Pub Date : 2026-03-01Epub Date: 2025-09-16DOI: 10.1016/j.annemergmed.2025.07.020
Michael F. Barton MD, MPH , Kailynn M. Barton BS , Mark Chottiner MD , Mathew A. Saab MD, MPH
Compression ultrasonography is the bedside standard for diagnosing lower-extremity deep venous thrombosis. Probe-induced thrombus dislodgement, though rare, can precipitate pulmonary embolism, as well as strokes and other end-organ infarcts in patients with patent foramen ovales. We report a 65-year-old woman whose noncompressible mid-femoral deep venous thrombosis detached during routine point-of-care ultrasound—captured in real time—and resulted in bilateral subsegmental pulmonary emboli (PE) noted on computed tomography pulmonary angiography. The case highlights the possibility of compression-induced embolization, the need for controlled compression pressure, and immediate PE assessment when embolization is observed.
{"title":"Real-Time Capture of Thrombus Embolization During Point-of-Care Lower-Extremity Compression Ultrasonography","authors":"Michael F. Barton MD, MPH , Kailynn M. Barton BS , Mark Chottiner MD , Mathew A. Saab MD, MPH","doi":"10.1016/j.annemergmed.2025.07.020","DOIUrl":"10.1016/j.annemergmed.2025.07.020","url":null,"abstract":"<div><div>Compression ultrasonography is the bedside standard for diagnosing lower-extremity deep venous thrombosis. Probe-induced thrombus dislodgement, though rare, can precipitate pulmonary embolism, as well as strokes and other end-organ infarcts in patients with patent foramen ovales. We report a 65-year-old woman whose noncompressible mid-femoral deep venous thrombosis detached during routine point-of-care ultrasound—captured in real time—and resulted in bilateral subsegmental pulmonary emboli (PE) noted on computed tomography pulmonary angiography. The case highlights the possibility of compression-induced embolization, the need for controlled compression pressure, and immediate PE assessment when embolization is observed.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 374-376"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-09DOI: 10.1016/j.annemergmed.2025.10.012
Kathryn F. Hawk MD, MHS , Arjun K. Venkatesh MD, MBA , Craig Rothenberg MPH , Dhruv Sharma MS , Pawan Goyal MD, MHA , Zhuohui Lin BS , Cindy Mendez-Hernandez BA , Prateek Sharma MBA , Megan Sambell MPH , Scott G. Weiner MD, MPH
Study objective
We sought to characterize changes in the proportion of key capabilities related to the emergency care of patients with opioid use disorder among emergency departments (EDs) participating in all years of the 2020 to 2024 the American College of Emergency Physicians Emergency Quality Network Opioid Initiative.
Methods
At the beginning of each annual quality improvement collaborative, EDs completed an online survey regarding capabilities on services for patients presenting to their ED with opioid use disorder or opioid overdose, including provision of outpatient naloxone after overdose, presence of a clinician who prescribes buprenorphine in the ED, an adopted protocol for buprenorphine initiation, and use of clinical support tools to guide opioid use disorder treatment.
Results
A total of 174 unique EDs participated in all E-QUAL opioid collaboratives from 2020 to 2024. More than half of participating EDs were rural and saw less than 20,000 visits per year. EDs reported an increase in the naloxone provision to patients presenting after opioid overdose from 39.1% (68/174) in 2020 to 89.7% (156/174) in 2024. The number of EDs reporting a clinician who prescribes buprenorphine in their ED also increased (16.7% [29/174] in 2022 to 52.87% [92/174] in 2024). Protocols for ED-initiated buprenorphine and use of clinical support tools to guide the treatment of opioid use disorder remained similar (4.0% [7/174] to 5.8% [10/174] and 46.0% [80/174] to 48.9% [85/174]).
Conclusions
These trends demonstrate increasing acceptance and incorporation of naloxone provision after opioid overdose and ED clinicians who prescribe buprenorphine among a group of mostly rural, small community EDs participating in a quality improvement-based learning collaborative.
