Emerg. Care Med., Volume 3, Issue 2 (June 2026) – 7 articles

Background: Non-invasive, real-time hemoglobin monitoring (SpHb) may reduce blood-draw costs and accelerate clinical decision-making. This study evaluated agreement between SpHb (Masimo^®) and laboratory hemoglobin (LabHb) in patients with and without dehydration. Methods/Approach: This single-center exploratory cross-sectional study included male veterans. SpHb and LabHb were measured simultaneously. Demographic data, fasting status, and laboratory markers of dehydration were extracted from the electronic health record. Descriptive statistics, correlation analyses, and Bland–Altman analyses were performed. Results: Fifty-three male veterans were included. LabHb ranged from 9.20–17.00 g·dL⁻¹ and SpHb ranged from 9.90–15.90 g·dL⁻¹. Patients with dehydration had higher LabHb (M = 14.54, SD = 1.60) than those without dehydration (M = 13.01, SD = 1.68; p < 0.001). SpHb and LabHb were strongly correlated in non-dehydrated patients (r = 0.82, p < 0.001) but not in dehydrated patients (r = 0.23, p = 0.275). Among non-dehydrated patients, limits of agreement were −1.67 to 2.18 g·dL⁻¹ (~69% within threshold). In dehydrated patients, limits widened to −1.97 to 5.27 g·dL⁻¹ (~25% within threshold), with 70.83% overestimating LabHb (>1 g·dL⁻¹). Conclusion: This exploratory study found a strong correlation and acceptable agreement between SpHb and LabHb in non-dehydrated patients, with substantially reduced agreement in dehydrated patients. Only approximately 25% of measurements in dehydrated patients met predefined agreement limits, indicating clinically meaningful variability. These findings suggest that hydration status may significantly affect SpHb performance. While SpHb may be useful in appropriately selected, hydrated populations, caution is warranted in dehydrated states. Larger, adequately powered studies are needed to further evaluate the impact of hydration and define the optimal patient populations and clinical applications. Full article

Background: Basic emergency care is an important component of health system strengthening in resource-limited settings in sub-Saharan Africa. Objectives: This scoping review mapped and synthesised evidence on the implementation, capacity-building approaches, and policy implications of the WHO/ICRC Basic Emergency Care (BEC) course in the region. Methods: Twenty studies from 13 countries were included. Reported facilitators of BEC implementation included perceived relevance to frontline practice, practical and structured course content, contextual adaptation, mentorship, and training-of-trainers or cascade approaches. Reported barriers included time constraints, staffing shortages, limited infrastructure and emergency care resources, and technological challenges affecting digital reinforcement strategies. Across studies, BEC was generally associated with short-term improvements in provider knowledge, confidence, and perceived competence. However, implementation outcomes were reported inconsistently and were largely limited to acceptability, feasibility, and appropriateness, with less evidence on adoption, cost, penetration, and sustainability. Evidence on longer-term retention, practice change, patient outcomes, and broader system-level impact remained limited. Conclusions: Overall, BEC appears to be a potentially useful and context-appropriate approach to strengthening frontline emergency care training, but stronger longitudinal and implementation-focused evaluations are needed. Full article

Background/Objectives: Febrile illness in returning travelers presents a diagnostic and operational challenge for emergency medicine clinicians as early symptoms of high-consequence tropical infections often overlap with common viral syndromes. This review synthesizes current evidence to guide frontline clinicians in the systematic evaluation, diagnosis, and management of internally acquired febrile illnesses with a focus on pathogen of greatest relevance to United States (US) emergency departments (ED). Methods: We conducted a narrative review of the literature addressing epidemiology, clinical presentation, diagnostic testing, and management strategies for key travel-associated infections. Special consideration was given to rapid diagnostic modalities, pediatric risk factors, and infections most frequently implicated in returning travelers, including chikungunya (CHIK), dengue virus (DENV) disease, Ebola virus (EBV) disease, malaria, Mpox, typhoid fever (TF), yellow fever (YF), and Zika virus (ZIKV) disease. Results: Effective evaluation begins with a detailed travel and exposure history, recognition of epidemiologic and clinical red flags, and targeted use of rapid diagnostic tests. Malaria remains the most common life-threatening cause of post-travel fever and the only pathogen with reliable Food and Drug Administration (FDA)-cleared rapid testing available in the ED. Arboviral infections such as DENV, CHIK, ZIKV, and YFrequire region-specific consideration and phase-appropriate molecular or serologic evaluation. Emerging and high-consequence pathogens, including Mpox and EBV, necessitate strict infection control measures and coordination with public health authorities. Pediatric travelers, particularly those visiting friends and relatives, face disproportionate risk for severe systemic infections and often require broader diagnostic testing. Conclusions: A structured approach integrating travel history, focused examination, rapid diagnostics, and early recognition of high-risk features is essential to improving outcomes for febrile returning travelers. Strengthened vector control, enhanced vaccination uptake, and global surveillance are critical to reducing future disease burden. Full article

