American Journal of Emergency Medicine最新文献

{"title":"Diagnosis and treatment of sexually transmitted infections among emergency department patients","authors":"Michael Gottlieb MD ,&nbsp;Eric Moyer MD ,&nbsp;Kevin G. Buell MBBS, MS ,&nbsp;Melissa Fleegler MD ,&nbsp;Supriya Mehta MHS, PhD ,&nbsp;Kyle J. Popovich MD, MS ,&nbsp;Richard E. Rothman MD, PhD ,&nbsp;Yu-Hsiang Hsieh PhD ,&nbsp;Kyle Bernard MD ,&nbsp;Jason Haukoos MD, MSc","doi":"10.1016/j.ajem.2025.12.037","DOIUrl":"10.1016/j.ajem.2025.12.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Sexually transmitted infections (STIs) remain a major public health concern, with emergency departments (EDs) serving as key sites for evaluation and treatment. Despite their importance, contemporary national-level data describing ED testing and treatment practices for patients presenting with symptoms suggestive of STI are limited.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of ED encounters from 2016 to 2024 using Cosmos, a large geographically diverse electronic health record database. Patients aged ≥15 years with symptoms suggestive of an STI were included. We examined diagnostic testing for <em>Neisseria gonorrhoeae</em>/<em>Chlamydia trachomatis</em> (NG/CT), <em>Trichomonas vaginalis</em>/bacterial vaginosis (TV/BV), syphilis, and HIV. Pregnancy testing was assessed among females aged 15–55 years. Empiric antibiotic treatment patterns were evaluated over time.</div></div><div><h3>Results</h3><div>Among 5,566,966 unique ED encounters, only 37.8 % underwent STI testing. NG/CT was the most frequently ordered test (34.1 %), followed by TV/BV (21.7 %), HIV (4.1 %), and syphilis (3.9 %). Among those tested for NG/CT, co-testing was 56.0 % for TV/BV, 9.3 % for syphilis, and 8.5 % for HIV. Pregnancy testing occurred in 68.5 % of eligible females. Nearly half (46.2 %) of NG/CT-tested patients received empiric treatment. Among TV/BV-tested patients, 13.4 % were empirically treated in the ED and 32.4 % were prescribed outpatient treatment.</div></div><div><h3>Conclusion</h3><div>Most ED patients who presented for conditions suggestive of STI did not undergo STI testing, and co-testing for other STIs was also uncommon. Empiric antibiotic therapy remains very common, occurring in approximately half of patients. These findings highlight opportunities to improve STI detection and treatment in EDs through standardized protocols and expanded use of co-testing.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 124-128"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deployment of automated external defibrillators by a supermarket chain","authors":"Kenneth A. Scheppke MD ,&nbsp;Paul E. Pepe MD, MPH ,&nbsp;Remle P. Crowe PhD, NREMT ,&nbsp;Junwei Jiang MPH ,&nbsp;Eric K. Scheppke DO ,&nbsp;Steve A. McCoy MS","doi":"10.1016/j.ajem.2025.12.033","DOIUrl":"10.1016/j.ajem.2025.12.033","url":null,"abstract":"<div><h3>Objective</h3><div>Automated external defibrillator (AED) installation has become commonplace in various public locations. However, AED retrievals involving actual shocks may still be very infrequent in many settings despite significant initial/ongoing costs for equipment acquisition, pad/battery expiry replacements and initial/refresher training for designated rescuers. The purpose here was to track frequencies of AED/CPR applications and shocks delivered following AED installations and related employee training throughout a multi-state retail store chain.</div></div><div><h3>Design</h3><div>Prospective 92-month observational study conducted across a large retail chain to document frequencies of AED device retrievals/applications, CPR performance, shocks delivered, and respective patient and scene characteristics.</div></div><div><h3>Setting</h3><div>1358 retail stores and two-dozen warehouses/offices located in multiple states.</div></div><div><h3>Subjects</h3><div>Persons collapsing with possible cardiopulmonary arrest on corporate properties.</div></div><div><h3>Interventions</h3><div>AED installation and on-going training of employees in CPR/AED use.