American Journal of Emergency Medicine最新文献

{"title":"Severe metabolic alkalosis and hypernatremia induced by excessive sodium bicarbonate intake: A case report and literature review.","authors":"Ryota Inokuchi, Akinori Maeda, Yohei Komaru, Toshiya Takahashi, Kent Doi","doi":"10.1016/j.ajem.2026.01.014","DOIUrl":"https://doi.org/10.1016/j.ajem.2026.01.014","url":null,"abstract":"<p><strong>Background: </strong>Sodium bicarbonate is a common household compound often promoted for unproven health benefits. However, excessive ingestion can result in severe toxicity. This report describes a case of life-threatening metabolic alkalosis and hypernatremia following self-medication and presents a systematic review of sodium bicarbonate toxicity.</p><p><strong>Case report: </strong>A previously healthy man in his 30s presented with nausea and progressive weakness after ingesting 60 g of sodium bicarbonate daily for 2 months, escalating to 480 g immediately before admission for intestinal cleansing. Laboratory evaluation demonstrated severe metabolic alkalosis (pH 7.54; HCO₃^- 54.5 mmol/L), hypernatremia (serum sodium 162 mEq/L), and chloride-resistant alkalosis. Supportive therapy, including oral acetazolamide, resulted in rapid biochemical normalization and complete clinical recovery.</p><p><strong>Review: </strong>Our systematic review of 78 cases of sodium bicarbonate toxicity identified a shift in reported indications from dyspepsia to diverse uses, including pica, drug test avoidance, and natural remedies. Clinical presentations differed by ingestion pattern: acute, massive ingestion was often complicated by gastric rupture and was associated with high mortality, whereas chronic ingestion predominantly caused severe metabolic alkalosis and electrolyte abnormalities.</p><p><strong>Conclusion: </strong>Excessive sodium bicarbonate ingestion can cause life-threatening complications. Clinicians should be alert to the risks of misuse driven by widely circulating unproven health claims.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"103 ","pages":"45-49"},"PeriodicalIF":2.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133552","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":"Rapid feedback on my emergency department hemorrhagic stroke care? It improves telestroke and in-person treatment times","authors":"Nick M. Murray MD ,&nbsp;Paul D. Johnson MD ,&nbsp;Gabriel V. Fontaine PharmD, MBA ,&nbsp;Trina Johnson RN ,&nbsp;Jami Hassler RN ,&nbsp;Heidi Hafen RN, NP ,&nbsp;Michelle Aucoin RN ,&nbsp;Lesley Miller RN ,&nbsp;Anne M. Anderson RN ,&nbsp;Chamonix Johnston RN, MPH ,&nbsp;Marilyn McKasson MD ,&nbsp;Kyle Hobbs MD ,&nbsp;H. Adrian Püttgen MD","doi":"10.1016/j.ajem.2026.01.023","DOIUrl":"10.1016/j.ajem.2026.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Rapid time to treatment of intracerebral hemorrhage (ICH) is important but not consistently achieved in emergency departments (EDs). The concept of CODE-ICH is now well-described, yet mechanisms to improve ED provider and system operation to reduce treatment times are lacking.</div></div><div><h3>Objective</h3><div>We aim to evaluate ICH treatment time metrics before and after a standardized ICH provider feedback intervention, individualized for each patient with an acute spontaneous ICH in the ED.</div></div><div><h3>Methods</h3><div>A multicenter retrospective cohort of consecutive patients ≥18 years old with an acute ICH were identified from March 1, 2022 to January 1, 2025 within a network of an integrated healthcare system in the U.S. A rapid feedback intervention for all providers involved in the patient case was developed to contain specific treatment times compared to goals, which, when not met, prompted a root cause analysis. Patients were grouped into pre- and post-intervention cohorts. The primary endpoints were CT scout time to antihypertensive and/or anticoagulation reversal agent administration and ICH orderset utilization. Secondary outcomes were effect of in-person daytime versus telehealth nighttime coverage, length of stay, and discharge disposition.</div></div><div><h3>Results</h3><div>A total of 226 patients met inclusion criteria, 108 pre- and 118 post-intervention, with similar age (median: 68 vs. 69 years) and 54% were female. Pre- to post-intervention median NIHSS was the same (10; <em>p</em> = 0.25), as were median ICH scores (pre: 2.0, interquartile range, IQR, 0–3 vs. post: 1.0, IQR 1–3; <em>p</em> = 0.90). Median post-intervention CT to antihypertensive treatment was 7 min faster (pre: 21 min, IQR 23–52 vs. post: 14 min, IQR 7–26; <em>p</em> = 0.0012), and median CT to anticoagulation reversal agent administration was 11 min faster (pre: 40 min, IQR 30–64 vs. post: 29 min, IQR 18–40; <em>p</em> = 0.03). The intervention was associated with increased orderset usage (54% pre- to 96% post-intervention; <em>p</em> = 0.0001).