Stenberg R, Ceraolo N, Ritz A
… +2 more, Makowski B, Simon EL
J Emerg Med
· 2026 Feb · PMID 41529364
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BACKGROUND: Acute sciatica can cause severe radicular pain that is often unresponsive to systemic medications in the emergency department (ED). Ultrasound-guided transgluteal sciatic nerve blocks offer a targeted, opioid...BACKGROUND: Acute sciatica can cause severe radicular pain that is often unresponsive to systemic medications in the emergency department (ED). Ultrasound-guided transgluteal sciatic nerve blocks offer a targeted, opioid-sparing method of pain. CASE REPORT: We present a case of a patient with intractable bilateral lower extremity pain secondary to sciatica, successfully treated with transgluteal nerve blocks under ultrasound guidance. The sciatic nerves were visualized in the gluteal region between the greater trochanter and ischial tuberosity. One side was anesthetized using dextrose 5% in water (D5W), and the other with a combination of bupivacaine and dexamethasone. The patient reported significant pain relief within 20 min and was safely discharged with outpatient follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the expanding role of regional anesthesia techniques in ED pain management and highlights a unique instance of bilateral nerve blocks producing effective analgesia despite the use of D5W alone on one side.
J Emerg Med
· 2026 Feb · PMID 41518716
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BACKGROUND: Thyroid gland rupture is extremely rare, typically occurring in individuals with underlying thyroid enlargement or hyperthyroidism. Thyroid gland rupture can lead to life-threatening complications such as air...BACKGROUND: Thyroid gland rupture is extremely rare, typically occurring in individuals with underlying thyroid enlargement or hyperthyroidism. Thyroid gland rupture can lead to life-threatening complications such as airway obstruction or thyroid storms. CASE REPORT: A 19-year-old male with no past medical history presented to the emergency department (ED) with painful swelling in the anterior neck after blunt neck trauma. The patient reported pain while swallowing but denied dyspnea or difficulty swallowing. Point-of-care ultrasound (POCUS) of the anterior neck area revealed hypo-echoic hematoma in the right lobe of the thyroid gland. A subsequent computed tomography (CT) scan with intravenous contrast confirmed that the right lobe of thyroid was enlarged with no contrast enhancement in the center of the right lobe. A thyroid gland rupture was finally diagnosed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should consider this rare but potentially serious injury in patients with blunt neck trauma and tailor the management based on the extent of thyroid damage, risk of airway compromise, and thyroid function status. This case suggests that POCUS can be a powerful tool when clinicians suspect thyroid gland rupture.
J Emerg Med
· 2026 Jan · PMID 41422690
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BACKGROUND: Severe bradycardia is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE OF THE REVIEW: This review highlights the pearls and pitfalls of severe bradycardia, including...BACKGROUND: Severe bradycardia is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE OF THE REVIEW: This review highlights the pearls and pitfalls of severe bradycardia, including presentation, diagnosis, and management in the emergency department based on current evidence. DISCUSSION: Severe bradycardias are critical conditions that can cause hemodynamic instability, necessitating emergent evaluation and management. Common causes include intrinsic conduction system disease, acute coronary syndrome, and acute myocardial infarction, pharmacologic agents (e.g., beta-blockers, calcium channel blockers, digitalis), and metabolic disturbances (e.g., hyperkalemia, decompensated hypothyroidism, hypothermia), among others. A focused history and physical examination are necessary to narrow the differential diagnosis. An electrocardiogram is essential and may establish a definitive diagnosis. Laboratory studies directed toward a specific, identifiable diagnosis can be useful, such as elevated serum troponin or potassium values. Initial management aims to increase the heart rate and thus stabilize cardiac output via initiation of transcutaneous pacing and administration of chronotropic agents while addressing the underlying cause. In cases of severe bradycardia with accompanying hypotension despite initial therapy, transvenous pacing may be required. Early recognition and prompt management of severe bradycardia are vital to preventing hemodynamic collapse. By combining a systematic diagnostic approach with tailored interventions, clinicians can effectively address underlying causes and improve patient outcomes, even in the most critical scenarios. CONCLUSION: An understanding of severe bradycardia can assist emergency clinicians in diagnosing and managing this potentially deadly condition.
