BACKGROUND: Cyberattacks on healthcare delivery organizations (HDOs) have escalated in frequency and severity, with emergency departments (EDs) disproportionately affected due to their reliance on electronic systems and...BACKGROUND: Cyberattacks on healthcare delivery organizations (HDOs) have escalated in frequency and severity, with emergency departments (EDs) disproportionately affected due to their reliance on electronic systems and the critical time-sensitive nature of their services. Ransomware and other malicious software disrupt patient care, delay diagnostics, and compromise data integrity, posing immediate threats to patient safety and operational continuity. OBJECTIVES: This literary review explores how cybersecurity incidents impact emergency medicine (EM), focusing on themes of patient safety, operational efficiency, community impacts, and data integrity. DISCUSSION: This literary review synthesizes findings from peer-reviewed articles and "gray literature" sources that demonstrate the effects of cybersecurity disasters on EM. Case reports illustrate initial responses and lessons learned from major cyberattacks on HDOs and their EDs. Retrospective studies reveal adverse ED patient outcomes and regional ripple effects. For instance, one study found that during a 2021 cyberattack, there was a significant increase in cardiac arrests, with neurologically unfavorable outcomes observed at an unaffected HDO geographically proximate to the facility experiencing the breach. Prospective simulations and surveys expose gaps in preparedness and cybersecurity hygiene among ED staff. Expert viewpoints and policy analyses underscore the need for informed consent regarding device vulnerabilities and advocate for integrating cybersecurity into disaster preparedness frameworks. Emergency physicians (EPs) are consistently identified as pivotal leaders in cyber-disaster response due to their adaptability and frontline experience. CONCLUSION: Cybersecurity is a key pillar to the foundation of modern EM practice. EDs can withstand the adverse effects of cyberattacks through careful regional planning, realistic simulation-based training, and proactive cybersecurity downtime protocols-measures that are critical to safeguarding patient care. EPs must champion these efforts to mitigate the growing threat of cyberattacks and enhance healthcare system resilience.
BACKGROUND: While most clinicians are familiar with the use of naloxone in the setting of opioid overdose, little is published regarding the real-world use of naloxone infusions. OBJECTIVES: To describe naloxone infusion...BACKGROUND: While most clinicians are familiar with the use of naloxone in the setting of opioid overdose, little is published regarding the real-world use of naloxone infusions. OBJECTIVES: To describe naloxone infusion use over a 10-year period as well as the clinical decision-making surrounding their utilization. METHODS: All cases of naloxone infusions administered at two academic medical centers from January 1, 2014 to January 31, 2023 were reviewed and the medical records abstracted for demographics and naloxone infusion data. Patients less than 18 years old, administered naloxone infusions for indications other than opioid overdose, or not initially emergency department patients were excluded. RESULTS: In total, 43 patients constituting 44 cases were identified, with a median age of 36 years; 83.7% were male. The most self-reported exposure was fentanyl, most commonly by ingestion. The majority (93.2%) received in-hospital naloxone, with a median total dose of 2 mg. The median time from arrival to initiation was 151 minutes and the median duration of infusion was 284 minutes. The infusion dose remained unchanged until discontinuation for a majority (70.5%) of infusions. The median naloxone infusion dose administered was 4 mg, with a median 8 mg wasted. In terms of disposition, 20 were discharged from the emergency department, three left against medical advice, and one expired. Eighteen were admitted: six to intensive care, 11 to the intermediate care/stepdown, and one to medical-surgical/floor. The mean hospitalization was 1.7 days. Two patients were transferred and lost to follow up. CONCLUSION: Naloxone infusions were uncommon but associated with drug waste and high resource utilization. Further studies are needed to optimize treatment strategies for prolonged opioid toxicity.
