This Week in Emergency Medicine — Oct 27, 2026
Generated Oct 27, 2026 · 11:17
The week's practice-changing Emergency Medicine research, summarized for clinicians.
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Intravenous ibuprofen versus ketorolac for acute low back pain in the emergency department: a triple-blind randomized clinical trial.
In a small triple-blind trial of 73 patients with acute low back pain, intravenous ibuprofen produced lower pain scores than ketorolac at 10 and 30 minutes with similar side effects.
Internal and Emergency Medicine · 2026 · PubMed
This week’s papers
- 01
Regional implementation of a prehospital advanced life support program with video-assisted physician direction and outcomes after out-of-hospital cardiac arrest.
Across about 129,000 Korean cardiac arrests, video-directed prehospital advanced life support modestly increased field return of circulation but did not improve survival to discharge or neurological outcome.
Choi Y · Resuscitation · 2026
From the briefingIn Resuscitation, Choi used South Korea's national cardiac arrest surveillance data, roughly 129,000 adult cases, to compare regions that adopted a smart advanced life support program, in which paramedics deliver advanced care under real-time video direction from a physician, against regions that did not [1]. Using a difference-in-differences design, the program regions saw longer prehospital times, by about four minutes, and a small gain in prehospital return of spontaneous circulation, a bit over one percentage point. But there was no significant improvement in survival to discharge or in favourable neurological outcome. The author also flags that the prehospital time finding should be read cautiously, because the regions were already trending differently before implementation. So this is observational evidence that video-directed field resuscitation can move an intermediate endpoint without yet translating into patients leaving hospital neurologically intact.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Real-time feedback during bag-valve-mask ventilation for out-of-hospital cardiac arrest: a before-and-after study (VEntilation during Cardiac Arrest Resuscitation Study, VECARS-2).
Real-time feedback made bag-valve-mask insufflation volumes more consistent and reduced leak during cardiac arrest, but exhaled tidal volumes were unchanged and rarely reached the guideline range.
Jost D, Petermann A, Tassart B, et al. · Resuscitation · 2026
From the briefingAlso in Resuscitation, Jost and colleagues from the Paris Fire Brigade looked at bag-valve-mask ventilation during thirty-to-two CPR, comparing a period with a masked volume sensor to a period with real-time feedback [2]. Across about 4,300 breaths in 163 patients, feedback made delivered volumes far more consistent, with roughly two thirds of breaths landing in the guideline range of 400 to 600 millilitres compared with about two in five breaths before, and leak volume fell by about twelve percent. The striking caveat is that exhaled tidal volume did not change, and only around one in seven breaths reached the target range on the expiratory side in either period. That suggests rescuers can learn to squeeze the bag correctly while much of that air still fails to ventilate the lungs, and the authors are careful to say that clinical significance and generalizability remain unproven.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Rapid Transport to Extracorporeal CPR: Urging Caution Prior to Implementation.
A review argues current randomized evidence for extracorporeal CPR after out-of-hospital arrest is too limited for widespread adoption, partly because its effect is confounded by intra-arrest transport.
Kimbrell JM, Kreinbrook JA, Robinson AE, et al. · Prehospital Emergency Care · 2026
From the briefingKimbrell and colleagues examine extracorporeal CPR for refractory out-of-hospital arrest and argue that the randomized evidence does not yet support widespread adoption [3]. They point out that the ARREST trial, the most favourable, enrolled only 30 patients, while the larger INCEPTION and Prague trials did not show statistically significant benefit. Their central point is methodological: nearly every extracorporeal program requires intra-arrest transport, so any apparent effect of the circuit itself cannot be cleanly separated from the effect of moving the patient during arrest. It is an opinion-weighted review rather than new data, but it frames a real question for systems leaders weighing these programs.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Fatigue, Anxiety and Depression 12 Months After Out-of-Hospital Cardiac Arrest: A Population Based Cohort Study.
One year after out-of-hospital cardiac arrest, about a third of Australian survivors reported fatigue, exceeding population norms, and symptom burden was linked to poorer recovery and return to work.
Okyere DO, Nehme E, Bray J, et al. · Resuscitation · 2026
From the briefingAnd for the patients who do survive, Okyere and colleagues, also in Resuscitation, followed about 730 survivors in Victoria, Australia, to twelve months [4]. Just over a third of survivors reported fatigue, nearly a quarter of survivors reported anxiety, and close to one in five reported depression, and higher symptom burden tracked with worse quality of life, poorer functional recovery, and lower return to work. Fatigue clearly exceeded population norms, whereas anxiety was actually lower than in the general population. Younger age, prior anxiety or depression, diabetes and a non-shockable initial rhythm were linked to heavier symptoms. Taken together with the Korean data, the week's message is that resuscitation success is increasingly measured beyond the return of a pulse.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Stroke mimics in the emergency department: Prevalence, etiologies, and clinical predictors in patients with suspected acute stroke.
