Western Journal of Emergency Medicine最新文献

{"title":"9-1-1 Call Data Modeling to Assess the Influence of a Mass Gathering on Host Community Metrics for Syndromic Surveillance.","authors":"Arthur H Yancey, Elijah Robinson, Timothy McMahan, George A Cotsonis","doi":"10.5811/westjem.53142","DOIUrl":"10.5811/westjem.53142","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-day planned mass gatherings are prevalent in various forms of sports competitions, concerts, professional, political, and religious conferences. The largest, the World Cup competition, will be hosted by large cities of the United States, Canada, and Mexico in June and July, 2026. These can present risks to the health of spectators, participants, organizers, and host communities, which if discovered faster, facilitates more effective responses in preventing morbidity/mortality. This study demonstrates visually modeled 9-1-1 medical data that uniquely contributes to existing syndromic surveillance activities by its practicality and time sensitivity.</p><p><strong>Objectives: </strong>Using data from the nine-day period of 2019 Super Bowl LIII festivities, this retrospective, quantitative, descriptive, population-based study was conducted to demonstrate how 9-1-1 emergency medical dispatch (EMD) data could be practically modeled to more rapidly detect changes from baseline host community 9-1-1 data. Our ultimate objective is to illustrate these visual models in the attempt to improve syndromic surveillance.</p><p><strong>Methods: </strong>All 9-1-1 medical calls from three host municipalities were processed and categorized at the Grady Emergency Medical Services (EMS) Communications Center during game day and eight preceding days of festivities (time frame-standardized to nine-day events period). This events period call volume was contrasted to that of the identical nine-day pre- and post-events periods. The mean 24 one-hour interval call volumes for each day of these three periods were analyzed. Data visualization techniques (a data table, bar graphs, geo-, and heat-mapping) were constructed to illustrate differences in 9-1-1 call volumes of three categories (hypothermia, traffic injury incidents, and violence-induced injuries), for the three periods. The most similar previous such studies were reviewed and related to our study.</p><p><strong>Results: </strong>The events period call volume (3,267) was less than that in pre- (3,356) and post-(3,460) events totals. Directional (increasing versus decreasing) patterns in hourly call frequencies were similar among all three periods. Cold exposure calls decreased across the three periods (successive period were 9, 7, and 4 respectively). Changes in traffic incidents were minimal (36, 39, and 38, respectively). Violent act injury calls increased during the post-events period (151, 150, and 166, respectively).</p><p><strong>Conclusion: </strong>Data from 9-1-1 calls could provide readily discoverable trends reflective of clinically significant syndromes threatening host community health status associated with planned mass gatherings. The study demonstrates practical data modeling to enhance syndromic surveillance. Recommendations are offered for enhancing 9-1-1 data analysis in conducting syndromic surveillance.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"1062-1072"},"PeriodicalIF":2.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Monitor Position and Operator Ability to Visualize a Desaturation Event During Intubation.","authors":"Eric Boccio, Rachelle Perkins, James Bonz","doi":"10.5811/westjem.52933","DOIUrl":"10.5811/westjem.52933","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;During endotracheal intubation, equipment setup typically includes the patient monitor fixed at the head of the bed behind the back of the operator. Inability to directly visualize the patient monitor may result in delayed recognition of desaturation. Our primary aim in this study was to measure the association between patient monitor position and the time to recognition of a desaturation event during endotracheal intubation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a randomized crossover trial of emergency medicine residents across two Accreditation Council for Graduate Medical Education-accredited programs. Subjects were asked to perform direct and video-assisted laryngoscopy once on a difficult airway trainer in a simulation. The sequence of laryngoscopy modality (direct vs video-assisted) and monitor position (head vs left vs right of bed) were randomized prior to each attempt. The simulated patient's peripheral capillary oxygen saturation (SpO2) was programmed to begin at 100% and decrease at a rate of 1% per second 10 seconds after the start of the subject's attempt. The primary outcome measure was time to operator recognition of hypoxia defined as the observed period during which the simulated SpO2 was &lt; 90%. Secondary outcomes were operator failure to visualize a desaturation event. We rendered Kaplan-Meier curves illustrating the time to visualization of hypoxia and performed a Cox regression adjusting for laryngoscopy modality and total number of previous intubations performed. Using