (6.8-12.7) to 13.4 (9-14), p < 0.001; medical emergency: 7.1 (5.7-12.9) to 12.2 (9.7-13.9), p < 0.001. CONCLUSIONS: Measured by questionnaires, we found that easy access to real-time EMS patient data, visualized on a screen in the trauma room before receiving patients with traumas or medical emergencies, significantly increases the overall self-reported readiness of the ED team members. TRIAL REGISTRATION: None.
Stewardship of Intravenous Fluids During Shortage and Beyond.
Moore AR, Gordon AJ, Marvel JT … +4 more , Maddali MV, Chen JH, Urdaneta A, Wilson JG
J Emerg Med · 2026 Jan · PMID 41289786 · Publisher ↗
BACKGROUND: Recent supply chain issues caused by Hurricane Helene highlighted opportunities to improve stewardship of intravenous (IV) fluids. OBJECTIVES: To quantify IV fluid bags saved by using "round down" strategies...
BACKGROUND: Recent supply chain issues caused by Hurricane Helene highlighted opportunities to improve stewardship of intravenous (IV) fluids. OBJECTIVES: To quantify IV fluid bags saved by using "round down" strategies designed to limit use of partial bags of IV fluid in the emergency department (ED), and to estimate the associated environmental impact of this intervention. METHODS: This was a retrospective analysis of all 30 mL/kg IV fluid bolus orders placed in the EDs at Stanford Healthcare for adult patients from 2020 to 2023. We calculated the number of IV fluid bags that would be saved or reduced in size by rounding down to either the nearest 250 mL or the nearest 500 mL. Projected environmental impact was assessed using previously published estimates of CO emissions and plastic waste generated by IV fluid use. RESULTS: Across 11,964 30 mL/kg IV fluid orders, rounding down would have saved up to 1567 bags of IV fluid, and reduced the size of IV fluid bag used for up to 3890 boluses. Depending on which "round down" strategy was used, the median reduction in fluid volume was 121 to 244 mL per patient. For each 1000 patients, this reduction was estimated to decrease CO emissions by 112.8 kg and eliminate 14 kg of plastic waste. CONCLUSION: Use of a "round down" strategy for IV fluid resuscitation in sepsis could substantially reduce the number of bags of IV fluid used, with associated reductions in CO emissions and plastic waste.
Phantom Scanning in Point-of-Care Ultrasound After Out-of-Hospital Cardiac Arrest: Impact of Clinical Presentation in a Single-Center Analysis.
Westein R, Nickel L, Phelan MB
J Emerg Med · 2026 Jan · PMID 41289785 · Publisher ↗
BACKGROUND: Phantom scanning, defined as the use of point-of-care ultrasound (POCUS) without image archiving, occurs frequently in cardiac arrest and carries clinical, legal, and quality improvement consequences. Its ass...
BACKGROUND: Phantom scanning, defined as the use of point-of-care ultrasound (POCUS) without image archiving, occurs frequently in cardiac arrest and carries clinical, legal, and quality improvement consequences. Its association with clinical presentation following out-of-hospital cardiac arrest (OHCA) remains understudied. OBJECTIVES: To evaluate the prevalence of phantom scanning in OHCA, stratified by clinical presentation and emergency department (ED) disposition. METHODS: We conducted a retrospective, single-center study of adult patients presenting with atraumatic OHCA. The primary outcome was phantom scanning among patients presenting with cardiopulmonary resuscitation (CPR) in progress versus return of spontaneous circulation (ROSC). The secondary outcome compared phantom scanning between admitted patients versus those who died in the ED. Descriptive statistics, chi-square tests, and odds ratios with 95% confidence intervals evaluated associations. RESULTS: Of 306 patients reviewed, 244 met inclusion criteria. POCUS was more likely with CPR in progress (OR = 3.58, 95% CI [2.08, 6.26], p < 0.001). Among patients who underwent POCUS, phantom scanning was more frequent with CPR in progress (OR = 3.15, 95% CI [1.49, 6.84], p = 0.002). POCUS was less likely among admitted patients (OR = 0.37, 95% CI [0.21, 0.66], p < 0.001), and phantom scanning was less common in this group (OR = 0.23, 95% CI [0.11, 0.47], p < 0.001). Differences in POCUS use and phantom scanning were significant by both presentation and disposition (p < 0.001). CONCLUSION: Phantom scanning occurred more often in OHCA patients with CPR in progress and in those who died in the ED. Future research should focus on strategies to reduce phantom scanning and promote adherence to POCUS best practices.