Jehle DVK, Mehta K, Kim EM
… +7 more, Bothwell LG, Mireles B, Ghogomu M, Davis CM, Paul KK, Lindsey RW, Mouton CP
J Emerg Med
· 2026 Jan · PMID 41418629
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BACKGROUND: Patients presenting to the emergency department (ED) with long bone fractures often require opioid or nonopioid analgesics. Historical data reveal racial disparities, with White patients more likely to receiv...BACKGROUND: Patients presenting to the emergency department (ED) with long bone fractures often require opioid or nonopioid analgesics. Historical data reveal racial disparities, with White patients more likely to receive pain medications than Hispanic patients. STUDY OBJECTIVES: This study investigates differences in the administration of opioid and nonopioid analgesics to Hispanic and White ED patients with long bone and femur fractures over the last 20 years. METHODS: Opioid and nonopioid analgesic administration rates in Hispanic and White patients with femur and long bone fractures were analyzed from 2004 to 2024 at 5-year intervals using data from 112 million patients within 64 U.S. healthcare organizations. Propensity matching was performed on demographic variables. RESULTS: There were 771,945 Hispanic or White patients identified with long bone fractures and 159,196 patients with femur fractures before propensity matching, and 248,008 with long bone fractures and 26,210 with femur fractures after propensity matching. In the propensity matched dataset, there was a significant gap in opioid analgesia use for long bone (10.4% vs. 21.4%, p < 0.001) and femur fractures (16.6% vs. 40.0%, p < 0.001) between Hispanic and White patients from 2004 to 2009. This disparity persisted through 2019-2024 for long bone (42.0% vs. 49.3%, p < 0.001) and femur (66.7% vs 77.7%, p < 0.001) fractures. Trends were comparable in the nonopioid cohorts. CONCLUSION: Over the past two decades, Hispanic patients with long bone and femur fractures were administered lower rates of opioid and nonopioid analgesia compared to White patients. This suggests that ethnic differences may still contribute significantly to disparities in analgesia administration in the ED.
Lee P, Ghobrial M, Greider K
… +8 more, Hryniewicki A, Luu E, Aminlari A, Murray M, Trivedi J, Bui Q, Wardi G, Self M
J Emerg Med
· 2026 Jan · PMID 41406700
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BACKGROUND: Left ventricular assist devices (LVADs) are increasingly used in patients with advanced heart failure. As their prevalence grows, emergency physicians (EPs) are more likely to encounter these patients. Howeve...BACKGROUND: Left ventricular assist devices (LVADs) are increasingly used in patients with advanced heart failure. As their prevalence grows, emergency physicians (EPs) are more likely to encounter these patients. However, LVAD-supported physiology differs from native cardiac function and can lead to unique complications. Prompt recognition and appropriate initial management are critical. OBJECTIVE OF THE REVIEW: The objective of this literature review is to examine carefully selected pieces of literature regarding the initial assessment, stabilization, and emergency management of patients with LVADs. Not all EPs are comfortable with LVADs, and we hope that this review will help identify key physiologic principles, common complications, and practical algorithms that can guide frontline EPs in delivering timely and effective care to this complex patient population. DISCUSSION: The emergency management of patients with LVADs requires a nuanced understanding of altered physiology, an approach to rapid stabilization, and device-specific complications. EPs can lack familiarity with essential LVAD principles, including interpreting non-pulsatile vital signs and identifying unique complications such as pump thrombosis, driveline infections, and right heart failure. While evidence supports early consultation with LVAD coordinators, standardized protocols remain inconsistent across institutions. Focused training and greater dissemination of evidence-based summaries and guidelines are necessary to help close knowledge gaps and improve outcomes in this growing patient population. CONCLUSIONS: Incorporating evidence-based research and promoting familiarity with LVAD physiology and complications can enhance both patient safety and provider readiness in these high-stakes encounters.
Ghazala M, Alkodami L, Farhat NMN
… +5 more, Alkhabour ST, Zain Al-Abeden MS, Jihwaprani MC, Sula I, Saquib N
J Emerg Med
· 2026 Jan · PMID 41364951
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BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality. Point of care (POC) blood gas analysis can aid in early risk stratification of OHCA patients by providing insights on metabolic derange...BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality. Point of care (POC) blood gas analysis can aid in early risk stratification of OHCA patients by providing insights on metabolic derangements during resuscitation and post-arrest care. OBJECTIVE: To assess the role of blood gas analysis in predicting OHCA outcomes. METHODS: Four electronic databases (i.e., ProQuest, PubMed/MEDLINE, ScienceDirect, and Web of Science) were searched in this systematic review (PROSPERO: CRD42024552025). Eligible studies were those that included patients who had experienced OHCA, reported blood gas values, and reported any of the following outcomes: return of spontaneous circulation [ROSC], survival to hospital discharge, or good neurological outcomes. RESULTS: Thirteen studies were included in the review, with a pooled sample of 14,584 patients; 57% were male. Sampling time differed between studies: either at the beginning of or after 2 cycles of resuscitation, upon arrival, or 10 minutes after arrival to the emergency department. Blood gas values (i.e., pH, pO and pCO) varied across studies for patients with ROSC. Some studies reported higher values in ROSC patients compared to non-ROSC patients, and vice versa. Blood gas values were generally higher among patients who survived or had favorable neurological outcomes; however, their mean values varied and were often contradictory across studies, which constrained the pooling of these estimates into a meta-analysis. CONCLUSION: At present, POC blood gas analysis cannot reliably be used for prognosis among OHCA patients. Future studies should improve the methodology by considering factors like sampling time and source (i.e., venous or arterial).