BACKGROUND: Sevoflurane is a widely used agent for the rapid induction and maintenance of anesthesia. Diffuse alveolar hemorrhage (DAH) is characterized by acute onset of alveolar infiltrates and hypoxemia, resulting in...BACKGROUND: Sevoflurane is a widely used agent for the rapid induction and maintenance of anesthesia. Diffuse alveolar hemorrhage (DAH) is characterized by acute onset of alveolar infiltrates and hypoxemia, resulting in progressive alveolar bleeding that requires urgent treatment. This report highlights the potential role of inhaled tranexamic acid (TXA) as an adjunctive therapy in DAH. CASE REPORT: A 29-year-old male, ASA-I patient underwent outpatient strabismus surgery. The patient presented to the emergency department (ED) with hypoxia and hemoptysis. These symptoms manifested within the first hour after surgery in the anesthesia unit. Based on the clinical findings, a diagnosis of DAH was established. The patient's hypoxemic respiratory distress was managed with high-flow nasal cannula (HFNC). For DAH, the patient was treated with intravenous glucocorticoids (1 mg/kg for 3 days) and a single 1 g dose of inhaled TXA. At discharge, the patient had no residual symptoms and abnormal clinical findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The popularity of outpatient surgery units is increasing; therefore, emergency and critical care clinicians should be particularly vigilant with post-anesthesia patients. The association between sevoflurane and DAH has not yet been fully elucidated. Further research is required to clarify the underlying pathophysiological mechanisms. DAH is a potentially fatal clinical condition. Clinicians must remain vigilant and be prepared to implement rapid resuscitation strategies. Inhaled TXA may form part of such strategies; however, further randomized controlled trials are required.
BACKGROUND: Emergency physicians spend hours on the electronic health record (EHR) per shift but only minutes per encounter. Empiric evidence regarding the relationship between EHR time and safety outcomes is scant. OBJE...BACKGROUND: Emergency physicians spend hours on the electronic health record (EHR) per shift but only minutes per encounter. Empiric evidence regarding the relationship between EHR time and safety outcomes is scant. OBJECTIVES: To evaluate whether emergency physicians' EHR use was associated with of high-risk unscheduled returns, defined as an emergency department (ED) visit resulting in hospital admission within 72 h of a preceding ED discharge (index visit). METHODS: Retrospective case-control study of adult patients at 3 EDs in a single health system from March-August 2022 with any of the 10 most common chief complaints. Index ED visits (cases) preceding high-risk unscheduled returns were matched 1:1 to controls without subsequent high-risk unscheduled returns matching on age, sex, acuity score, chief complaint, site, night arrival, and Charlson comorbidity index. Attending physicians' EHR use time was compared between cases and controls using logistic regression adjusted for chief complaint and clustered by physician. RESULTS: Of 13,747 ED visits meeting inclusion criteria, 300 (2.2%) met our case definition; these were matched to 300 controls with similar baseline characteristics. Physicians spent a mean (SD) of 7.16 (5.70) EHR minutes on cases, compared to 8.00 (6.23) min on controls (p = 0.08). Index visit EHR time (in minutes) was not associated with high-risk unscheduled return visits (OR 0.98; 95% CI 0.95-1.00) in adjusted analyzes. CONCLUSION: Attending physicians' EHR time on index ED visits was not associated with odds of unscheduled return. Future research should further examine the association between EHR use patterns and ED quality and safety, including in high-risk groups.