Conservative Management of Spontaneous Posterior Mediastinal Intercostal Artery Hemorrhage: A Case Report and Literature Review.
Okada M, Yanaihara H, Misaki M … +3 more , Kohata N, Suzuki Y, Asakura T
J Emerg Med · 2026 Jan · PMID 41289784 · Publisher ↗
BACKGROUND: Intercostal artery hemorrhage (ICAH) is an extremely rare, potentially life-threatening condition. The etiology of ICAH includes trauma, anticoagulation therapy, bleeding disorders, infections, and underlying...
BACKGROUND: Intercostal artery hemorrhage (ICAH) is an extremely rare, potentially life-threatening condition. The etiology of ICAH includes trauma, anticoagulation therapy, bleeding disorders, infections, and underlying diseases such as neurofibromatosis type 1, systemic lupus erythematosus, and hypertension. Due to the rarity of this condition, standardized treatment strategies remain undefined. We report a rare case of spontaneous ICAH successfully managed with conservative therapy and review relevant literature. CASE REPORT: A 49-year-old male presented with sudden and progressively worsening abdominal and back pain. He had no history of trauma or underlying diseases, except for previously undiagnosed and uncontrolled hypertension. Imaging revealed a hemorrhage from the intercostal artery in the posterior mediastinum, which was considered to be the likely source of bleeding. Given the patient's hemodynamic stability and location of the hematoma, conservative management was selected. Blood pressure was initially controlled with intravenous nicardipine, followed by oral sacubitril/valsartan and nifedipine administration. The hematoma did not increase in size, and the patient was discharged on day 15, without complications. Follow-up imaging confirmed complete resolution of the hematoma, and the patient's blood pressure remained stable without further antihypertensive medication use. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although ICAH is extremely rare, it can cause life-threatening bleeding. Prompt recognition is essential, especially when imaging reveals a posterior mediastinal hematoma without trauma or anticoagulation therapy. Conservative management may be feasible in hemodynamically stable patients with natural tamponade; however, careful patient selection and close monitoring are crucial. Awareness of this condition can help avoid unnecessary invasive procedures.
Diagnosis of Late-Presenting Congenital Diaphragmatic Hernia by Point-of-Care Ultrasound.
Alkhurayji A, Takadera T, Harel-Sterling M
J Emerg Med · 2026 Jan · PMID 41285083 · Publisher ↗
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a rare developmental anomaly, defined by a defect in the diaphragm that permits herniation of abdominal viscera into the thoracic cavity. While the majority of CDH cas...
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a rare developmental anomaly, defined by a defect in the diaphragm that permits herniation of abdominal viscera into the thoracic cavity. While the majority of CDH cases are identified prenatally or present with severe respiratory distress in the immediate neonatal period, a minority are diagnosed beyond the first month of life, referred to as late-presenting or delayed-diagnosis CDH. CASE REPORT: Here we describe a previously well, full-term 2-month-old infant presenting with sudden onset of respiratory distress and cyanosis, initially raising concern for an acute pulmonary or cardiac event. Point-of-care ultrasound (POCUS) confirmed the diagnosis of CDH, demonstrating the presence of bowel loops with peristalsis in the left chest. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS can serve as a valuable diagnostic tool for infants with acute respiratory symptoms and can confirm the rare and life-threatening diagnosis of CDH when X-ray imaging is not readily available or is challenging to interpret.
"Is My Face Swollen?"-Utilizing Point-of-Care Ultrasound to Diagnose Odontogenic Infections.
Hoffer JT, Park R, Brenner DS
J Emerg Med · 2026 Jan · PMID 41285082 · Publisher ↗
BACKGROUND: Odontogenic infections are a common presentation in the emergency department. Most odontogenic infections can be managed with oral antibiotics, analgesia, and outpatient dentistry referrals, but cases of odon...