multivariable linear regression, we modeled the association between time to recognition of hypoxia in seconds and patient monitor position with similar adjustments. To assess differences in the number of observed failure events between study arms, we used chi-squared or Fisher exact tests. The threshold for statistical significance was a two-sided P &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We observed 68 attempts by 34 subjects. Twenty-two (32.5%), 22 (32.5%), and 24 (35%) intubations were performed with the monitor positioned at the head, left, and right, respectively. The median times to recognition of hypoxia were 37 seconds [sec] (95% CI, 25-86 sec) for the head, 32 sec (95% CI, 18-50 sec) for the left, and 23 sec (95% CI, 19-34 sec) for the right groups, respectively. Cox regression demonstrated hazard ratios of 2.7 and 3.2 for the left and right groups when compared to the head group, and these findings were statistically significant (P = .04 and P = 0.03, respectively). We found no statistically significant associations between time to recognition of hypoxia and laryngoscopy modality or total number of previous intubations (P = .82 and .21, respectively). Failure rates across head, left, and right groups were similar, at 36%, 59%, and 50%, respectively (P = .30).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Positioning of the patient monitor at the head of the bed results in delayed visualization of desaturation events duri","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"956-963"},"PeriodicalIF":2.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Question vs Ongoing Violence Assessment Tool for Intimate Partner Violence Screening.","authors":"Gretchen Nonawzki, Zhengqiu Zhou, Maureen Mohan, Saria Slowey, Donna Carden, Robyn Hoelle","doi":"10.5811/westjem.49021","DOIUrl":"10.5811/westjem.49021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Intimate partner violence (IPV) represents a pervasive and costly public health issue. Many IPV victims seek care in the emergency department (ED) due to injuries or related medical complaints; yet a substantial number of cases remain undetected. The challenge lies in implementing effective screening tools within the demanding environment of an ED. In this study we aimed to assess the efficacy of two brief IPV screening tools- the single question, \"Have you been hit, kicked, punched, or otherwise hurt by someone in the past year?\" and the 4-item Ongoing Violence Assessment Tool-and to compare them to the more comprehensive Index of Spouse Abuse, a validated 30-item survey that is considered the gold standard for IPV assessment. Our objective was to identify improved strategies for IPV screening in the busy ED setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective study, every third English-speaking female patient 18-55 years of age presenting to our ED triage was invited to participate. Each participating patient was sequentially assigned to either the single question or the ongoing assessment screening group. Both groups completed feedback surveys about their experiences and the Index of Spouse Abuse survey. We used chi-square tests to compare categorical variables, and we used frequency tables to calculate the sensitivity, specificity, positive predictive value, and negative predictive value of each IPV screening tool. We compared test characteristics between the Ongoing Violence Asessment Tool or the single question screening tool to the Index of Spouse Abuse using the Fisher exact test. Mean duration was compared using two-tailed Student t-tests. The primary outcome was the sensitivity and specificity of the single question assessment. and the 4-item Ongoing Violence Assessment Tool, using the Index of Spouse Abuse as the gold standard for IPV screening. Secondary outcomes were to record the length of time needed to screen with the single question assessment and the Ongoing Violence Assessment Tool and to collect participant feedback on the two screening tools.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 400 participants were enrolled in the study and completed the designated surveys. Screening time was significantly shorter in the single question group (median 6 seconds) compared to the ongoing assessment group (median13 seconds; P &lt; .001). Feedback surveys did not reveal significant differences between the two groups. When compared to the Index of Spouse Abuse, the single question tool exhibited sensitivity of 53.3% and specificity of 94.1%, while the ongoing assessment demonstrated slightly higher sensitivity levels of 75.0% and lower specificity of 92.8%. For the single question assesssment, the positive predictive value was 42.1% and negative predictive value was 96.1%. For the Ongoing Violence Assessment Tool, the positive predictive value was 40.1% and the negative predictive value was 98.2%.&lt;/p&gt;&lt;","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"977-984"},"PeriodicalIF":2.