Background: Isolated gallbladder injuries are rare, especially when initial imaging is normal. Advanced imaging is required to detect delayed complications. Moreover, it is necessary to make an appropriate diagnosis while selecting the most suitable treatment option. Case Presentation: A 49-year-old man fell while cycling and developed worsening abdominal pain. Initial contrast-enhanced computed tomography (CT) scans showed no abnormalities. However, the patient later developed cholangitis and cholecystitis caused by biliary obstruction from a delayed gallbladder hematoma. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) were used to diagnose this condition. The patient was initially managed conservatively with antibiotics, which led to temporary symptomatic improvement. Notably, the patient developed a delayed recurrence of suspected acute cholangitis (Grade I) on Day 12 due to hematoma migration. After recurrence, endoscopic nasobiliary drainage was performed as a step-up approach, in accordance with the Tokyo Guidelines 2018 management bundle, to achieve biliary decompression, followed by elective laparoscopic cholecystectomy. Pathological examination revealed chronic cholecystitis with hematoma. Conclusions: Isolated gallbladder injuries should be considered in patients with blunt abdominal trauma. Delayed hematoma formation can lead to biliary obstruction, even without initial CT findings. In such cases, early implementation of MRI and MRCP, along with close clinical monitoring for delayed recurrence, is essential. A strategic “step-up approach” incorporating endoscopic drainage is a safe and effective management option prior to definitive surgery. Full article

Background: Few studies have assessed the safety and efficacy of discharging emergency department patients with alcohol withdrawal after receiving parenteral phenobarbital. This study aimed to validate this practice and delineate the role of intramuscular phenobarbital for this indication. Methods: This single-center retrospective chart review included adult patients with non-severe alcohol withdrawal, as diagnosed by treating providers based on clinical judgment, who were managed in the emergency department’s low-acuity provider at triage zone, received parenteral phenobarbital, and were discharged within 12 h of arrival. The primary safety and efficacy endpoints were the percentages of patients who expired or re-presented to the emergency department for an alcohol-related diagnosis within seven days of the initial presentation, respectively. A subgroup analysis was performed to compare outcomes between those who only received intramuscular or intravenous phenobarbital. Results: Of the 192 patient encounters included, no deaths were reported. Twenty-one (10.9%) patients re-presented after the initial visit, received treatment, and were discharged home. One (0.52%) patient was admitted following re-presentation. The percentages of patients who re-presented in the intramuscular-only and intravenous-only groups were 8% and 13.5%, respectively (p = 0.25). The total and weight-based doses received were not significantly different between those who did and did not re-present in both the intramuscular-only and intravenous-only groups. The median length of stay in the intramuscular-only and intravenous-only groups was 3.97 h and 5.87 h, respectively (p < 0.001). Conclusions: Our findings suggest that patients presenting with non-severe alcohol withdrawal symptoms may be discharged from the emergency department following receipt of parenteral phenobarbital, without requiring additional outpatient alcohol withdrawal medications. Intramuscular phenobarbital appears to be a viable alternative route of administration and warrants further investigation. Full article

Background/Objectives: Comprehensive epidemiological studies of bicycle crashes involving all ages in Japan are limited, particularly regarding multiple-rider incidents. This study investigated the epidemiology of single- and multiple-rider bicycle crashes in a Japanese core regional city. Methods: Ambulance transport data from Takatsuki City (1 January 2014 to 31 July 2024) were retrospectively analyzed, including demographics, crash characteristics, and severity of injury for bicycle crash patients. The primary outcome was examination of the epidemiology of bicycle crashes with moderate and severe severity or severe and fatal severity, encompassing both single- and multiple-rider incidents. Statistical tests and logistic regression analysis were used. Results: For 6683 transported patients, 6377 (95.4%) involved single-rider crashes and 306 (4.6%) involved multiple riders. Single-rider crash patients were older and more often male. Moderate or greater injuries occurred in 625 single-rider and 11 multiple-rider crash patients. No severe or fatal injuries occurred in multiple-rider crashes. General roadways and intersections were common crash locations. Male sex and older age predicted greater injury severity in single-rider crashes. Fifty single-rider bicycle crashes resulted in severe or greater severity injuries, and four fatal crashes were recorded. Conclusions: This study uniquely details multiple-rider bicycle crashes in Japan, revealing a lower severity of injuries compared to single-rider crashes. Full article

Background/Objectives: Optimization of the frequency and depth of chest compressions is considered essential for effective cardiopulmonary resuscitation in patients with cardiac arrest. Structured debriefing performed after actual or simulated cardiac arrest may help resuscitators maintain chest compression parameters within guideline-recommended ranges. The objective of the present study was to analyze whether Plus/Delta structured debriefing after clinical simulation of cardiac arrest on the duration of chest compressions performed within guideline-recommended frequency and depth ranges. Methods: A quasi-experimental study without a control group was carried out with nursing students. Compression frequency and depth parameters were analyzed in two manikin-based tests separated by the performance of a Plus/Delta structured debriefing. Results: After the intervention, the frequency and depth of chest compressions showed a slight decrease, accompanied by a statistically significant increase in the duration of cardiopulmonary resuscitation within the ranges recommended by the guidelines, although with limited clinical relevance. Conclusions: In this simulated setting, Plus/Delta structured debriefing was associated with a modest increase in the duration during which chest compressions were maintained within guideline-recommended frequency and depth ranges. Given the absence of a control group, these findings should be interpreted as exploratory but suggest a potential educational value of structured reflective debriefing in CPR training. Full article