Abstract: Background and objectives: The purpose of this study was to investigate whether high ethmoid sinus volume (ESV) constitutes a risk factor for the formation of orbital blowout fractures (OBF) after craniofacial trauma and whether it affects the fracture pattern. Materials and Methods: This is a retrospective case-control study involving subjects over 15 years of age who presented to the emergency department with craniofacial trauma. The case group included subjects with OBF, while the control group included subjects without any facial fractures. The case group was divided into subgroups according to the fracture location. We performed volumetric measurements on computed tomography images of the ethmoid sinuses of subjects in the case and control groups using the fully automated 3D Slicer application. The mean ESV values of the groups were compared using the necessary statistical methods. P-values below 0.05 were considered significant. Results: The case group consisted of 108 (median age: 41.5 years; 76 males, 69%), and the control group consisted of 122 (median age: 38 years; 84 males, 69%) subjects. OBFs were more frequent in males (69%), most commonly detected in the orbital floor (68.2%), and were bilateral in two (1.8%) subjects. The mean ESV in the case group (3.91 ± 1.39 cm³) was significantly higher than that in the control group (2.82 ± 0.94 cm³) (p< 0.001). Unlike the cases with medial wall fractures and those with orbital floor fractures, there was no significant difference in mean ESV between the cases with medial wall and orbital floor fractures and the control group (p= 0.562). Conclusions: A large ethmoid sinus not only increases the risk of orbital blowout fracture but also has an impact on the fracture pattern. Based on the data obtained from our study, we identified a large ethmoid sinus as a predictive risk factor for orbital blowout fracture.

Abstract: Background: Type B aortic dissection management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in NHS. Bridging the gap between Emergency Medicine and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improved outcomes and reduced mortality. Methods: A cross-sectional survey of EM consultants yielded n=173 valid responses from n=33 units across UK. Subgroup analyses was conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland-Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to rapid CTA was 70% (95% CI: 63.3%–76.8%, p < 0.001), while 32% had SOPs for TBAD (95% CI: 25.3%–39.1%), and 26% were aware of any decision tool (95% CI: 20.6%–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with reported bias of bias of 23.58% (-38.20% to 85.36%) (p = 0.02). Results: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks.

Abstract: Background: Diagnosing coagulopathy in sepsis remains challenging, as current Conventional scoring systems based on routine coagulation biomarkers are insufficient to predict mortality accurately. Endothelial molecular markers may improve risk stratification. Objectives: To evaluate the prognostic value of thrombin–antithrombin complex (TAT), tissue-type plasminogen activator–inhibitor complex (t-PAIC), and antithrombin (AT) activity, and to develop a unified score augmenting International Society on Thrombosis and Hemostasis (ISTH) overt-DIC criteria. Methods: In this prospective, longitudinal study, adults with Sepsis-3 presenting to the emergency department underwent serial clinical assessment, routine coagulation testing, and measurement of endothelial markers on Days 1, 3, and 7. Receiver operating characteristic (ROC) analyses screened candidate biomarkers, and multivariable logistic regression identified independent predictors of 28-day mortality. A unified score (Unified ISTH+) was constructed by adding optimal molecular markers to ISTH components and compared with ISTH, JAAM, and SIC criteria. In addition, a non-parametric bootstrap procedure was performed to assess the internal stability and empirical power of the predictive models given the modest sample size. Results: Fifty-four patients (mean age 59.6 ± 16.6 years) were included; 28-day mortality was 31.5%. TAT, t-PAIC, and AT activity were independent predictors of mortality. Individual ROC performance was high for t-PAIC (AUC 0.846), TAT (AUC 0.845), and AT (AUC 0.789). The Unified ISTH+ score achieved superior discrimination (AUC 0.856; 95% CI 0.757–0.955) versus ISTH (0.783), JAAM (0.718), and SIC (0.676), and showed the greatest net benefit on DCA across clinically relevant thresholds. Unified ISTH+-positive patients had higher SOFA/APACHE II scores and worse survival (log-rank p < 0.001). Conclusions: t-PAIC, TAT, and AT activity are strong prognostic markers in sepsis-associated coagulopathy. Incorporating them into a unified ISTH+ score improves mortality prediction versus existing criteria and may enable earlier risk stratification and clinical decision-making.