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid Overdose-Related Emergency Department Visits Pre- and Post-COVID-19.","authors":"Melanie F Molina, Samuel D Pimentel, Maria C Raven, Kathy T LeSaint, David G Dillon","doi":"10.5811/westjem.53227","DOIUrl":"10.5811/westjem.53227","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Understanding changes in opioid overdose-related emergency department (ED) visits and ED-based opioid use disorder (OUD) treatment post-coronavirus disease 2019 (COVID-19) pandemic can inform ongoing efforts to address the opioid crisis. We aimed to examine trends in opioid overdose-related ED visits, ED-based medication for OUD (MOUD) treatment, and appendicitis-related ED visits (as a control) before and after the initial COVID-19 peak in April 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted an interrupted time series analysis of monthly ED visits from January 2017-December 2022 at three hospitals in California. We modeled pre- and post-COVID-19 visit trends and the change in trend from pre- to post-COVID-19 peak using linear regression controlling for study site. Our primary outcome included monthly rates of opioid overdose-related ED visits, with monthly rates of ED visits with MOUD treatment as a secondary outcome. Appendicitis-related visits served as a control for temporal trends.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 781,488 ED visits across the entire study period, there were 2,536 (0.32%) opioid overdose-related visits, 9,755 (1.25%) MOUD treatment visits, and 1,123 (0.14%) appendicitis-related visits. Pre-pandemic, monthly increases were observed in opioid overdose-related visits (6.7 visits/10,000 per month, 95% confidence interval [CI] 2.6-10.8, P = .001), MOUD-positive visits (34.9 visits/10,000 per month, 95% CI, 26.0-43.7, P &lt; .001), and appendicitis visits (2.5 visits/10,000 per month, 95% CI, 1.2-3.9, P &lt; .001). After April 2020, only MOUD-positive visits showed an immediate (level change) increase (49 visits/10,000 or 34% of April 2020 projected pre-COVID-19 visit rates, 95% CI, 26.1-71.9, P &lt; .001), with opioid overdose-related visits subsequently declining (-4.6 visits/10,000 per month or -11% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -7.2 to -2.0, P = .001). Across the entire pre- to post-COVID-19 period, significant decreases in overall visit trends were observed across all visit types, greatest for MOUD-positive visits (-39.2 visits/10,000 per month, or -27% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -51.5 to -26.8, P &lt; .001), followed by opioid overdose visits (-11.3 visits/10,000 per month, or -27% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -16.1 to -6.5, P &lt; .001) and appendicitis visits (-4.2 visits/10,000 per month, or -23% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -7.2 to -1.2, P = .01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;From pre- to post-initial COVID-19 peak, absolute ED-based MOUD treatment trends declined over three times faster than those of opioid overdose-related ED visits (although percentage changes relative to expected April 2020 rates were both -27%). These findings may reflect reduced perceived urgency as overdose presentations decreased and a shift away from crisis-driven implementation, underscoring the ","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 4","pages":"875-879"},"PeriodicalIF":2.3,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curb to Needle Time: A Five-Year Descriptive Analysis Evaluating a Mobile Stroke Unit in a Suburban EMS System.","authors":"Eric Wetzel, Zachary Weisner, Marina Ulhaq, Matthew Kening, Alvin Wang, Gerald Wydro","doi":"10.5811/westjem.62948","DOIUrl":"10.5811/westjem.62948","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Stroke is a significant cause of mortality and long-term disability in the United States. Reduced time to thrombolytic therapy may lower stroke-related morbidity and mortality. The integration of a mobile stroke unit (MSU) into emergency medical service (EMS) systems of care has been focused in large metropolitan areas. A MSU may reduce the time from first medical contact (FMC) to thrombolytic therapy versus traditional care models, but this value must be evaluated in the context of the logistic and operational challenges of non-metropolitan EMS systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the impact of integrating an MSU into a large suburban EMS system with specific attention to key time metrics, logistics, and patient safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective observational study of MSU dispatches by a County 911 emergency communication center (ECC) across a large suburban EMS system involving multiple agencies between August 1st, 2019, and July 31st, 2024. The MSU is a specialty ambulance with computerized tomography and telemedicine consultation capable of prehospital treatment of patients with thrombolytics. Criteria to dispatch the MSU were defined by the ECC caller-interrogation protocols for stroke and dispatcher discretion. Time metrics in minutes were reviewed for all incidents by the MSU, including dispatch to on-scene, and times from on-scene to key milestones such as imaging by computed tomography, neurology telemedicine consultation, thrombolytic therapy, and transport to the stroke center. Demographic data were obtained on those who received