BACKGROUND: Odontogenic infections are a common presentation in the emergency department. Most odontogenic infections can be managed with oral antibiotics, analgesia, and outpatient dentistry referrals, but cases of odontogenic perimandibular or perimaxillary abscess often require drainage and more acute specialist referral. Computed tomography is commonly utilized to differentiate simple odontogenic infections from more complex pathology. Point-of-care ultrasound has emerged as a primary imaging modality to differentiate simple cellulitis from abscess in most parts of the body, but has not historically been utilized for odontogenic infections. This case series utilizes multiple examples to demonstrate how to utilize point-of-care ultrasound to diagnose simple or complex odontogenic infections and describes the relevant sonographic anatomy for interested users. CASE REPORTS: We present the cases of 10 patients where point-of-care ultrasound successfully diagnosed odontogenic infections, in some cases allowing proper treatment without computed tomography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound can be utilized to diagnose odontogenic infections and reduce computed tomography utilization in otherwise healthy, uncomplicated patients.
Prevalence and Clinical Relevance of Incidental Computed Tomography Findings in Pediatric Trauma: A Systematic Review and Meta-Analysis of 23,706 Patients.
Alansari AN, Abusamaan S, Alyafei T … +2 more , Elshanbary AA, Zaazouee MS
J Emerg Med · 2026 Jan · PMID 41285081 · Publisher ↗
BACKGROUND: Radiological computed tomography (CT) reports often reveal incidental findings (IFs) unrelated to acute clinical concerns. These findings can range from clinically significant to benign variants, and their id...
BACKGROUND: Radiological computed tomography (CT) reports often reveal incidental findings (IFs) unrelated to acute clinical concerns. These findings can range from clinically significant to benign variants, and their identification may have implications for follow-up care, resource utilization, and patient outcomes. OBJECTIVE: This study aims to estimate the pooled IFs on CT scans in pediatric trauma patients and to classify these findings into clinically meaningful categories. METHODS: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from database inception up to April 2025 for studies reporting incidental findings on CT in pediatric trauma patients. Incidental findings were categorized as: category 1 (clinically significant requiring urgent follow-up), category 2 (indeterminate, requiring context-based evaluation), and category 3 (benign variants requiring no follow-up). Quantitative analyses were performed using Comprehensive Meta-Analysis (CMA) software, employing a random-effects model with 95% confidence intervals. RESULTS: Eleven studies were included in this meta-analysis. The overall pooled incidence of incidental findings on CT scans was 20.1% (95% CI: 9.6%-37.3%). Among incidental findings, 5.5% were classified as category 1, 36.7% as category 2, and 45.2% as category 3. Masses (tumors or nodules) were rare, constituting 0.8% (95% CI: 0.5%-1.3%), whereas cysts were more prevalent at 4.5% (95% CI: 2.8%-7.1%). Considerable heterogeneity was observed across studies (I² > 90% for most categories), likely reflecting differences in study design, populations, and reporting practices. CONCLUSION: Incidental findings are highly prevalent in pediatric trauma CT scans. This underscores the importance of standardized reporting and appropriate follow-up protocols. Categorization of these findings provides clinically useful insights, though the substantial heterogeneity observed suggests that clinical context plays an important role.
Impact of 2023 Centers for Medicare and Medicaid Services (CMS) Guidelines on Point-of-Care Emergency Ultrasound Billing.
Cen E, Kingsbury K, Amaya L … +3 more , Kwolek W, Shrestha M, Coneybeare D
J Emerg Med · 2026 Jan · PMID 41275847 · Publisher ↗
BACKGROUND: The 2023 Centers for Medicare and Medicaid Services (CMS) billing guidelines allowed a refocus on medical decision-making, the risk of morbidity, and overall medical complexity. It is uncertain how point-of-c...
