Emerg Med Clin North Am
· 2026 May · PMID 41895883
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Tachypnea is a sentinel sign of physiologic distress and a critical, early marker of illness in emergency department (ED) patients. Despite its clinical significance, it is often overlooked or inaccurately measured. Tach...Tachypnea is a sentinel sign of physiologic distress and a critical, early marker of illness in emergency department (ED) patients. Despite its clinical significance, it is often overlooked or inaccurately measured. Tachypnea frequently precedes dyspnea and may be the first clue to life-threatening conditions such as sepsis, pulmonary embolism, heart failure, diabetic ketoacidosis, or tamponade. This review provides emergency physicians with a practical framework to assess tachypnea at the bedside using physical examination, point-of-care ultrasound, capnography, and noninvasive ventilation. A systematic approach to this vital sign can improve diagnostic accuracy, guide management, and reduce missed diagnoses in the ED.
Emerg Med Clin North Am
· 2026 May · PMID 41895882
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Temperature is a critical vital sign that can influence workup and clinical diagnosis in the emergency department. Although temperature derangement is often environmentally mediated, it is important to consider other cau...Temperature is a critical vital sign that can influence workup and clinical diagnosis in the emergency department. Although temperature derangement is often environmentally mediated, it is important to consider other causes. Fever can be attributed to infections, inflammatory processes, endocrine dysfunctions, or adverse reactions to medications. Similarly, hypothermia may be the result of shock, endocrine disorder, malnutrition, or iatrogenic factors. An understanding of the impact of temperature on physiology, diagnostics, and patient outcomes enables early recognition of underlying pathologic condition and supports appropriate clinical intervention.
Emerg Med Clin North Am
· 2026 May · PMID 41895881
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In patients with shock, early recognition and timely initiation of appropriate management critically impacts patient outcomes. Currently prevalent approaches to shock in the emergency department have two major limitation...In patients with shock, early recognition and timely initiation of appropriate management critically impacts patient outcomes. Currently prevalent approaches to shock in the emergency department have two major limitations: reliance hypotension as a defining criterion, and confining evaluation and management within a four-category framework. This approach risks oversimplifying a complex, dynamic physiologic state by emphasizing diagnostic labeling over a mechanistic approach to circulatory failure. This article reframes shock as a continuum progressing from physiologic stress to tissue hypoperfusion resulting from a failure of forward flow, which is conceptualized here as the sum of competing forward, backward, and external pressures. Approaching hemodynamics through this lens offers a mental model of shock that balances physiologic sophistication with clinical utility in order to equip frontline clinicians with a more robust toolset for evaluation and management of complex shock patients.
Emerg Med Clin North Am
· 2026 May · PMID 41895880
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Tachycardia is among the most common abnormalities encountered in emergency department (ED) patients and simultaneously one of the most frequently underappreciated. Although often attributed to benign or physiologic caus...Tachycardia is among the most common abnormalities encountered in emergency department (ED) patients and simultaneously one of the most frequently underappreciated. Although often attributed to benign or physiologic causes, tachycardia may represent the earliest-and occasionally the only-objective sign of life-threatening illness. Failure to appropriately contextualize tachycardia contributes to diagnostic error, premature closure, and adverse outcomes, particularly at ED disposition. This review reframes tachycardia as a compensatory physiologic signal rather than a primary pathology. We examine the hemodynamic and neurohumoral drivers of sinus tachycardia and identify high-risk clinical contexts in which tachycardia heralds' critical disease.
Emerg Med Clin North Am
· 2026 May · PMID 41895879
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Bradycardia has a broad differential, which can be narrowed by history, physical examination, and electrocardiogram. Symptomatic cases often stem from sick sinus syndrome or atrioventricular block. High-risk, cannot-miss...Bradycardia has a broad differential, which can be narrowed by history, physical examination, and electrocardiogram. Symptomatic cases often stem from sick sinus syndrome or atrioventricular block. High-risk, cannot-miss causes include hyperkalemia, myocardial ischemia, toxins, hypoxia, increased intracranial pressure, and thyroid dysfunction. Early recognition is critical to prevent progression to bradycardic arrest. Management ranges from targeted interventions and antidotes to pharmacologic and electrical therapies.
Emerg Med Clin North Am
· 2026 May · PMID 41895878
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Necrotizing soft tissue infections (NSTIs) are surgical infections known for being difficult to diagnose and having a high mortality. Familiarity with this disease is particularly critical for emergency physicians, as de...Necrotizing soft tissue infections (NSTIs) are surgical infections known for being difficult to diagnose and having a high mortality. Familiarity with this disease is particularly critical for emergency physicians, as delay in diagnosis or mistakes in treatment are associated with higher mortality, morbidity, and amputation rates. This article will review the pathophysiology and microbiology of NSTIs and describe the current literature on diagnosis of NSTIs. Key concepts in management will be covered, including antibiotic selection, critical care pearls, and surgical management. After reading this review, emergency physicians should feel comfortable with best practices in NSTI care.