Cohen JS, Patel P, Finney A
… +3 more, Zheng M, Badaki O, Prichett L
J Emerg Med
· 2026 Jan · PMID 41330306
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BACKGROUND: Children with autism spectrum disorders face high rates of mental health emergencies often requiring hospitalization, but limited psychiatric unit access often leaves them waiting in emergency departments (ED...BACKGROUND: Children with autism spectrum disorders face high rates of mental health emergencies often requiring hospitalization, but limited psychiatric unit access often leaves them waiting in emergency departments (EDs). OBJECTIVE: To determine if autism is an independent risk factor for prolonged emergency department (ED) stays (>90%), ED psychiatric boarding (>24 hours), and prolonged ED boarding (>48 or 72 hours) for children with mental health concerns requiring hospitalization METHODS: This was a retrospective cohort study using the PECARN Registry Dataset from 2016 through 2021. All ED encounters for patients ages 5 to 18 years of age requiring admission for a primary mental health diagnosis were included. The primary outcome was ED length of stay, the primary exposure variable was autism, and potential confounding variables were age, sex, race/ethnicity, and insurance status. RESULTS: A total of 73,624 ED visits were included, 66,113 visits without autism and 7511 with autism. When adjusted for age, sex, race and insurance, admitted patients with autism had higher odds of a prolonged ED stay (aOR 1.26, 95% CI 1.15-1.38), ED boarding (aOR 1.68, 95% CI 1.41-2.00), and prolonged ED boarding > 48 hours (aOR 3.91, 95% CI 2.62-5.84) and > 72 hours (aOR 3.91, 95% CI 2.14-7.14). CONCLUSION: Autism is an independent risk factor for having a prolonged ED stay, for boarding in the ED, and for prolonged ED boarding when presenting to the ED with a mental health crisis that requires hospitalization.
Murk W, Gartenberg A, Maik J
… +16 more, Montenegro MA, Antora S, Bandagi A, Boulay M, Clemmensen J, Dixon T, Jones M, Khambhati K, Leonard-Shiu N, Liveris A, O'Donnell P, Scoccimarro A, Sperling J, Wiseman D, Ramachandran A, Halperin M
J Emerg Med
· 2025 Dec · PMID 41326133
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Larsen SE, Davis JIM, Murphy N
… +7 more, Moukaddam NJ, Swann AC, Kosten TR, Hundt NE, Verrico CD, Elechi O, Thomas YT
J Emerg Med
· 2026 Jan · PMID 41319493
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BACKGROUND: Post-traumatic stress disorder (PTSD) is a psychiatric condition that can develop after trauma and imposes substantial, long-term morbidity. Emergency departments (EDs), as the initial point of healthcare con...BACKGROUND: Post-traumatic stress disorder (PTSD) is a psychiatric condition that can develop after trauma and imposes substantial, long-term morbidity. Emergency departments (EDs), as the initial point of healthcare contact, can reduce patients' risk of developing PTSD following trauma exposure through trauma-informed care (TIC). Women face a two- to threefold higher PTSD incidence than men and show distinct symptom patterns, indicating that clinical approaches should be adapted to reflect these differences in trauma response. OBJECTIVES: To present a narrative review that summarizes current evidence on gender-related differences in early posttraumatic responses, TIC practices feasible in the ED, and pathways that connect ED care to psychiatric and outpatient follow-up. METHODS: We conducted a narrative literature review to explore current evidence on mitigating PTSD risk through gender-sensitive, TIC approaches in ED settings. Searches were conducted in PubMed, Web of Science, Science Direct, and Open Evidence using terms such as "PTSD," "acute stress disorder," "emergency department," "trauma-informed care," "gender differences," "sex differences," and "trauma patients." Articles in English published primarily in the last 15 years that focused on adult trauma patients in ED settings and gender-specific outcome or interventions were included. Studies that focused exclusively on military or chronic PTSD were excluded. DISCUSSION: Women more often present with hyperarousal, intrusive re-experiencing, and interpersonal violence-related trauma, whereas men commonly exhibit dissociation and delayed help seeking. Universal micro practices, such as explicit introductions, consent before contact, plain language explanations, and privacy protection, enhance psychological safety and are particularly protective for women. Brief, validated PTSD risk screeners, electronic health record prompts, concise clinician TIC training, and on demand psychiatric consultation streamline early detection for vulnerable patients without impacting ED workflow. CONCLUSIONS: Embedding gender-sensitive TIC into routine ED workflows enables PTSD risk identification, reduces re-traumatization, and facilitates prompt linkage to mental health services. Practical communication techniques, efficient screening, and structured referral pathways can empower emergency medicine clinicians to mitigate long-term PTSD sequelae across diverse trauma populations.