tPA and who were transported. Data are presented as a median with interquartile ranges (IQR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over a five-year period, the MSU had 1,752 dispatches, of which 717 patients were transported to the emergency department. The median time on scene before initiating transport to a comprehensive stroke center was 21 minutes (IQR 18-24). The median arrival to CT scan was 9 minutes (IQR 7 - 11), median FMC to neurology telemedicine consultation was 14 minutes (IQR 12 - 17), and dispatch to thrombolytic therapy was 38 min (IQR 31-43). A total of 91 patients (4%) received thrombolytics prehospital and FMC to thrombolytic therapy had a median time of 26 minutes (IQR 22 - 31). An equal number of men (47%) and women received thrombolytics (p value = 0.602) and the median age was 73. (IQR 64.5-83). The median time from reported last known well to thrombolytic was 71 minutes (IQR 53-136).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We describe the successful integration of an MSU into a suburban EMS system involving multiple agencies with rapid FMC to thrombolytic administration time. Time metrics for each step to thrombolytic administration were consistent with little variance; no patient received thrombolytics beyond the 270 minutes safety limit. Of the 1,752 dispatches, 91 patients received thrombolytics. This shou","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"841"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Wellness and Burnout from Electronic Medical Record and Administrative Tasks.","authors":"Hamza Choudry, William Adams, Jacqueline M Dziedzic","doi":"10.5811/westjem.62945","DOIUrl":"10.5811/westjem.62945","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Rising physician burnout, exacerbated by the increasing complexity and time demands of electronic medical record (EMR) systems and administrative tasks, threatens physician well-being and patient care quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the impact of EMRs and administrative tasks on physician burnout in the emergency department (ED), identifying specific factors that contribute to increased burnout and decreased well-being among emergency physicians (EPs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional survey was sent to 53 EM attending and resident physicians at Loyola University Medical Center. We measured the following: time spent on EMR-related tasks, as well as the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which measures burnout across three domains: emotional exhaustion, depersonalization, and personal accomplishment. For each MBI-HSS domain, participants' scores were calculated by summing the responses to domain-specific items and dividing by the number of items answered, yielding an average score that reflects the degree of burnout. Linear regression was employed to assess the relationship between each ordinal survey item and the average MBI-HSS domain score. Kruskal-Wallis tests were conducted as sensitivity analyses due to the ordinal nature of the survey items. Burnout levels were based on established thresholds to facilitate interpretation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 24 respondents (response rate 45.3%), 50% (n = 12) reported high emotional exhaustion, and 54.2% (n = 13) reported high depersonalization, indicating a substantial prevalence of burnout.. Weekly hours dedicated to EMR-related tasks were associated with increased emotional exhaustion (β = 0.89, SE = 0.21; p &lt; .001) and depersonalization (β = 0.64, SE = 0.24; p = .01). Interestingly, perceived time pressure and workload related to EMR use were inversely associated with depersonalization (β = -1.19, SE = 0.34; p = .002). No significant association was found between EMR time and personal accomplishment, although 25% (n = 6) of respondents reported low scores in this domain, indicating the need to explore additional factors contributing to this aspect of burnout. 41.6% (n = 10) of subjects reported 15-20 hours per week spent using EMR, followed by 25% (n = 6) reported 10-15 hours per week and 16.6 % (n = 4) reported 5-10 hours per week and another 16.6% (n = 4) reported greater than 20 hours per week.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study demonstrates a significant association between time spent on EMR tasks and elevated levels of emotional exhaustion and depersonalization among ED physicians, underscoring the impact of administrative burdens on burnout. The inverse association between perceived EMR workload and depersonalization suggests that higher time pressure may paradoxically reduce feelings of detachment, potentially due to increased engagement in patient care during high-press","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"837"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Pelvic Ultrasound with Negative Computed Tomography in Adult Females.","authors":"Mary Rometti, Amanda Esposito, Michael Mirza, Sara Heinert, Christopher Bryczkowski","doi":"10.5811/westjem.48919","DOIUrl":"10.5811/westjem.48919","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency physicians must consider ovarian torsion in all biologically female patients who present to the emergency department (ED) with abdominal pain. A misdiagnosis can result in detrimental outcomes, such as loss of an ovary. Female patients who present to the ED for evaluation of their abdominal pain may have a computed tomography (CT) or pelvic ultrasound performed to further evaluate for concerning pathology. Our objective in this study was to describe the occurrence of critical or emergent findings on pelvic ultrasound not identified on a concurrent or previously performed CT of the abdomen and pelvis.