</div></div><div><h3>Conclusions</h3><div>A rapid, root-cause focused ICH feedback intervention improved standardized orderset usage and resultant faster treatment times for blood pressure and anticoagulation reversal in the ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 65-70"},"PeriodicalIF":2.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038936","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":"Are antibiotics an effective initial treatment for acute appendicitis compared to appendectomy?","authors":"Peter Victoria,&nbsp;Joshua Easter,&nbsp;Brit Long","doi":"10.1016/j.ajem.2026.01.018","DOIUrl":"10.1016/j.ajem.2026.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Acute appendicitis is among the most common emergency presentations and has traditionally been treated with appendectomy. However, recent randomized controlled trials suggest that antibiotic therapy is a reasonable, non-operative alternative for appropriately selected patients who understand the risks. The purpose of this review article was to summarize findings from a recent individual patient data meta-analysis comparing antibiotic therapy versus appendectomy in adults with imaging-confirmed acute appendicitis.</div></div><div><h3>Methods</h3><div>The reviewed meta-analysis included six randomized controlled trials encompassing 2101 adult patients. A one-stage analysis was performed applying an intention-to-treat analysis. A mixed-effects model accounted for study-level clustering. Complications were standardized using the Clavien-Dindo classification, a widely used tool for classification of surgical complications. The primary endpoint was the overall complication rate at one year, and secondary outcomes included rate of step-up appendectomy, hospital length of stay, and time away from work.</div></div><div><h3>Results</h3><div>No significant difference in overall, major, or minor complication rates was found at one year between patients receiving initial antibiotic therapy and those undergoing appendectomy. 34% of patients treated with antibiotics required delayed appendectomy within one year and 25% of those patients were found to have complicated appendicitis. In contrast, patients with an appendicolith demonstrated significantly higher complication rates, and 49% required subsequent appendectomy.</div></div><div><h3>Conclusions</h3><div>Antibiotic therapy is a reasonable initial management strategy for adults with uncomplicated, imaging-confirmed acute appendicitis as long as patients understand the risks. However, caution is warranted in those with an appendicolith due to increased risk of complications and treatment failure with antibiotic therapy.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 104-107"},"PeriodicalIF":2.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038937","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":"Remote real-time ambulatory ECG monitoring of the longest RR interval and corresponding arrhythmias during altitude ascent","authors":"Li-Hong Zheng,&nbsp;Yan Wang,&nbsp;Xue-Wen Huang,&nbsp;Miao Li,&nbsp;Hai-Ying Xian,&nbsp;Chun-Xia Guo,&nbsp;Zi-Yang He,&nbsp;Lin Ma","doi":"10.1016/j.ajem.2026.01.020","DOIUrl":"10.1016/j.ajem.2026.01.020","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to characterize the longest RR intervals and associated arrhythmias during the early phase of rapid ascent to high altitude environments using ambulatory electrocardiography (AECG), with the aim of informing strategies to prevent acute high-altitude illness and cardiovascular adverse events.</div></div><div><h3>Methods</h3><div>Participants residing at low altitude underwent rapid ascent to high-altitude locations at 3060 m, 3460 m, and 4014 m. Beginning on the first day at altitude, AECG monitoring was conducted for more than 24 h using a Model 401 wearable ECG monitor, enabling remote, real-time data transmission via a 4G network and immediate clinical response to high-risk arrhythmias. Cloud-based storage and analytic platforms facilitated statistical evaluation of the longest RR intervals and corresponding rhythm types.