Gladhill G, Schwei RJ, Griffin M
… +7 more, Glinert R, Haleem A, Hess J, Keenan T, McBride JA, Redwood R, Pulia MS
J Emerg Med
· 2026 Jul · PMID 42102539
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BACKGROUND: Cellulitis is overdiagnosed in up to 36% of emergency department (ED) cases. Teledermatology has been proposed as a solution to reduce diagnostic misclassification yet there is a paucity of data supporting th...BACKGROUND: Cellulitis is overdiagnosed in up to 36% of emergency department (ED) cases. Teledermatology has been proposed as a solution to reduce diagnostic misclassification yet there is a paucity of data supporting this approach. OBJECTIVE: To compare cellulitis diagnostic discordance, confidence and perceived difficulty of diagnosis between emergency medicine (EM); dermatology (Derm); and infectious diseases (ID) physicians using information available during teledermatology conditions. METHODS: We conducted a secondary analysis of adult patients presenting to the ED for an acute skin complaint of the lower extremity. A consensus panel of six acute care physicians independently reviewed cases and determined cellulitis diagnosis. We then compared diagnostic discordance, confidence, and perceived difficulty between the three specialties using chi-squared tests. RESULTS: 201 participants were included in this analysis. Diagnostic discordance did not vary significantly by specialty (Derm: 15.7%; EM: 12.9%; ID: 17.7%; p = 0.176). There were significant differences in the confidence of diagnosis with ID physicians being very certain 38% of the time compared to Derm, 19%, and EM, 17% (p < 0.001) and in ratings of difficulty with ID physicians rating the diagnosis as very easy in 35% of cases compared to Derm: 13%, and EM: 14% (p < 0.001). CONCLUSIONS: Under conditions that replicate teledermatology, cellulitis diagnosis did not differ by specialty. These findings suggest that diagnostic acumen is not a primary driver of ED cellulitis overdiagnosis. Future research aimed at improving cellulitis diagnosis should focus on interventions and clinical tools that target reported barriers, such as diagnostic uncertainty and access to follow-up care.
BACKGROUND: Four randomized trials found no benefit to intravenous thrombolytics (IVT) in minor stroke patients. However, most patients considered to have disabling deficits were excluded from these trials. Some argue th...BACKGROUND: Four randomized trials found no benefit to intravenous thrombolytics (IVT) in minor stroke patients. However, most patients considered to have disabling deficits were excluded from these trials. Some argue that this means minor strokes should still be considered for IVT if the provider considers the deficit disabling. OBJECTIVES: To conduct a structured narrative review of the IVT literature and argue that, if subgroups of patients with minor stroke benefit from IVT, they must first be identified in randomized trials. DISCUSSION: Compared to other analogous therapies like IVT for acute coronary syndrome, or mechanical thrombectomy for stroke, the literature for IVT in ischemic stroke patients is inconsistent-there are beneficial, negative, and harmful results. In the positive trials, there is movement in the modified Rankin Scale; in minor stroke trials, it is not clear there will be movement in this outcome as we suspect most minor stroke patients will have low scores. Considering the inconsistent results of IVT for stroke in all patients, the theoretical difficulty in showing a benefit in minor stroke patients, and the negative trials-broadly accepting that IVT benefits certain minor stroke patients risks exposing patients to a potentially harmful treatment while consuming resources for an uncertain benefit. CONCLUSION: Randomized trials for IVT in minor stroke patients should explore which deficits experience benefit. Intravenous thrombolytics should not be routinely offered to patients with minor stroke in the absence of clearly demonstrable, measurable disability.
BACKGROUND: Dehydration is a common but underrecognized in acute ischemic stroke and is associated with increased complications and poor outcomes. OBJECTIVES: This study aimed to determine the prevalence of dehydration a...BACKGROUND: Dehydration is a common but underrecognized in acute ischemic stroke and is associated with increased complications and poor outcomes. OBJECTIVES: This study aimed to determine the prevalence of dehydration among stroke patients presenting to the emergency department (ED) and evaluate its prognostic impact on clinical outcomes using the inferior vena cava (IVC) collapsibility index. METHODS: In this prospective observational study, consecutive adult patients with acute ischemic stroke admitted to the ED were evaluated. Volume status was assessed at presentation by bedside ultrasound measuring the IVC collapsibility index (CI), alongside laboratory markers including blood urea nitrogen/creatinine ratio and estimated glomerular filtration rate. Dehydration was defined as CI > 50% with an IVC expiratory diameter < 2.1 cm. Neurological severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes were determined by the modified Rankin Scale (mRS) at discharge and 3 months. Patients were categorized by treatment modality as conservative, intravenous thrombolysis, or mechanical thrombectomy, with poor outcome defined as mRS 3-6. RESULTS: Among 211 patients, hypovolemia was present in 72 (34.1%). Multivariable logistic regression identified collapsed IVC as an independent predictor of poor functional outcome in the anterior circulation cohort (adjusted OR: 2.606, 95% CI: 1.097-6.189, p = 0.030), even after adjusting for critical confounders such as baseline NIHSS. Conversely, no significant association between volume status and prognosis was observed in posterior circulation strokes. CONCLUSION: Dehydration assessed by IVC collapsibility is independently associated with poor outcomes, particularly in anterior circulation strokes. Early ultrasonographic volume assessment may assist in optimizing treatment strategies in the ED.
