Journal of Emergency Medicine最新文献

{"title":"No Pulse? No Problem. Navigating Left Ventricular Assist Device Emergencies in the Emergency Department","authors":"Paulyne Lee MD ,&nbsp;Mina Ghobrial MD ,&nbsp;Kylee Greider MD ,&nbsp;Adam Hryniewicki MD ,&nbsp;Elizabeth Luu MD ,&nbsp;Amir Aminlari MD ,&nbsp;Matthew Murray MD ,&nbsp;Jal Trivedi MD ,&nbsp;Quan Bui MD ,&nbsp;Gabriel Wardi MD, MPH ,&nbsp;Michael Self MD","doi":"10.1016/j.jemermed.2025.10.041","DOIUrl":"10.1016/j.jemermed.2025.10.041","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective of the Review</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 276-286"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774704","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":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(26)00001-6","DOIUrl":"10.1016/S0736-4679(26)00001-6","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 340-341"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976215","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":"Comment on “Painful Left Bundle Branch Block Syndrome Diagnosed in the Emergency Department”","authors":"Chien-Chieh Hsieh MD ,&nbsp;Fu-Shan Jaw MD ,&nbsp;Yu-Hsuan Lee MD ,&nbsp;Ching-Tang Hsu MD","doi":"10.1016/j.jemermed.2025.10.030","DOIUrl":"10.1016/j.jemermed.2025.10.030","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 336-337"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972797","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 Point-of-Care Ultrasound-Guided Nerve Block for Geriatric Hip Fracture Analgesia in the Emergency Department Improve Outcomes?","authors":"Alexander S. Finch MD ,&nbsp;Samuel M. Keim MD, MS ,&nbsp;Venkatesh R. Bellamkonda MD ,&nbsp;Tobias Kummer MD ,&nbsp;Larissa T. Shiue MD ,&nbsp;Christopher R. Carpenter MD, MSC ,&nbsp;Srikar R. Adhikari MD, MS","doi":"10.1016/j.jemermed.2025.10.014","DOIUrl":"10.1016/j.jemermed.2025.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric hip fractures are a commonly encountered in the emergency department (ED) with significant associated morbidity and mortality. Providing appropriate analgesia has many challenges, and the majority of patients require opioid medications for adequate pain control. Complications of opioids include delirium, respiratory depression, and constipation, among others. Ultrasound-guided nerve blocks for hip fractures have emerged as an additional modality to utilize as part of a multimodal approach to analgesia.</div></div><div><h3>Clinical Question</h3><div>In older adults diagnosed with hip fractures in the ED, do ultrasound-guided nerve blocks improve patient-centered outcomes when compared with standard interventions, such as opioid analgesia?</div></div><div><h3>Evidence Review</h3><div>Three studies were reviewed: a systematic review and meta-analysis, a randomized controlled trial, and a prospective feasibility study.</div></div><div><h3>Conclusion</h3><div>Compared with standard ED management strategies for analgesia after hip fractures in adults, fascia iliaca compartment blocks do not reduce mortality. Single injection fascia iliaca compartment blocks appeared to improve delirium rates, though this effect was not seen on the included randomized controlled trial. Hospital length-of-stay and opioid use were decreased in patients who received nerve blocks for hip fractures. Some ED literature also supports using femoral nerve blocks as the blocks are feasible, effective, and safe.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 81-90"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573039","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":"Reliability of Alternative Sonographic Approaches for Inferior Vena Cava: Comparison of Subcostal, Transhepatic, and Coronal Windows","authors":"Aslihan Küçük Albayrak MD,&nbsp;Mehmet Ali Aslaner MD,&nbsp;Ömer Faruk Korkak MD,&nbsp;Fikret Bildik MD","doi":"10.1016/j.jemermed.2025.10.024","DOIUrl":"10.1016/j.jemermed.2025.10.024","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasonographic evaluation of the inferior vena cava (IVC) is widely used in critical care settings; however, the standard subcostal (SC) approach is not always feasible.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the agreement of IVC diameter and collapsibility index (cIVC) measurements obtained from the SC, anterior transhepatic (TH), and right coronal (CR) ultrasonographic windows.</div></div><div><h3>Methods</h3><div>In this prospective, single-center study conducted in an emergency department, IVC ultrasonography was performed on 219 adult patients using SC, TH, and CR approaches. Clear visualization of the anterior and posterior IVC walls was considered essential, while the visualization of IVC entry into the right atrium and the hepatic vein were supportive. Image acquisition time, operator-assessed ease, body mass index, and intermethod agreement were assessed using intraclass correlation coefficients (ICCs) and Bland–Altman analysis.</div></div><div><h3>Results</h3><div>The mean image acquisition times were 24.26 ± 24.77 s for SC, 28.89 ± 25.85 s for TH, and 35.66 ± 29.52 s for CR. ICC analysis demonstrated strong correlation across all methods, with the highest correlation observed between SCmin and THmin (<em>r</em> = 0.952). Bland–Altman plots showed acceptable limits of agreement, indicating good agreement. ICC analysis found to be positive and highly significant correlation across body mass index categories. More than half of the images obtained via each window were rated as “easy” or “very easy” by the operators.