International Journal of Emergency Medicine最新文献

{"title":"An atypical presentation of Lemierre syndrome in a child with nephrotic syndrome: a case report and literature review.","authors":"Rabisa Mobeen, Maryam Tariq, Izere Salomon, Hamna Junaid, Alina Asif, Hira Anwar","doi":"10.1186/s12245-026-01318-7","DOIUrl":"10.1186/s12245-026-01318-7","url":null,"abstract":"<p><strong>Background: </strong>Lemierre's syndrome (LS) is a rare but potentially fatal condition characterized by septic thrombophlebitis of the internal jugular vein (IJV) following oropharyngeal infection, with an estimated incidence of 3.6 cases per million population. It primarily affects healthy adolescents and young adults; pediatric presentations, particularly in children under ten, are exceedingly rare and frequently atypical, with a heightened risk of diagnostic delay and multisystem morbidity. Although orbital cellulitis and intracranial venous extension have each been individually described in pediatric LS, their combined occurrence together with culture-negative status and a prolonged, indolent clinical course remains sparsely documented in children under ten years of age.</p><p><strong>Case presentation: </strong>We report a case of a previously healthy 6-year-old Asian male who presented to a tertiary pediatric hospital after approximately one year of intermittent fever and progressive left-sided facial swelling. Over the preceding 15 days, his illness acutely worsened, with the development of necrotic periorbital and facial lesions and chest pain, prompting emergency referral. On admission, generalized edema, hypoalbuminemia, and nephrotic-range proteinuria raised an initial working diagnosis of nephrotic syndrome, which reflected a true concurrent glomerular process, a hypercoagulable cofactor, or an epiphenomenon of prolonged systemic inflammation that could not be definitively resolved, as the family left the hospital before a complete nephrological work-up could be completed. Contrast-enhanced MRI of the brain and orbits demonstrated preseptal, periorbital, and facial soft tissue inflammation with diffusion restriction, along with loss of flow-void signal in the left sigmoid sinus and left IJV, indicative of thrombosis. Subsequent contrast-enhanced CT of the neck and chest confirmed left IJV thrombosis with septic pulmonary embolization, fulfilling the imaging criteria for Lemierre's syndrome with intracranial venous extension in the likely but not histologically or microbiologically confirmed setting of an oropharyngeal or dental portal of entry. Serial blood cultures yielded no bacterial growth, consistent with culture-negative LS in a child with probable prior antibiotic exposure, although the details of any treatment administered before referral could not be retrieved. The patient was managed with broad-spectrum intravenous antibiotics, subcutaneous enoxaparin, intravenous immunoglobulin, fresh frozen plasma, packed red cell transfusion, and albumin supplementation delivered through a multidisciplinary care pathway. Despite ongoing management, the family elected to leave against medical advice on day 19 of admission before a full antimicrobial and anticoagulation course could be completed.</p><p><strong>Conclusions: </strong>This case illustrates an unusually indolent, culture-negative pediatric presentation at the interf","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No ingestion, no inhalation, still toxic: acetone poisoning via skin absorption.","authors":"Qutaiba Qafisheh, Roaa Aljunaidi, Abdalhakim Shubietah, Muath A Baniowda, Mohamed S Elgendy, Ahmed Emara, Mohanad Qwaider, Nezam Altorok","doi":"10.1186/s12245-026-01286-y","DOIUrl":"10.1186/s12245-026-01286-y","url":null,"abstract":"<p><strong>Background: </strong>Acetone toxicity is typically associated with ingestion or inhalation, whereas clinically meaningful transdermal absorption is uncommon and may be overlooked, particularly in patients with impaired skin barriers.