About one in five suspected acute strokes at a Thai centre were mimics, with seizure, fever, vertigo and altered consciousness favouring mimics and limb weakness or speech disturbance favouring stroke.
Tangpaisarn T, Sapthanakorn S, Phungoen P, et al. · American Journal of Emergency Medicine · 2026
From the briefingIn the American Journal of Emergency Medicine, Tangpaisarn and colleagues reviewed about 1,600 suspected acute strokes triaged through a fast-track protocol at a Thai university hospital [5]. Roughly one in five of these patients turned out to have a stroke mimic, with seizure-related disorders the most common cause. Seizure at presentation was associated with roughly two and a half times the odds of a mimic, fever with about three times the odds, and altered consciousness and vertigo with smaller increases, while limb weakness and speech disturbance pointed toward true stroke. Younger age and a history of migraine, epilepsy or psychiatric illness also leaned toward mimics. This is single-centre retrospective data, and none of these features is strong enough on its own to exclude stroke, but it gives a quantified picture of who is likely to be a mimic within a stroke pathway.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Prognostic Value of Thromboelastography Parameters for Early Trauma-Induced Coagulopathy in Severely Injured Patients: A Retrospective Cohort Study.
In 262 severely injured trauma patients, conventional INR outperformed individual thromboelastography parameters for predicting massive transfusion and mortality, suggesting viscoelastic testing complements rather than replaces standard labs.
Honnef G, Zoidl P, Hallmann B, et al. · Academic Emergency Medicine · 2026
From the briefingIn Academic Emergency Medicine, Honnef and colleagues tested thromboelastography against conventional coagulation tests in 262 severely injured trauma patients at a German level one centre [6]. About a third of patients had early trauma-induced coagulopathy, and individual thromboelastography parameters showed only moderate ability to detect it. The plain INR consistently did better, discriminating reasonably well for massive transfusion and for in-hospital mortality. The authors conclude that viscoelastic testing may add complementary information but did not replace standard labs for prognosis in this cohort, which is retrospective and single-centre, and which did not test whether guiding transfusion by either method changes outcomes.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Epidemiology of Nephrolithiasis Among United States Emergency Departments Over a 9-Year Period.
Across 2.8 million United States emergency visits for kidney stones from 2016 to 2024, CT use and admissions rose while ultrasound declined and opioid use fell.
Riley GV, Buell KG, Moyer E, et al. · Journal of Emergency Medicine · 2026
From the briefingFinally, in the Journal of Emergency Medicine, Riley and colleagues used the Epic Cosmos database to describe nearly 2.8 million kidney stone visits across United States emergency departments from 2016 to 2024 [7]. CT use climbed to roughly nine in ten visits while ultrasound use, already low, fell further, and admissions rose to about one in eight visits. On the positive side, opioid use dropped to about half of visits, ketorolac was the most common analgesic, and tamsulosin remained the leading discharge prescription. The authors read the imaging trend as a divergence from guidelines that favour ultrasound-first strategies in many patients, though a descriptive database study cannot say which individual scans were unnecessary.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Intravenous ibuprofen versus ketorolac for acute low back pain in the emergency department: a triple-blind randomized clinical trial.
In a small triple-blind trial of 73 patients with acute low back pain, intravenous ibuprofen produced lower pain scores than ketorolac at 10 and 30 minutes with similar side effects.
Jafarkhani M, Bahreini M, Rasooli F · Internal and Emergency Medicine · 2026
From the briefingPicking up on ketorolac's dominance in renal colic, Jafarkhani and colleagues, in Internal and Emergency Medicine, ran a triple-blind trial across three university emergency departments comparing intravenous ibuprofen 800 milligrams with intravenous ketorolac 30 milligrams for acute low back pain [8]. Among 73 patients, pain scores were significantly lower with ibuprofen at both ten and thirty minutes, and at thirty minutes about seven in ten ibuprofen patients rated their pain as mild versus roughly a third of ketorolac patients. Length of stay was shorter with ibuprofen, while rescue analgesia and side effects were similar. It is a small trial with short follow-up and a fixed ketorolac dose, so it supports intravenous ibuprofen as a reasonable alternative rather than proving superiority across settings.