Emerg Med Clin North Am
· 2026 May · PMID 41895877
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Acute limb ischemia (ALI) and compartment syndrome (CS) are pathologies that can be difficult to identify but have devastating outcomes if not diagnosed in a timely manner. ALI can be missed if the provider fails to perf...Acute limb ischemia (ALI) and compartment syndrome (CS) are pathologies that can be difficult to identify but have devastating outcomes if not diagnosed in a timely manner. ALI can be missed if the provider fails to perform a pulse examination on every patient and fails to recognize the subtlety of early presentation. CS can be missed if providers are not aware of atypical presentations and fail to consider the diagnosis in certain at-risk patient populations.
Emerg Med Clin North Am
· 2026 May · PMID 41895876
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Acute mesenteric ischemia (AMI) presents variably based on etiology-arterial embolism (often from atrial fibrillation), arterial thrombosis (due to atherosclerosis), mesenteric venous thrombosis (linked to hypercoagulabi...Acute mesenteric ischemia (AMI) presents variably based on etiology-arterial embolism (often from atrial fibrillation), arterial thrombosis (due to atherosclerosis), mesenteric venous thrombosis (linked to hypercoagulability), or nonocclusive ischemia (from low-flow states in critically ill patients). Diagnosis is confirmed with biphasic multidetector CT angiography. Early recognition is essential, as delayed diagnosis worsens outcomes. Treatment varies from anticoagulation to surgery or endovascular intervention. Resuscitation, rapid diagnosis, and revascularization ("3 R"s) are key. AMI should not be ruled out with normal laboratories if the patient has risk factors for the disease. Multidisciplinary collaboration is crucial to improve outcomes and preserve bowel viability.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260859
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A structured, problem-based history and physical examination are essential for accurate diagnosis and treatment of an acutely dizzy patient. The ATTEST or STANDING algorithms are diagnostic approaches for acute vertigo p...A structured, problem-based history and physical examination are essential for accurate diagnosis and treatment of an acutely dizzy patient. The ATTEST or STANDING algorithms are diagnostic approaches for acute vertigo patients presenting to the emergency department. First rule out stroke or look for obvious medical causes. If negative, follow either the ATTEST or STANDING algorithms to differentiate peripheral from central causes of dizziness by separating them into different categories of episodic vestibular syndrome or acute vestibular syndrome. The Dix-Hallpike maneuver is used to diagnose posterior canal benign positional paroxysmal vertigo in patients with triggered episodic vestibular syndrome.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260858
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A transient ischemic attack is an acute neurologic event caused by focal ischemia affecting the brain, eye, or spinal cord, resolving quickly without infarction on magnetic resonance imaging (MRI) diffusion-weighted imag...A transient ischemic attack is an acute neurologic event caused by focal ischemia affecting the brain, eye, or spinal cord, resolving quickly without infarction on magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI). It is a tissue-based diagnosis, highlighting the need for prompt recognition and risk stratification. Evaluation in the emergency department includes detailed history, risk assessment, neurologic examination, and initial noncontrast computed tomography (CT) to rule out other conditions, with MRI DWI as the gold standard for confirming no infarction. Vascular imaging, echocardiography, electrocardiogram (ECG), and laboratories help identify underlying causes. Central retinal artery occlusion (CRAO) requires urgent diagnosis and ophthalmology consultation to prevent permanent vision loss.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260857
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Acute ischemic stroke is the most prevalent neurologic emergency and a common cause of disability and death in the United States, as well as the rest of the world. As emergency department encounters for stroke are only e...Acute ischemic stroke is the most prevalent neurologic emergency and a common cause of disability and death in the United States, as well as the rest of the world. As emergency department encounters for stroke are only expected to rise, frontline clinicians should be readily equipped to recognize and treat this disease process. A rapid, accurate history and examination may help screen for large-vessel occlusions, navigate among potential stroke mimics, and even detect subtle clinical chameleons. Awareness of the utility of advanced perfusion and MRI modalities allows clinicians to offer interventions even to those without a clear time of symptom onset.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260856
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Carotid and vertebral artery dissections are an important cause of stroke in younger patients that can present a diagnostic challenge. Symptoms can range from subtle neck pain and headache to a clear stroke syndrome. Car...Carotid and vertebral artery dissections are an important cause of stroke in younger patients that can present a diagnostic challenge. Symptoms can range from subtle neck pain and headache to a clear stroke syndrome. Carotid and vertebral artery dissections, referred to as cervical artery dissections, are often associated with a traumatic mechanism of varying severity, and screening has been incorporated into major trauma guidelines. Diagnosis is achieved through vessel imaging, most commonly computed tomography angiography or magnetic resonance angiography. Treatment with antiplatelet or antithrombotic agents depends on individual patient risk factors and is typically continued for 3 to 6 months.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260855
