International Journal of Emergency Medicine

Abouelmagd, Khaled; Mohamed Mousa, Mariam; Mohamed Mohamed Abdelbar, Sohaila; Berger, Gabriela; Nalli, Sara; Zawrah, Alaa Mahmoud; Fatima, Kisa; Alsabri, Mohammed

doi: 10.1186/s12245-026-01215-zpmid: 41975252

BackgroundPediatric syncope accounts for 1–3% of emergency department (ED) visits. Although most cases are benign, 4% are caused by cardiac disease and 3% by seizures, which carry a risk of sudden death or neurologic injury if missed. Vasovagal syncope accounts for 52–74% of cases and postural orthostatic tachycardia syndrome (POTS) for approximately 13%.ObjectiveTo provide an emergency-department risk-stratified diagnostic and disposition framework for pediatric syncope.Key findingsA universal 12-lead electrocardiogram (ECG) identifies nearly all life-threatening cardiac causes of syncope. When combined with structured red-flag screening and clinical risk stratification, patients can be reliably divided into low-, intermediate-, and high-risk groups, allowing safe discharge of benign cases and rapid admission of dangerous ones.ConclusionA standardized ED syncope pathway based on risk tiers and ECG-first evaluation improves patient safety while reducing unnecessary admissions and testing.Clinical trial numberNot applicable.

Haveraaen, Hans Magnus; Seel, Udo; Romeike, Broder; Zinn, Sebastian; Mutlak, Haitham; Zacharowski, Kai; Neef, Vanessa; Friedrichson, Benjamin; Kloka, Jan Andreas

doi: 10.1186/s12245-026-01208-ypmid: 41965509

BackgroundEndotracheal intubation is a high-stakes intervention in emergency airway management, with patient safety closely linked to first-pass success and avoidance of repeated attempts. The Frankfurt Intubation Device (FID) is a bougie-inspired intubation device intended to provide fast protection against aspiration once positioned in the trachea.MethodsThis dual-center randomized crossover simulation study used an easy-to-intubate airway manikin. Ninety participants were divided into three groups of different experience (anesthesiologists, non-physician critical care staff, and medical students) to perform intubation with the Frankfurt Intubation Device (FID) and a standard endotracheal tube with stylet in randomized order. The primary outcome was non-inferiority of time to airway protection, measured from laryngoscope insertion to inflation of a cuffed device positioned in the trachea (T2; Δ = 5 s). Secondary outcomes included first-pass success, tooth damage, and exploratory assessment of training effects, with additional time-based outcomes assessed descriptively.ResultsAcross all participants, the FID was non-inferior to the endotracheal tube with stylet for T2 (mean paired difference − 0.77 s, 95% CI − 2.50 to 0.97; non-inferiority margin 5 s). Exploratory analyses demonstrated consistent non-inferiority for T2 across experience groups (G1–G3) and randomization sequences. First-pass success was high in both arms (FID 96.7% vs. ET+stylet 94.4%), while tooth damage occurred less frequently with the FID (7.8% vs. 14.4%). Training effects were observed in the simulator.ConclusionIn this standardized simulation study using an easy-to-intubate airway manikin, the Frankfurt Intubation Device demonstrated non-inferiority to conventional endotracheal intubation with stylet for time to airway protection. Secondary findings support continued staged evaluation of the FID, particularly in more challenging airway scenarios and among users with limited airway experience, where differences in procedural performance may become more apparent.Trial registrationNot applicable (simulation study).

