Journal of Emergency Medicine最新文献

{"title":"Effect of 24-h Shifts on Cardiopulmonary Resuscitation Performance and Fatigue: A Simulation-Based Study","authors":"Abdul Samet Sahin MD ,&nbsp;Emre Dilaver MD ,&nbsp;Kaan Basar Candas MD ,&nbsp;Ozgen Gonen Cekic MD ,&nbsp;Muhammet Fatih Beser MD ,&nbsp;Melih Imamoglu MD ,&nbsp;Sinan Pasli MD","doi":"10.1016/j.jemermed.2025.12.028","DOIUrl":"10.1016/j.jemermed.2025.12.028","url":null,"abstract":"<div><h3>Background</h3><div>High-quality cardiopulmonary resuscitation (CPR) is critical for maintaining effective circulation during cardiac arrest. CPR success depends on uninterrupted, high-quality chest compressions delivered at an appropriate rate and depth. However, whether this performance can be sustained under prolonged working conditions is uncertain.</div></div><div><h3>Objectives</h3><div>This simulation-based study evaluated the impact of fatigue developing during 24-h shifts on CPR quality among emergency medicine residents.</div></div><div><h3>Methods</h3><div>This prospective simulation study included 37 emergency medicine residents from two tertiary hospitals. Participants performed CPR on a manikin equipped with feedback devices at 0, 8, 16, and 24 h of a 24-h shift. Each session lasted 10 min and consisted of five 2-min cycles of chest compressions, interspersed with 2-min rest periods. Compression rate, depth, and quality metrics were recorded. Fatigue levels were assessed using the Modified Borg Scale before and after each session.</div></div><div><h3>Results</h3><div>Mean chest compression rate and depth remained within guideline-recommended ranges at all time points, indicating sustained clinical performance. Although subjective fatigue scores increased significantly and progressively throughout the shift (<em>p</em> &lt; 0.001), this physiological strain did not correlate with a significant decline in CPR quality metrics. While minor statistical fluctuations were observed in compression rate relative to baseline, the group performance consistently met standard resuscitation targets.</div></div><div><h3>Conclusion</h3><div>Emergency medicine residents maintained guideline-compliant CPR throughout 24-hour shifts despite fatigue. However, implementing fatigue management strategies, including optimized scheduling and structured rest, is recommended for provider and patient safety.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 99-108"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Performance With the Use of a Novel All-in-One Acute Central Venous Catheter Insertion System","authors":"Megan Wimmer MBA ,&nbsp;Matthew Donovan PhD ,&nbsp;Matthew O’Brien MBA, MPAS ,&nbsp;Clarisse Hall MBA, MHA ,&nbsp;Graham E. Snyder MD, FACEP","doi":"10.1016/j.jemermed.2025.12.008","DOIUrl":"10.1016/j.jemermed.2025.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Challenges with the acute central venous catheter (ACVC) insertion procedure can introduce potential delays in treatment, clinician stress, and an increase in clinical risk. A novel all-in-one insertion system may improve efficiency by decreasing procedure steps, reducing procedural challenges, and lowering the risk of some insertion-related complications.</div></div><div><h3>Objectives</h3><div>The primary objective of this study was to quantify the difference in total procedure time when comparing insertion of a novel all-in-one ACVC insertion system and a traditional ACVC among less experienced placers. Secondary objectives were to investigate the frequency of common procedural challenges, especially guidewire kinking, and to evaluate differences in kit and component usage.</div></div><div><h3>Methods</h3><div>A prospective, randomized crossover simulation study was conducted at a Medical Simulation Center. Fifty participants each placed one traditional and one novel ACVC insertion system, in randomized order, in simulated patient mannequins.</div></div><div><h3>Results</h3><div>The novel insertion system had a shorter total procedure time (mean difference 2.58 min, [SD ± 4.757]) when compared with a traditional ACVC (<em>p</em> = 0.0005). Guidewire kinking was observed across 0/49 (0%) novel insertion system placements, whereas the traditional ACVC had a significantly higher number of occurrences in 9/49 (18.4%) placements (<em>p</em> = 0.0039).</div></div><div><h3>Conclusion</h3><div>In a simulated environment, the novel insertion system reduced total procedure time and procedural challenges, particularly guidewire kinking, which may aid in prevention of guidewire complications when compared with a traditional ACVC.