</div></div><div><h3>Results</h3><div>Among 396 reported AED retrievals/applications (&gt;4/month), 75 % occurred inside stores and the remainder in parking lots/sidewalks/other venues. Among these, 294 persons (ages 1–93 years; 74 % men) received basic CPR and/or AED shocks (&gt;3 cases/month), performed most often by store employees. CPR-patient median age was 60 years (IQR:45–70) for men and 58 (IQR:38–68) for women. AEDs delivered 157 shocks during 112 events (&gt;1 case/month); 71 % involved one shock, 20 % two, 9 % three and one involved four shocks. Documented ages for shocked patients (80 % men) ranged 32–90 years with men's median age 62 (IQR:55–70) and women's 61 (IQR:55–65). In one state's retrospective sub-analysis of shockable cases, hospital outcome records were matched to 37 patients with the majority (at least 19 confirmed) surviving to successful hospital discharge.</div></div><div><h3>Conclusions</h3><div>For this multi-state retail chain, AED installation and employee CPR/AED training appeared to be well-justified considering that AEDs were retrieved/applied frequently systemwide, quite often involving defibrillatory shocks that were associated with survival for many patients. Investigators encourage comparable businesses to adopt/study similar employee-based programs nationwide.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 147-151"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency medicine updates: Pediatric brief resolved unexplained event","authors":"Brit Long MD ,&nbsp;Anna M. DePompolo MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.12.036","DOIUrl":"10.1016/j.ajem.2025.12.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Brief resolved unexplained events (BRUEs) can occur in a large number of pediatric patients, with most having a benign etiology. However, in many cases, these can result in unnecessary evaluations and admissions among low-risk patients. Therefore, it is critical for clinicians to be aware of the current evidence regarding BRUE in the emergency department (ED) setting.</div></div><div><h3>Objective</h3><div>This paper evaluates key evidence-based updates concerning pediatric BRUE for the emergency clinician.</div></div><div><h3>Discussion</h3><div>A BRUE is defined as a clinical entity occurring in an infant less than 1 year of age that an observer reports as sudden, brief (&lt; 1 min), and now resolved episode with no explanation and accompanied by at least one of the following: Change in breathing, pallor or cyanosis, change in tone, or altered level of consciousness. BRUEs often cause significant distress for both caregivers and medical professionals. Having an approach to risk-stratification and engaging in shared decision-making with caregivers can help guide clinicians during these encounters. Clearly identifying what qualifies as a low-risk event can minimize unnecessary testing while ensuring that children who do not meet low-risk criteria receive an appropriately focused evaluation</div></div><div><h3>Conclusion</h3><div>An understanding of the current literature concerning BRUE can assist emergency clinicians and improve the care of these patients.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 141-146"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balanced crystalloids versus normal saline for trauma resuscitation: A systematic review and meta-analysis","authors":"Hany A. Zaki ,&nbsp;Hussam Elmelliti ,&nbsp;Amira Shaban ,&nbsp;Ahmed Shaban ,&nbsp;Ali Elkandow ,&nbsp;Mohamed Gafar Abdelrahim ,&nbsp;Wadah Musaed ,&nbsp;Eman E. Shaban","doi":"10.1016/j.ajem.2025.12.030","DOIUrl":"10.1016/j.ajem.2025.12.030","url":null,"abstract":"<div><h3>Background</h3><div>Fluid resuscitation is a key element for the management of critical care patients. However, it is uncertain whether balanced crystalloids may be preferred over normal saline (NS) in trauma patients. Therefore, the current meta-analysis compared the efficacy and safety of balanced crystalloids with NS in trauma resuscitation.