If you only have time for one paper this week, make it the ibuprofen versus ketorolac trial in Internal and Emergency Medicine [8]. It addresses one of the most common analgesic choices in emergency practice with a blinded randomized design, and it reopens the assumption that ketorolac is the default parenteral anti-inflammatory for musculoskeletal pain.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Rapid bolus versus 3-h continuous infusion of 3% hypertonic saline for acute symptomatic hyponatremia.
In 58 emergency patients with symptomatic hyponatremia, rapid bolus and slow infusion hypertonic saline corrected sodium similarly, while readmission appeared higher after infusion in an exploratory finding needing confirmation.
Şafak S, Şirin İ · American Journal of Emergency Medicine · 2026
From the briefingIn the American Journal of Emergency Medicine, Şafak and Şirin compared a twenty-minute rapid bolus with a three-hour infusion of three percent hypertonic saline in 58 adults with acute symptomatic hyponatremia [9]. Twenty-four-hour sodium correction was similar between the two approaches, there was one overcorrection in the infusion group, and there were no cases of osmotic demyelination. Hyponatremia-related readmission at thirty days was considerably higher after slow infusion, about four in ten patients versus about one in seven, but this was a small, non-randomized cohort and the authors explicitly call that difference exploratory. The safety signal aligns with the move toward bolus-based therapy, though the study is far too small to settle safety questions.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Community Paramedics Addressing the Evolving Opioid Crisis: A Case Series Addressing the Kratom Derivatives 7-Hydroxymitragynine and MGM-15.
Two patients withdrawing from concentrated kratom derivatives needed full-dose buprenorphine from community paramedics and stayed in treatment at 30 days, showing these products can cause true opioid dependence.
Gormley MA, Wampler WR, Darby T, et al. · Prehospital Emergency Care · 2026
From the briefingLastly, in Prehospital Emergency Care, Gormley and colleagues describe two patients in severe opioid-like withdrawal after stopping concentrated kratom derivatives, 7-hydroxymitragynine and a related compound called MGM-15, which until recently were sold over the counter [10]. Community paramedics working within a prehospital buprenorphine program treated them, with one patient receiving 24 milligrams of buprenorphine in the field and the other needing 32 milligrams of buprenorphine with naloxone, and both patients remained in treatment at thirty days. Two cases cannot define dosing, but the report documents that these products can produce true opioid dependence requiring full-dose buprenorphine induction.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Emergency Medicine. This week we're covering 10 notable papers spanning the systems and aftermath of out-of-hospital cardiac arrest, diagnostic testing and resource use in the emergency department, and practical treatment questions from analgesia to hyponatremia to a new kind of opioid withdrawal. Let's dive in.
We start with cardiac arrest, where several papers this week ask whether adding technology or complexity to the prehospital chain actually changes the outcomes that matter. In Resuscitation, Choi used South Korea's national cardiac arrest surveillance data, roughly 129,000 adult cases, to compare regions that adopted a smart advanced life support program, in which paramedics deliver advanced care under real-time video direction from a physician, against regions that did not [1]. Using a difference-in-differences design, the program regions saw longer prehospital times, by about four minutes, and a small gain in prehospital return of spontaneous circulation, a bit over one percentage point. But there was no significant improvement in survival to discharge or in favourable neurological outcome. The author also flags that the prehospital time finding should be read cautiously, because the regions were already trending differently before implementation. So this is observational evidence that video-directed field resuscitation can move an intermediate endpoint without yet translating into patients leaving hospital neurologically intact. Also in Resuscitation, Jost and colleagues from the Paris Fire Brigade looked at bag-valve-mask ventilation during thirty-to-two CPR, comparing a period with a masked volume sensor to a period with real-time feedback [2]. Across about 4,300 breaths in 163 patients, feedback made delivered volumes far more consistent, with roughly two thirds of breaths landing in the guideline range of 400 to 600 millilitres compared with about two in five breaths before, and leak volume fell by about twelve percent. The striking caveat is that exhaled tidal volume did not change, and only around one in seven breaths reached the target range on the expiratory side in either period. That suggests rescuers can learn to squeeze the bag correctly while much of that air still fails to ventilate the lungs, and the authors are careful to say that clinical significance and generalizability remain unproven.