{"title":"Capabilities Among Emergency Departments Participating in a Nationwide Quality Improvement Learning Collaborative to Care for Patients With Opioid Use Disorder: 2020 to 2024","authors":"Kathryn F. Hawk MD, MHS , Arjun K. Venkatesh MD, MBA , Craig Rothenberg MPH , Dhruv Sharma MS , Pawan Goyal MD, MHA , Zhuohui Lin BS , Cindy Mendez-Hernandez BA , Prateek Sharma MBA , Megan Sambell MPH , Scott G. Weiner MD, MPH","doi":"10.1016/j.annemergmed.2025.10.012","DOIUrl":"10.1016/j.annemergmed.2025.10.012","url":null,"abstract":"<div><h3>Study objective</h3><div>We sought to characterize changes in the proportion of key capabilities related to the emergency care of patients with opioid use disorder among emergency departments (EDs) participating in all years of the 2020 to 2024 the American College of Emergency Physicians Emergency Quality Network Opioid Initiative.</div></div><div><h3>Methods</h3><div>At the beginning of each annual quality improvement collaborative, EDs completed an online survey regarding capabilities on services for patients presenting to their ED with opioid use disorder or opioid overdose, including provision of outpatient naloxone after overdose, presence of a clinician who prescribes buprenorphine in the ED, an adopted protocol for buprenorphine initiation, and use of clinical support tools to guide opioid use disorder treatment.</div></div><div><h3>Results</h3><div>A total of 174 unique EDs participated in all E-QUAL opioid collaboratives from 2020 to 2024. More than half of participating EDs were rural and saw less than 20,000 visits per year. EDs reported an increase in the naloxone provision to patients presenting after opioid overdose from 39.1% (68/174) in 2020 to 89.7% (156/174) in 2024. The number of EDs reporting a clinician who prescribes buprenorphine in their ED also increased (16.7% [29/174] in 2022 to 52.87% [92/174] in 2024). Protocols for ED-initiated buprenorphine and use of clinical support tools to guide the treatment of opioid use disorder remained similar (4.0% [7/174] to 5.8% [10/174] and 46.0% [80/174] to 48.9% [85/174]).</div></div><div><h3>Conclusions</h3><div>These trends demonstrate increasing acceptance and incorporation of naloxone provision after opioid overdose and ED clinicians who prescribe buprenorphine among a group of mostly rural, small community EDs participating in a quality improvement-based learning collaborative.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 305-312"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1016/j.annemergmed.2025.09.041
Brit Long MD, Steven G. Schauer DO, Michael Gottlieb MD
{"title":"In reply:","authors":"Brit Long MD, Steven G. Schauer DO, Michael Gottlieb MD","doi":"10.1016/j.annemergmed.2025.09.041","DOIUrl":"10.1016/j.annemergmed.2025.09.041","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 397-398"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-06DOI: 10.1016/j.annemergmed.2025.07.032
Arjuna Srikrishnaraj , Allison Ruth Souter , Nicolas Woods , Kristine Van Aarsen , Alla Iansavitchene , Nathan L. Haas MD , Justin W. Yan MD, MSc
Study objective
We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of the two-bag versus one-bag method in diabetic ketoacidosis (DKA) management in adult and pediatric populations.
Methods
The study was registered with the Prospective Register of Systematic Reviews, in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was conducted across MEDLINE, EMBASE, and CENTRAL databases up to March 2025, with no restrictions on study design. Two reviewers independently assessed studies for bias using Cochrane Risk of Bias 2 (RoB2) tool and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I), extracted data, and synthesized findings using RevMan software. The Grading of Recommendations, Assessment, Development, and Evaluations tool was used to assess certainty of evidence. Main outcomes of interest were incidence of hypoglycemia and time to DKA resolution.
Results
Of 4,190 studies screened, 21 met inclusion criteria. These included 9 adult studies with 3,329 patient visits and 12 pediatric studies with 1,385 visits. Of these, one study was at critical risk of bias and was removed from meta-analysis. In both adult and pediatric populations, the two-bag method was associated with reduced incidence of hypoglycemia (risk ratio: 0.50, 95% confidence interval [CI] 0.41 to 0.59; I2=51.8%) and time to DKA resolution (MD: –1.76 hours; 95% CI –2.80 to –0.71; I2=61%). In adults only, the two-bag method was associated with a shortened duration of insulin infusion (MD: –3.74 hours, 95% CI –4.96 to –2.52; I2=0%) and reduced incidence of hypokalemia (risk ratio: 0.84, 95% CI 0.76 to 0.93; I2=47%).
Conclusion
The two-bag method is associated with reduced incidence of hypoglycemia and time to DKA resolution in both adult and pediatric populations.