</div></div><div><h3>Methods</h3><div>The online search for articles relevant to our study objective was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus. This search was limited to randomized controlled trials (RCTs) available in English language. The primary outcome of our study was all-cause mortality, and secondary outcomes were incidence of acute kidney injury (AKI), length of intensive care unit (ICU) stay, ventilator-free days, need for renal replacement therapy (RRT), and base deficit. The statistical analyses were performed using RevMan 5.4.1, and bias assessment was performed using the Cochrane risk of bias tool (ROB-2).</div></div><div><h3>Results</h3><div>Six distinct RCTs involving 1950 trauma patients were included. The pooled analyses revealed that NS was associated with decreased mortality in traumatic brain injury (TBI) patients (OR: 1.35; 95 % CI: 1.06 to 1.72; <em>p</em> = 0.02), but not in trauma patients without TBI (OR: 1.17; 95 % CI: 0.47 to 2.90; <em>p</em> = 0.74). Similarly, more ventilator-free days were observed in the NS group than in the balanced crystalloids group among TBI patients (MD: −0.67 days; 95 % CI: −0.86 to −0.48; <em>p</em> &lt; 0.00001), but not in trauma patients without TBI (MD: 3.0 days; 95 % CI: −3.36 to 9.36; <em>p</em> = 0.36). On the other hand, no significant difference was observed in total volume of study fluid administered, AKI incidence and length of ICU stay among patients with or without TBI.</div></div><div><h3>Conclusions</h3><div>In trauma patients with TBI, NS was associated with lower mortality and more ventilator-free days than balanced crystalloids, whereas no significant difference was noted in trauma populations without TBI. Moreover, there was no significant difference between NS and balanced crystalloids in terms of AKI incidence, need for RRT, and ICU stay, suggesting that balanced crystalloids remain a safe and reasonable option for trauma resuscitation.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 84-91"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes after removal of malpositioned intrauterine devices in the emergency department","authors":"Jessica Zola MD ,&nbsp;Sarah Petelinsek ,&nbsp;Patrick G. Hughes DO","doi":"10.1016/j.ajem.2025.12.029","DOIUrl":"10.1016/j.ajem.2025.12.029","url":null,"abstract":"<div><div>Pelvic pain is a common chief complaint in the acute care setting. As intrauterine devices continue to grow in prevalence, incidence of complications will naturally increase. While the care of malpositioned IUDs is well described in obstetrics/gynecologic and radiologic literature, there is limited information regarding it in the emergency department. In this case series we identified four cases of symptomatic, malpositioned IUDs with removal in the emergency department and documented symptomatic improvement. Removal in all cases was uncomplicated. These cases suggest that malpositioned IUDs are a potential source of acute pelvic pain and vaginal bleeding and that removal has been safe and effective. While these findings align with prior literature that removal of malpositioned IUDs is safe, their broader clinical implications are limited by the small sample size and safeguards inherent in a tertiary care center. Further research specific to the acute care setting and the emergency provider is needed.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 79-83"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global epidemiology of botulism outbreaks from open-source intelligence, 2017–2024","authors":"Damian Alexander Honeyman ,&nbsp;David James Heslop ,&nbsp;Chandini Raina MacIntyre","doi":"10.1016/j.ajem.2025.12.022","DOIUrl":"10.1016/j.ajem.2025.12.022","url":null,"abstract":"<div><h3>Background</h3><div>Botulism is a rare but potentially fatal illness caused by botulinum neurotoxin, with outbreaks reported globally in humans, animals, and the environment. In the absence of a global surveillance system, open-source intelligence (OSINT) offers real-time insight into botulism activity.</div></div><div><h3>Methods</h3><div>Using the Artificial-Intelligence-driven OSINT early warning system EPIWATCH®, we extracted a dataset published between 31 December 2016 and 1 January 2025 and filtered by our search terms to identify botulism outbreaks. Data collected included country, event date, location, symptoms, outbreak type (human/animal), case numbers, hospitalisations, antitoxin treatment, deaths, source and origin of outbreak, botulism type, toxin strain, and time from exposure to symptom onset. Analyses were conducted using STATA/BE 17.0.