Abstract: Introduction Emerging technologies have significantly transformed disaster preparedness and training in healthcare, especially for prehospital responders engaged in mass casualty incidents (MCIs). As scenarios grow more complex, traditional training methods alone are insufficient for developing critical skills such as triage, decision-making, and rapid coordination under pressure. Technology-enhanced solutions such as virtual reality (VR), wearable sensors, serious games, and AI-based systems offer immersive, scalable, and repeatable training experiences. While several studies have explored these tools individually, a comprehensive synthesis is lacking to map how diverse technologies are employed in MCI-focused prehospital training. Methods This scoping review is conducted as part of the MCI-PHER project (Mass Casualty Incident – Prehospital Emergency Response), a collaborative initiative to advance disaster medicine education and prehospital preparedness. The review will follow the Arksey and O’Malley framework, refined by Levac et al., and adhere to PRISMA-ScR guidelines. A systematic search will be conducted across databases, including PubMed, Embase, Scopus, CINAHL, PsycINFO, Cochrane Library, and ClinicalTrials.gov. Eligible studies must describe, implement, or evaluate technological training interventions targeted at healthcare professionals or students in simulated or actual prehospital MCI settings. Two independent reviewers will conduct study selection, data extraction, and quality checks, with disagreements resolved by a third reviewer. Data will be charted using a customized extraction tool, refined through piloting five relevant studies. Results and Analysis Studies will be synthesized using a combination of descriptive and narrative approaches. Key domains will include the type of technology and training modality, learning objectives, target professional groups, instructional design models, evaluation strategies, and reported outcomes. Quantitative findings will be summarized using descriptive statistics, while qualitative results, such as user perceptions and contextual insights, will be narratively organized to reflect patterns and diversity across studies. The synthesis will identify common applications, outcome trends, implementation barriers, and evidence gaps to inform future research and practice in prehospital MCI training. Dissemination and Ethics As no human subjects are involved, ethical approval is not required. Results will be disseminated via peer-reviewed publications, conference presentations, stakeholder briefings, and open-access platforms to inform EMS leaders, simulation educators, and health policymakers.

Abstract: Background: Late presentation of Congenital Diaphragmatic Hernia (CDH) is a herniation of abdominal contents through a diaphragmatic defect into the thoracic cavity and diagnosed after the neonatal period. The reported case is a left-sided congenital diaphragmatic hernia, diagnosed as pneumonia and seen as a pneumothorax on a chest radiograph.Case presentation: This is a seven-month-old female child who presented in the emergency department with fever and shortness of breath of four days' duration. Chest x-ray was suggestive of left pneumothorax with left mid-zone consolidation. Chest tube insertion was initially planned. While noticing clear localized air inferiorly with an indistinct left diaphragm, a late diaphragmatic hernia was suspected, and chest tube insertion was not done. A nasogastric tube was swallowed, and a chest radiograph was taken. The x-ray revealed the gastric tube in the left thorax. Surgical repair was carried out after resolution of the infection. The postoperative period was uneventful, and the patient was discharged from hospital after six days. At one month of follow-up visit, the patient was stable, and recovery was satisfactory.Conclusion: This case characterized the clinical manifestation and diagnostic delay of the patient. Early diagnosis and avoiding inappropriate treatment decreases morbidity and mortality. Late presentation of diaphragmatic hernia, although uncommon, needs to be considered in a child with respiratory distress and in unusual patient presentations.

Abstract: Background: Agitated adult trauma patients are common in Canadian emergency departments (EDs). Cooperation and monitoring constraints can delay essential imaging and risk missed injury. Objective: To synthesize current guidance and evidence into an educational framework for timely, safe imaging when the trauma exam is unreliable due to agitation. Methods: Narrative review using targeted searches of guideline/agency sources and peer‑reviewed trials/meta‑analyses on agitation control, eFAST, and selective versus whole‑body CT. Outputs were a conceptual evidence map and a worked case. Results: Current research prioritizes parallel resuscitation with early eFAST. Unstable, eFAST‑positive patients usually proceed to hemorrhage control rather than CT. For stable or stabilized adults with an unreliable exam, brief, monitored behavioral control (single, guideline‑supported regimen) creates a one‑trip imaging window under continuous SpO₂/NIBP/ECG (± capnography). Teams select an up‑front imaging approach: selective CT once cooperation returns and injuries localize (using CCHR/CCR where applicable), or whole‑body CT when multi‑region injury is likely or unreliability persists. The scanner‑side bundle includes named monitoring responsibility, an airway plan, and dose‑optimized protocols. Downstream steps include IR‑supported non‑operative strategies for eligible solid‑organ injury, a 24–48‑hour tertiary trauma survey, and a structured psychiatry handoff to limit re‑sedation. Conclusions: In agitated adult trauma, a single, monitored trip to obtain the necessary imaging after brief, guideline‑aligned behavioral control may improve safety and throughput. This educational synthesis requires local policy alignment and prospective evaluation.