J Emerg Med
· 2026 Jan · PMID 41313851
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BACKGROUND: An acute Stanford Type A aortic dissection (ATAAD) carries a high in-hospital mortality rate that increases with delays to surgical intervention. Early diagnosis is therefore critical for improving outcomes....BACKGROUND: An acute Stanford Type A aortic dissection (ATAAD) carries a high in-hospital mortality rate that increases with delays to surgical intervention. Early diagnosis is therefore critical for improving outcomes. Unfortunately, ATAAD is often misdiagnosed initially. Moreover, definitive diagnosis with computed tomography angiography (CTA) requires time to obtain and may not be feasible in an unstable patient. Fortunately, emergency physicians can use transthoracic cardiac point-of-care ultrasound (POCUS) to make a quicker diagnosis, prompt earlier CTA, initiate goal-directed therapy, and reduce time-to-operative intervention. OBJECTIVE: This narrative review reports four echocardiographic findings that suggest the presence of ATAAD. For each finding, we describe the associated pathophysiology and summarize the literature evaluating diagnostic utility. We also use high-quality media to provide step-by-step tutorials and advanced pearls and pitfalls for translation to the bedside. DISCUSSION: The echocardiographic findings that suggest ATAAD are: aortic intimal flap, aortic root enlargement, aortic regurgitation, and pericardial effusion. CONCLUSION: The use of cardiac POCUS can rule in or strongly suggest the diagnosis of ATAAD. Although cardiac POCUS on its own should not be used to rule out ATAAD, the lack of any suggestive echocardiographic findings may lower suspicion for this diagnosis.
Gray S, Amadon G, Temkin N
… +9 more, Darsie M, Giacino JT, Corrigan JD, Korley F, Whyte J, Stein MB, Manley GT, McCrea MA, Nelson LD
J Emerg Med
· 2026 Jan · PMID 41297111
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BACKGROUND: Experts recommend administering a traumatic brain injury (TBI) symptom checklist as part of routine evaluation for TBI with Glasgow Coma Scale score 13-15 ("mild" TBI [mTBI]) in adult emergency departments (E...BACKGROUND: Experts recommend administering a traumatic brain injury (TBI) symptom checklist as part of routine evaluation for TBI with Glasgow Coma Scale score 13-15 ("mild" TBI [mTBI]) in adult emergency departments (EDs). However, such assessment is not routine, partly due to limited guidance on interpreting symptom scores. OBJECTIVES: Assess the utility of Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores, assessed in-hospital within 24 h of injury (day 1), in discriminating individuals with, vs. without, persistent TBI-related symptoms (persistent post-concussive symptoms [PPCS]) at 3 months post-injury, and provide interpretive guidance. METHODS: Adults with mTBI across three Level I trauma centers completed the RPQ at day 1 and 3 months post-injury. Using binary logistic regression models and fivefold internal cross-validation, we calculated the mean area under the curve (AUC) for day 1 RPQ total score in predicting 3-month PPCS. Clinical interpretation tables were provided. RESULTS: Two hundred fifty-two participants who completed a day 1 RPQ were included in the analysis. Inverse probability weighting was used to adjust for bias in attrition (n = 168 followed). The mean cross-validated AUC was 0.84 using day 1 RPQ score alone. Multivariable models, including those using previously validated sets of variables, did not outperform day 1 RPQ alone. CONCLUSIONS: In adults presenting to Level I trauma centers for acute mTBI, symptom burden (RPQ total score) is robustly associated with 3-month symptom outcome. The RPQ, which can be completed in about 3 min, may support recognition of mTBI symptoms in the ED and risk stratification for triage into appropriate follow-up pathways.