Saada, Layth J. M.; Al-Deeb, Rawan; Qafesha, Ruaa Mustafa; Atawneh, Amir; Saada, Jamil

doi: 10.1186/s12245-026-01149-6pmid: 41781866

BackgroundCongenital diaphragmatic hernia (CDH) is typically diagnosed in the prenatal or immediate postnatal period. Late-presenting CDH is rare and can have varied, nonspecific symptoms. Upper gastrointestinal bleeding is an uncommon initial manifestation.Case presentationWe present the case of an 11-month-old male infant with respiratory distress and coffee-ground emesis. Initial imaging revealed a large left-sided diaphragmatic hernia with mediastinal shift. Laparotomy showed herniation of stomach, small intestine, and spleen, with gastric ischemia and subcapsular splenic hematoma. Resection of the ischemic gastric segment and diaphragmatic repair were performed. The postoperative course was uneventful until a febrile episode revealed a urinary tract infection and moderate to severe left-sided hydronephrosis.ConclusionThis case highlights the importance of considering late-presenting CDH in the differential diagnosis of upper GI bleeding and respiratory distress in infants, and the need for thorough evaluation of associated anomalies. Clinicians should maintain a high index of suspicion for diaphragmatic hernia in infants with unexplained GI bleeding and respiratory distress.

Jiang, Xiaodan; Zhang, Yang; Li, Yi; Sun, Mingwei; Zhou, Ping

doi: 10.1186/s12245-026-01176-3pmid: 41888644

BackgroundIngestion of raw fish gallbladder remains a rare but potentially life-threatening cause of toxin-induced multi-organ dysfunction in certain Asian regions. Case presentation: A previously healthy 57-year-old woman developed acute kidney injury and hepatic dysfunction within 24 h after ingesting a raw fish gallbladder. Rapid laboratory deterioration prompted early initiation of hemoperfusion combined with continuous veno-venous hemodiafiltration, alongside comprehensive supportive management. Organ function gradually improved, and she was discharged without permanent sequelae. Conclusions: Although the toxic effects of fish gallbladder ingestion have been described, this case highlights the importance of early recognition and structured emergency management. Prompt extracorporeal toxin removal and coordinated multi-organ support may improve outcomes in severe presentations.

Mossavarali, Shervin; Sarvi, Dorsa Ghorban; Khajehnasiri, Farahnaz; Aarabi, Sepideh

doi: 10.1186/s12245-026-01184-3pmid: 41840363

BackgroundFalls are a major cause of injury and death among older adults, yet recent data from Iran are limited. This study examines the demographic and clinical characteristics of fall-related hospitalizations in Tehran and identifies predictors of adverse in-hospital outcomes.MethodsThis retrospective cohort study included all adults aged ≥ 65 years initially presenting to the Emergency Department of a major trauma center in Tehran and subsequently admitted for fall-related injuries from September 2024 to September 2025. Electronic records provided demographic, clinical, and fall data. Logistic regression analyses were performed to identify factors associated with intensive care unit (ICU) admission and prolonged (≥ 7 days) hospitalization, while Firth penalized logistic regression was used for in-hospital mortality.ResultsAmong 192 older adults (mean age 78.70 years; 53.1% female), same-level falls were most frequent (81.3%), with lower-extremity injuries predominating (52.1%), notably intertrochanteric fractures (26.0%) and femoral neck fractures (14.6%). Overall, 21.9% required ICU admission, 7.3% died in hospital, and the mean length of stay was 6.8 days. In the multivariable analysis, injury severity was the only predictor of in-hospital mortality and the main predictor of other adverse outcomes. Besides injury severity, having cardiac disease was associated with ICU admission (OR 2.667, 95% CI 1.083–6.566; p = 0.033), and neurological disease was associated with both ICU admission (OR 2.494, 95% CI 1.070–5.814; p = 0.034) and prolonged hospitalization (≥ 7 days) (OR 2.118, 95% CI 1.008–4.449; p = 0.048).ConclusionCharacterizing older adults hospitalized for falls can help clinicians and health-service planners identify high-risk patients, optimize care pathways, and inform targeted interventions.