BACKGROUND: The 2023 Centers for Medicare and Medicaid Services (CMS) billing guidelines allowed a refocus on medical decision-making, the risk of morbidity, and overall medical complexity. It is uncertain how point-of-care ultrasound (POCUS) billing has been affected by these changes. Elucidation of how 2023 CMS changes to POCUS billing can allow us to ensure alignment with best practices. OBJECTIVE: To investigate the effect of the 2023 CMS changes on POCUS billing. METHODS: This was a retrospective cohort study performed at a large urban quaternary care center. The baseline characteristics of patients and volume of documented POCUS, as well as by Current Procedural Terminology (CPT) codes and reimbursement rates in 2022 and 2023, were compared. We also evaluated the proportion of charts in which POCUS was incorporated into medical decision-making in 2 months in 2023. RESULTS: In total, there were 2900 and 2778 patient encounters with at least one POCUS documentation in 2022 and 2023, respectively. There was no difference in the volume of POCUS billed monthly, or CPT codes of billed POCUS between 2022 and 2023 (p = 0.47 and 0.90, respectively). Reimbursement rates for separately billed POCUS procedures remained unchanged, with an exception to private insurance, where reimbursement rate increased slightly (p = 0.011). There was a small proportion of visits (4.1%) in which POCUS billing affected the evaluation and management code for the emergency department visit. CONCLUSIONS: The 2023 CMS changes to billing have not significantly changed billing practices for POCUS.
Association of Troponin Elevation with Cardiovascular Event in Stable Supraventricular Tachycardia in the Emergency Department.
Khan M, Tzeng CT, Hsieh YL … +6 more , Healy J, Lee C, Ku K, Shedd A, Bhakta T, Chou EH
J Emerg Med · 2026 Jan · PMID 41275846 · Publisher ↗
BACKGROUND: Cardiac troponin is routinely measured in the emergency department (ED) to evaluate patients with chest discomfort or dysrhythmias. However, its prognostic value in patients presenting with stable supraventri...
BACKGROUND: Cardiac troponin is routinely measured in the emergency department (ED) to evaluate patients with chest discomfort or dysrhythmias. However, its prognostic value in patients presenting with stable supraventricular tachycardia (SVT) remains uncertain. OBJECTIVES: To assess the prognostic value of troponin for 30-day major adverse cardiac events (MACE) in adult patients presenting with stable SVT in the ED. METHODS: This was a retrospective, multi-center cohort study conducted in EDs in North Texas. Adult patients presenting with stable SVT in the ED were included. The primary endpoint was the occurrence of 30-day MACE, defined as a composite outcome of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, and all-cause mortality. RESULTS: A total of 493 patient encounters met inclusion criteria. Of these, 34 (6.9%) did not have troponin measured, 349 (70.8%) had non-elevated troponin levels, and 110 (22.3%) had elevated troponin levels. Patients who underwent troponin testing were at higher risk of MACE compared with those without testing (p < 0.001). Among patients with troponin testing, MACE occurred in 28.2% of those with elevated troponin versus 4.6% of those with non-elevated troponin (p < 0.001). Elevated troponin was associated with higher odds of 30-day MACE (OR 5.32, 95% CI: 1.92-14.7; p < 0.001). Compared to non-elevated troponin group, patients with elevated troponin had higher rates of ED SVT recurrence, hospital, and intensive care unit (ICU) admission. CONCLUSION: Elevated troponin levels were associated with a significantly increased risk of 30-day MACE in our cohort. These findings highlight a potential role for troponin in identifying patients at higher risk for adverse short-term cardiac outcomes, even after successful rhythm conversion.
Effects of Cold Exposure on Neurological Mortality of Out-of-Hospital Cardiac Arrest Patients.
Uechi T, Shibata S, Suda T … +5 more , Hata N, Hirabuki K, Tsukada T, Hirasawa A, Matsuda T
J Emerg Med · 2026 Jan · PMID 41275845 · Publisher ↗
BACKGROUND: Survival rates after out-of-hospital cardiac arrest (OHCA) are lower at night than during the day. Cold exposure may stimulate the sympathetic nervous system and provoke and sustain ventricular tachycardia (V...