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of ED visits from January 1-December 31, 2021 at a large, suburban, academic medical center. Eligible patients were adult females (≥ 21 years of age) who had a CT of the abdomen and pelvis and pelvic ultrasound, with the CT ordered either before or simultaneously with the pelvic ultrasound. We excluded from the study CTs with abdominal or pelvic pathology. The primary outcome measure was to determine the occurrence of pelvic ultrasounds without acute pathology with a negative CT. The secondary outcome measure was to identify non-emergent findings on pelvic ultrasound with a negative CT.</p><p><strong>Results: </strong>Of 281 eligible ED visits, 172 patients (61.2%) had gynecologic pathology on CT and 60 patients (21.4%) had other pathology on CT. The mean age was 43.3 years (SD 16.4). Forty-nine patients (17.4%) had unremarkable CT results. Of those, 39 patients (79.6%; 95% CI, 65.7-89.8%) had a normal ultrasound; three patients (6.1%; 95% CI,1.3-16.9%) had an ovarian cyst; six patients (12.2%; 95% CI, 4.6-24.8%) had other non-emergent results; and one patient (2.0%; 95% CI, 0.05-10.9%) had a 10- by 11-mm ovarian mass on ultrasound. In patients with unremarkable CTs, 48 (98.0%; 95% CI, 89.1-99.9%) also had normal or not clinically significant ultrasound results. No definite ovarian torsions were diagnosed on ultrasound after a negative CT.</p><p><strong>Conclusion: </strong>Obtaining a pelvic ultrasound following an unremarkable CT of the abdomen and pelvis may not produce additional clinically relevant results in an emergency setting.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"731-734"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Simulation-based Awake Fiberoptic Intubation Curriculum: Pilot Study.","authors":"Daniel Haas, Jenna Fredette, Kathleen A Murphy, Andrew Deitchman, Jacob Anderson, Maxwell Blodgett","doi":"10.5811/westjem.50778","DOIUrl":"10.5811/westjem.50778","url":null,"abstract":"<p><strong>Introduction: </strong>Awake fiberoptic intubation is a critical skill of emergency physicians in scenarios where rapid sequence intubation may be impossible or catastrophic. While the equipment to perform awake fiberoptic intubation has become more readily available to emergency physicians, inadequate training and lack of confidence are often cited as barriers to performing the procedure. To address this, we created and studied a simulation-based awake fiberoptic intubation curriculum with the goal of improving physicians' performance of this skill.</p><p><strong>Methods: </strong>A procedural checklist was developed and iteratively refined among EM, anesthesiology, and critical care physicians. An instructional video was created based on this checklist. Participants viewed the instructional video and underwent supervised deliberate practice on a manikin and bronchoscopy simulator using a rapid-cycle deliberate practice paradigm with 1:1 supervision from an instructor. Comparisons were made between a pre-test and a three-month post-test. We evaluated participants using calculated simulator metrics, the Objective Structured Assessment of Technical Skill global rating scale (GRS), a checklist, and pre- and post-intervention self-assessment.</p><p><strong>Results: </strong>We collected data from 46 participants. Observed performance using the GRS improved from 22.5 (standard deviation 4.5) to 28.8 (6.3) (P < .001). Time from scope insertion to verbalized passage of the endotracheal tube on the simulator decreased from a mean of 147.0 (148.3) seconds to 84.6 (39.1) seconds (P = .01). Participants reported improved self-assessed performance compared with others at their stage of training, 3.7 (1.5) to 5.0 (1.2), P < .001, and their reported confidence performing the procedure increased from 3.0 (1.5) to 5.1 (1.2), P < .001. No significant difference was seen among checklist scores.</p><p><strong>Conclusion: </strong>In this novel simulation-based awake fiberoptic intubation curriculum, subjective and objective performance improvements were observed at three months. Learners who participated in the course reported feeling more confident and capable of performing awake fiberoptic intubation and being satisfied with the curriculum.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"745-752"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SonoGuar: A Self-healing Hydrogel for Higher Fidelity Ultrasound-guided Procedure Training.","authors":"Aswin Bikkani, Fiona Pudewa, Beshoy Gabriel, Sarah Kim, En Chang, Stephen Chai, Sreekavya Immadisetty, Xiaofeng Liu, Andrew Crouch, Steven Johnson, Jamshid Mistry","doi":"10.5811/westjem.48400","DOIUrl":"10.5811/westjem.48400","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasound-compatible procedural phantoms are critical for vascular access training, but commercial models are expensive, degrade with use, and provide limited simulation of key procedural steps. Existing low-cost alternatives often lack durability and fidelity.