</p><p><strong>Case presentation: </strong>A 48-year-old man with C4 quadriplegia, a chronic sacral ulcer, and cranial cortical stimulation electrodes from the ReHAB trial presented with two weeks of poor oral intake and progressive encephalopathy culminating in respiratory failure. Initial testing showed high anion-gap metabolic acidosis with an elevated osmolar gap (pH 7.22; HCO₃ 6 mmol/L; anion gap 28 mmol/L; measured osmolality 453 mOsm/kg), beta-hydroxybutyrate 7.2 mmol/L, and serum acetone 29.8 mg/dL, with undetectable isopropanol and other toxic alcohols. Additional history revealed topical isopropyl alcohol application to scalp connector sites approximately 36 h before presentation. The patient improved with intravenous fluids and bicarbonate therapy, required brief mechanical ventilation, and returned to baseline mentation by hospital day 9.</p><p><strong>Conclusion: </strong>This case demonstrates two concurrent mechanisms: starvation ketoacidosis as the primary driver of anion-gap acidosis and transdermal isopropyl alcohol exposure with hepatic conversion to acetone as a plausible contributor to acetonemia and the elevated osmolar gap. Clinicians should consider noningestional exposures in unexplained dual-gap acidosis, especially in patients with neurodisability and device-adjacent or compromised skin.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasogastric tube as an improvised chest drain for tension pneumothorax in a resource-limited rural clinic: bridging a 4-hour transfer time in the absence of a standard intercostal drain.","authors":"Ugyen Rinzin, Chimi Rinzin, Shankar LeVine","doi":"10.1186/s12245-026-01335-6","DOIUrl":"10.1186/s12245-026-01335-6","url":null,"abstract":"<p><strong>Background: </strong>Tension pneumothorax is a life-threatening emergency requiring immediate decompression followed by definitive pleural drainage to prevent rapid cardiopulmonary collapse. Management becomes particularly challenging in resource-limited settings where standard intercostal chest drains are unavailable.</p><p><strong>Case presentation: </strong>A 21-year-old woman presented with recurrent tension pneumothorax at a rural clinic in Bhutan after initial needle decompression. Because a standard intercostal chest drain was unavailable and transfer to the nearest referral hospital required approximately four hours, an improvised chest drain using an 18-Fr nasogastric tube connected to an underwater seal was inserted. The patient improved clinically and radiographically, allowing safe transfer for definitive management.</p><p><strong>Discussion: </strong>This case demonstrates that prompt clinical decision-making and the use of an improvised nasogastric tube connected to an underwater seal can provide an effective temporary bridge when standard pleural drainage equipment is unavailable in remote settings.</p><p><strong>Conclusion: </strong>Judicious use of readily available devices may provide a lifesaving bridge for recurrent tension pneumothorax when standard equipment is unavailable, allowing safe transfer for definitive management.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research on the value screening of combat rescue information based on the Markov decision tree model.","authors":"Xiaoxue Li, Zhengping Li, Yuwen Hao, Weizhi Ma","doi":"10.1186/s12245-026-01271-5","DOIUrl":"https://doi.org/10.1186/s12245-026-01271-5","url":null,"abstract":"<p><strong>Background: </strong>In future digital battlefields, the systematic collection of combat casualty care information is essential for improving trauma outcomes and guiding medical resource allocation. However, a significant methodological gap exists in determining which specific data points are most valuable to record when prospective wartime data are unavailable. Rather than constructing a physical information collection system, this study aims to develop a simulation-based screening framework that can identify and prioritize high-value examination and treatment information across the continuum of tactical combat casualty care.</p><p><strong>Methods: </strong>A Markov decision tree model was used to simulate the effects of different treatment techniques on injury-state transitions during casualty evacuation, spanning line-of-fire care, tactical medical care, and damage-control treatment at rescue institutions. Inspection and treatment techniques recorded in battlefield medical documents were screened and ranked based on expert-informed evaluation.