Abstract: Introduction: Tabletop exercises (TTEs) are low-stress, discussion-based simulations designed to enhance decision-making, coordination, and communication in emergency scenarios. While recent articles have explored their use in medical emergencies, the role of TTXs in prehospital settings, specifically their impact on preparedness activities leading up to hospital admission, remains underexplored. This scoping review aims to map how TTXs have been utilized to assess and improve prehospital preparedness, identify outcome measures aligned with the Kirkpatrick Model, and explore the characteristics and contexts of these exercises. Methods: This scoping review is conducted as part of the MCI-PHER project (Mass Casualty Incident – Prehospital Emergency Response), a collaborative initiative to advance disaster medicine education and prehospital preparedness. The review will follow Arksey and O’Malley’s five-stage framework, enhanced by Levac et al., and report according to PRISMA-ScR guidelines. A comprehensive search of databases, including PubMed, Scopus, Embase, PsycINFO, CINAHL, Cochrane, and ClinicalTrials.gov, along with gray literature from Google Scholar, will be conducted. Eligible studies will include TTXs used in prehospital or EMS-related emergency preparedness, across all primary study designs. The outcomes will be mapped to the four levels of the Kirkpatrick Model. Two independent reviewers will conduct study selection, data extraction, and quality checks, with disagreements resolved by a third reviewer. Data will be charted using a customized extraction tool, refined through piloting five relevant studies. Results and Analysis: The scoping review will synthesize and map the evidence on the use of tabletop exercises (TTXs) in prehospital emergency preparedness. Findings will be organized and presented in tables, figures, and other visual formats to provide a structured overview. Studies will be categorized according to their focus and objectives, educational or training context, target populations, TTX characteristics, and reported outcomes. Quantitative data (e.g., frequencies, sample sizes, outcome measures) will be summarized descriptively, while qualitative evidence (e.g., participant experiences, lessons learned) will be analyzed narratively to capture contextual insights. This comprehensive synthesis will highlight current practices, underexplored areas, and evidence gaps to inform future research and guide the development of effective training strategies for prehospital emergency preparedness. Dissemination and Ethics: No ethical approval is required as no human subjects are involved. Findings will be disseminated through peer-reviewed publications, conference presentations, policy briefs, and stakeholder engagement.

Abstract: Introduction: Mass casualty incidents (MCIs), where casualty numbers exceed available emergency resources, are rising globally due to natural disasters, terrorism, and pandemics. Effective response requires well-trained healthcare professionals, yet training programs vary widely in structure and delivery. Previous reviews, such as Baetzner et al., focused on first responders and training effectiveness but offered limited insight into curriculum design across broader healthcare roles. Similarly, Bahattab et al. reviewed humanitarian health education in low- and middle-income countries but excluded high-income settings and did not examine the pedagogical design of MCI training for clinical professionals. This scoping review aims to map global evidence on how disaster and MCI training curricula are designed and implemented across diverse healthcare groups. Methods: This scoping review is conducted as part of the MCI-PHER project (Mass Casualty Incident – Prehospital Emergency Response), a collaborative initiative to advance disaster medicine education and prehospital preparedness. The review will follow the methodological framework by Arksey and O’Malley, with refinements from Levac et al., and will be reported according to the PRISMA-ScR guidelines. A comprehensive search of seven databases (PubMed, Embase, Scopus, PsycINFO, CINAHL, Cochrane Library, and ClinicalTrials.gov) will be conducted using a combination of MeSH terms and keywords. Studies published in English over the past ten years will be considered. Two independent reviewers will conduct study selection, data extraction, and quality checks, with disagreements resolved by a third reviewer. Data will be charted using a customized extraction tool, refined through piloting five relevant studies. Inclusion criteria will cover all healthcare learners (e.g., paramedics, nurses, physicians, medical students) in prehospital or in-hospital disaster training contexts. Both qualitative and quantitative studies, including grey literature, will be included. Results and Analysis: The review will map and synthesize existing literature on disaster and mass casualty incident (MCI) training curricula across healthcare disciplines. Extracted data will be organized into tables and figures, presenting curriculum structures, learner groups, instructional methods, competency frameworks, assessment strategies, and reported outcomes. Both quantitative findings (e.g., frequencies of approaches and participant characteristics) and qualitative insights (e.g., implementation experiences and contextual factors) will be summarized. This integrated analysis will highlight current practices, innovations, and gaps in disaster training education to inform future curriculum development and policy. Ethics and Dissemination: No ethical approval is required as no human participants are involved. Findings will be disseminated through peer-reviewed publications, conference presentations, policy briefs, and stakeholder engagement.