Memon, Farheen; Muhammad Soomar, Salman; Deepak, Desh; Alqemzi, Mariam; Matarneh, Layanah; Almheiri, Amal; Raheem, Mohammed Abdul

doi: 10.1186/s12245-026-01174-5pmid: 41826828

BackgroundOut-of-hospital cardiac arrest is a global health challenge with survival rates influenced by timely intervention and regional healthcare dynamics. Despite extensive research in Western contexts, data from rapidly urbanizing regions, such as Dubai, are scarce. This study aims to determine the survival and outcomes of Out-of-hospital cardiac arrest patients visiting emergency department.MethodsThis is a single-center, small observational study which used electronic health records and emergency logs to identify 48 Out-of-hospital cardiac arrest cases from a single healthcare center (January 2020–October 2024). Out-of-hospital cardiac arrest cases with resuscitation attempts and complete records were included only. Cox proportional hazard analysis was applied to determine the association between survival predictors and Out-of-hospital cardiac arrest outcomes.ResultsThe majority were male (93.75%), belonging to low socioeconomic status (83.33%). Bystanders were present in 75% of cases, but only 22.92% performed cardiopulmonary resuscitation. Mean emergency medical services response time was 15.75 ± 8.55 min. Multivariable analysis identified the absence of bystanders (HR = 3.58, 95% CI1.53–5.51), no bystander cardiopulmonary resuscitation (HR = 2.12, 95% CI1.82–4.58), prior cardiac arrest (HR = 7.35, 95% CI1.81–9.76), and lack of ROSC (HR = 5.99, 95% CI2.16–8.38) as significant mortality predictors.ConclusionThe survival rate in this study (20.83%) reflects intermediate outcomes, constrained by low bystander cardiopulmonary resuscitation rates and prolonged EMS response times. Outcomes could be improved via targeted public cardiopulmonary resuscitation training, automated external defibrillator, accessibility, and optimized emergency response systems.Clinical trial numberNot applicable.

Prakash, Prabha; Nayak, Kirtana Raghurama; Devi, Elsa Sanatombi; Chaudhuri, Souvik; Babu, Abraham Samuel; Pai, Dinker Ramananda; Krishnan S, Vimal

doi: 10.1186/s12245-026-01224-ypmid: 41975262

BackgroundIn spite of focused cardiopulmonary resuscitation (CPR) training, the in-hospital cardio-pulmonary resuscitation (CPR) performance often remains suboptimal, due to technical domain barriers and non-technical skill (NTS) barriers. We aimed to determine the technical domain and NTS barriers encountered by the in-hospital interprofessional (IP) CPR resuscitation teams through a cross-sectional, quantitative, analytical survey, and to determine whether a poor NTS score alone is associated with non-adherence to high-quality CPR.MethodsA validated questionnaire was developed comprising 17 items on technical domain barriers and 9 on the NTS barrier domain. A web-based Likert-scale questionnaire was administered to assess perception-based barriers among 400 IP team members across healthcare settings in India, focusing on technical domain barriers and NTS domain barriers. IP members with at least 1 year of work experience, hands-on CPR training, and in-hospital CPR experience were recruited.ResultsThere were 32.75% doctors, 29.75% nurses, 24% respiratory therapists, 10.25% emergency technicians, and 2.25% ICU technicians. The logistic regression analysis revealed that only five items independently predicted a poor technical domain score: inability to identify cardiac rhythm, non-working defibrillator, unavailability of a supraglottic airway device, unavailability of a correct-size laryngoscope blade, and a delay in loading medications. Five NTS items independently predicted a poor NTS score: lack of clear instructions from the team leader, lack of awareness of the dynamic nature of resuscitation, lack of closed-loop communication, lack of assigned tasks completed by a team member, and lack of knowledge sharing among team members. A poor NTS score is associated with perceived non-adherence to high-quality CPR (Chi-Square test, p-value < 0.001).ConclusionBoth NTS barriers and technical domain barriers were associated with perceived non-adherence to high-quality CPR.Trial registrationClinical Trial Registry of India CTRI/2025/05/086727 registered on 13/05/2025.