</p><p><strong>Results: </strong>Simulation outputs indicate that the on-site treatment phase exerts the most substantial impact on injury state evolution, with comparatively smaller changes observed during ground and air evacuation. The model differentiated the information value of various diagnostic and therapeutic techniques, yielding a prioritized list of essential data elements specific to each care echelon. These include immediate life-saving interventions (e.g., tourniquet application time, needle decompression status) and continuous monitoring parameters (e.g., pulse oximetry trends, serial Glasgow Coma Scale assessments) that should be captured in field medical documentation.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily, weekly, and monthly dynamics of crowding in emergency department of university clinical centre Serbia: a one-year analysis of NEDOCS score.","authors":"Slobodan Dzelebdzic, Bosiljka Djikanovic, Zoran Bukumiric, Natasa Maksimovic, Dusan Micic, Zorana Ana Rakočević, Vasa Curcin, Aleksandar Medarevic","doi":"10.1186/s12245-026-01313-y","DOIUrl":"10.1186/s12245-026-01313-y","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) crowding is increasingly recognized as a global public health issue, while evidences from South-East Europe remain limited. The aim of this study was to characterize daily, annual, weekly, and monthly patterns of ED crowding in a high-volume tertiary hospital.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of ED crowding in the largest ED in Serbia over 360 consecutive days (8,640 one-hour intervals). Crowding was measured hourly using the National Emergency Department Overcrowding Score (NEDOCS), derived from routinely collected data from health information system and expressed on a 0-200 scale, later grouped into six standard categories. Descriptive analyses assessed annual distribution, circadian and weekly variation, seasonal trends, and patient age structure. Between-group differences in NEDOCS scores were assessed using the Kruskal-Wallis test. Effect sizes were estimated using eta-squared (η²).</p><p><strong>Results: </strong>The majority of patients in ED (43.14%) were older than 60. Almost 90% of patients (89.5%) waited up to 4 h for the first check up by doctor. The median annual NEDOCS score was 43.87 (IQR 51.92 ), corresponding to a \"busy\" operational state. Level 2 (\"busy\") occurred in 39.4% of hourly intervals and level 1 (\"not busy\") in 29.5%, while overcrowding (levels 4-6) was observed in 5.6% of intervals. Crowding was significantly higher during daytime than nighttime hours (p < 0.001), with a pronounced morning peak. Weekday crowding exceeded weekend levels, peaking on Tuesdays. Seasonal variation showed higher crowding during winter and transitional months.</p><p><strong>Conclusions: </strong>ED crowding demonstrates predictable temporal patterns that mirror broader population health dynamics. Routine high-frequency monitoring may inform strategic staffing, adaptive capacity planning, and governance mechanisms aimed at strengthening emergency care performance and system resilience.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable artificial intelligence in ICU admission prediction for methanol poisoning patients: a comparative study of deep and machine learning models.","authors":"Mohammad Reza Afrash, Mitra Rahimi, Khadijeh Moulaei, Babak Mostafazadeh, Heliya Rafsanjani, Peyman Erfan Talab Evini, Mohammad Parvin, Mohanna Sharifi, Somayeh Salehi, Amir Hossein Daeechini, Mahdi Baharestani, Shahin Shadnia","doi":"10.1186/s12245-026-01328-5","DOIUrl":"10.1186/s12245-026-01328-5","url":null,"abstract":"<p><strong>Background: </strong>Methanol poisoning poses significant challenges due to its rapid progression and high mortality rate, necessitating timely and accurate ICU admission decisions. Explainable artificial intelligence (XAI) offers transparent insights into these decisions, enhancing trust and interpretability in predictive models. This study aims was to compare the effectiveness of deep learning and machine learning models in predicting ICU admissions for methanol poisoning patients using explainable AI techniques.</p><p><strong>Methods: </strong>This study analyzed a dataset of 897 patient records collected from Loghman Hakim Hospital in Tehran, Iran, involving confirmed cases of methanol poisoning. Among these patients, 202 required ICU admission, whereas 695 did not. To develop predictive models, eight established approaches were implemented, including machine learning methods (Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), Decision Tree (DT), and Random Forest (RF)) as well as deep learning architectures (Deep Neural Network (DNN), Feedforward Neural Network (FNN), Long Short-Term Memory (LSTM), and Convolutional Neural Network (CNN)). To reduce the risk of overfitting, 10-fold cross-validation and systematic hyperparameter tuning were applied. Model interpretability was ensured using Shapley Additive Explanations (SHAP) and Local Interpretable Model-agnostic Explanations (LIME). The performance of all models was evaluated through multiple metrics, including accuracy, sensitivity, specificity, F1-score, and the area under the ROC curve (AUC).