BACKGROUND: Survival rates after out-of-hospital cardiac arrest (OHCA) are lower at night than during the day. Cold exposure may stimulate the sympathetic nervous system and provoke and sustain ventricular tachycardia (VT)/ventricular fibrillation (VF). Diurnal temperature changes and sympathetic stimulation may explain these. OBJECTIVE: The aim of this study was to investigate our hypothesis that the colder the ambient temperature, the worse the neurologic outcome in VT/VF OHCA patients. METHODS: We used the All-Japan Registry (2005-2010) combined with atmospheric temperature data and enrolled adult OHCA patients who had been witnessed and resuscitated. The primary outcome was a favorable neurological outcome 1 month after OHCA, and the secondary outcome was the return of spontaneous circulation (ROSC) before hospital admission. Ambient temperature on the primary and secondary outcomes was assessed with adjustment for factors known to potentially affect OHCA outcomes by classifying the initial cardiac rhythm. RESULTS: Among 263,750 witnessed OHCA patients, neurological survival rates significantly increased with adjusted ORs of 1.09 (95% CI, 1.05-1.13) and 1.07 (95% CI, 1.05-1.10) for 9°C (1 SD) temperature increase in VT/VF patients and overall population, respectively. ROSC rates significantly increased with adjusted HRs of 1.11 (95% CI, 1.08-1.13), 1.06 (95% CI, 1.03-1.08), 1.06 (95% CI, 1.02-1.09), and 1.09 (95% CI, 1.07-1.10) for 9°C (1 SD) temperature increase in VT/VF, pulseless electrical activity (PEA), asystole, and overall population, respectively. CONCLUSIONS: Cold exposure during OHCA in patients with initial VT/VF rhythm resulted in lower 1-month neurological survival rates, likely due to prolonged time to ROSC. Avoiding cold exposure may improve survival by reducing the time to ROSC.
Ultrasound Guided Erector Spinae Plane Block for Pain Management in the Emergency Department: A Scoping Review.
Gawel RJ, Zhou Z, Urban C … +2 more , Middleton J, Shalaby M
J Emerg Med · 2026 Jan · PMID 41274025 · Publisher ↗
BACKGROUND: The ultrasound-guided erector spinae plane block (ESPB) is a relatively new regional anesthesia technique increasingly used in the emergency department (ED) for multimodal analgesia. OBJECTIVES: To summarize...
BACKGROUND: The ultrasound-guided erector spinae plane block (ESPB) is a relatively new regional anesthesia technique increasingly used in the emergency department (ED) for multimodal analgesia. OBJECTIVES: To summarize the existing literature on ESPBs performed by emergency physicians (EPs). METHODS: Following PRISMA-ScR guidelines, we searched five databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, and CINAHL) from inception to June 10, 2025. Records were screened in duplicate, and data were extracted for quantitative and qualitative synthesis in accordance with best practices. RESULTS: Of 157 unique records, 42 articles met inclusion criteria, reporting 341 ESPBs performed on 279 patients. Most studies were case reports (25 articles, 60%) or small case series (8 articles, 19%), with only six randomized clinical trials (14%). Common indications included visceral abdominal pain (18 articles, 43%), rib fractures (8 articles, 19%), and low back pain (4 articles, 9.5%). Technical approaches varied widely in terms of block laterality, patient positioning, and transducer type. Adverse events were infrequent (9 cases, 3.2%), with only one suspected case of local anesthetic systemic toxicity (0.4%). CONCLUSIONS: Emergency physician-performed ESPBs are increasingly described for diverse indications, but the current evidence base is limited and heterogeneous. Further research should focus on standardizing techniques, enhancing safety monitoring, and conducting high-quality studies to support broader implementation in emergency medicine.
Fulminant Aortic Occlusion Causing Paraplegia and Multiorgan Ischemia in a Young Adult: A Case Report.
Gupta K, Ambure S, Agrawal N … +2 more , Mathew R, Tripathy D
J Emerg Med · 2026 Jan · PMID 41274024 · Publisher ↗
BACKGROUND: Acute aortic occlusion (AAO) is a rare and catastrophic vascular emergency, typically affecting older adults and presenting with acute limb ischemia. CASE REPORT: We report a case of a 39-year-old male chroni...
BACKGROUND: Acute aortic occlusion (AAO) is a rare and catastrophic vascular emergency, typically affecting older adults and presenting with acute limb ischemia. CASE REPORT: We report a case of a 39-year-old male chronic alcoholic and smoker who presented with severe back pain followed by sudden-onset bilateral paraplegia and multiorgan ischemia. The patient developed complete motor and sensory loss below the T10 level and urinary incontinence within an hour of symptom onset. Physical examination revealed cold, mottled lower limbs with absent femoral, tibial, and distal pulses. Computed tomography (CT) angiography showed complete occlusion of the infrarenal aorta, left renal artery occlusion with complete left kidney infarction. Despite initial consideration of spinal myelopathies, the diagnosis of AAO was made based on the vascular examination. The patient's delayed presentation and extensive ischemia precluded revascularization, and he died within hours of presentation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the need for a high level of suspicion for AAO across a broader patient demographic, even in presentations dominated by neurological symptoms. Prompt recognition and immediate diagnosis via CT angiography are crucial for improving the outcomes in this time-sensitive and devastating condition.
