Emerg. Care Med., Volume 2, Issue 4 (December 2025) – 11 articles

Background: Patients presenting to the Emergency Department (ED) with amphetamine-type stimulant (ATS) use can exhibit a wide range of symptoms, ranging from mild agitation to life-threatening dysrhythmias. Early identification of patients at risk for more severe medical complications after ATS use is a key challenge in emergency care. Objective: To identify clinical and demographic predictors associated with a medical condition among patients presenting to the ED after ATS use. Methods: Retrospective cohort study of patients who presented to the ED with suspected ATS use at a large academic community hospital in Ontario from 1 September 2016 to 31 August 2017. Patients were screened using ICD-10 codes and included if they had a positive drug screen and clinical suspicion for ATS use. Our primary outcome was a composite of recognized complications of ATS toxicity. Predictor variables included age, sex, employment status, mental illness or substance use history, ED administration of benzodiazepines, antipsychotics, or physical restraints. Multivariable logistic regression was used to assess associations. Results: Of 1591 charts reviewed, 128 (8%) met the inclusion criteria. The median age was 29.5 years (interquartile range [IQR]: 23–36), and 50.8% were female. In adjusted analyses, benzodiazepine administration was significantly associated with a medical condition (Odds Ratio [OR] 3.33; 95% CI: 1.31–8.45; p = 0.011) as was employment status (OR 9.30; 95% CI: 1.00–86.03; p = 0.019). Conclusions: Benzodiazepine administration and unemployment were strong predictors of a medical condition among patients presenting to the ED after ATS use. These patients should undergo thorough physical examination and diagnostic testing to identify and manage potentially life-threatening conditions. Full article

Background: D-dimers are frequently elevated in older Emergency Department (ED) patients and often lead to diagnostic dilemmas as specific underlying causes remain unclear. We aimed to investigate the association of elevated D-dimer levels with serious diseases with special focus on occult malignancy in the following 6 months. Methods: In this Dutch prospective cohort study in older (≥65 years) medical ED patients, D-dimer levels were routinely measured upon ED arrival but blinded to clinicians. Associations with serious medical conditions were evaluated using Cox regression, in a real-life clinical context. Results: Among 407 patients (median age 79 years), 69.8% had elevated age-adjusted D-dimers (AADD). Sepsis, ischemia, and venous thromboembolism (VTE) were all associated with AADD, although VTE was present in only 4.2% of patients. In 336 patients without active malignancy, occult malignancy was diagnosed in 9.2% within 6 months, with a time to diagnosis of 5 days. D-dimer levels ≥2000 µg/L predicted occult malignancy (HR of 2.61) and interval likelihood ratios (LRs) increased with higher D-dimer levels (highest LR 2.88). Low D-dimers (<500 µg/L) had very low LR 0.21. Conclusions: Older ED patients frequently have elevated D-dimer levels, and these levels are often associated with non-thrombotic conditions including sepsis, ischemia, and occult malignancy. While elevated levels are associated with an increased risk of occult malignancy, the absolute risk increment is modest. Consequently, routine screening for occult malignancy solely based on D-dimers is not recommended, as most malignancies were diagnosed within a short timeframe. Interestingly, occult malignancy is extremely unlikely in patients with low D-dimer levels. Full article

Background/Objectives: Accurate patient weight estimation is critical for safe and effective drug dosing in emergency and critical care settings. Inaccurate estimates exceeding a 10% deviation from true weight can result in significant dosing errors in time-sensitive treatments such as thrombolysis for stroke or urgent sedation. In situations where direct weight measurement is impractical, reliable alternative estimation methods are essential. Methods: We propose a three-dimensional (3D) depth-camera system that employs a convolutional neural network (CNN) pipeline to automatically estimate total body weight (TBW), ideal body weight (IBW), and lean body weight (LBW) from volumetric features derived from a single supine patient image. Our approach was evaluated in a prospective pilot study to assess feasibility and accuracy. CNNs were selected because of their ability to extract spatial features from complex image data, outperforming regression and tree-based models in preliminary comparisons. Results: The results demonstrated that our 3D camera system was more accurate than conventional techniques, including clinician visual estimation (Mean Absolute Percentage Error [MAPE]: 12%), tape-based methods (±8.5%), and anthropometric formulas (±9.2%), achieving a mean error of ±5.4%. Conclusions: Future work will extend this technology to pediatric populations, support integration with automated dosing systems, and explore prehospital applications to further reduce medication errors and enhance patient safety. Full article

Background: This study represents the first registry to assess patients’ clinical characteristics and key predictors of 30-day post-cardiovascular surgery mortality in wartime Yemen. Methods: This study retrospectively analyzed 2169 patients who underwent cardiac surgery. Comprehensive patient data were extracted from Nabdh Al-Hayat Cardiac Center registries across Hadhramaut Governorate, Republic of Yemen, over 7 years from 2018 to 2024. Results: The study cohort comprised predominantly adult patients, with 69% aged 18 years and above, while 31% were under 18 years of age. The overall survival rate was high (95%), yet 5% of the patients experienced 30-day postoperative mortality. Cold cardioplegia and certain solution types were associated with increased mortality. Heart failure and ventricular dysfunction accounted for most mortality, though non-cardiac factors, such as cerebral hemorrhage and multi-organ failure, contributed as well. Conclusions: While Yemen’s crises have devastated healthcare delivery, the 30-day postoperative mortality data highlight the resilience of coordinated efforts. However, current standards remain far from universal benchmarks, highlighting the urgent need to rebuild local capacity and ensure equitable access to cardiac surgical services nationwide. Full article