</p><p><strong>Results: </strong>Among all DL and ML models, the XGBoost ML model outperformed the others, achieving an accuracy of 92.0%, a precision of 92.0%, a recall of 97.0%, an F1-score of 95.0%, and a AUROC of 92.0%. Among DL models, the FNN emerged as the top performer with an accuracy of 91.0%, precision of 92.0%, recall of 96.0%, F1-score of 94.0%, and AUROC of 90.0%. Generally, ML models exhibited higher accuracy (87% - 92%) than DL models (89% - 91%), with similar precision (75% - 92% for ML, 91% - 92% for DL), recall (90% - 97% for ML, 94% - 96% for DL), F1-scores (82% - 95% for ML, 93% - 94% for DL), and AUROC scores (84% - 92% for ML, 89% - 90% for DL).</p><p><strong>Conclusion: </strong>While both ML and DL models demonstrated strong performance, ML models, especially XGBoost, proved to be more effective in predicting ICU admissions for methanol poisoning patients. The proposed model is intended to support early ICU admission risk stratification during the initial emergency department assessment and should be used as a decision-support tool rather than a replacement for clinical judgment.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four decades of tinnitus pathology research: a bibliometric analysis of scientific trends, collaborations, and research hotspots.","authors":"Selena M Shen, Rakin Haq, Latha Ganti","doi":"10.1186/s12245-026-01311-0","DOIUrl":"10.1186/s12245-026-01311-0","url":null,"abstract":"<p><strong>Introduction: </strong>Tinnitus is a debilitating auditory disorder affecting approximately 14% of adults worldwide, often co-occurring with hearing loss, sleep disturbance, anxiety and depression. Despite its high global prevalence and substantial socioeconomic burden, tinnitus research remains underfunded, and effective treatments are limited due to the condition's complex and heterogeneous pathophysiology. A comprehensive understanding of the research landscape in tinnitus pathology is essential for guiding future scientific and clinical efforts, including the evaluation of patients presenting with tinnitus in emergency and acute care settings.</p><p><strong>Methods: </strong>A bibliometric analysis was conducted on648 documents related to tinnitus pathology indexed in the Web of Science Core Collection (1977-2025). The analytical tools VOSviewer, R-bibliometrix, and Microsoft Excel were used to assess publication trends, source journals, contributing countries and institutions, author networks, and thematic keyword evolution.</p><p><strong>Results: </strong>Findings reveal a steady increase in both publication count and academic attention to tinnitus pathology, with even more rapid growth projected. The United States leads in publication volume and international collaboration, although countries like Finland and Switzerland demonstrate higher average citation impact. Authors Dirk de Ridder and James A. Henry were identified as key points of dissemination of academia. Keyword analysis revealed a historical shift from peripheral auditory models to central neurophysiological frameworks, with recent emphasis on intervention-focused topics. Thematic mapping identified \"pathology,\" \"prevalence,\" and \"diagnosis as central yet underdeveloped areas requiring further academic investment.</p><p><strong>Conclusion: </strong>This bibliometric analysis contributes a comprehensive overview of the research landscape for tinnitus pathology. Current research focuses on translating our basic understanding of tinnitus into intervention. Despite recent advancements, critical knowledge gaps persist in tinnitus pathophysiology, diagnostic specificity, and prevalence metrics standardization. These findings have important implications for emergency medicine, where tinnitus may represent either a benign symptom or the manifestation of serious neurologic, vascular, or otologic disease requiring urgent evaluation.