</div></div><div><h3>Results</h3><div>OSINT identified 296 botulism outbreaks, of which 259 (87.5 %) were in humans, totalling 1097 cases and 47 deaths. There were 37 animal outbreaks (12.5 %), accounting for 27,537 cases and 27,287 animal deaths. The highest number of human outbreaks occurred in Ukraine (56.0 %, <em>n</em> = 145), the Russian Federation (10.8 %, <em>n</em> = 28), and the United States of America (7.0 %, <em>n</em> = 18). Common symptoms included dysphagia (11.0 %), nausea (9.0 %), and generalised weakness (8.8 %). The primary transmission routes were foodborne (79.5 %), iatrogenic (3.1 %) and wound (3.1 %, <em>n</em> = 8). The most frequently implicated sources were dried fish (33.2 %), canned fish (5.4 %) and canned meat (4.6 %, <em>n</em> = 12). Toxin strain was rarely reported (97.7 %).</div></div><div><h3>Conclusion</h3><div>OSINT-based surveillance, despite some limitations, provides a new mechanism for insight into global botulism patterns, particularly where traditional reporting is limited.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 71-78"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the presence of the thumb sign in acute epiglottitis","authors":"Ching-Wen Yu ,&nbsp;Ching-Hsiang Yu ,&nbsp;En-Chih Liao ,&nbsp;Yu-Jang Su","doi":"10.1016/j.ajem.2025.11.011","DOIUrl":"10.1016/j.ajem.2025.11.011","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 173-175"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical profiles and demographics of suicide attempts in early-to-mid adolescents in emergency departments: A retrospective study","authors":"Wan Wang ,&nbsp;Yun Cao ,&nbsp;Feng Chen ,&nbsp;JiaWen Qiu,&nbsp;Xue Zhang,&nbsp;ZhenZhen Huang,&nbsp;YingYing Wu,&nbsp;XueLi Ji,&nbsp;Hao Wu","doi":"10.1016/j.ajem.2025.12.019","DOIUrl":"10.1016/j.ajem.2025.12.019","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the clinical profile of early-to-mid adolescents (EMA) who attempted suicide in the emergency department (ED) and to provide suggestions for suicide prevention.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using electronic medical records of 227 EMA admitted to the ED of a tertiary general hospital in Nanjing, China, for suicide attempts between January 2021 and December 2024.</div></div><div><h3>Results</h3><div>Among the 227 patients, 70.04 % had diagnosed mental disorders. Attempts predominantly occurred between 18:01 and 24:00. Higher attempt proportions were observed among females and mid-adolescents. The most common method of suicide was drug overdose (69.60 %), primarily involving psychotropic medications (65.19 %). Rural EMA more frequently used poison ingestion than urban EMA (<em>n</em> = 28; 31.11 % vs. <em>n</em> = 12; 8.76 %; <em>P</em> &lt; 0.05). EMA with a mental disorder history mostly chose drug overdose (83.65 %), while those without also preferred poison ingestion (35.29 %). Psychological factors (49.34 %) and school-related factors (22.03 %) were the leading triggers, with school-related factors being more prevalent among rural EMA and early-adolescents. EMA without mental disorders showed higher treatment compliance than those with mental disorders (<em>n</em> = 57; 83.82 % vs. <em>n</em> = 113; 71.07 %; <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Adolescent females, particularly those with mental disorders, account for a relatively high proportion of suicide attempts, often via psychotropic drug overdose. This highlights the urgent need for stricter medication regulation. Suicide methods differed by mental disorder history (presence/absence) and urban/rural status. Psychological and school-related factors were main triggers. We recommend that schools and families collaborate to develop targeted interventions based on subgroups' specific needs and reduce the suicide behaviors.