Journal of the American College of Emergency Physicians open最新文献

{"title":"A Toddler With Persistent Crying and a Coin Overlying the Upper Mediastinum.","authors":"Jason Becker, Mark Scheatzle","doi":"10.1016/j.acepjo.2026.100443","DOIUrl":"10.1016/j.acepjo.2026.100443","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100443"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Woman With Fever and Hypoxia.","authors":"Wei F Lee, Natalie Tang, Daphne X Soh, Sachin K B Damodhara","doi":"10.1016/j.acepjo.2026.100438","DOIUrl":"10.1016/j.acepjo.2026.100438","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100438"},"PeriodicalIF":1.8,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparedness of the Emergency Medical Services Educational System: Pandemic Barriers and Adaptations.","authors":"Adrienne K Kramer, Kim D McKenna, Jonathan R Powell, Juan March, William J Leggio, Rebecca E Cash, Ashish R Panchal","doi":"10.1016/j.acepjo.2026.100429","DOIUrl":"10.1016/j.acepjo.2026.100429","url":null,"abstract":"<p><strong>Objectives: </strong>The emergency medical services (EMS) educational infrastructure plays a critical role in maintaining a resilient and stable EMS workforce. Clear disaster preparedness strategies/initiatives are needed to maintain this pipeline during emergencies. Our objective was to build a basis for the EMS educational program's disaster preparedness planning by identifying educational barriers and adaptations experienced through the COVID-19 pandemic.</p><p><strong>Methods: </strong>We held focus groups with EMS educational program directors (PDs) to identify educational barriers and the adaptations they used during the COVID-19 pandemic. PD participants discussed topics in small online groups of 3-6 PDs and 2 facilitators. Thematic analysis was performed to identify emerging themes. Initial coding of the transcribed conversations was performed with themes aggregated and categorized as barriers or adaptations.</p><p><strong>Results: </strong>A total of 35 PDs were enrolled across 8 focus groups. Barriers and adaptations were grouped into 6 domains: regulatory, primary institution/program, faculty/educators, technology use, curriculum, and students. PDs and faculty noted increased workload, increased feelings of stress, and uncertainty in situations where online learning was not in place. New or enhanced technology implementation was essential to program continuation. Program, lab, and clinical structures changed substantially with a rapid increase in the use of simulation, scenarios, and distance learning to adapt to the lack of clinical and field sites.</p><p><strong>Conclusion: </strong>As EMS initial educational programs addressed the pandemic, significant barriers resulting in unique real-time adaptation were noted. To prepare for future educational interruptions, lessons learned from previous widespread system interruptions can be leveraged for informed educational system disaster planning.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100429"},"PeriodicalIF":1.8,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13266170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective, Observational Study Evaluating the Impact and Safety of an Emergency Physician Collaboration With a Nurse Triage Phone Line.","authors":"Elizabeth C Fogelson, Christopher S Russi, Asif Iqbal, James M Colletti, Gregory M Davis, Rachel A Lindor, David M Nestler, John C Schupbach, Laura E Walker, Derick D Jones","doi":"10.1016/j.acepjo.2026.100424","DOIUrl":"10.1016/j.acepjo.2026.100424","url":null,"abstract":"<p><strong>Study objective: </strong>Nurse triage phone lines (NTPLs) are widely used to guide patients to appropriate care levels, often relying on conservative clinical decision support systems (CDSS). This study describes the association of integrating emergency medicine physician consultation (TeleEM) with NTPL recommendations, and subsequent emergency department (ED) utilization.</p><p><strong>Methods: </strong>From October 2020 to July 2024, a prospective, observational study was conducted across a multistate health system. TeleEM physicians reviewed NTPL cases for which nurse staff requested consultation and could agree with, upgrade, or downgrade the CDSS recommendation. Seventy-two-hour ED utilization following TeleEM consultation was also assessed.</p><p><strong>Results: </strong>Among 15,196 TeleEM consults, physicians agreed with the CDSS in 56% of cases, downgraded to a less urgent endpoint in 34% of cases (n = 5164), and upgraded to a more urgent endpoint in 10% of cases (n = 1517). Of downgraded patients, 32.1% (n = 1656) presented to the ED within 72 hours, and 92.2% of those were discharged from the ED. Of upgraded patients, 72.7% (n = 1,103) presented to the ED within 72 hours, and 88.5% of those were discharged from the ED. The most common ED chief complaints among downgraded patients who presented within 72 hours were chest pain (12.9%), abdominal pain (7.0%), and dizziness (4.6%).</p><p><strong>Conclusions: </strong>Integrating emergency physician input into NTPL calls was associated with changes in triage disposition in >40% of cases. Among patients whose recommendations were downgraded, lower observed ED utilization was seen relative to patients whose recommendations were upgraded, although nearly one-third of downgraded patients still presented to the ED within 72 hours. These findings should be interpreted as associative rather than causal.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100424"},"PeriodicalIF":1.8,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Dysesthesia After Massive Accidental Semaglutide Overdose: A Case Report.","authors":"Massimo Quarenghi, Anastasia Stanga, Alessia Bergamaschi","doi":"10.1016/j.acepjo.2026.100427","DOIUrl":"10.1016/j.acepjo.2026.100427","url":null,"abstract":"<p><p>The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has expanded rapidly worldwide for the treatment of obesity, accompanied by a parallel increase in medication errors and accidental overdoses. Gastrointestinal symptoms are the most commonly reported adverse effects in cases of supratherapeutic exposure, whereas neurologic manifestations remain poorly characterized. We report a case of a 50-year-old man with obesity receiving weekly semaglutide 2.4 mg who accidentally administered a total dose of 9.6 mg due to a pen-device handling error. Two days after the injection, he developed generalized burning dysesthesia and marked asthenia in the absence of nausea, vomiting, or abdominal pain. Laboratory tests performed 4 days after exposure were unremarkable. Symptoms gradually improved and resolved completely within 7 days without specific treatment. Clinical trial data suggest a possible dose-related signal for dysesthesia with high-dose oral semaglutide; however, reports of acute parenteral supratherapeutic exposure presenting with isolated neurologic symptoms are scarce. This case suggests that isolated dysesthesia may occur following semaglutide overdose and may follow a benign, self-limited course, a presentation relevant to emergency physicians given the increasing use of GLP-1 RAs.