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the text-based diagnostic reasoning performance of emergency medicine physicians and large language models in both definitive and differential diagnoses using standardized clinical vignettes: a preliminary study.","authors":"Mehdi Arzani Shamsabadi, Roya Vatankhah, Hasan Jalilvand, Ali OmraniNava, Masoud Shahabian, Somayeh Rajabzadeh, Seyyed Mohsen Azizi","doi":"10.1186/s12245-026-01324-9","DOIUrl":"10.1186/s12245-026-01324-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Timely and highly accurate diagnoses by physicians play a crucial role in improving the quality and effectiveness of patient treatment outcomes. Currently, the use of artificial intelligence capabilities in this area has garnered the attention of many health science researchers. Therefore, the main goal of this preliminary study was to compare the text-based diagnostic reasoning performance of emergency medicine physicians and large language models in definitive and differential diagnoses using standardized clinical vignettes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This descriptive comparative study evaluated the diagnostic accuracy of 10 emergency medicine physicians and 4 large language models (LLMs)-ChatGPT (GPT-5.2), Gemini 3, Microsoft Copilot (GPT-4), and Claude Opus 4.1-using 10 standardized clinical vignettes. All LLMs were accessed via official web interfaces. Clinical vignettes were developed from emergency department presentations, validated by an expert panel, and presented as text-only inputs to all evaluators. Diagnostic accuracy was assessed using a standardized scoring protocol: definitive diagnoses required an exact match with expert-derived reference standards, while differential diagnoses required ≥ 3 matches. Overall diagnostic accuracy was the primary outcome. Data were analyzed using Pearson's Chi-square test, McNemar's test, and Generalized Estimating Equation (GEE) logistic regression with Bonferroni correction (SPSS version 28).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 280 diagnostic evaluations (10 clinical cases assessed by 14 evaluators across 2 diagnosis types) were analyzed. Overall diagnostic accuracy was 61.79%. AI models demonstrated significantly higher overall accuracy (73.75%) compared to emergency medicine physicians (57.00%, p = 0.014). Across all evaluators, definitive diagnoses were more accurate than differential diagnoses (70.71% vs. 52.86%). Generalized Estimating Equation (GEE) analysis revealed a significant interaction between evaluator group and diagnosis type (p = 0.036). Specifically, physicians experienced a significant decline in accuracy when providing differential diagnoses compared to definitive diagnoses (45.0% vs. 69.0%, p = 0.003; remained significant after Bonferroni correction). In contrast, AI models maintained consistently high accuracy across both diagnosis types, with no significant difference between definitive (75.0%) and differential (72.5%) diagnoses (p = 1.000).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Large language models outperformed emergency medicine physicians in overall diagnostic accuracy and demonstrated superior consistency across different types of diagnostic tasks. While human physicians struggled significantly with differential diagnoses, AI models maintained high and stable performance regardless of the diagnostic complexity. These findings indicate that AI possesses robust pattern-recognition and reasoning capabilities, suggesting it could serv","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophagopericardial fistula secondary to battery acid ingestion in a 3-year-old boy: a case report.","authors":"Yasser Abdurabo Obadiel, Mohammed Al-Shehari, Aref Al-Hashedi, Mansour Al-Hameli, Nardeen Alqousi, Anas Al-Kubati, Abdullah Al-Kubati, Bilal Sleiay, Osama Al-Khawlani, Majeed Shallan","doi":"10.1186/s12245-026-01332-9","DOIUrl":"https://doi.org/10.1186/s12245-026-01332-9","url":null,"abstract":"<p><strong>Background: </strong>Esophagopericardial fistula (EPF) is an extremely rare and life-threatening condition associated with a high mortality rate, particularly when diagnosis and intervention are delayed. Here we present the case of a 3-year-old boy who developed EPF secondary to accidental battery acid ingestion.