</div></div><div><h3>Conclusion</h3><div>While the SC window remains the first-line approach for IVC assessment, the TH and CR windows offer reliable and practical alternatives when SC imaging is limited.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 64-73"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573075","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":"Response to: Emergency Department Observation for Back Pain: Patient Characteristics and Factors Associated with Hospital Admission or 90-Day Return Visit","authors":"Joseph F. Orlando MClinPhys ,&nbsp;Pippa Flanagan MClinPhys ,&nbsp;Rebekah Griffith DPT ,&nbsp;Matthew Beard MClinPhys ,&nbsp;Piers Truter PhD ,&nbsp;Matthew K. Bagg PhD","doi":"10.1016/j.jemermed.2025.10.027","DOIUrl":"10.1016/j.jemermed.2025.10.027","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 330-331"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573747","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":"Phantom Scanning in Point-of-Care Ultrasound After Out-of-Hospital Cardiac Arrest: Impact of Clinical Presentation in a Single-Center Analysis","authors":"Riley Westein,&nbsp;Lauren Nickel,&nbsp;Mary Beth Phelan","doi":"10.1016/j.jemermed.2025.10.004","DOIUrl":"10.1016/j.jemermed.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Phantom scanning, defined as the use of point-of-care ultrasound (POCUS) without image archiving, occurs frequently in cardiac arrest and carries clinical, legal, and quality improvement consequences. Its association with clinical presentation following out-of-hospital cardiac arrest (OHCA) remains understudied.</div></div><div><h3>Objectives</h3><div>To evaluate the prevalence of phantom scanning in OHCA, stratified by clinical presentation and emergency department (ED) disposition.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center study of adult patients presenting with atraumatic OHCA. The primary outcome was phantom scanning among patients presenting with cardiopulmonary resuscitation (CPR) in progress versus return of spontaneous circulation (ROSC). The secondary outcome compared phantom scanning between admitted patients versus those who died in the ED. Descriptive statistics, chi-square tests, and odds ratios with 95% confidence intervals evaluated associations.</div></div><div><h3>Results</h3><div>Of 306 patients reviewed, 244 met inclusion criteria. POCUS was more likely with CPR in progress (OR = 3.58, 95% CI [2.08, 6.26], <em>p</em> &lt; 0.001). Among patients who underwent POCUS, phantom scanning was more frequent with CPR in progress (OR = 3.15, 95% CI [1.49, 6.84], <em>p</em> = 0.002). POCUS was less likely among admitted patients (OR = 0.37, 95% CI [0.21, 0.66], <em>p</em> &lt; 0.001), and phantom scanning was less common in this group (OR = 0.23, 95% CI [0.11, 0.47], <em>p</em> &lt; 0.001). Differences in POCUS use and phantom scanning were significant by both presentation and disposition (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Phantom scanning occurred more often in OHCA patients with CPR in progress and in those who died in the ED. Future research should focus on strategies to reduce phantom scanning and promote adherence to POCUS best practices.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 187-193"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604501","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":"Characteristics of Young Children Presenting to the Emergency Department for Psychiatric Evaluation","authors":"Muhammad Waseem MD, MS ,&nbsp;Afaf F. Moustafa MD ,&nbsp;Kathryn D. Esposito MD ,&nbsp;Rebecca Yang MD, MPH ,&nbsp;Aubrey Vinh MD ,&nbsp;Danyah Nadim MD ,&nbsp;Masood A. Shariff MD","doi":"10.1016/j.jemermed.2025.09.028","DOIUrl":"10.1016/j.jemermed.2025.09.028","url":null,"abstract":"<div><h3>Background</h3><div>The rising influx of young children in emergency departments (ED) for behavioral concerns represents a current crisis requiring immediate intervention. These children face heightened risks of emotional impairments and mood disorders.</div></div><div><h3>Objective</h3><div>This study identifies factors contributing to disruptive behavior and examines baseline characteristics associated with ED visits to highlight the urgent need for targeted action.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of ED records (2015–2021) at an inner-city hospital, focusing on pediatric patients who presented with behavioral symptoms and received psychiatric evaluations. Data included demographics, psychiatric comorbidities, social history, adverse childhood experiences (ACEs), and ED length of stay. Patients were categorized into the no-prior-ED group and the prior-ED group. Reviewed overall characteristics and statistical tests analyzed differences between subgroups.