</div></div><div><h3>Results</h3><div>(1) The longest RR intervals and associated arrhythmias were primarily observed during nighttime sleep. (2) Statistically significant differences (<em>p</em> &lt; 0.05) were found among the three altitude groups in the incidence of the longest RR intervals &lt;1.00 s, abnormal rhythms associated with the longest RR intervals, premature beats corresponding to the longest RR intervals, and sinus pause episodes. (3) The primary arrhythmias associated with the longest RR intervals included ventricular premature beats, second-degree type II atrioventricular block, high-degree atrioventricular block, sinus pause, and atrial fibrillation.</div></div><div><h3>Conclusion</h3><div>Clinically significant bradyarrhythmia may occur during rapid ascent to altitudes between 3060 m and 4014 m, particularly during nocturnal hours. These findings highlight the need to consider targeted preventive attention during nighttime exposure, given the high prevalence of nocturnal bradyarrhythmias. Remote real-time AECG monitoring may serve as a useful tool for early detection and intervention in populations at risk of altitude-related cardiac rhythm disturbances.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 98-103"},"PeriodicalIF":2.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039487","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":"Pulmonary hypertension in cardiac tamponade: An observational cohort study of in-hospital mortality and echocardiographic findings","authors":"Robert James Adrian MD ,&nbsp;Onyinyechi F. Eke MD, MPH ,&nbsp;Nour Al Jalbout MD ,&nbsp;Moustafa Al Hariri PhD ,&nbsp;Kristofer Montoya MD ,&nbsp;Patricia Hernandez MD ,&nbsp;Hamid Shokoohi MD, MPH","doi":"10.1016/j.ajem.2026.01.013","DOIUrl":"10.1016/j.ajem.2026.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Patients with pulmonary hypertension (PHTN) (i.e., chronic PHTN) have right ventricular hypertrophy, elevated right-sided heart pressures, and frequently have pericardial effusions. When evaluating these patients for cardiac tamponade, the hypertrophy and elevated pressure in right heart may be protective from tamponade by counteracting the pressure from the pericardial effusion. However, these patients may be harmed if echocardiographic signs of tamponade (e.g., right ventricular diastolic collapse) are obscured.</div></div><div><h3>Study objective</h3><div>The effect of PHTN on patients with cardiac tamponade remains unclear. We aimed (1) to evaluate whether PHTN influences the echocardiographic findings of tamponade, and (2) to examine whether PHTN is associated with in-hospital mortality among patients undergoing pericardial drainage primarily for cardiac tamponade.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of adult patients who underwent pericardial drainage within 48 h of emergency department presentation at two academic centers. PHTN probability was classified using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. We classified patients in four categories: no PHTN, low probability, intermediate probability, and high probability of PHTN. PHTN parameters were manually extracted from cardiologist-interpreted echocardiography reports. The primary outcome was in-hospital mortality. Secondary outcomes included the prevalence of echocardiographic findings of cardiac tamponade and their associations with mortality.</div></div><div><h3>Results</h3><div>A total of 249 patients met the inclusion criteria. In-hospital mortality did not significantly differ across PHTN probability categories: no PHTN (63.8%), low probability (9.3%), intermediate probability (20.9%), and high probability (5.3%) (<em>p</em>-values all &gt;0.2). Among patients who died, 50.0% were in the no PHTN group compared to 7.1% in the high probability group (<em>p</em> = 0.222). The echocardiographic impression of cardiac tamponade was significantly lower among patients with high PHTN probability compared to those with no PHTN (64.3% vs. 85.4%, <em>p</em> = 0.041), with a weak negative correlation (<em>r</em> = −0.493) between increasing PHTN probability and tamponade impression.</div></div><div><h3>Conclusions</h3><div>In this cohort of patients undergoing pericardial drainage primarily for cardiac tamponade, PHTN was not significantly associated with in-hospital mortality. However, patients with a high probability of PHTN showed fewer echocardiographic signs of tamponade, suggesting that PHTN may obscure typical sonographic findings of tamponade.