</p><p><strong>Case presentation: </strong>A 3-year-old Yemeni boy presented with persistent epigastric pain, fever, and progressive dyspnea three weeks after accidental ingestion of battery acid, having initially received conservative supportive management at a regional hospital before delayed referral. Clinical examination revealed tachycardia, tachypnea, and a pericardial friction rub. Laboratory investigations demonstrated leukocytosis, severe thrombocytopenia, anemia, hypoalbuminemia, and markedly elevated inflammatory markers, consistent with sepsis. Imaging studies, including an iso-osmolar contrast swallow and CT, identified a 12-mm esophagopericardial fistula located in the distal esophagus, 2.5 cm above the gastroesophageal junction, accompanied by pyopneumopericardium. Following initial stabilization, the patient underwent a right posterolateral thoracotomy. Intraoperatively, gross inspection revealed extensive full-thickness ischemic necrosis and friability of the distal esophagus with inflammation extending to the pericardium, necessitating radical esophagectomy. The pericardium was opened, thoroughly irrigated with warm sterile saline, and a wide pericardial window was created for continuous drainage. An esophagectomy with gastric pull-up reconstruction was performed to achieve source control. Despite aggressive postoperative critical care, the patient developed refractory sepsis with multiorgan failure and died on the sixth postoperative day.</p><p><strong>Conclusion: </strong>This case highlights the poor prognosis of esophagopericardial fistula following corrosive ingestion in children, especially with delayed presentation and subacute progression. Early recognition and immediate referral to specialized tertiary pediatric surgery centers are paramount.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of safety, comfort, and design ergonomics in ambulance retrieval vehicles: a survey in Southern India.","authors":"Lavanya Aradhya, Vrinda Lath, Freston Marc Sirur, Jayaraj Mymbilly Balakrishnan, Arundhathi Hebbar, Aniketh Kumar Shetty","doi":"10.1186/s12245-026-01316-9","DOIUrl":"10.1186/s12245-026-01316-9","url":null,"abstract":"<p><strong>Background: </strong>Ambulance interior design influences the safety, comfort, and operational efficiency of Emergency Medical Services (EMS) personnel. However, evidence regarding ergonomic challenges faced by EMS providers in the Indian prehospital setting remains limited.</p><p><strong>Objective: </strong>To evaluate EMS personnel perspectives on ambulance ergonomics, safety, comfort, and factors affecting patient care during transport.</p><p><strong>Methods: </strong>A multicentre, cross-sectional survey-based observational study was conducted among Emergency Medical Technologists (EMTs) and paramedics, recruited by convenience sampling, who were involved in patient transport using standard Advanced Life Support (ALS) ambulances across Southern India. Data on ergonomic challenges, safety concerns, occupational injuries, and patient-care factors were collected using a questionnaire developed from existing literature and refined through focused-group discussion and expert content review. Data were analysed using descriptive statistics and chi-square tests in jamovi.</p><p><strong>Results: </strong>A total of 130 EMS providers participated. Limited patient-cabin space (60%) and difficulty accessing equipment (50%) were the most frequently reported factors affecting safety and comfort. Half of the respondents reported concerns regarding EMT seat positioning during patient care. Uneven roads (49.23%) and sudden vehicle breakdowns (41.53%) were the leading causes of transport-related injuries. CPR was the procedure most commonly associated with injuries to the care giver (53.84%), while back pain was the predominant occupational health hazard (57.69%). Significant associations were observed between work experience and perceptions of ambulance ergonomics, injury mechanisms, patient safety concerns, and occupational health hazards (p < 0.05).</p><p><strong>Conclusion: </strong>EMS personnel reported substantial concerns regarding ambulance ergonomics, particularly seat positioning, equipment accessibility, cabin workspace, and occupational safety. These findings emphasize the importance of further ergonomic research in ambulance design to enhance operational ease during in transit care while assuring provider and patient safety.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}