BACKGROUND: The instrument tie is a common introductory wound closure technique but has limitations when a hand tie is needed. DISCUSSION: This article contains instructions on how a trainee can use fingers to mimic the...BACKGROUND: The instrument tie is a common introductory wound closure technique but has limitations when a hand tie is needed. DISCUSSION: This article contains instructions on how a trainee can use fingers to mimic the motion of an instrument tie when needed if conventional 1- or 2-handed knots have not yet been mastered. CONCLUSION: The mechanics of an instrument tie can be replicated by using the index and middle fingers to mimic the motion typically performed by a needle holder.
J Emerg Med
· 2026 Jun · PMID 42066526
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BACKGROUND: Clinical Informatics is wide-ranging field that engages with nearly every aspect of clinical care that is documented in the electronic health record (EHR). While studies from the informatics literature had be...BACKGROUND: Clinical Informatics is wide-ranging field that engages with nearly every aspect of clinical care that is documented in the electronic health record (EHR). While studies from the informatics literature had been gradually introducing more sophisticated machine learning and artificial intelligence (AI) techniques into clinical settings, the explosive growth of Large Language Models (LLMs) has enticed both entrepreneurs and clinicians to rapidly introduce LLMs into the Emergency Department. DISCUSSION: Clinical Informaticists possess a deep understanding of both the clinical significance and underlying architecture of clinical data. Misunderstanding how data is represented can pose significant hazards for clinical care, research, and AI systems. Despite the seemingly high performance of LLMs on some clinical measures, evidence for their ability to reason clinically is lacking, and they often provide confident, false answers. Emergency Physicians (EPs) who are board-certified in Clinical Informatics could be a natural constituency to help to integrate these technologies safely into the ED. However, there are very few EPs with this board-certification, due to high demand, few training programs, and a lack of visibility of the subspecialty. CONCLUSIONS: LLMs and other AI systems are likely to play a growing role within the ED as technology improves and hospitals partner with commercial vendors. Working EPs need to have a strong understanding of the potential benefits and limitations of these technologies, and EPs with training in Informatics will play an essential role. Increasing exposure to Clinical Informatics within Emergency Medicine residencies and supporting EPs to go into Informatics fellowships is paramount.