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 64-72"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities Persist in Outcomes After the 2015 Severe Sepsis and Septic Shock Early Management (SEP-1) Bundle","authors":"Kalyan Chaliki MD ,&nbsp;Danny Hughes PhD ,&nbsp;Frank LoVecchio DO, MPH ,&nbsp;Edward Ofori PhD ,&nbsp;Chad Stecher PhD","doi":"10.1016/j.jemermed.2025.12.024","DOIUrl":"10.1016/j.jemermed.2025.12.024","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis remains a significant public health concern, with evidence of significant racial and ethnic disparities in outcomes.</div></div><div><h3>Objectives</h3><div>This study investigates how racial and ethnic disparities in severe sepsis and septic shock outcomes may have changed following the implementation of the 2015 Severe Sepsis and Septic Shock Early Management (SEP-1) Bundle.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of a patient cohort from the 2013-2017 National Inpatient Sample datasets. ICD codes from the SEP-1 manual were used to identify eligible patients with severe sepsis or septic shock. Mortality rates, length of stay, and total costs were examined as primary outcomes using multivariable logistic and linear regression models, and an event study design was used to estimate changes in these outcomes post-SEP-1 implementation. Racial and ethnic disparities were assessed pre- and post-SEP-1 implementation, and differences in post-SEP-1 time trends in each outcome were compared across groups.</div></div><div><h3>Results</h3><div>At baseline, racial and ethnic minorities, particularly Black patients, demonstrated significantly higher mortality rates, lengths of stay, and costs compared to White patients. Following SEP-1 implementation, there were overall reductions in mortality and costs; however, racial and ethnic disparities remained statistically unchanged. The event study analysis indicated a statistically significant decline in mortality rates post-SEP-1 bundle, and the benefits were experienced equally across all racial and ethnic groups.</div></div><div><h3>Conclusions</h3><div>Despite the introduction of the SEP-1 guidelines leading to some improvements in severe sepsis and septic shock outcomes, racial and ethnic disparities in mortality, length of stay, and costs remained statistically significant.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 45-52"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I Shake Hands with Helen Taussig: Epiphanies in the Emergency Department","authors":"Richard M. Ratzan MD","doi":"10.1016/j.jemermed.2025.12.010","DOIUrl":"10.1016/j.jemermed.2025.12.010","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 6-8"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orbital Emphysema From Chronic Intranasal Cocaine Use","authors":"Gio Manguerra DO,&nbsp;Wesley Eilbert MD","doi":"10.1016/j.jemermed.2026.01.001","DOIUrl":"10.1016/j.jemermed.2026.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Chronic intranasal cocaine use can cause destruction of sinonasal osteocartilaginous structures. Communication between the paranasal sinuses and the orbit may result in orbital emphysema.</div></div><div><h3>Case Report</h3><div>A 47-year old man with a history of chronic intranasal cocaine use presented to the emergency department with two months of recurrent episodes of right eye proptosis exacerbated by nose blowing. Maxillofacial computed tomography revealed a large amount of right orbital emphysema, with obvious destruction of the lateral border of the right ethmoid sinus.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Orbital emphysema requires specific treatment depending on its level of severity. Damage to the midface sinuses from chronic intranasal cocaine use may result in orbital emphysema.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 117-119"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Time to Operation in Adults Presenting to the Emergency Department with Gonadal Torsion","authors":"Christie L. Fritz MD ,&nbsp;Stephen H. Thomas MD, MPH ,&nbsp;Ben Bloom MD, PhD ,&nbsp;Robert Petcu MD ,&nbsp;Maureen Chase MD, MPH ,&nbsp;Leslie Bilello MD ,&nbsp;Carlo L. Rosen MD","doi":"10.1016/j.jemermed.2025.12.021","DOIUrl":"10.1016/j.jemermed.2025.12.021","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian and testicular torsion are fertility threatening surgical emergencies and represent relatively frequent emergency department (ED) presentations.