Background: Emergency department (ED) demand is increasing due to rising patient complexity and an aging population complicated by limited access to general practitioners. Virtual emergency departments (VEDs) have been proposed as an alternative to deliver high-quality care for some ED presentations. This qualitative study explores stakeholder experiences with the Southeast Melbourne Virtual Emergency Department to inform future development of telehealth services. Methods: A qualitative study was conducted utilising semi-structured interviews with 24 stakeholders, including emergency physicians, geriatricians, general practitioners, and residential aged care staff. Content analysis was performed to identify key enablers, challenges, and opportunities for improvement. Results: Stakeholders reported that the VED facilitated high-quality care in the community and worked well by coordinating with follow-up services. Themes identified were that the services were particularly beneficial for older adults and palliative care patients. Challenges included technological limitations and some clinician scepticism about delivering care via telehealth. Further integration with community services and standardised telehealth training were identified as opportunities for enhancement. Conclusions: The VED was perceived as an effective model for community-based emergency care. Future implementations should prioritise clinician training, technological infrastructure, and service integration to optimise patient outcomes. Full article

Gunshot injuries are challenging conditions because of the unique characteristics of the wounding agents producing soft tissue damage that may be compounded by the formation of an expanding temporary cavity (cavitation). Variations in ballistic performance leading to higher energy transfer by the projectile, including bullet tumbling, deformation, and fragmentation, cause increased soft tissue injury and may also lead to more extensive bone comminution compromising local blood supply. Once life-threatening injuries have been excluded or properly addressed, the emergency management of localized trauma from bullets and shotgun pellets may be complicated due to progressive tissue necrosis within the zone of injury. Additionally, the risk of infection should be tackled, especially in high energy bone injuries. War experience suggests a baseline separation between wounds with limited tissue destruction which can routinely be managed as simple penetrating injuries and those resulting from high energy transfer to the tissues involving a substantial amount of necrotic elements surrounding the wound channel which call for a more aggressive surgical approach. A further justification for such a distinction is the need for antibiotic therapy, which varies according to most studies depending on the wounding mechanism, the nature of the wound, and the extent of tissue injury. The emergency physician should also be aware of the possibility of “bizarre” bullet paths resulting in occult injuries of important anatomic structures. Full article

Background: Gerstmann syndrome (GS) is characterised by the tetrad of agraphia, acalculia, finger agnosia, and right-left disorientation, which was first described by Josef Gerstmann in 1924 and is conventionally linked to lesions of the dominant angular gyrus. Contemporary neuroimaging and lesion mapping research indicates that a more dispersed parietal and occipito-temporal network may be involved. Bilateral parietal lobe infarcts are uncommon and usually arise from embolic events or small artery pathology, frequently resulting in multifocal cognitive and perceptual impairments. Method: This case report describes a 52-year-old male presented with acute confusion, perseverative speech, and an inability to follow commands. The neurological examination indicated the presence of the complete Gerstmann tetrad. The Magnetic Resonance Imaging (MRI brain) revealed bilateral parieto-occipital infarcts, with greater severity on the left, indicative of ischaemia in the territory of the posterior cerebral artery (PCA). The medical team provided supportive care and implemented secondary stroke prevention, leading to partial neurocognitive recovery over a period of three weeks. Results: This case highlights a rare presentation of Gerstmann syndrome due to bilateral parieto-occipital infarcts and emphasises that the syndrome can arise from bilateral or widespread parietal injury rather than lesions limited to the angular gyrus. Conclusions: The prompt identification of the Gerstmann constellation helps localise the lesion, enhances diagnostic accuracy, and aids in rehabilitation planning. Full article

Background/Objectives: This study aimed to assess the anthropometric and body composition characteristics, blood profiles and fitness-related parameters of emergency medical services (EMS) professionals. Methods: A total of 39 EMS professionals participated in the study, consisting of 18 males (age: 37.78 ± 10.62 years, height 180.87 ± 6.00 cm, weight 105.42 ± 25.40 kg) and 21 females (age: 33.05 ± 7.44 years, height 167.29 ± 3.89 cm, weight 90.63 ± 21.20 kg). The testing included anthropometric measurements, blood profiling, handgrip and low back strength assessments, vertical jump evaluation, flexibility testing, sit-up and push-up assessments, as well as timed performance measurements for a 300 m sprint and a 1.5-mile run. Results: According to the body mass index (BMI), 41% of the EMS professionals were classified as obese. Self-reported data indicated a smoking prevalence of 23%, while diabetes (n = 3), asthma (n = 2), and hypertension (n = 2) were also reported. Our results reveal that a great proportion of EMS professionals demonstrated suboptimal body composition and performance levels, with many failing to meet recommended health and performance standards. Elevated BMI, waist and hip circumferences, and body fat percentages were observed, along with relatively low performance in the strength and endurance tests. Conclusions: These findings highlight the need for targeted interventions among EMS professionals, who are expected to maintain adequate levels of aerobic capacity, flexibility, muscular strength and endurance. Full article

