Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 6 Articles
Purpose The number of older adults attending Emergency Departments (EDs) is increasing rapidly in Italy. This trend poses substantial challenges to services that are not structured to address multidimensional needs. Despite the availability of international guidance, implementation of geriatric emergency care models remains inconsistent in Italy. This study aimed to establish a national, inter-specialty expert consensus on priorities for improving geriatric emergency care....
Electrical impedance tomography (EIT) is a promising imaging tool in critical care. Its capacity to provide noninvasive bedside visualization of regional ventilation and perfusion with high temporal resolution makes it an ideal monitoring modality for patients on ventilation. However, its widespread implementation has been hindered by physical limitations in spatial resolution and a lack of robust evidence linking its use to improved clinical outcomes. In recent years, the commercialization of several bedside devices has led to growing clinical experience, gradually yielding concrete evidence regarding its clinical utility. Furthermore, beyond respiratory monitoring, data are increasingly accumulating in non-pulmonary fields, including perfusion, neuro-critical care and gastroenterology. Therefore, the objective of this review is to synthesize emerging evidence regarding the recent clinical applications of electrical impedance tomography and discuss future perspectives....
Background: Subarachnoid hemorrhage (SAH) results from extravasation of blood into the subarachnoid space and is associated with high morbidity and mortality. This study aimed to compare systolic blood pressure variability (SBPV) and intracranial pressure variability (ICPV) in three 8 h intervals during the first 24 h after hospital admission and investigate their associations with discharge disposition and in-hospital mortality. Methods: We retrospectively reviewed charts of adult patients with spontaneous, non-traumatic SAH admitted for at least 24 h from 2016 to 2020. Hourly measurements were recorded for both systolic blood pressure (SBP) and intracranial pressure (ICP), and SBPV and ICPV were measured using successive variation (SV) and standard deviation (SD). Results: A total of 240 patients were included (mean age 57 ± 14.2 years, 64.6% female); 40 (16.7%) died. Univariate analyses showed higher SBP-SV (22.7 ± 13.8) in the first 8 h to be significantly associated with mortality (p = 0.028) and not being discharged home (p = 0.022), compared to those who survived (17.6 ± 7.5) or were discharged home (16.7 ± 5.5). Multivariate logistic regression did not show an association between SBPV and outcomes of interest. Conclusions: Greater early SBPV was associated with mortality in univariate analysis but was not independently predictive after adjustment for clinical severity, suggesting it reflects underlying physiologic instability rather than an independent prognostic factor in SAH....
Background: Pediatric emergency medicine (PEM) training within emergency medicine (EM) residency programs varies widely in preceptor expertise, critical care exposure, and procedural opportunities. Despite the importance of pediatric airway management, real- world exposure to critically ill children remains limited and inconsistent across training sites. Current ACGME guidelines provide minimal direction on pediatric- specific content or mandatory procedures, leaving gaps in emergent airway training. Objective of the Innovation: To address perceived deficiencies in pediatric airway skills among EM residents, we implemented a longitudinal, simulation- based pediatric airway curriculum. The primary goal was to improve pediatric airway knowledge, confidence, procedural competency in airway equipment setup, bag- valve- mask (BVM) ventilation, troubleshooting, intubation techniques using a flipped classroom model, and rapid cycle deliberate practice (RCDP). Development Process and Implementation: Guided by Kern's curriculum design framework and selected components of Sawyer's six- step procedural learning model, the curriculum incorporated asynchronous learning and eight interactive simulation sessions over a 12- month period. 40 residents in four postgraduate years participated in two individualized RCDP sessions annually, supported by faculty trained in pediatric airway management. A novel checklist was used for objective performance assessment. Outcomes: Thirty- one residents completed baseline and post- intervention procedural assessments. Significant improvements were observed in equipment setup and intubation steps (p < 0.05), with first- pass intubation time reduced from 9 min and 12 s to 7 min and 9 s (p < 0.05). Self- reported confidence in pediatric airway management increased across all PGY levels (p < 0.05), and knowledge scores improved (7.8 vs. 9.7, p < 0.05). Resident feedback strongly endorsed the curriculum's value in building skills and confidence. Conclusion: A structured, simulation- based pediatric airway curriculum using RCDP effectively enhances EM residents' procedural performance and confidence. This model offers a scalable approach for addressing critical skill gaps in PEM training. Future directions include integrating advanced airway techniques and longitudinal retention assessments....