Cline L, Downey K, Rashid Y
… +2 more, Vora N, Fine L
J Emerg Med
· 2026 Jun · PMID 42001735
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BACKGROUND: Millions of U.S. women live in contraceptive deserts, with limited or no access to comprehensive reproductive health services. Barriers are intensified by Medicaid restrictions, provider shortages, and growin...BACKGROUND: Millions of U.S. women live in contraceptive deserts, with limited or no access to comprehensive reproductive health services. Barriers are intensified by Medicaid restrictions, provider shortages, and growing reproductive health inequities. The emergency department (ED), as the healthcare safety net, is uniquely positioned to expand contraceptive access. OBJECTIVES: To highlight the public health need for ED-initiated contraception, describe feasible approaches for implementation, and address common challenges to integrating contraception into emergency care. DISCUSSION: Women of reproductive age account for nearly a quarter of ED visits, and many present with conditions that can be effectively treated or prevented with contraception. Evidence demonstrates patient demand and feasibility of ED-based contraceptive care, including among adolescents and marginalized groups. Practical strategies include patient-centered counseling, use of decision-support tools, quick-start initiation, and prescribing year-long supplies. Challenges such as time constraints, uncertain follow-up, and scope-of-practice concerns are similar to those encountered with many other medications already managed in the ED. Training models and multidisciplinary frameworks show that emergency physicians can deliver safe and effective contraceptive care. CONCLUSIONS: Initiating contraception in the ED is feasible, evidence-based, and aligned with the core mission of emergency medicine. By expanding access to contraception, emergency physicians can prevent unintended pregnancies, reduce downstream emergencies, and address reproductive health inequities, particularly for underserved populations.
Dluhy LA, Dluhy DH, Arky RA
… +3 more, Brown FL, Peteet JR, Wright SC
J Emerg Med
· 2026 May · PMID 42000340
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BACKGROUND: Due to limits in state and federal law in the United States, little is known about the health and health care delivery to persons experiencing medical crises during contact with law enforcement officers. DISC...BACKGROUND: Due to limits in state and federal law in the United States, little is known about the health and health care delivery to persons experiencing medical crises during contact with law enforcement officers. DISCUSSION: Federally, and in 49 U.S. states, persons lack a statutory right to emergency medical care during law enforcement interactions. Additionally, limits in state and federal law preclude systematic data collection regarding the health and health care delivery to persons in these circumstances. CONCLUSION: With the implementation of the statutory changes proposed in this article, all persons in the United States would be guaranteed a statutory right to emergency medical care during direct contact with law enforcement officers. Further, complete data could be collected regarding the prevalence, nature and handling of medical emergencies among persons held in custody, as well as among persons experiencing medical crises during interactions with law enforcement officers in the field.
Jenkins JL, Everly GS, Roemer EC
… +8 more, Hsu EB, Han G, Zhang A, Sharma R, Asenso E, Bidmead D, Bass EB, Saldanha IJ
J Emerg Med
· 2026 Jun · PMID 42000301
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BACKGROUND: As frontline health care workers, Emergency Medical Service (EMS) clinicians are subject to stressful conditions. These conditions contribute to burnout, stress, and moral injury. OBJECTIVE: The objectives of...BACKGROUND: As frontline health care workers, Emergency Medical Service (EMS) clinicians are subject to stressful conditions. These conditions contribute to burnout, stress, and moral injury. OBJECTIVE: The objectives of this systematic review were to 1) evaluate the incidence, prevalence, and severity of adverse occupationally related mental health conditions, including burnout, stress, and moral injury among EMS clinicians; and 2) to identify any modifying factors associated with those conditions. METHODS: We searched MEDLINE, Embase®, Cochrane Register of Clinical Trials, PsycINFO®, and Cumulative Index to the Nursing and Allied Health Literature from January 1, 2001 through June 30, 2024. We also searched websites, the ClinicalTrials.gov registry, and journals not indexed in Medline. To increase applicability to the U.S. decision-making context, we restricted to studies of EMS clinicians in high-income countries. We used standard methods to assess the risk of bias and evaluate the strength of evidence. RESULTS: We included 92 studies (88 cross-sectional studies and 4 cohort studies). During routine practice, the mean levels of organizational job stress were mild to moderate, burnout and general stress were mild to severe, and secondary traumatic stress was mild (moderate strength of evidence for each). There was considerable heterogeneity in prevalence and severity by country, setting, population, context, and outcome measurement instruments and scoring methodology or threshold. No study reported on incidence. Some modifying factors (e.g., more trauma exposure, more hours per week, more burnout, higher call volumes) may be associated with poor outcomes. CONCLUSIONS: Despite considerable variation, the stress issues in the EMS workforce are substantial enough to merit greater attention by health systems. Addressing these challenges will require evidence-based comprehensive strategies that consider the modifying factors associated with poor outcomes.