研究目的：我们进行了一项系统回顾和荟萃分析，以评估两袋法与一袋法在成人和儿童糖尿病酮症酸中毒（DKA）治疗中的安全性和有效性。方法：本研究按照系统评价和荟萃分析指南的首选报告项目，在前瞻性系统评价注册中注册。通过MEDLINE、EMBASE和CENTRAL数据库进行检索，截止到2025年3月，对研究设计没有限制。两位审稿人使用Cochrane Risk of bias 2 （RoB2）工具和非随机干预研究（ROBINS-I）工具独立评估研究的偏倚，提取数据，并使用RevMan软件综合研究结果。采用推荐、评估、发展和评估的分级工具来评估证据的确定性。主要观察结果为低血糖发生率和DKA解决时间。结果在筛选的4190项研究中，有21项符合纳入标准。其中包括9项成人研究，有3329名患者就诊，12项儿科研究，有1385名患者就诊。其中，一项研究存在严重偏倚风险，从meta分析中删除。在成人和儿童人群中，双袋法与降低低血糖发生率（风险比：0.50,95%可信区间[CI] 0.41至0.59;I2=51.8%）和降低DKA解决时间（MD: -1.76小时；95% CI -2.80至-0.71;I2=61%）相关。仅在成人中，两袋方法与缩短胰岛素输注时间（MD: -3.74小时，95% CI: -4.96至-2.52;I2=0%）和降低低钾血症发生率（风险比：0.84,95% CI: 0.76至0.93;I2=47%）相关。结论在成人和儿童人群中，双袋法与降低低血糖发生率和减少DKA解决时间有关。
{"title":"Two-bag Versus One-bag Method for Adult and Pediatric Diabetic Ketoacidosis Management","authors":"Arjuna Srikrishnaraj , Allison Ruth Souter , Nicolas Woods , Kristine Van Aarsen , Alla Iansavitchene , Nathan L. Haas MD , Justin W. Yan MD, MSc","doi":"10.1016/j.annemergmed.2025.07.032","DOIUrl":"10.1016/j.annemergmed.2025.07.032","url":null,"abstract":"<div><h3>Study objective</h3><div>We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of the two-bag versus one-bag method in diabetic ketoacidosis (DKA) management in adult and pediatric populations.</div></div><div><h3>Methods</h3><div>The study was registered with the Prospective Register of Systematic Reviews, in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was conducted across MEDLINE, EMBASE, and CENTRAL databases up to March 2025, with no restrictions on study design. Two reviewers independently assessed studies for bias using Cochrane Risk of Bias 2 (RoB2) tool and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I), extracted data, and synthesized findings using RevMan software. The Grading of Recommendations, Assessment, Development, and Evaluations tool was used to assess certainty of evidence. Main outcomes of interest were incidence of hypoglycemia and time to DKA resolution.</div></div><div><h3>Results</h3><div>Of 4,190 studies screened, 21 met inclusion criteria. These included 9 adult studies with 3,329 patient visits and 12 pediatric studies with 1,385 visits. Of these, one study was at critical risk of bias and was removed from meta-analysis. In both adult and pediatric populations, the two-bag method was associated with reduced incidence of hypoglycemia (risk ratio: 0.50, 95% confidence interval [CI] 0.41 to 0.59; I<sup>2</sup>=51.8%) and time to DKA resolution (MD: –1.76 hours; 95% CI –2.80 to –0.71; I<sup>2</sup>=61%). In adults only, the two-bag method was associated with a shortened duration of insulin infusion (MD: –3.74 hours, 95% CI –4.96 to –2.52; I<sup>2</sup>=0%) and reduced incidence of hypokalemia (risk ratio: 0.84, 95% CI 0.76 to 0.93; I<sup>2</sup>=47%).</div></div><div><h3>Conclusion</h3><div>The two-bag method is associated with reduced incidence of hypoglycemia and time to DKA resolution in both adult and pediatric populations.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 346-364"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1016/j.annemergmed.2025.09.042
Jace C. Bradshaw MD, Laeben Lester MD, Garrett Kirk BSN, CCRN, RN, David A. Leon MD, MS
{"title":"Emergency Department Extubation Collaboration to Bridge Training Gaps","authors":"Jace C. Bradshaw MD, Laeben Lester MD, Garrett Kirk BSN, CCRN, RN, David A. Leon MD, MS","doi":"10.1016/j.annemergmed.2025.09.042","DOIUrl":"10.1016/j.annemergmed.2025.09.042","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 400-401"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1016/j.annemergmed.2025.09.004
Thomas K. Hagerman MD , Tiara Lang BS , Maryam Nour MD, MBA , Jo-Ann K. Rammal MBA , Howard Klausner MD , Joseph Miller MD, MS
{"title":"The Discharge Clock","authors":"Thomas K. Hagerman MD , Tiara Lang BS , Maryam Nour MD, MBA , Jo-Ann K. Rammal MBA , Howard Klausner MD , Joseph Miller MD, MS","doi":"10.1016/j.annemergmed.2025.09.004","DOIUrl":"10.1016/j.annemergmed.2025.09.004","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 385-386"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-19DOI: 10.1016/j.annemergmed.2025.09.028
Megan A. Rech PharmD, MS, Michael Gottlieb MD
{"title":"Norepinephrine Should Be the Preferred Vasopressor After Return of Spontaneous Circulation Following Cardiac Arrest","authors":"Megan A. Rech PharmD, MS, Michael Gottlieb MD","doi":"10.1016/j.annemergmed.2025.09.028","DOIUrl":"10.1016/j.annemergmed.2025.09.028","url":null,"abstract":"","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"87 3","pages":"Pages 342-343"},"PeriodicalIF":5.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号