</div></div><div><h3>Objectives</h3><div>The current study aimed to evaluate for association between demographics and time-related endpoints related to evaluation and management of gonadal torsion in adults presenting to the ED. The primary endpoint was time from ED presentation to arrival in the operating room (tOR). Secondary endpoints included times from ED presentation to radiology-performed ultrasound (tUS) and to specialist consultation.</div></div><div><h3>Methods</h3><div>We assessed four years (2020–23) of adult (age &gt; 18) gonadal torsion patients diagnosed in an urban academic center. Eligible cases were those with a primary diagnosis of gonadal torsion.</div></div><div><h3>Results</h3><div>Of 57 patients, 45 were female sex (79.0%). Race was most commonly White (35, 61.4%), with 9 patients (15.8%) each in categories of Hispanic or Black/African–American and remaining 4 patients (7.0%) were Asian. 48 (84.2%) of 57 torsion patients went directly from the ED to OR. Univariate analysis found that compared to males, tOR for females was prolonged by 156 min (95% CI: 79–239), and tUS was prolonged by 32 min (95% CI: 7–66). Multivariable QR confirmed longer tOR for females (128 min, 95% CI: 5–251, <em>p</em> = 0.042) and found prolonged tOR for Asians as compared to Whites (229 min, 95% CI: 49–409, <em>p</em> = 0.014) although with small subgroup numbers.</div></div><div><h3>Conclusions</h3><div>Despite constituting a substantial majority of adult ED patients with gonadal torsion, time from presentation to ultrasound was prolonged by more than 30 min and operative intervention was prolonged by over 2 h for females as compared to males.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 73-81"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Cardiac Standstill on Early Focused Transthoracic Echocardiography Predict Absence of Return of Spontaneous Circulation in Cardiac Arrest? A Systematic Review and Meta-Analysis","authors":"Andrea Breglia MD ,&nbsp;Ilaria Costantini MD ,&nbsp;Mirko Zanatta MD, PhD","doi":"10.1016/j.jemermed.2025.12.018","DOIUrl":"10.1016/j.jemermed.2025.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Focused transthoracic echocardiography (TTE) during cardiopulmonary resuscitation (CPR) is a useful tool for the identification of reversible causes of cardiac arrest. Recent evidences also indicated a predictive function of focused TTE in distinguishing patients for whom resuscitation efforts may be futile.</div></div><div><h3>Objectives</h3><div>The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of cardiac standstill, irrespective of the etiology and of presentation rhythm cardiac arrest, in identifying patients who are unlikely to achieve return of spontaneous circulation (ROSC).</div></div><div><h3>Methods</h3><div><em>Population:</em> we included adult patients (age ≥16 years) affected by either nontraumatic or traumatic cardiac arrest, with no restrictions regarding the setting. <em>Index test:</em> performance of focused TTE during CPR, assessing the presence or absence of any wall or valve movement (cardiac standstill). <em>Target condition:</em> ROSC after cardiac arrest. We defined “Disease Positive” as death (ROSC–) and “Disease Negative” as ROSC achievement (ROSC+).</div></div><div><h3>Results</h3><div>A total of 24 studies comprising 3684 patients were included. The pooled sensitivity and specificity of the cardiac standstill in predicting the absence of ROSC were 0.856 (95% CI 0.789–0.904) and 0.790 (95% CI 0.671–0.874), respectively. The calculated diagnostic odds ratio was calculated as 22.595 (95% CI 12.452–40.999). The summary receiver operating characteristic curve showed an area under the curve of 0.871 (95% CI 0.836–0.909), indicating a good diagnostic accuracy.</div></div><div><h3>Conclusion</h3><div>Cardiac standstill has demonstrated considerable sensitivity, specificity, and odds ratio in predicting unsuccessful CPR.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 9-44"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Vessel Vasculitis from Mycoplasma Infection and Concurrent Topical Nonsteroidal Anti-Inflammatory Drug (NSAID) Medication","authors":"Elaine Yu DO, MS ,&nbsp;Akousa Osei-Tutu DO, MS, MDiv, MBA ,&nbsp;Rachna Subramony MD","doi":"10.1016/j.jemermed.2025.12.003","DOIUrl":"10.1016/j.jemermed.2025.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Vasculitis is characterized by inflammation of blood vessels, and can manifest as characteristic skin rashes and, in severe cases, lead to end-organ damage. Causes of vasculitis include autoimmune conditions, infections, and allergens.