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 55-61"},"PeriodicalIF":2.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031711","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":"Large academic enterprise load balancing: ED patient transfers to regional hospitals.","authors":"Mehul Shah, Ethan Fargo, Nicole M Acquisto, Aekta Miglani","doi":"10.1016/j.ajem.2026.01.015","DOIUrl":"https://doi.org/10.1016/j.ajem.2026.01.015","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042108","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":"Lightweight interpretable AI model using multiple blood parameters for emergency diagnosis of acute appendicitis","authors":"Shun Liao ,&nbsp;Yan Li ,&nbsp;Haoran Tang ,&nbsp;Zixiong Li ,&nbsp;Tianqi Xu ,&nbsp;Zongfang Ren","doi":"10.1016/j.ajem.2026.01.006","DOIUrl":"10.1016/j.ajem.2026.01.006","url":null,"abstract":"<div><div>Background: Acute appendicitis poses diagnostic challenges due to symptom overlap with other abdominal conditions, often leading to misdiagnosis or missed diagnosis. This study aimed to develop and validate an interpretable machine learning model based on routine hematological indicators to facilitate rapid diagnosis. Methods: A retrospective analysis was conducted on 408 patients with acute abdominal pain, including both adult and pediatric patients. The median age of patients in the appendicitis group was 37.5 years (IQR: 26.5 years). Univariate logistic regression revealed significant group differences in hematological indicators (all <em>P</em> &lt; 0.001). Three feature selection methods—LASSO, ElasticNet, and Random Forest—were applied, with neutrophil percentage (NE%) and eosinophil percentage (EO%) consistently identified across all methods, and red blood cell (RBC) and white blood cell (WBC) repeatedly selected by at least two methods. Eleven commonly used machine learning classifiers were developed and evaluated on an independent test set. Results: The support vector machine with a radial basis function kernel (SVM-RBF) using LASSO-selected features achieved the best performance, with an AUC (area under the curve) of 0.903 (95% CI: 0.84–0.96), accuracy of 90.2%, sensitivity of 80.3%, and specificity of 100%. The average precision exceeded 0.92, and the calibration curve demonstrated good agreement (Brier score: 0.092). Interpretability analyses with SHAP (Shapley additive explanations) and LIME (local interpretable model-agnostic explanations) applied to the LightGBM (Light Gradient Boosting Machine) model confirmed EO%, RBC, and WBC as the most influential predictors. Conclusion:This parsimonious and interpretable model, relying solely on routine blood indicators, may enable timely and accurate diagnosis of acute appendicitis while providing additional insights, particularly in resource-limited settings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 39-48"},"PeriodicalIF":2.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031718","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":"Practice changing articles: Efficacy of albuterol-budesonide inhaler compared with albuterol alone in mild asthma.","authors":"Rachel E Bridwell, Ali Pourmand, Michael Gottlieb, Brit Long","doi":"10.1016/j.ajem.2026.01.010","DOIUrl":"https://doi.org/10.1016/j.ajem.2026.01.010","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031688","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":"Evaluation of the prehospital characteristics of traumatic amputation cases: A retrospective observational study","authors":"Mehmet Yılmaz MD ,&nbsp;Burak Bekgöz MD ,&nbsp;İshak Şan MD","doi":"10.1016/j.ajem.2026.01.003","DOIUrl":"10.1016/j.ajem.2026.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to comprehensively assess the epidemiological, etiological, and operational characteristics of prehospital traumatic amputations with a specific focus on demographic patterns, injury mechanisms, anatomical distribution, and emergency medical services (EMS) response intervals and distances.