Abstract:

Background: In patients over 65 years who experience severe trauma the underlying health status has a significant impact on overall mortality. This study aims to assess if CT evaluation of skeletal muscle quality could be a risk stratification tool in the ED for these patients. Methods: Retrospective observational study between January 2018 and September 2021, including consecutive patients ≥ 65 years admitted to the ED for a major trauma (defined as Injury Severity Score > 15). Muscle quality analysis was made by specific software (Slice-O-Matic v5.0, Tomovision®, Montreal, QC, Canada) on a CT-Scan slice at the level of the third lumbar vertebra. Results: 263 patients were included (72.2% males, median age 76 [71-82]), and 88 (33.5%) deceased. The deceased patients had a significantly lower skeletal muscle area density (SMAd) compared to survivors. The multivariate Cox regression analysis confirmed that SMAd < 38 at the ED admission was an independent risk for death (adjusted HR 1.68 [1.1 – 2.7]). The analysis also revealed that, among the survivors after the first week of hospitalization, the patients with low SMAd had an increased risk of death (adjusted HR 3.12 [1.2 – 7.9]). Conclusions: The skeletal muscle density evaluated by a CT scan at ED admission could be a valuable risk stratification tool for patients ≥ 65 years with major trauma. In patients with SMAd <38 HU the in-hospital mortality risk could be particularly increased after the first week of hospitalization.

Abstract: Introduction: Iron deficiency is a common condition in the general population, with a higher incidence in critically ill patients. Anemia associated with these alterations is linked to increased morbidity and mortality in ICU patients. Objective: This pilot study explored whether provisional CRP and ferritin thresholds might relate to survival and examined preliminary associations with analytical and clinical variables in critically ill patients. Material and Method: A prospective, observational pilot study was conducted on 75 ICU patients over three months. Hematological and biochemical parameters (CRP, ferritin, iron, transferrin, hemoglobin) were analyzed at admission, 48 hours, and on days 4 and 7. Clinical data included age, sex, ICU stay, survival, SOFA and APACHE II scores, complications (AKI, acute lung injury), and interventions (mechanical ventilation, in-fections). Data were analyzed using mixed regression models and Wilcoxon tests. Results: In this pilot cohort (mean age 53.65 years; 61.33% male), survival was 82.67%. Higher CRP and ferritin levels were observed among non-survivors and those with AKI p< 0.05. A CRP level ≥145 mg/L was associated with a constellation of more unfavorable clinical indicators (older age, longer ICU stay, higher APACHE II and SOFA scores, more me-chanical ventilation, higher AKI and infection rates, and reduced survival) p< 0.05. Ferritin levels were higher in males and non-survivors and showed positive correlations with SOFA score and ICU length of stay. The exploratory prognostic performance of the CRP threshold was AUC=0.8103.