</div></div><div><h3>Case Report</h3><div>We describe a 63-year-old woman who presented to the Emergency Department with petechiae, ecchymosis, and purpura after topical diclofenac application, initially diagnosed with a hypersensitivity vasculitis. Further investigation revealed a case of mycoplasma-induced IgA vasculitis that required several months of multidisciplinary care to treat and resolve.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case highlights the importance of a broad differential and workup in cases of suspected vasculitis. Any rash with petechiae and purpura may indicate underlying vasculitis. Early investigation into causes of vasculitis, including infection, hypersensitivity, and autoimmune conditions, as well as signs of end-organ damage are crucial to initiate proper treatment and prevent further complications.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 88-93"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Positive Pressure Ventilation Use in the Prehospital Setting: A Preliminary Cross-Sectional Analysis of State Protocols and Nationwide Clinical Practice","authors":"Gregory A. Peters MD ,&nbsp;Tyler Allerhand NRP ,&nbsp;Jane M. Hayes MD, MPH ,&nbsp;Anjali J. Misra MD, MPH ,&nbsp;Lindsay V. Walsh MD ,&nbsp;Abraham Akbar MD ,&nbsp;Rebecca E. Cash PhD, MPH ,&nbsp;Scott A. Goldberg MD, MPH","doi":"10.1016/j.jemermed.2025.12.023","DOIUrl":"10.1016/j.jemermed.2025.12.023","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital respiratory distress is a common and high-risk condition that often requires critical interventions, including noninvasive positive pressure ventilation (NIPPV).</div></div><div><h3>Objective</h3><div>We aimed to describe U.S. emergency medical services (EMS) state protocols and nationwide practice patterns related to the prehospital use of NIPPV.</div></div><div><h3>Methods</h3><div>We completed a cross-sectional analysis of all publicly available, active state-level EMS protocols in the United States related to the prehospital use of NIPPV. Second, we completed a cross-sectional analysis of nationwide EMS practice patterns related to NIPPV use in 2023. We included EMS patient care reports filed by the unit that treated and transported the patient in which NIPPV was administered during a 9-1-1 scene response. Descriptive statistics were computed, stratified by suspected diagnostic indication.</div></div><div><h3>Results</h3><div>Among 30 states with an NIPPV protocol, early use of NIPPV was recommended in eight protocols for suspected pulmonary edema, compared with two for bronchospasm. Among an analytic sample of 30,358,677 EMS encounters, 133,768 (0.6%) included NIPPV use. Bronchospasm was suspected in 44.0% of encounters, 16.2% pulmonary edema, 7.1% mixed (i.e., bronchospasm and pulmonary edema), and 32.8% either other or unspecified indication.</div></div><div><h3>Conclusion</h3><div>State EMS protocols tended to recommend NIPPV use as first-line for pulmonary edema and only a salvage measure for bronchospasm; however, NIPPV was used nearly three times more often for bronchospasm. Further research is encouraged to enable an evidence-based approach to achieving improved alignment between protocols and practice to better support EMS when administering critical care for respiratory distress.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 120-127"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the Utility of Point-of-Care Ultrasound for Diagnosing Abdominal Aortic Aneurysm?","authors":"Kristine Jeffers MD ,&nbsp;Samuel M. Keim MD, MS ,&nbsp;Brit Long MD ,&nbsp;Michael Gottlieb MD ,&nbsp;Srikar R. Adhikari MD, MS","doi":"10.1016/j.jemermed.2025.12.006","DOIUrl":"10.1016/j.jemermed.2025.12.006","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal aortic aneurysm (AAA) is a high-risk condition that can be associated with morbidity and mortality if untreated. Ultrasound is a primary means of diagnosis.</div></div><div><h3>Clinical Question</h3><div>What is the utility of point-of-care ultrasound (POCUS) for diagnosing AAA?</div></div><div><h3>Evidence Review</h3><div>Studies retrieved included 4 systematic reviews and meta-analyses evaluating the use of POCUS for diagnosing AAA. These studies provide estimates of the potential utility of POCUS, with a sensitivity of 97.5 to 100% and specificity of 94.1 to 100%.</div></div><div><h3>Conclusion</h3><div>Based upon the available literature, POCUS by emergency clinicians can reliably diagnose AAA.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"82 ","pages":"Pages 82-87"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}