This Week in Emergency Medicine — May 14, 2026

Welcome to This Week in Emergency Medicine. This week we're covering 10 notable papers spanning the emergency department's growing role in public health, key updates in core clinical practice for conditions like stroke and pneumonia, and a look at broader health policy. Let's dive in.

The ED as a Public Health Frontline

This week, several papers highlight the emergency department's unique position as a crucial site for public health interventions, moving beyond the immediate chief complaint. We saw studies on screening for STIs and cervical cancer, initiating treatment for alcohol misuse, and distributing harm reduction tools.

Two papers, one in *Annals of Emergency Medicine* and one in *The American Journal of Emergency Medicine*, demonstrated novel ways to boost screening rates. In *Annals of Emergency Medicine*, a randomized trial evaluated a digital patient decision aid called STIckER for adolescents and young adults aged 14 to 24 [6]. The tool, used on a smartphone, provided personalized testing recommendations. Clinicians randomized to use the tool had patients who were nearly twice as likely to receive gonorrhea and chlamydia testing compared to those receiving usual care. Pharyngeal testing rates were over four times higher. The tool was rated as highly acceptable and feasible, suggesting digital aids can be a scalable way to improve sexual health screening in the ED.

Similarly, a study in *The American Journal of Emergency Medicine* looked at the feasibility of on-site, self-collection for HPV testing as a form of cervical cancer screening [2]. Among 200 eligible ED patients who needed screening, 83% agreed to participate, and nearly 79% successfully completed the self-collection during their visit. Importantly, less than 2% of samples were inadequate for testing, and about 16% of tests came back positive for high-risk HPV. This demonstrates that ED-based HPV self-collection is not only feasible but also highly acceptable to patients.

Moving from screening to treatment, a paper in *Annals of Emergency Medicine* showcased a powerful strategy to help patients with alcohol misuse [4]. Investigators implemented a multi-component 'nudge' strategy across four emergency departments, using EHR banners and clinical decision support in the discharge order set to prompt conversations and facilitate treatment. At the intervention hospitals, the rate of discharging patients with an alcohol-related diagnosis on a naltrexone prescription jumped from just 0.2% at baseline to over 3% after the intervention. In contrast, control hospitals saw virtually no change. In the formal analysis, patients at intervention hospitals were over 14 times more likely to be prescribed naltrexone compared to baseline. This shows that a thoughtful, integrated ED protocol can significantly increase the initiation of evidence-based treatment for alcohol use disorder.

Finally, on the harm reduction front, a study in *The American Journal of Emergency Medicine* compared the usability of single-step versus multi-step intranasal naloxone devices for overdose reversal [3]. In a simulated overdose scenario with participants who had no prior naloxone training, the difference was stark. 85% of users could successfully administer naloxone with the single-step device on their first try, compared to only 20% with the multi-step kit that required assembly. The single-step device was also administered about 30 seconds faster. While a brief training session improved success rates for the multi-step kit, the single-step device remained quicker to use. The clinical takeaway is clear: for take-home naloxone programs targeting lay responders, the simplicity of a single-step device can dramatically improve the odds of successful and timely administration in a real-world crisis.

Updates in Core Clinical Practice

Our next theme covers updates on how we manage common conditions and how our own work environment affects our health. This includes new guidelines for pneumonia, a landmark trial in stroke, a safety review of pediatric ketamine, and a look at physician scheduling.

First, a review in *The American Journal of Emergency Medicine* summarizes the 2025 guideline updates for community-acquired pneumonia, or CAP [7]. A few key points for emergency practice: First, the guidelines now formally support the use of lung ultrasound for diagnosing CAP when performed by experienced clinicians. Second, for antibiotic therapy, the new advice is nuanced. In otherwise healthy outpatients with a positive viral test but no clear imaging findings of pneumonia, the guidelines suggest that not prescribing antibiotics may be reasonable, though clinical judgment is key. For those who do need antibiotics, a shorter duration of less than 5 days is now recommended for both outpatients and admitted patients with non-severe CAP. Finally, corticosteroids are recommended only for patients with severe CAP, not for non-severe cases.