</p><p><strong>Methods: </strong>We synthesized a novel, self-healing, ultrasound-compatible hydrogel (SonoGuar) using guar gum, borax, glycerol, oil, and water. We constructed vascular-access task trainers and evaluated SonoGuar across three domains: 1) rheological analysis of viscoelastic recovery after injury; 2) a blinded ultrasound image comparison study comparing SonoGuar against a commercial model; and 3) a prospective, randomized, single-blind crossover simulation study comparing SonoGuar to a commercial model with 41 participants (medical students, residents, and attendings).</p><p><strong>Results: </strong>At grocery store material prices, one kilogram of SonoGuar took 10 minutes of active time and about $3 to fabricate, including vessel-mimic balloons. The commercial comparison model was quoted at $350 for a single replacement insert. SonoGuar recovered its viscoelastic profile within 30 minutes of injury and demonstrated visible healing of needle tracts by five hours. In the image comparison, SonoGuar was 1.8 times more likely than the commercial model to be selected as resembling human tissue in a head-to-head comparison (64.5% SonoGuar vs 35.5% commercial model, P < .001). In simulation, 41-residents and attendings rated SonoGuar higher than the commercial phantom across all model aspects, including anatomy identification, appearance, tactile feedback, and needle visualization (average of 4.47 vs 3.77 on a 5-point Likert scale, P < .01). After cost was disclosed, all preferred SonoGuar. Medical students rated both models similarly across all model aspects and demonstrated increased levels of confidence after training with SonoGuar or commercial phantom (pre-simulation average confidence on a 5-point Likert scale of 1.46 and post-simulation average of 3.54 and 3.37, respectively, both comparisons P < .05).</p><p><strong>Conclusion: </strong>A do-it-yourself, high-fidelity hydrogel with self-healing properties, SonoGuar can be rapidly fabricated and is suitable for realistic, durable, and scalable ultrasound-guided procedure training. The low-cost hydrogel outperformed a leading commercial model in imaging realism, user confidence, and overall preference among experienced clinicians.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"735-744"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Interventions in Organophosphate Poisoning: An Umbrella Review of Systematic Reviews.","authors":"Vivek Chauhan, Divyam Goyal, Suman Thakur, Sagar Galwankar, Tamas R Peredy","doi":"10.5811/westjem.50823","DOIUrl":"10.5811/westjem.50823","url":null,"abstract":"<p><strong>Introduction: </strong>Organophosphate (OP) poisoning is a significant global health issue, particularly in tropical regions. Despite established treatments such as atropine and oximes, the effectiveness of other interventions remains uncertain. This umbrella review is a critical synthesis of evidence from systematic reviews and meta-analyses on OP self-poisoning.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted a review of systematic reviews and meta-analyses published up to January 2025. Databases searched included PubMed, Epistemonikos, and the Cochrane Library. We performed quality assessment using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR-2), and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate evidence certainty.</p><p><strong>Results: </strong>Of 416 potential papers identified we assessed 27 for eligibility, of which 19 were included in the review. The papers evaluated 11 different interventions as an adjuvant to atropine. Oximes, although commonly used, showed neither benefit nor harm. The systematic reviews and meta-analyses on gastric lavage, plasma exchange with hemoperfusion, lipid emulsions, magnesium sulfate, penehyclidine, rhubarb, and xuebijing have reported significant reductions in mortality, but the evidence comes from very low-quality studies. Alkalinization was not found to be effective for OP poisoning. Evidence was limited by small sample size, inconsistent protocols, and geographical bias, with many studies originating from China.</p><p><strong>Conclusion: </strong>After careful scrutiny of evidence pooled by various systematic reviews and meta-analyses, we found that atropine remains the mainstay of treatment for OP self-poisoning. It may be supplemented with oximes, as recommended by the World Health Organization. Gastric lavage has doubtful efficacy and may even be harmful. Additionally, we recommend against the routine use of penehyclidine, rhubarb, xuebijing, hemofiltration, plasma exchange with hemoperfusion, lipid emulsions, magnesium sulfate, and alkalinization in the management of OP self-poisoning.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"27 3","pages":"819-830"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}