Point-of-Care Ultrasound vs. Manual Palpation for Pulse Check in Cardiac Arrest Patients: A Systematic Review.
Ko SY, Ghotb Razmjou S, Haagsma JA … +1 more , Verdonschot RJCG
J Emerg Med · 2026 Jan · PMID 41274023 · Publisher ↗
BACKGROUND: Accurate pulse checks are extremely important in the management of cardiac arrest patients. Pulse check through manual palpation is known to be difficult and unreliable, even for health care providers. Given...
BACKGROUND: Accurate pulse checks are extremely important in the management of cardiac arrest patients. Pulse check through manual palpation is known to be difficult and unreliable, even for health care providers. Given the increasing role of point-of-care ultrasound (POCUS) in cardiac arrest care, it may offer a more effective method for pulse check. OBJECTIVE: This systematic review aimed to investigate whether POCUS of the great arteries would be a more accurate and faster alternative to manual palpation for the pulse check during cardiac arrest. METHODS: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A search was performed through Medline, Embase, Web of Science Core, Cochrane Central, and Google Scholar. The articles were screened for eligibility and assessed for risk of bias by two independent reviewers through the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. RESULTS: The search yielded 437 articles, of which six matched our inclusion criteria. All three studies that reported about the accuracy had a higher accuracy for pulse check with POCUS. All five studies that reported about the speed of the pulse check had a shorter mean pulse check duration for POCUS. CONCLUSION: This systematic review suggests that POCUS is quicker and more accurate than manual palpation for checking the pulse during cardiac arrest. However, the evidence is limited by the scarcity, variable quality, and the heterogeneity of the studies.
Characteristics of Young Children Presenting to the Emergency Department for Psychiatric Evaluation.
Waseem M, Moustafa AF, Esposito KD … +4 more , Yang R, Vinh A, Nadim D, Shariff MA
J Emerg Med · 2026 Jan · PMID 41274022 · Publisher ↗
BACKGROUND: The rising influx of young children in emergency departments (ED) for behavioral concerns represents a current crisis requiring immediate intervention. These children face heightened risks of emotional impair...
BACKGROUND: The rising influx of young children in emergency departments (ED) for behavioral concerns represents a current crisis requiring immediate intervention. These children face heightened risks of emotional impairments and mood disorders. OBJECTIVE: This study identifies factors contributing to disruptive behavior and examines baseline characteristics associated with ED visits to highlight the urgent need for targeted action. METHODS: We conducted a retrospective review of ED records (2015-2021) at an inner-city hospital, focusing on pediatric patients who presented with behavioral symptoms and received psychiatric evaluations. Data included demographics, psychiatric comorbidities, social history, adverse childhood experiences (ACEs), and ED length of stay. Patients were categorized into the no-prior-ED group and the prior-ED group. Reviewed overall characteristics and statistical tests analyzed differences between subgroups. RESULTS: The records of 184 children (with an average age of 9.4 years, 65% male) revealed that 49% were Hispanic, 39% were Black, and 12% were from other racial backgrounds. Behavioral issues included aggression (51%), suicidal ideation (34%), and acting out (22%). Children were brought in to ED, mainly, from home (59%) and school (33%). Notably, 52% had no prior psychiatric diagnosis, with attention-deficit/hyperactivity disorder (40%) as the most common diagnosis. ACEs were identified in 42% of cases. Compared to the no-prior-ED group, children in the prior-ED group showed higher ACEs scores, longer ED stays, and increased rates of disabilities and suicidal thoughts (p < 0.05). CONCLUSION: This study underscores the cyclical nature of ED visits among children with mental and behavioral health and high ACEs. These findings highlight the need for further investigation into early identification strategies and coordinated care to interrupt this cycle.