</div></div><div><h3>Methods</h3><div>This retrospective observational study initially assessed 1704 suspected traumatic amputation cases recorded in the Ankara Ambulance Service Operations System between January 2018 and December 2023. After applying the exclusion criteria of on-scene death (<em>n</em> = 60), interfacility transfer (<em>n</em> = 556), and non-amputation trauma (<em>n</em> = 72), a total of 1016 eligible cases were included in the final analysis. Extracted variables included patient demographics, injury etiology, extremity involvement (upper vs. lower), urban vs. rural location, prehospital vital signs, and operational metrics (dispatch-to-arrival, on-scene, and scene-to-hospital times and corresponding distances). Statistical analyses entailed chi-square or Fisher exact tests for categorical variables, <em>t</em>-tests or Mann–Whitney <em>U</em> tests for continuous variables, and Bonferroni corrections for multiple comparisons.</div></div><div><h3>Results</h3><div>The median age of the patients was 32 years (IQR: 21–47) and 75.8% were male. Upper extremity amputations predominated (79.5%), particularly in cases of occupational (86.5%) and domestic (86.1%) injuries, while lower extremity amputations were more frequent in traffic accidents (34.9%). Occupational accidents were significantly more common among men and domestic accidents among women (<em>p</em> &lt; 0.001, Bonferroni-adjusted). Rural patients had significantly longer call-to-arrival times (median: 15.0 vs. 8.0 min), scene-to-hospital times (21.0 vs. 13.0 min), and total distances (median 45.0 vs. 17.0 km) than urban patients (all <em>p</em> &lt; 0.001). Traffic accidents had the longest on-scene times (median: 10.8 min) compared to occupational (9.0 min) and domestic (8.8 min) injuries (p &lt; 0.001). Vital signs showed no significant differences between upper and lower extremity cases.</div></div><div><h3>Conclusion</h3><div>Prehospital traumatic amputations in this large cohort displayed clear demographic and etiological trends, with upper extremity injuries predominating and distinct sex- and mechanism-specific patterns. Rural–urban disparities in prehospital times and distances were pronounced and traffic-related amputations required longer on-scene management. These findings highlight the need for targeted prevention strategies, EMS workflow optimization, and the strengthening of rural trauma systems to improve survival and limb salvage outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 126-130"},"PeriodicalIF":2.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068798","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":"Exertional and classic heat stroke: A narrative review","authors":"Rosie I. Perez ,&nbsp;Maria J. Londono ,&nbsp;Bryan Everitt ,&nbsp;Douglas Young ,&nbsp;R. Lyle Hood ,&nbsp;Robert A. De Lorenzo ,&nbsp;Brendon P. McDermott","doi":"10.1016/j.ajem.2026.01.008","DOIUrl":"10.1016/j.ajem.2026.01.008","url":null,"abstract":"<div><div>Exertional (EHS) and classic heat stroke (CHS) share similarities in pathophysiology, progression, and potential sequelae. Further, quick recognition and management demonstrate favorable outcomes. Limited publications have examined parallels between types of heat stroke. Therefore, the purpose of this review was to search available literature and critically outline current evidence-informed clinical management of heat stroke. Our result was a thorough search and analysis of related literature that answers questions related to heat stroke. The pathophysiology of heat stroke is similar between EHS and CHS, with the only difference being onset predisposition and typical affected population. The main driver toward EHS includes exercise intensity inconsistent with environmental demands. CHS often presents in geriatric or pediatric populations and in patients with predisposing thermoregulatory limitations. Although debate continues in diagnostic criteria, both EHS and CHS are diagnosed with concomitant hyperpyrexia and central nervous system dysfunction. Following initial onset, the progression of cell death, tissue and organ failure, and potentially fatal outcome remains consistent between EHS and CHS. Emergency management of EHS has resulted in 100% survival when prompt diagnosis and effective treatment are administered. Results are not as favorable with CHS, albeit with a lack of robust data. The available evidence suggests similar management protocols would potentially improve outcomes with CHS. A potential addition to successful cooling may include hemodynamic support. Lastly, recommendations for enhanced data and documentation for heat stroke in emergency management could help foster consistent, updated clinical guidelines.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 49-54"},"PeriodicalIF":2.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031731","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}