Background: Falls in older adults are a leading cause of morbidity, particularly when compounded by polypharmacy. There is mixed evidence of the efficacy of medicine reviews, but there is little work exploring this in the ambulance setting. A new referral pathway enabling ambulance staff to connect patients to primary care pharmacists aimed to address this. This study explored staff and patient experiences with the pathway and its potential to improve medication safety after a fall. Methods: A mixed-method service evaluation was conducted to assess the implementation and impact of this pathway. Routine data from an ambulance trust and pharmacist proformas were used to address objectives relating to referral rates, clinical appropriateness, and fall recurrence. Patient and staff stakeholder perspectives were gathered through two cross-sectional surveys designed to explore emotional, behavioral, and practical responses to the intervention. Quantitative data were analyzed descriptively and using ordinal logistic regression where appropriate. Free-text responses were analyzed thematically. Results: Between May 2019 and March 2020, referrals were initiated for 775 older adults after ambulance attendance for a fall, with pharmacists completing medicine reviews on 340 patients. Survey data revealed improvements in patients’ emotional responses to their medicines. Ambulance clinicians identified patient disclosure, stockpiling, and the presence of expired medicines as key indicators of poor medicines management and valued the ability to refer patients. Conclusions: Overall, referral to the pathway demonstrates a marginal improvement in recontact rates in the short-term but does not necessarily represent an improvement in overall patient safety. The cost of such an intervention and patient expectations need further exploration to prove efficacy and patient satisfaction. Full article

Background/Objectives: In-hospital cardiac arrest (IHCA) remains a critical event with high mortality, requiring coordinated multidisciplinary response. Return of spontaneous circulation (ROSC) and hospital discharge rates are key quality indicators in resuscitation efforts. In Costa Rica, there is limited published data on team performance, protocol adherence, and the pharmacist’s role in code blue events, despite similar evidence gaps across Latin America. This study aimed to evaluate clinical outcomes and operational performance of in-hospital cardiac arrest events at a Costa Rica hospital. Methods: This retrospective cohort study included 77 adult patients who experienced IHCA at Clínica Bíblica between 2020 and 2024. Data collection was conducted between February and May 2025 from electronic medical records and code blue activation logs. Clinical variables, comorbidities, pharmacologic interventions, and outcomes were analyzed. Predictive models (Charlson Comorbidity Index [CCI], IHCA-ROSC, RISQ-PATH) and Kaplan–Meier survival analysis were applied. Results: ROSC was achieved in 55.8% of patients, and 21% were discharged alive. Asystole was the predominant initial rhythm (76.6%), and comorbidities such as renal disease and myocardial infarction were most frequent. A higher comorbidity burden was significantly associated with lower discharge rates (p = 0.032). Despite 98.7% of patients being classified as low probability for ROSC by the IHCA-ROSC model, observed outcomes exceeded expectations (predicted: 5.53% vs. actual: 55.84%; p < 0.000001). The code team adhered to institutional protocols in 100% of cases, with clinical pharmacists playing a key role in documentation and medication tracking. Conclusions: Structured multidisciplinary response was associated with ROSC rates notably higher than predicted by validated models. Opportunities for improvement include post-event laboratory testing, pharmacist-led documentation, and therapeutic hypothermia in shockable rhythms. Full article

Background/Objectives: The COVID-19 pandemic caused a widespread shift to remote work, significantly altering child supervision. In Australia, prolonged lockdowns created unique conditions where many parents were working from home while simultaneously caring for children. This study aimed to investigate potential changes in the epidemiology of paediatric injury-related presentations to emergency health services among children in Southwest Victoria, Australia, during the COVID-19 pandemic. Methods: A retrospective cross-sectional study was conducted using deidentified emergency presentation data from ten health services in regional Victoria for children aged 0–14 years between 2018 and 2023. Injury data were analysed across three timeframes (Pre-COVID, COVID, Post-COVID). Chi-squared tests assessed differences in injury presentations by age, gender, and service type. Significance was determined at p < 0.05. Results: A total of 21,072 child injury-related presentations occurred. Males accounted for 57.6% of presentations, with the 10–14 age group comprising 39.8% of cases. During lockdown, injury presentations increased among 0–4-year-old females (from 30.2% to 32.0%), likely reflecting reduced supervision as parents juggled work-from-home responsibilities. Conversely, rates declined among older children, particularly 10–14-year-olds, potentially due to reduced participation in sports and outdoor activities. More than half of all cases (59.1%) were presented to Victorian Emergency Minimum Dataset (VEMD)-reporting emergency departments. Conclusions: The shift to working from home during the pandemic had a measurable impact on childhood injury patterns, particularly among younger children. These findings highlight the importance of considering parental work and childcare arrangements in injury prevention strategies and highlight the benefits of additional regional data to provide a more accurate picture of regional health service use. Full article