Abstract: Background Abdominopelvic computed tomography (APCT) is a frontline diagnostic modality for acute abdominal pain, but it often reveals incidental findings (IFs) that are unrelated to the presenting complaint. While many IFs are benign, some require structured follow-up and long-term management. In military settings, where healthcare access may be limited and continuity of care is vulnerable to frequent personnel transfers, IFs represent a critical challenge for health system readiness. Methods We retrospectively reviewed the records of 1,062 male Korean soldiers (aged 18–28 years) who underwent APCT for acute abdominal pain at a military emergency department between January 2021 and December 2022. Two board-certified radiologists independently re-assessed all scans to identify IFs and classify those requiring clinical follow-up. Prevalence estimates were calculated, and clinically significant findings were highlighted in the context of healthcare delivery. Results Incidental findings were identified in 218 of 1,062 patients (20.5%). The most frequent were renal cysts (6.2%) and hepatobiliary abnormalities (7.5%). Clinically significant lesions included Bosniak II-F renal cysts (0.3%), inherited cystic kidney diseases (0.2%), intraductal papillary mucinous neoplasm (0.1%), adrenal incidentalomas (0.4%), and appendiceal mucoceles (0.2%). These conditions required specialist follow-up or surgical management. Exploratory analysis also revealed clusters of co-occurring IFs, such as renal and hepatic cysts, highlighting potential shared risk factors. Conclusions Incidental findings on APCT are prevalent even in a young, ostensibly healthy military population. Their discovery reveals a gap between detection and effective follow-up in military healthcare systems. To mitigate long-term health risks and maintain operational readiness, implementation of structured reporting protocols, automated tracking systems, and cross-institutional referral pathways is essential. These measures are particularly critical in environments where access to subspecialty care is constrained and service members frequently change duty stations.

Abstract: Severe neonatal jaundice (SNJ) or hyperbilirubinemia is responsible for over 114,000 unnecessary neonatal deaths annually as the technology that can treat the condition is cost prohibitive for low- and middle-income countries. In this study an open-source neonatal light therapy device to treat SNJ is designed, built and validated against phototherapy technical specifications set by the American Academy of Paediatrics and UNICEF. The open source device can be built for a tenth of the cost of the least expensive proprietary alternative on the market, while producing treatment metrics equivalent to or exceeding commercial devices available in developed nations. The device, whose material costs are $93.00 USD, was shown to produce irradiance of 80 µW/cm²/nm within the acceptable range of 420 – 500 nm. It was further demonstrated that the unit could produce a uniform distribution of (34.5 ± 4.3) µW/cm²/nm over a surface area exceeding 3,200cm². These findings validate the effectiveness of the open-source neonatal light therapy device in delivering accurate, consistent, and reliable irradiance for neonatal jaundice management. By releasing full documentation in an open-source manner the device may be broadly distributed to ensure affordable and consistent low-cost means of improving the quality of care for newborns suffering from jaundice.

Abstract: Purpose: A 12 lead electrocardiogram is the standard diagnostic method for the detection of an acute coronary syndrome, as it is also used in emergency medical services. A novel sonification method can convert an important part of the electrocardiogram biosignal into an acoustic signal: The ST segment sonification is particularly useful for the detection of transient ST elevations in patients with suspicion of acute coronary syndrome. A quick and accurate detection of transient electrocardiogram changes of the ST segment is prerequisite for proper treatment, thus having immediate therapeutic consequences. Methods: As part of an emergency training program, a cohort of n = 44 medical students was recruited to participate in a two-part study. The recently reported diagnostic accuracy with regard to audibly presented electrocardiogram sequences of different ST elevation myocardial infarction severity levels provides the background for the randomized controlled trial reported here. A part (n = 32) of the entire cohort was randomly assigned in two-person teams to either an intervention (n = 8 teams of two) or a control (n = 8 teams of two) arm, respectively, whereby all teams went through an emergency simulation where they had to detect an emerging ST elevation myocardial infarction. The intervention group was endowed with a sonification-assisted equipment whereas the control group used standard visual-based electrocardiogram diagnosis only. Results: An adjusted multivariable regression yielded a statistically significant reduction for the intervention group of the delay time from starting a first electrocardiogram to the correct diagnosis by 163 seconds (p = 0.002) corresponding to 56% of the average delay time in the control group. A subgroup analysis within the intervention arm revealed a notable impact of the attitude toward sonification on delay time between the second electrocardiogram and diagnosis. Specifically, increasing disagreement with statement “I conceived the sound of the sonification as pleasant” counterintuitively reduced the delay, whereas an increasing disagreement with “sonification was helpful in making the diagnosis” increased the delay. Conclusion: Sonification of electrocardiograms should be seriously considered as an accompanying diagnostic measure in emergency medical services in cases of suspected acute coronary syndrome. The established dependence on individual attitudes towards sonification serves to further optimize sonification aesthetics and implementation.