Perhaps the biggest news this week comes from *The New England Journal of Medicine*, which published a trial on endovascular thrombectomy for strokes caused by medium-vessel occlusions, or MeVOs [8]. While thrombectomy is standard for large-vessel occlusions, its role in MeVOs has been less clear. This randomized trial in China enrolled patients with moderate-to-severe strokes who presented within 24 hours of onset. The results were positive. At 90 days, 58.6% of patients in the thrombectomy group achieved functional independence, compared to only 46.6% in the medical management group. This benefit came with a slightly higher risk of symptomatic intracranial hemorrhage—4.7% in the thrombectomy group versus 2.2% in the control group. Mortality at 90 days was similar between groups. This trial provides strong evidence that for selected patients with moderate-to-severe deficits from a medium-vessel occlusion, thrombectomy improves functional outcomes.

For those of us practicing pediatric emergency medicine, a large systematic review in *Annals of Emergency Medicine* provides strong reassurance about the safety of intravenous ketamine for procedural sedation [5]. The review pooled data from 20 studies, totaling nearly 68,000 children. The findings were striking: there were no reported deaths or permanent adverse outcomes. Sentinel adverse events, such as the need for intubation or chest compressions, were extremely rare, occurring in only about 1 per 11,500 sedations. While factors like older age, an upper respiratory infection, or co-administered opioids were identified as predictors for less severe 'serious adverse events', their effect was modest. This large-scale evidence robustly supports the safety profile of ED ketamine for children.

Finally, a pilot study in *The American Journal of Emergency Medicine* explored a potential solution for the negative health effects of shift work on physicians [1]. The study looked at 'casino shifts', which use a 4 a.m. turnover to better preserve anchor sleep. Twelve emergency physicians were studied under three conditions: baseline, traditional overnight shifts, and casino shifts. Compared to traditional nights, the casino shifts were associated with a return to baseline for inflammatory markers like white blood cell and platelet counts. Participants also had more deep sleep and reported less post-shift sleepiness. While this is a small pilot study, it suggests that schedule design can be a powerful tool for improving physician wellness and mitigating the physiologic stress of night shifts.

Policy and Global Health Perspectives

Our final section looks at the bigger picture, with a position paper on telemedicine policy and lessons from a successful Marburg virus outbreak response.

In *Annals of Internal Medicine*, the American College of Physicians released an updated position paper on telemedicine [10]. It addresses the massive changes in policy and practice that accelerated during the COVID-19 pandemic. The paper provides a comprehensive overview of the current landscape regarding payment policies, interstate licensure, and rules for prescribing controlled substances via telehealth. It advocates for integrating telemedicine into longitudinal care relationships to improve access and reduce patient burden, but also highlights the critical need to address challenges related to equity, patient safety, and regulation. This paper serves as a valuable summary of where telemedicine stands today and the policy questions that still need to be resolved.

Lastly, a report in *The Lancet. Global health* provides crucial insights from Rwanda's response to its first Marburg virus disease outbreak in 2024 [9]. The outbreak had an unusually low case-fatality rate of 23%, a stark contrast to rates of 80-100% seen in other countries. The authors attribute this success to several key pillars: a strong 'One Health' surveillance system that quickly traced the outbreak to a zoonotic source, rapid expansion of testing, comprehensive supportive care with access to investigational therapies, and strong community engagement. Rwanda's experience demonstrates that high survival rates from this deadly virus are achievable even in low-resource settings when a coordinated, multi-sectoral response is in place.

If you only have time for one paper this week, make it the trial on endovascular thrombectomy for medium-vessel-occlusion strokes in *The New England Journal of Medicine* [8]. This positive trial expands the population of stroke patients who may benefit from thrombectomy, and it's crucial to be aware of this when consulting with neurology and interventional radiology for your stroke patients.

Here are the key takeaways from this week in Emergency Medicine. First, for moderate-to-severe strokes caused by medium-vessel occlusions, endovascular thrombectomy improves functional outcomes at 90 days, making it a critical consideration for this patient group [8]. Second, the ED can be a highly effective site for public health screening and treatment initiation; digital aids for STI testing [6], self-collection for HPV [2], and EHR nudges for alcohol use disorder [4] all show significant success in engaging patients. Third, new pneumonia guidelines endorse lung ultrasound, suggest shorter antibiotic courses for non-severe CAP, and recommend considering withholding antibiotics in select healthy outpatients with viral illness but no clear radiographic pneumonia [7]. Fourth, for take-home naloxone programs, simpler, single-step intranasal devices are significantly easier and faster for untrained individuals to use, potentially improving real-world effectiveness [3]. And finally, intravenous ketamine for pediatric procedural sedation remains exceptionally safe, with sentinel adverse events being extremely rare, as confirmed by a large systematic review of nearly 68,000 patients [5].

That's your roundup for This Week in Emergency Medicine. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.