Chang R, Deveau R, Hayes MM
… +4 more, Stenson B, Kistler E, McDonald N, Wong A
J Emerg Med
· 2026 Jun · PMID 41980483
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BACKGROUND: Long-term benzodiazepine (BZD) use in the intensive care unit (ICU) is associated with negative patient outcomes, while data on short-term BZD use are limited. OBJECTIVES: This study evaluated ICU outcomes as...BACKGROUND: Long-term benzodiazepine (BZD) use in the intensive care unit (ICU) is associated with negative patient outcomes, while data on short-term BZD use are limited. OBJECTIVES: This study evaluated ICU outcomes associated with short-term midazolam infusion (<24 h) compared to propofol in emergency department (ED) patients who were mechanically ventilated. METHODS: This was a retrospective cohort study of mechanically ventilated patients in the ED who received either midazolam or propofol infusions from 1/1/2020 to 3/15/2022. Patients with either status epilepticus, acute pancreatitis, or status postcardiac arrest, had continuous midazolam for >24 h, or concurrent midazolam and propofol use for >2 h, were excluded. The primary outcome was ventilator-free days (VFDs) at day 7. Secondary outcomes were duration of mechanical ventilation, incidence of delirium within 48 h, and in-hospital mortality. RESULTS: A total of 137 patients were included (midazolam, n = 82; propofol, n = 55). Patients were older in the midazolam group (65 vs. 59 years), while baseline Acute Physiology and Chronic Health Evaluation II scores were comparable between the two groups. Midazolam was most often initiated due to need for vasopressors (25.6%), with a median norepinephrine equivalent of 0.15 mcg/kg/min (IQR 0.07-0.29) at initiation. In the midazolam group, 36.6% were changed to propofol within 60 minutes of ICU admission. No significant differences were observed in VFDs at day 7 between the propofol and midazolam groups (difference 0, 95% CI -0.69 to +0.58; p = 0.75). We also did not find differences in duration of mechanical ventilation (p = 0.53), incidence of delirium at 48 h (p = 0.85), or in-hospital mortality (p = 0.49). CONCLUSION: Short-term midazolam use (i.e., <24 h) was not associated with longer VFDs at day 7 in this retrospective study. No significant differences were observed in duration of mechanical ventilation, delirium incidence, or in-hospital mortality. Further research is warranted to validate these findings.
Akın Özdemir M, Şancı E, Özturan İU
… +2 more, İnci Ö, Delice Y
J Emerg Med
· 2026 Jun · PMID 41974162
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BACKGROUND: Shift durations and working schedules are associated with cognitive fatigue and increased risk of burnout, potentially comprimising both physicians' well-being and patient safety. OBJECTIVES: This study aims...BACKGROUND: Shift durations and working schedules are associated with cognitive fatigue and increased risk of burnout, potentially comprimising both physicians' well-being and patient safety. OBJECTIVES: This study aims to investigate the effects of different work schedules on cognitive performance and burnout levels among emergency medicine residents by psychological scales and objective cognitive testing. METHODS: A total of 110 residents were enrolled from 4 institutions implementing 2 distinct work schedules: 24-hour shift system and 8-hour day + 16-hour night shift model. Cognitive performance was assessed using the Stroop test at multiple time points, and Interferance Index (IG) Scores were calculated to quantify the stroop effect. Burnout levels were evaluated with Maslach Burnout Inventory (MBI). RESULTS: Residents working 24-hour shifts showed significant time-dependent decline in Stroop test performance and IG scores (p < 0.001), indicating reduced cognitive function by the end of the shift. Conversely, residents in the 8-hour day shifts also showed cognitive decline (p < 0.001), while no significant changes were observed in the 16-hour night shift group. Burnout analysis revealed that emotional exhaustion scores were significantly higher in the 8/16-hour group compared to the 24-hour group (p = 0.027), while depersonalization and personal accomplishment scores did not differ significantly between groups. CONCLUSION: Both long and fragmented shift models may impair cognitive performance among emergency medicine residents. Interestingly, the 8/16-hour system was associated with higher emotional exhaustion, despite its shorter duration. These findings underscore the importance of reevaluating shift structures to promote physician wellness and preserve clinical performance.