Abstract: Background: Although tryptophanyl-tRNA synthetase (WRS) is a novel biomarker released during bacterial and viral infections, its prognostic value in sepsis has rarely been reported. We aimed to investigate the prognostic value of WRS in patients with sepsis in the emergency department (ED). Methods: This prospective, observational study included 243 patients with sepsis. Blood samples were collected to measure full-length WRS levels. The prognostic value of WRS was evaluated using the area under the receiver operating characteristic curve, Kaplan–Meier survival curve analysis, and the Cox proportional hazards model. Results: The WRS levels were higher in patients with septic shock than in those without shock (p = 0.018). WRS could predict 30-day mortality (area under the curve, 0.648; 95% confidence interval [CI], 0.569–0.726; sensitivity, 56.7%; specificity, 73.3%; cutoff value, 84.15 µg/L; p &lt; 0.001). Patients with WRS levels of ≥ 84.15 µg/L showed higher 30-day mortality than those with WRS levels of &lt;84.15 µg/L. Among patients with WRS levels of ≥ 84.15 µg/L, those with positive urine culture results had higher 30-day mortality than those with negative urine culture. Patients with renal Sequential Organ Failure Assessment (SOFA) score of ≥ 1 had higher 30-day mortality than those with renal SOFA score of 0. WRS was an independent predictor of 30-day mortality (hazard ratio = 1.003; 95% CI, 1.001–1.005; p = 0.014). Conclusions: WRS showed significant prognostic value in patients with sepsis and could be more useful in those with kidney dysfunction or urinary tract infection.

Abstract: Background: Emergency laparotomy (EL) is associated with high morbidity and mortality compared with elective abdominal surgery. Enhanced Recovery After Surgery (ERAS) principles improve outcomes in elective settings, but their adaptation to emergencies remains inconsistent. The emergency department (ED) offers a critical opportunity for rapid risk stratification and pre-optimization, provided that interventions do not delay definitive surgery. Methods: We conducted a scoping review in accordance with PRISMA-ScR to map evidence on ED-initiated ERAS-aligned strategies for EL. PubMed, Scopus, and Cochrane were searched through February 2025. Guidelines, systematic reviews, cohort studies, consensus statements, and programmatic reports were included. Evidence was charted into five domains: (i) ERAS standards, (ii) comparative effectiveness, (iii) ED-feasible pre-optimization, (iv) risk stratification (Emergency Surgery Score [ESS], frailty, sarcopenia), and (v) oncological emergencies. Results: Twenty-five studies met inclusion criteria. ERAS Society guidelines codify rapid assessment, intraoperative multimodal care, and postoperative rehabilitation under a strict no-delay rule. Meta-analysis and cohort studies suggest ERAS-aligned pathways reduce complications and length of stay, though heterogeneity persists. Feasible ED interventions include multimodal analgesia, goal-directed fluids, early safe nutrition, respiratory preparation, and anemia/micronutrient optimization (IV iron, vitamin B12, folate, vitamin D). Sarcopenia, frailty, and ESS consistently predicted poor outcomes, supporting targeted bundle activation. Evidence from oncological emergencies, such as obstructive colorectal cancer, confirmed feasibility under no-delay governance. Conclusion: A minimal ED-initiated ERAS-aligned bundle is feasible, guideline-concordant, and may reduce complications and hospitalization in EL. This review proposes a pragmatic framework linking rapid risk stratification, opportunistic pre-optimization, and continuity into perioperative care. Future studies should test bundle fidelity, cost-effectiveness, and outcome impact in real-world emergency pathways.

Abstract: 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 Latin America, there is limited data on team performance, protocol adherence, and the pharmacist’s role in code blue events. This study aimed to evaluate clinical outcomes and operational performance of code blue events at a Latin American hospital.Methods:This retrospective cohort study included 77 adult patients who experienced IHCA at Hospital 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 &lt; 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.