</div></div><div><h3>Results</h3><div>The records of 184 children (with an average age of 9.4 years, 65% male) revealed that 49% were Hispanic, 39% were Black, and 12% were from other racial backgrounds. Behavioral issues included aggression (51%), suicidal ideation (34%), and acting out (22%). Children were brought in to ED, mainly, from home (59%) and school (33%). Notably, 52% had no prior psychiatric diagnosis, with attention-deficit/hyperactivity disorder (40%) as the most common diagnosis. ACEs were identified in 42% of cases. Compared to the no-prior-ED group, children in the prior-ED group showed higher ACEs scores, longer ED stays, and increased rates of disabilities and suicidal thoughts (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>This study underscores the cyclical nature of ED visits among children with mental and behavioral health and high ACEs. These findings highlight the need for further investigation into early identification strategies and coordinated care to interrupt this cycle.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 104-111"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578329","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":"Fulminant Aortic Occlusion Causing Paraplegia and Multiorgan Ischemia in a Young Adult: A Case Report","authors":"Kriti Gupta MBBS,&nbsp;Sachin Ambure MBBS,&nbsp;Naman Agrawal MD,&nbsp;Roshan Mathew MD,&nbsp;Debendra Tripathy MD","doi":"10.1016/j.jemermed.2025.09.020","DOIUrl":"10.1016/j.jemermed.2025.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Acute aortic occlusion (AAO) is a rare and catastrophic vascular emergency, typically affecting older adults and presenting with acute limb ischemia.</div></div><div><h3>Case Report</h3><div>We report a case of a 39-year-old male chronic alcoholic and smoker who presented with severe back pain followed by sudden-onset bilateral paraplegia and multiorgan ischemia. The patient developed complete motor and sensory loss below the T10 level and urinary incontinence within an hour of symptom onset. Physical examination revealed cold, mottled lower limbs with absent femoral, tibial, and distal pulses. Computed tomography (CT) angiography showed complete occlusion of the infrarenal aorta, left renal artery occlusion with complete left kidney infarction. Despite initial consideration of spinal myelopathies, the diagnosis of AAO was made based on the vascular examination. The patient's delayed presentation and extensive ischemia precluded revascularization, and he died within hours of presentation.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case highlights the need for a high level of suspicion for AAO across a broader patient demographic, even in presentations dominated by neurological symptoms. Prompt recognition and immediate diagnosis via CT angiography are crucial for improving the outcomes in this time-sensitive and devastating condition.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 91-94"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578327","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":"Conservative Management of Spontaneous Posterior Mediastinal Intercostal Artery Hemorrhage: A Case Report and Literature Review","authors":"Masahiko Okada MD ,&nbsp;Hisashi Yanaihara MD ,&nbsp;Mika Misaki MD ,&nbsp;Nao Kohata MD, PhD ,&nbsp;Yusuke Suzuki MD, PhD ,&nbsp;Takanori Asakura MD, PhD","doi":"10.1016/j.jemermed.2025.11.001","DOIUrl":"10.1016/j.jemermed.2025.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Intercostal artery hemorrhage (ICAH) is an extremely rare, potentially life-threatening condition. The etiology of ICAH includes trauma, anticoagulation therapy, bleeding disorders, infections, and underlying diseases such as neurofibromatosis type 1, systemic lupus erythematosus, and hypertension. Due to the rarity of this condition, standardized treatment strategies remain undefined. We report a rare case of spontaneous ICAH successfully managed with conservative therapy and review relevant literature.</div></div><div><h3>Case Report</h3><div>A 49-year-old male presented with sudden and progressively worsening abdominal and back pain. He had no history of trauma or underlying diseases, except for previously undiagnosed and uncontrolled hypertension. Imaging revealed a hemorrhage from the intercostal artery in the posterior mediastinum, which was considered to be the likely source of bleeding. Given the patient’s hemodynamic stability and location of the hematoma, conservative management was selected. Blood pressure was initially controlled with intravenous nicardipine, followed by oral sacubitril/valsartan and nifedipine administration. The hematoma did not increase in size, and the patient was discharged on day 15, without complications. Follow-up imaging confirmed complete resolution of the hematoma, and the patient’s blood pressure remained stable without further antihypertensive medication use.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>Although ICAH is extremely rare, it can cause life-threatening bleeding. Prompt recognition is essential, especially when imaging reveals a posterior mediastinal hematoma without trauma or anticoagulation therapy. Conservative management may be feasible in hemodynamically stable patients with natural tamponade; however, careful patient selection and close monitoring are crucial. Awareness of this condition can help avoid unnecessary invasive procedures.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 181-186"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604552","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}