Objective: Medical domain large language models (LLMs) exhibit verified clinical decision-support capabilities in simulated case analyses and standardized tests, yet their diagnostic efficacy in real-world emergency settings remain insufficiently explored. This study evaluates the diagnostic performance of 5 mainstream LLMs (ChatGPT-4o, Gemini-2.0, Grok3, DeepSeek-V3, Doubao) against emergency department junior physicians (EDJP) on real-world emergency internal medicine cases. Methods: A single-center retrospective analysis design was conducted. 154 anonymized emergency internal medicine patients of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to May 2025 were included, covering common acute diseases of multiple systems. 15 EDJPs and 5 LLMs were selected to diagnose the cases, respectively. The main diagnostic accuracy, comprehensiveness of differential diagnosis, and response time were used as evaluation indicators. Non-parametric tests were used for statistical analysis. Results: (1) Main diagnostic accuracy: DeepSeek-V3 (90.0%), ChatGPT-4o (86.0%), and Grok3 (86.0%) were significantly higher than that of EDJP (77.5%, p < 0.05); in the subgroup of respiratory system diseases, Gemini-2.0 and DeepSeek-V3 performed better (p < 0.05). (2) Comprehensiveness of differential diagnosis: The scores of all LLMs were significantly higher than that of EDJP (p < 0.05), and the medians of DeepSeek-V3, Gemini-2.0, and Grok3 reached 5.0 points. (3) Response time: LLMs (6.3–14.0 s) were significantly faster than EDJP (360.2 s, p < 0.05), and Doubao had the fastest response. The inter-rater reliability was good (ICC: 0.617–0.899). Conclusion: This retrospective study shows that LLMs outperformed EDJPs in diagnostic accuracy, differential diagnosis comprehensiveness and response efficiency for emergency internal medicine diseases, demonstrating significant potential for clinical decision support. Subsequent efforts will focus on exploring how to effectively integrate into physician-led collaborative workflows to enhance emergency care quality and efficiency....
Background: In the United States, the initial management of trauma patients is coordinated by multidisciplinary teams, typically led by surgeons. As a result, Emergency Medicine (EM) residents often have limited experience in the trauma team lead role. However, in rural or critical access hospitals, EM physicians frequently serve as team leaders without surgical backup. Objective: To map and summarize educational strategies used to train EM residents to lead Level 1 trauma resuscitations and describe how outcomes such as confidence, performance, and preparedness are assessed. Methods: Following Joanna Briggs Institute scoping review methodology, a systematic search of PubMed and Embase was conducted. Inclusion criteria focused on training EM residents in trauma leadership using keywords related to education, competence, and leadership. Covidence was used for blinded screening and data extraction, and 23 studies were included following double- blind review. Results: Simulation- based training dominated the literature, including high- fidelity mannequins, cadaver labs, animal models, and standardized patients. Combined approaches integrating didactics, video- assisted debriefs, and mental rehearsal improved trauma leadership, procedural, and nontechnical skills. Most studies evaluated outcomes using self- reported confidence and perceived competence, while fewer used validated performance assessment tools in simulated settings, and only one study evaluated resident leadership in real- world trauma activations. Studies also assessed psychosocial constructs such as confidence and stress. Conclusion: Existing literature describes simulation as the most frequently used modality for trauma leadership training among EM residents, often paired with structured debriefing, didactics, mental rehearsal, and progressive complexity. Most studies assess learner- reported outcomes and simulated performance, while real- world clinical leadership assessment remains limited. Future efforts should prioritize curriculum development, standardized evaluation tools (Kirkpatrick or milestone- based outcomes), and longitudinal models that combine simulation with real- world practice to ensure consistent, high- quality trauma leadership preparation....
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