Abstract: Introduction: The prognosis for patients admitted to emergency departments (ED) after drowning or diving accidents is often uncertain. In this study, we evaluated a range of clinical and laboratory parameters as potential predictors of survival. Many of these markers have previously been investigated in the context of survival prediction in both trauma-related and non-trauma-related clinical scenarios. Methods: We conducted a retrospective analysis of 25 patients aged >17 years who were admitted to the ED of the University Hospital Leipzig after drowning or diving accidents between 2012 and 2024. Clinical and laboratory parameters were compared between survivors and nonsurvivors, with survival defined as discharge from the hospital. Results: Of all cases analyzed—comprising 19 drowning and six diving incidents—10 patients (40%) survived, while 15 (60%) did not. Age, sex, or etiology of the accident were not statistically associated with survival. Compared to survivors, nonsurvivors were significantly more likely to have received prehospital cardiopulmonary resuscitation (CPR; 20% vs. 86.7%) and to have exhibited lower Glasgow Coma Scale scores and lower pH values (7.4 vs. 6.7). They were also more likely to have shown increased levels of lactate (4.3 mmol/l vs. 14.8 mmol/l), CK-MB quotient (9.7% vs. 51.8%), myoglobin (188.9 µg/l vs. 1930.9 µg/l), and blood sugar (6.6 mmol/l vs. 14.3 mmol/l). Conclusions: The need for CPR appears to be the most significant risk factor for not surviving a drowning or diving accident. Furthermore, selected laboratory parameters, such as pH and lactate, may serve as tools for predicting survival in these patients. Early decision-making regarding the continuation of CPR remains a critical and routine challenge for ED teams. Our findings offer a rationale for future prospective studies, aiming to incorporate additional clinical and biochemical markers and potentially develop new prognostic scoring systems for patients following drowning or diving accidents.

Abstract: Jellyfish stings induce a range of symptoms, from localized irritation to severe systemic reactions, yet the underlying immune mechanisms remain poorly understood. This study employed single-cell RNA sequencing (scRNA-seq) to analyze peripheral blood mononuclear cells from a severely affected patient and healthy controls, uncovering key changes in immune cell populations and signaling pathways. We identified 11 major immune cell types, with a marked increase in CD14+ monocytes (81.86% of total cells) and significant reductions in T cells, B cells, and CD16+ monocytes in the patient. Subclustering revealed six monocyte and four neutrophil subsets, each displaying distinct functional profiles. Patient monocytes were enriched for MMP9+ and RETN+ subsets, associated with leukocyte migration and inflammation, whereas healthy controls exhibited CD74+ monocytes linked to oxidative phosphorylation. Neutrophils in the patient were predominantly LTF+ and S100A12+, implicating inflammatory and immune regulatory pathways. These findings provide a detailed single-cell atlas of immune dysregulation post-jellyfish sting, highlighting the roles of MMP9+ monocytes and S100A12+ neutrophils in driving inflammation. This study offers potential therapeutic targets for mitigating severe immune responses in jellyfish envenomation.

Abstract: 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 the 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.

Abstract: Background: Acute aortic syndromes (AAS), encompassing aortic dissection, intramural hematoma, and penetrating aortic ulcers, are life-threatening emergencies requiring swift diagnosis and management in the emergency room (ER). This review provides a practical, evidence-based framework for managing suspected AAS in emergency settings.Methods: A narrative review was conducted, searching PubMed, Embase, Cochrane Library, and Web of Science from January 2000 to December 2024, using terms such as “aortic dissection,” “intramural hematoma,” “penetrating aortic ulcer,” “emergency aortic repair,” “EVAR,” and “TEVAR.” Clinical trials, cohort studies, and guidelines for adults (≥18 years) with AAS were included, adhering to PRISMA principles. Data were synthesized narratively to guide clinical decision-making.Results: Suspected AAS requires rapid triage, with CT angiography (CTA, 98% sensitivity) as the gold standard. Type A dissection mandates urgent open repair (15–25% 30-day mortality), while complicated type B dissection benefits from thoracic endovascular aortic repair (TEVAR, 5–10% mortality). Ruptured abdominal aortic aneurysms (rAAA) favor endovascular aortic repair (EVAR, 15–20% mortality) when feasible. Intramural hematoma and penetrating ulcers may require TEVAR for progression. Special populations (e.g., Marfan syndrome, elderly, women) and resource-limited settings necessitate tailored approaches.Conclusions: Clinicians should prioritize rapid imaging, hemodynamic stabilization, and multidisciplinary consultation. Open repair is critical for type A dissection, TEVAR/EVAR for type B and rAAA, and medical management for uncomplicated cases. Training and transfer protocols improve outcomes.