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Cerebral venous thrombosis (CVT) is a rare yet serious cerebrovascular condition distinct from arterial stroke. Despite its low prevalence (0.5%-3% of strokes), incidence has risen due to improved awareness and diagnosti...Cerebral venous thrombosis (CVT) is a rare yet serious cerebrovascular condition distinct from arterial stroke. Despite its low prevalence (0.5%-3% of strokes), incidence has risen due to improved awareness and diagnostics. CVT presents variably, commonly with headache, seizures, and focal deficits, making early recognition crucial. Diagnosis relies on CT/MR venography, while anticoagulation remains the mainstay of treatment. Prognosis is generally favorable, though long-term complications such as recurrent thrombosis and cognitive impairment are possible. Emerging research continues to refine diagnostic and management strategies, including anticoagulation choices and treatment of special populations such as pregnant patients.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260854
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Weakness is a challenging and broad chief complaint in emergency medicine, necessitating rapid and accurate differentiation among numerous etiologies. Effective diagnosis involves recognizing symptoms of central and peri...Weakness is a challenging and broad chief complaint in emergency medicine, necessitating rapid and accurate differentiation among numerous etiologies. Effective diagnosis involves recognizing symptoms of central and peripheral neurologic disorders, neuromuscular junction diseases, nutritional deficiencies, and toxin exposures. Prompt identification and intervention in conditions such as Guillain-Barré syndrome, transverse myelitis, botulism, and nutritional deficiencies are crucial. Despite vaccines reducing cases of polio, tetanus, and diphtheria, vigilance remains essential due to their potential resurgence. This article emphasizes a systematic evaluation, critical diagnostic challenges, management pitfalls, and future directions for improving patient outcomes.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260853
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Neurologic emergencies often require timely access to neuroimaging and accurate diagnosis may be highly dependent on which imaging modality is chosen. It is important for the emergency clinician to have a foundational un...Neurologic emergencies often require timely access to neuroimaging and accurate diagnosis may be highly dependent on which imaging modality is chosen. It is important for the emergency clinician to have a foundational understanding of the appropriate indications of various neuroimaging modalities to avoid false reassurance and misdiagnosis. The following article is intended to provide an overview of the 2 most common neuroimaging modalities used in the emergency department, computed tomography and MRI, their respective strengths and weaknesses, as well as pearls and pitfalls to ensure accurate, efficient, and appropriate use.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260852
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Atraumatic back pain is a common condition affecting a significant portion of adults. Approximately 80% of individuals will experience it during their lifetime, making it a frequent reason for primary care and emergency...Atraumatic back pain is a common condition affecting a significant portion of adults. Approximately 80% of individuals will experience it during their lifetime, making it a frequent reason for primary care and emergency visits. In the United States, about 4.4 million emergency department (ED) visits in 2021 were due to back pain, representing 2% to 4% of all ED visits. While most cases are benign, serious spinal pathologies occur in 2.5% to 5.1% of ED presentations, requiring prompt diagnosis and management. This review categorizes causes into emergent, "worst first" conditions and less urgent, yet sometimes still critical, etiologies.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260851
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Status epilepticus (SE) is a life-threatening neurological emergency defined by prolonged seizure activity or seizure activity without a return to baseline. SE can lead to permanent neuronal injury, and it is crucial tha...Status epilepticus (SE) is a life-threatening neurological emergency defined by prolonged seizure activity or seizure activity without a return to baseline. SE can lead to permanent neuronal injury, and it is crucial that it be recognized as soon as possible. Management of SE follows a stepwise approach, with benzodiazepines first-line, followed by antiseizure drugs, and finally with anesthetics. Assessing airway status, along with checking for hypoglycemia and pregnancy status in reproductive-age women, are imperative. Nonconvulsive SE can be difficult to diagnose and requires EEG for detection. Special considerations apply for cases of SE in pregnant, elderly, and immunocompromised patients.
Emerg Med Clin North Am
· 2026 Feb · PMID 41260850
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Most patients presenting with headaches to the emergency department (ED) are experiencing benign exacerbations of chronic conditions. The ED focus is on identifying dangerous secondary causes of headaches and providing p...Most patients presenting with headaches to the emergency department (ED) are experiencing benign exacerbations of chronic conditions. The ED focus is on identifying dangerous secondary causes of headaches and providing pain relief. Given the high recurrence rate, emergency physicians must optimize acute treatment, address unmet needs, and ensure appropriate outpatient follow-up.