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100427"},"PeriodicalIF":1.8,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Neurologic Decline in a Patient With a Headache.","authors":"Jacquelyn Pearlmutter, Dillon Warr","doi":"10.1016/j.acepjo.2026.100430","DOIUrl":"10.1016/j.acepjo.2026.100430","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100430"},"PeriodicalIF":1.8,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agency-Level Turnover Rates of Emergency Medical Service Clinicians and Their Characteristics.","authors":"Jordan D Kurth, Jonathan R Powell, Christopher B Gage, Jacob C Kamholz, Shea van den Bergh, Rebecca E Cash, Ashish R Panchal","doi":"10.1016/j.acepjo.2026.100418","DOIUrl":"10.1016/j.acepjo.2026.100418","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical service (EMS) clinician-level turnover is high and varies dramatically by agency type. There is a need to evaluate mean turnover rates, adjusted by agency characteristics, to provide standardized and comparable measures across workplace settings. Our objective was to leverage recent methods to evaluate agency-level mean turnover and describe the agency-level characteristics of those leaving the agency of record.</p><p><strong>Methods: </strong>A 2-year retrospective evaluation of EMS clinicians from 2020 to 2022 was conducted to evaluate agency-level turnover. EMS clinicians and agencies from 9 states that required National EMS Certification to obtain/maintain EMS licensure were used. Demographic and EMS-related characteristics were collected, including agency-specific attributes (agency type, service type, majority full-time employees) and state-level identifiers. The percentage of those leaving each EMS agency was calculated, and multivariable linear regression was used to calculate adjusted agency-level mean turnover rates.</p><p><strong>Results: </strong>A total of 1137 EMS agencies with 20,881 EMS clinicians met the inclusion criteria. The adjusted agency-level mean turnover rate was 17.4% and varied dramatically based on agency type (14.3% to 23.7%), with the lowest being fire agencies and the highest being private. When we examined the EMS demographics and work-related characteristics, we discovered significant variability, which is consistent with the theory that each agency type may have different characteristics of clinicians leaving.</p><p><strong>Conclusion: </strong>Adjusted agency-level mean turnover rates varied dramatically by agency type with associated variability in EMS clinician demographics and workplace characteristics. This suggests that the characteristics of agency turnover potentially vary by specific organizational culture, and identifying these variations may assist in developing interventions to enhance retention.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100418"},"PeriodicalIF":1.8,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Man With Acute Kidney Injury and Lower Abdominal Pain.","authors":"Sarah Uhranowsky, Dylan Perez, Yosef Berlyand","doi":"10.1016/j.acepjo.2026.100421","DOIUrl":"10.1016/j.acepjo.2026.100421","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100421"},"PeriodicalIF":1.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Condition-Specific Protocols Used in the Emergency Department Observation Unit: A Scoping Review.","authors":"Kian D Samadian, Andrew D Luo, Malia Pollock, Henry Chen, Joshua J Baugh, Carl T Berdahl, Melissa A Meeker, David A Meguerdichian, Christopher W Baugh","doi":"10.1016/j.acepjo.2026.100425","DOIUrl":"10.1016/j.acepjo.2026.100425","url":null,"abstract":"<p><strong>Background: </strong>Emergency Department Observation Units (EDOUs) provide time-limited care for patients not clearly requiring inpatient admission. Despite widespread adoption, evidence describing condition-specific EDOU protocols remains fragmented. We conducted a scoping review to map the clinical conditions, characteristics, and outcomes of published EDOU protocols.</p><p><strong>Methods: </strong>This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed was searched for articles published between January 1, 2000, and June 1, 2025. Eligible publications reported condition-specific EDOU clinical care pathways for adult populations. Articles were screened and extracted by 2 reviewers in Covidence. Findings were summarized using descriptive statistics and Poisson regression modeling.</p><p><strong>Results: </strong>Of 6,741 publications identified, 239 met the inclusion criteria. Publications appeared in 93 journals and increased annually by 4%. Most studies were observational (72%) and conducted at academic centers (78%). Most protocols addressed diagnostic (45%) or diagnostic-therapeutic (28%) pathways, although there was a recent increasing trend in therapeutic pathways. Cardiology, particularly chest pain management, represented the predominant clinical focus, followed by infectious disease. Protocols describing geriatric care and viral illness management showed significant annual increases of 16% and 19%, respectively. Frequently reported outcomes included disposition rates, mortality, and return emergency department visits, whereas patient- and provider-centered outcomes were less commonly assessed.</p><p><strong>Conclusions: </strong>The EDOU protocol literature has expanded substantially over the past 25 years but remains concentrated in a limited number of clinical domains. Greater emphasis on underrepresented conditions and outcome measures may help guide the next generation of evidence-based EDOU protocols.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100425"},"PeriodicalIF":1.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13234234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Painful Immobile Shoulder.","authors":"Niklas Damberg, Wesley Eilbert","doi":"10.1016/j.acepjo.2026.100423","DOIUrl":"10.1016/j.acepjo.2026.100423","url":null,"abstract":"","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":"7 4","pages":"100423"},"PeriodicalIF":1.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}