Response to: Emergency Department Observation for Back Pain: Patient Characteristics and Factors Associated with Hospital Admission or 90-Day Return Visit.
Orlando JF, Flanagan P, Griffith R … +3 more , Beard M, Truter P, Bagg MK
J Emerg Med · 2026 Jan · PMID 41271452 · Publisher ↗
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Does Point-of-Care Ultrasound-Guided Nerve Block for Geriatric Hip Fracture Analgesia in the Emergency Department Improve Outcomes?
Finch AS, Keim SM, Bellamkonda VR … +4 more , Kummer T, Shiue LT, Carpenter CR, Adhikari SR
J Emerg Med · 2026 Jan · PMID 41270324 · Publisher ↗
BACKGROUND: Geriatric hip fractures are a commonly encountered in the emergency department (ED) with significant associated morbidity and mortality. Providing appropriate analgesia has many challenges, and the majority o...
BACKGROUND: Geriatric hip fractures are a commonly encountered in the emergency department (ED) with significant associated morbidity and mortality. Providing appropriate analgesia has many challenges, and the majority of patients require opioid medications for adequate pain control. Complications of opioids include delirium, respiratory depression, and constipation, among others. Ultrasound-guided nerve blocks for hip fractures have emerged as an additional modality to utilize as part of a multimodal approach to analgesia. CLINICAL QUESTION: In older adults diagnosed with hip fractures in the ED, do ultrasound-guided nerve blocks improve patient-centered outcomes when compared with standard interventions, such as opioid analgesia? EVIDENCE REVIEW: Three studies were reviewed: a systematic review and meta-analysis, a randomized controlled trial, and a prospective feasibility study. CONCLUSION: Compared with standard ED management strategies for analgesia after hip fractures in adults, fascia iliaca compartment blocks do not reduce mortality. Single injection fascia iliaca compartment blocks appeared to improve delirium rates, though this effect was not seen on the included randomized controlled trial. Hospital length-of-stay and opioid use were decreased in patients who received nerve blocks for hip fractures. Some ED literature also supports using femoral nerve blocks as the blocks are feasible, effective, and safe.
Comparison of the Doses Needed to Achieve Initial Control for F(ab') vs. Fab Antivenom in North American Pit Viper Envenomation: A Retrospective, Pre-Post Study.
Volland K, Welch C, Cook R … +1 more , Andrews J
J Emerg Med · 2026 Jan · PMID 41270323 · Publisher ↗
BACKGROUND: There are only two antivenoms on the market approved for North American pit viper envenomations; crotalidae polyvalent immune Fab (ovine) and crotalidae immune F(ab') (equine). There is currently no consensus...
BACKGROUND: There are only two antivenoms on the market approved for North American pit viper envenomations; crotalidae polyvalent immune Fab (ovine) and crotalidae immune F(ab') (equine). There is currently no consensus on which agent may be more effective. OBJECTIVES: This study aimed to investigate the efficacy and safety of F(ab') compared with Fab regarding systemic and local effects of North American pit viper envenomation. METHODS: Patients two years of age and older were retrospectively included and separated into groups if they received Fab or F(ab'). The primary outcome compared the amount of Fab or F(ab') doses needed to achieve initial control. Secondary outcomes included incidence of recurrent coagulopathies, skin and soft tissue injury, 30-day readmission, length of stay, cost of drug therapy, and adverse events. Statistical significance was set at p < 0.05. RESULTS: 114 patients were included, 57 in each group. F(ab') patients required less doses to achieve initial control (1 vs. 4 doses; p < 0.01) and had a shorter length of stay (36 vs. 46 hours, p < 0.01). There were no differences in recurrent coagulopathies [20 (F(ab')) vs. 13 (Fab)], serious adverse events [1 (F(ab')) vs. 0 (Fab)] and readmission within 30 days [1 (F(ab')) vs. 0 (Fab)]. Non-serious adverse events were significantly greater in the F(ab') group (10 vs. 1 event; p < 0.01). CONCLUSIONS: Patients treated with F(ab') antivenom for North American pit viper envenomation required less doses to achieve initial control, but experienced a greater incidence of non-serious adverse events.
Reliability of Alternative Sonographic Approaches for Inferior Vena Cava: Comparison of Subcostal, Transhepatic, and Coronal Windows.