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 54-60"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled trial comparing static ultrasound guided lumbar puncture to the dynamic paramedian approach","authors":"Gitansh Bhargava ,&nbsp;Matthew Kongkatong ,&nbsp;Jakob Ottenhoff ,&nbsp;James Moak ,&nbsp;Colleen Mullins ,&nbsp;David Joyner ,&nbsp;David Moyer ,&nbsp;Christopher Thom","doi":"10.1016/j.ajem.2025.12.011","DOIUrl":"10.1016/j.ajem.2025.12.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The dynamic paramedian (DP) approach to lumbar puncture (LP) is a novel technique that allows for active ultrasound (US) guidance. We sought to investigate the efficacy of this approach as compared to traditional static US guidance using a cadaver model.</div></div><div><h3>Methods</h3><div>This was a prospective study between November 2024 and May 2025 at a single institution. Four ultrasound-trained emergency physicians performed simulated LPs on soft-embalmed cadavers using both the static midline (SMLP) and dynamic paramedian (DPLP) ultrasound approaches. For each spinal level, the order in which the techniques were performed was randomized. Outcomes evaluated included overall success, time, number of bony contacts, and number of needle redirections.</div></div><div><h3>Results</h3><div>A total of 36 SMLP and 36 DPLP attempts were performed on four separate cadavers. Overall success was 72 % (95 %CI 56 %–84 %) for SMLP and 81 % (95 %CI 65 %–90 %) for DPLP, <em>p</em> = 0.6. Median time to completion for SMLP was 96 s (IQR 57.5–300) and 72 s (IQR 35.5–200.5) for DPLP, <em>p</em> = 0.07. Median bony contacts and needle re-directions were both lower with the DPLP approach compared to the standard approach (2 vs. 7, <em>p</em> = 0.0004; and 4 vs. 8.5, <em>p</em> = 0.011, respectively). The subcohort analysis of ultrasound-fellowship trained emergency physicians had a DPLP success rate of 96 % (95 %CI 82 %–99 %).</div></div><div><h3>Conclusion</h3><div>The DPLP approach to LP is a promising technique for the emergency physician. In a cadaveric model, it was associated with fewer bony contacts and needle redirections as compared to SMLP. Overall procedural success was higher with the DPLP approach, though this did not reach statistical significance.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 1-6"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surviving ventricular fibrillation: A documented Lazarus phenomenon","authors":"Oscar Thabouillot MD, PhD student ,&nbsp;Emmanuel Rozenberg MD ,&nbsp;Simon-Pierre Corcostegui MD ,&nbsp;Clément Derkenne PhD","doi":"10.1016/j.ajem.2025.12.024","DOIUrl":"10.1016/j.ajem.2025.12.024","url":null,"abstract":"<div><h3>Case presentation</h3><div>A 94-year-old woman with no major medical history developed chest pain and experienced ventricular fibrillation at home. In accordance with written advance directives specifying refusal of “unreasonable or futile treatment,” no resuscitation was performed. After approximately ten minutes of asystole, spontaneous circulation resumed. Forty minutes later, the patient regained consciousness with complete neurologic recovery. Coronary angiography revealed significant coronary lesions that were successfully treated with two drug-eluting stents. The patient was discharged neurologically intact and remains well.</div></div><div><h3>Discussion</h3><div>This case documents a Lazarus phenomenon in the absence of any resuscitative maneuver—an event not previously described in the literature. Physiologic hypotheses may include delayed venous return, spontaneous myocardial reperfusion, or electrical recovery following ventricular fibrillation. The ethical implications are substantial, as the patient's interpretation of her advance directives differed markedly from the medical team's understanding. This case underscores both the physiological mystery of spontaneous circulation recovery and the ethical need for precise, individualized advance directives. It also highlights the importance of adaptability and clinical judgment when unexpected reversals of presumed death occur.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 110-113"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}