Defibrillating the Data

Real-time Point-of-Care Ultrasound (POCUS) significantly improves first-attempt urethral catheterization success and reduces futile attempts in pediatric patients. This guidance also enhances caregiver satisfaction and minimizes patient distress without delaying emergency department workflow. These findings support integrating ultrasound into routine pediatric emergency care protocols.

The AZ-SWED trial randomized children with wheezing to azithromycin or placebo, finding no clinical benefit from the antibiotic regardless of bacterial detection status. The study suggests that detecting nasopharyngeal bacteria does not drive acute wheezing episodes in preschoolers. Clinically, this supports withholding routine antibiotics for preschool wheezing while continuing standard care like bronchodilators and corticosteroids.

A Japanese trial demonstrated that standard-dose tenecteplase (TNKase) was superior to low-dose alteplase when used as a bridge therapy for stroke thrombectomy in patients at risk of bleeding. The early reperfusion outcomes significantly favored the use of tenecteplase in this patient population.

This article discusses ultrasound-facilitated, catheter-directed fibrinolysis for acute pulmonary embolism. The study was published in the New England Journal of Medicine on March 28, 2026.

This article discusses ultrasound-facilitated, catheter-directed fibrinolysis for acute pulmonary embolism. The study was published in the New England Journal of Medicine on March 28, 2026.

This article summarizes consensus statements from the 2025 Canadian Prehospital Transfusion Summit regarding best practices for prehospital hemorrhage protocols across Canada's diverse environments. The panel established foundational therapies, identifying red blood cells and tranexamic acid as core components, while also noting that freeze-dried plasma and whole blood are advantageous in remote settings. Clinicians can use these 12 consensus statements to guide safe PHP implementation by addressing activation criteria and product prioritization.

The article discusses the HI-PEITHO trial, which investigated ultrasound-facilitated, catheter-directed fibrinolysis versus anticoagulation alone for intermediate-risk pulmonary embolism. While the primary composite outcome favored the intervention group, the author argues there is no actual benefit, noting that the difference was largely due to cardiorespiratory decompensation captured by the NEWS score. Clinically, the author suggests that a "wait and see" approach is preferable to thrombolysis for patients in this intermediate-risk group.

This article discusses the ICARUS-ED pilot randomized controlled trial, which investigated concentrated albumin for undifferentiated sepsis in the emergency department. The study demonstrated the feasibility of real-time sepsis trial enrollment, including ward-based patients, and confirmed infection in 95% of enrolled patients.

This case report details using serial point-of-care lung ultrasound (LUS) as a complementary diagnostic tool during atropine titration for severe organophosphate poisoning. The study demonstrated that repeat LUS showed a progressive reduction in B-line burden corresponding with cumulative atropine dosing and clinical improvement in one patient. This suggests a potential role for ultrasound in assessing pulmonary involvement during toxicologic resuscitation efforts.

This systematic review assessed the benefit of using supraglottic airway devices (SGA) compared to bag-valve mask (BVM) use by basic life support (BLS)-trained providers during resuscitation. The review concluded that there was no evidence of SGA benefit over BVM for this group, noting considerable heterogeneity among studies and a lack of data for first rescuers and first responders. Clinicians should be aware that current evidence does not support the routine use of SGAs over BVMs by BLS providers in resuscitation settings.

This systematic review and meta-analysis compared short-term outcomes of endovascular repair (ER) versus open surgery (OS) for traumatic axillosubclavian arterial injuries. The key finding is that ER was associated with lower short-term mortality compared to OS, while rates of amputation, thrombosis, and stroke were similar between the two approaches. Clinicians should note these findings are limited by retrospective study designs, suggesting a need for prospective validation.

This study compared outcomes in patients receiving mechanical circulatory support for cardiogenic shock who had a preceding out-of-hospital cardiac arrest (OHCA) versus those who did not. Although 30-day mortality rates were comparable between groups, the predictors of death differed significantly. Clinicians should recognize that OHCA status alone should not preclude a patient from receiving MCS or participating in related trials.

Ultrasound demonstrates high sensitivity (90%–99%) for detecting radiolucent soft-tissue foreign bodies in the extremities, compared to plain radiography which detected none in comparative studies. While ultrasound appears superior, the included literature is limited by small, single-center designs, suggesting a need for larger prospective studies.

This expert consensus identifies the most influential literature for first-trimester pregnancy and scrotal point-of-care ultrasound (POCUS) from an emergency medicine perspective. The selected papers highlight POCUS's diagnostic value in confirming intrauterine pregnancy versus excluding ectopic pregnancy, and its role in timely testicular torsion recognition. Clinicians can use this resource as a practical educational framework to support evidence-informed POCUS implementation.

This article details the development and validation of a new screening score, the GED-SS model, designed to identify older adult emergency department patients at high risk for short-term mortality and acute care utilization. The model was shown to perform comparably to or better than existing tools like the ISAR score, demonstrating improved discrimination with an AUC of 0.73. Clinically, this structured data model can be deployed automatically at ED triage to help stratify risk more effectively.

This systematic review of four observational studies found that ambulance offload delays are consistently associated with prolonged Emergency Department (ED) length of stay and a modest increase in 30-day repeat ambulance attendance. However, direct evidence linking these delays to increased patient mortality or clinical deterioration remains unclear due to methodological limitations across the included studies. Future research needs rigorous causal inference methods to better inform policy regarding timely patient care.

Integrating Retrieval-Augmented Generation (RAG) with Large Language Models (LLMs) improves the reliability and guideline alignment of decision support for acute otolaryngologic emergencies. Results showed that RAG-enabled models significantly improved diagnostic accuracy, management planning, and adherence to guidelines compared to baseline models. This suggests RAG integration could enhance evidence-based decision-making when managing ED presentations like SSNHL or epistaxis.

A 57-year-old woman with chronic kidney disease presented with 6 hours of rapidly progressive, nontraumatic lower extremity weakness and numbness. Examination revealed flaccid paralysis (grade 0) in the lower limbs, absent reflexes, and dissociative sensory loss affecting pain and temperature below the nipple-to-xiphoid level.

This ethnographic study explored how emergency department clinicians navigate care for patients with vaginal bleeding following Indiana's abortion ban, revealing altered approaches to history-taking and documentation. The key finding is that legal uncertainty reshapes clinician behavior around information gathering and reporting, risking delayed or defensive care. Therefore, clear institutional guidance and interdisciplinary support are essential to safeguard evidence-based emergency care in these restrictive environments.

This emDocs series provides an expedited review of clinical basics using a case presentation involving suspected meningococcal disease. The article details a patient presenting with fever, headache, lethargy, petechial rash, and nuchal rigidity, leading to CSF analysis findings. Clinicians should be aware that *N. meningitidis* is a common cause of bacterial meningitis with high morbidity and mortality rates, making prompt diagnosis crucial in the ED setting.

This systematic review and meta-analysis found no difference in outcomes when comparing early versus delayed opioid administration for pediatric sickle cell vaso-occlusive crisis (VOE). The comparison showed no difference across hospital admission, ED discharge, ED length of stay, or pain reassessment.