Salimi, Rasoul; Familgarosian, Sahar; Mohammadpour, Ali; Heidari, Bijan; Jiryaee, Nasrin; Rezaei, Bareza

doi: 10.1186/s12245-026-01237-7pmid: 42014989

IntroductionThe financial cost and loss of quality of life due to death or non-fatal physical and psychological injuries resulting from interpersonal violence impose substantial financial and non-financial burdens on the economy and society. Unfortunately, violence is more prevalent in low-income countries, and treating the physical and psychological consequences of violence places a significant burden on the healthcare system. The present study aimed to investigate the epidemiology of conflict-related injuries among emergency department attendees.MethodsThis cross-sectional study analyzed 422 individuals presenting with conflict-related injuries to an emergency department in Hamedan in 2019. Data on demographics, incident details, and clinical outcomes were collected via a validated checklist and analyzed using SPSS v.24.ResultsThe majority of participants were male (91.9%), aged 20–29 (60.7%), and single (73.7%). Most incidents occurred in spring (46.0%) and on the street (43.4%). The primary cause of conflict was animosity/hostility (28.2%). The head and neck were the most frequently injured areas (40.5%). While most patients (71.6%) were discharged directly from the ED, the mortality rate was 0.7%.ConclusionGenerally, the study results have shown that focusing educational programs on high-risk groups and taking necessary measures to fill their leisure time, along with educating families and individuals at different levels, can play a significant role in creating community security, preserving people’s health, and reducing healthcare costs.

Baskaran, Dharanidaran; Raju, K. N. J. Prakash; Giridharan, S.; Mathyam Ashok, Tharoon Kumar

doi: 10.1186/s12245-026-01120-5pmid: 41559551

BackgroundCardiac tamponade is a critical emergency that needs to be recognized and treated without delay. There is a significant knowledge gap regarding cardiac tamponade in early pregnancy, with no reported cases or guidelines on its evaluation and management. The impact of hemodynamic instability on maternal and fetal outcomes remains unclear.Case presentationWe present a case of 24-year-old gravida 2 para 1 living 1 (G2P1L1) antenatal mother with no prior co-morbidities who developed sudden cardiovascular collapse secondary to cardiac tamponade caused by massive pericardial effusion. The patient did not survive despite timely aggressive resuscitative efforts, owing to refractory shock from severe myopericarditis probably viral origin.ConclusionThis case highlights the importance of early point – of – care ultrasound (POCUS) evaluation of pregnant female presenting with unexplained hemodynamic instability and provides critical information on the safety and efficacy of pericardiocentesis in this unique clinical scenario.

Le, Huong Thi Thanh; Nguyen, Ninh Xuan; Pham, Ngoc Tien; Tran, Quoc Viet; Tran, Hang Ngoc Thuy; Tran, Nhat Hong

doi: 10.1186/s12245-025-01113-wpmid: 41530671

BackgroundRecurrent syncope with seizure-like stiffening may mimic epilepsy or neurological disorders, and when routine tests are repeatedly normal, intermittent arrhythmia can be easily overlooked.Case presentationWe report a case of a 65-year-old man with hypertension, hyperuricaemia, dyslipidaemia, and asthma who experienced recurrent syncopal episodes over one month. He presented several times to emergency departments and tertiary hospitals. Neurological and cardiovascular investigations—including brain MRI, echocardiography, coronary angiography, laboratory tests, and a previous Holter ECG—were consistently unremarkable. The initial diagnosis was hypertensive crisis based on marked post-event blood pressure surges, which was later recognized as a secondary phenomena rather than the primary cause of syncope. On the index admission, continuous emergency monitoring captured a sinus arrest of ~ 17 s with absent arterial pulse waveform, followed by bradyarrhythmia. Post-event blood pressure spiked to 220/110 mmHg. A repeat Holter ECG confirmed intermittent Mobitz II and complete AV block with asystole up to 18.6 s. EEG, performed during this admission to exclude epilepsy, was normal. A dual-chamber permanent pacemaker was implanted with complete resolution of symptoms (Shen et al, Circulation 136(5):e60-e122, 2017; Kusumoto et al, Circulation 140(8): e382-e482, 2019; Brignole et al, Eur Heart J 39(21):1883-1948, 2018).ConclusionThis case demonstrates how intermittent AV block may masquerade as seizure or hypertensive crisis, underlining the critical role of emergency department monitoring and prolonged ECG recording in recurrent unexplained syncope.