J Emerg Med
· 2026 Jun · PMID 41966734
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BACKGROUND: An ostomy is a surgical opening between a hollow organ and the body surface. These are necessary for several conditions, but complications may arise following ostomy creation. OBJECTIVE: This narrative review...BACKGROUND: An ostomy is a surgical opening between a hollow organ and the body surface. These are necessary for several conditions, but complications may arise following ostomy creation. OBJECTIVE: This narrative review provides emergency clinicians with a focused overview of ostomy complications. DISCUSSION: An ostomy is a diverting measure for management of several conditions, including gastrointestinal malignancy, inflammatory bowel disease, bowel obstruction, perforation, and trauma, and in pediatric patients, other indications include bowel malformations, Hirschsprung's disease, and necrotizing enterocolitis. Ileostomies connect the small bowel to the skin surface and are typically on the right side of the abdomen with a smaller stoma, while colostomies connect the large bowel to the skin and are typically on the left side with a larger stoma. A number of complications may occur, most commonly within the first 5 years after ostomy creation. Early complications include high-output, stoma necrosis, stoma retraction, and skin irritation/dermatitis, while later complications include parastomal hernia, stomal prolapse, stomal stenosis, and bleeding. Surgical consultation is recommended for many of these complications. Emergent surgical intervention may be necessary in those with stoma necrosis and parastomal hernia with strangulated bowel, as well as those with obstruction. CONCLUSION: An understanding of ostomy complications can assist emergency clinicians.
Imamoglu M, Akkaya S, Sahin AS
… +3 more, Akil SC, Karaca Y, Pasli S
J Emerg Med
· 2026 May · PMID 41965963
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BACKGROUND: Syncope is a frequent presentation to the emergency department and may result in secondary trauma such as falls. Cardiac syncope carries high morbidity and mortality, while blunt thoracic trauma may also lead...BACKGROUND: Syncope is a frequent presentation to the emergency department and may result in secondary trauma such as falls. Cardiac syncope carries high morbidity and mortality, while blunt thoracic trauma may also lead to a wide spectrum of cardiac injuries, particularly in patients with prior cardiovascular surgery. Blunt thoracic trauma may present with chest pain, dyspnea, and hemodynamic instability. These clinical features closely resemble those of acute coronary syndromes. Electrocardiographic findings such as ST-segment elevation may indicate either primary acute coronary ischemia or myocardial involvement resulting from blunt cardiac injury. Differentiating between cardiac syncope with acute coronary syndrome and trauma-related cardiac injury can therefore be extremely challenging for emergency physicians. CASE REPORT: A 64-year-old man with a history of coronary artery bypass grafting (CABG) and mitral valve replacement presented after a three-meter fall preceded by exertional syncope. On arrival, he reported chest pain, and an electrocardiogram (ECG) revealed ST-segment elevation in the lateral leads. An extended focused assessment with sonography in trauma (E-FAST) demonstrated a left-sided hemothorax. Computed tomography angiography (CTA) identified a large mediastinal hematoma with active extravasation from the left internal mammary artery-left anterior descending artery (LIMA-LAD) graft, distal occlusion of the graft, and compression-induced stenosis of the aorta-obtuse marginal (Ao-OM) saphenous vein graft. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This is, to our knowledge, the first reported case of traumatic rupture of a coronary bypass graft. Emergency physicians should recognize this rare but fatal complication, which can be distinguished from primary cardiac syncope through appropriate multimodal emergency evaluation and imaging.