Albayrak AK, Aslaner MA, Korkak ÖF … +1 more , Bildik F
J Emerg Med · 2026 Jan · PMID 41270322 · Publisher ↗
BACKGROUND: Ultrasonographic evaluation of the inferior vena cava (IVC) is widely used in critical care settings; however, the standard subcostal (SC) approach is not always feasible. OBJECTIVES: This study aimed to asse...
BACKGROUND: Ultrasonographic evaluation of the inferior vena cava (IVC) is widely used in critical care settings; however, the standard subcostal (SC) approach is not always feasible. OBJECTIVES: This study aimed to assess the agreement of IVC diameter and collapsibility index (cIVC) measurements obtained from the SC, anterior transhepatic (TH), and right coronal (CR) ultrasonographic windows. METHODS: In this prospective, single-center study conducted in an emergency department, IVC ultrasonography was performed on 219 adult patients using SC, TH, and CR approaches. Clear visualization of the anterior and posterior IVC walls was considered essential, while the visualization of IVC entry into the right atrium and the hepatic vein were supportive. Image acquisition time, operator-assessed ease, body mass index, and intermethod agreement were assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. RESULTS: The mean image acquisition times were 24.26 ± 24.77 s for SC, 28.89 ± 25.85 s for TH, and 35.66 ± 29.52 s for CR. ICC analysis demonstrated strong correlation across all methods, with the highest correlation observed between SCmin and THmin (r = 0.952). Bland-Altman plots showed acceptable limits of agreement, indicating good agreement. ICC analysis found to be positive and highly significant correlation across body mass index categories. More than half of the images obtained via each window were rated as "easy" or "very easy" by the operators. CONCLUSION: While the SC window remains the first-line approach for IVC assessment, the TH and CR windows offer reliable and practical alternatives when SC imaging is limited.
Cooling-Seeking Behavior and Hot Sensation as Hallmark Toxidromes in Chlorfenapyr Intoxication: A Case Report.
Yu JH, Hsieh CH, Pan CS … +1 more , Mu HW
J Emerg Med · 2026 Jan · PMID 41270321 · Publisher ↗
BACKGROUND: Chlorfenapyr is a pyrrole-based insecticide that disrupts mitochondrial oxidative phosphorylation, leading to delayed toxicity marked by hyperthermia and multiorgan failure. While early stages are often descr...
BACKGROUND: Chlorfenapyr is a pyrrole-based insecticide that disrupts mitochondrial oxidative phosphorylation, leading to delayed toxicity marked by hyperthermia and multiorgan failure. While early stages are often described as asymptomatic, recognizing early subtle clinical signs is crucial to improve patient monitoring and management. This report highlights thermogenic symptoms, such as persistent hot sensations and cooling-seeking behaviors, as early warning signs of Chlorfenapyr intoxication, reconsidering existing assumptions of an asymptomatic latent phase. CASE REPORT: A 78-year-old woman presented to the emergency department two hours after ingesting several mouthfuls of a pesticide. She was initially stable, with only mild gastrointestinal symptoms. Despite normothermia, she persistently reported feeling hot and demonstrated active cooling-seeking behaviors-kicking off blankets, removing clothing, and using fans-documented in a supplemental video. Laboratory tests showed mild lactic acidosis without early organ dysfunction. On day four, she developed agitation, respiratory distress, hyperthermia (39°C), and generalized muscle rigidity, followed by cardiac arrest unresponsive to resuscitation. Serum obtained at the initial emergency department visit demonstrated a Chlorfenapyr concentration of 0.97µg/mL, measured by gas chromatography-mass spectrometry. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the importance of recognizing hot sensations and cooling-seeking behaviors as potential early markers of Chlorfenapyr poisoning. Awareness of these subtle but distinctive symptoms can facilitate early confirmatory testing and timely clinical monitoring.
ST-Segment Elevation in Lead aVR in Acute Intracranial Pathologies: A Diagnostic Pitfall?
Túri BZ, Ádám K, Szakáll A … +6 more , Fenyves BG, Kálmán Z, Gaál-Marschal S, Mészáros H, Imecz J, Varga C
J Emerg Med · 2026 Jan · PMID 41270320 · Publisher ↗
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