The most invasive end of the arrest spectrum gets a deliberately cautious review in Prehospital Emergency Care. Kimbrell and colleagues examine extracorporeal CPR for refractory out-of-hospital arrest and argue that the randomized evidence does not yet support widespread adoption [3]. They point out that the ARREST trial, the most favourable, enrolled only 30 patients, while the larger INCEPTION and Prague trials did not show statistically significant benefit. Their central point is methodological: nearly every extracorporeal program requires intra-arrest transport, so any apparent effect of the circuit itself cannot be cleanly separated from the effect of moving the patient during arrest. It is an opinion-weighted review rather than new data, but it frames a real question for systems leaders weighing these programs. And for the patients who do survive, Okyere and colleagues, also in Resuscitation, followed about 730 survivors in Victoria, Australia, to twelve months [4]. Just over a third of survivors reported fatigue, nearly a quarter of survivors reported anxiety, and close to one in five reported depression, and higher symptom burden tracked with worse quality of life, poorer functional recovery, and lower return to work. Fatigue clearly exceeded population norms, whereas anxiety was actually lower than in the general population. Younger age, prior anxiety or depression, diabetes and a non-shockable initial rhythm were linked to heavier symptoms. Taken together with the Korean data, the week's message is that resuscitation success is increasingly measured beyond the return of a pulse.
Our second theme is diagnostic testing in the emergency department, and how well our tools and habits match the evidence. In the American Journal of Emergency Medicine, Tangpaisarn and colleagues reviewed about 1,600 suspected acute strokes triaged through a fast-track protocol at a Thai university hospital [5]. Roughly one in five of these patients turned out to have a stroke mimic, with seizure-related disorders the most common cause. Seizure at presentation was associated with roughly two and a half times the odds of a mimic, fever with about three times the odds, and altered consciousness and vertigo with smaller increases, while limb weakness and speech disturbance pointed toward true stroke. Younger age and a history of migraine, epilepsy or psychiatric illness also leaned toward mimics. This is single-centre retrospective data, and none of these features is strong enough on its own to exclude stroke, but it gives a quantified picture of who is likely to be a mimic within a stroke pathway. In Academic Emergency Medicine, Honnef and colleagues tested thromboelastography against conventional coagulation tests in 262 severely injured trauma patients at a German level one centre [6]. About a third of patients had early trauma-induced coagulopathy, and individual thromboelastography parameters showed only moderate ability to detect it. The plain INR consistently did better, discriminating reasonably well for massive transfusion and for in-hospital mortality. The authors conclude that viscoelastic testing may add complementary information but did not replace standard labs for prognosis in this cohort, which is retrospective and single-centre, and which did not test whether guiding transfusion by either method changes outcomes. Finally, in the Journal of Emergency Medicine, Riley and colleagues used the Epic Cosmos database to describe nearly 2.8 million kidney stone visits across United States emergency departments from 2016 to 2024 [7]. CT use climbed to roughly nine in ten visits while ultrasound use, already low, fell further, and admissions rose to about one in eight visits. On the positive side, opioid use dropped to about half of visits, ketorolac was the most common analgesic, and tamsulosin remained the leading discharge prescription. The authors read the imaging trend as a divergence from guidelines that favour ultrasound-first strategies in many patients, though a descriptive database study cannot say which individual scans were unnecessary.
Our third theme covers treatment decisions at the bedside and in the field. Picking up on ketorolac's dominance in renal colic, Jafarkhani and colleagues, in Internal and Emergency Medicine, ran a triple-blind trial across three university emergency departments comparing intravenous ibuprofen 800 milligrams with intravenous ketorolac 30 milligrams for acute low back pain [8]. Among 73 patients, pain scores were significantly lower with ibuprofen at both ten and thirty minutes, and at thirty minutes about seven in ten ibuprofen patients rated their pain as mild versus roughly a third of ketorolac patients. Length of stay was shorter with ibuprofen, while rescue analgesia and side effects were similar. It is a small trial with short follow-up and a fixed ketorolac dose, so it supports intravenous ibuprofen as a reasonable alternative rather than proving superiority across settings. In the American Journal of Emergency Medicine, Şafak and Şirin compared a twenty-minute rapid bolus with a three-hour infusion of three percent hypertonic saline in 58 adults with acute symptomatic hyponatremia [9]. Twenty-four-hour sodium correction was similar between the two approaches, there was one overcorrection in the infusion group, and there were no cases of osmotic demyelination. Hyponatremia-related readmission at thirty days was considerably higher after slow infusion, about four in ten patients versus about one in seven, but this was a small, non-randomized cohort and the authors explicitly call that difference exploratory. The safety signal aligns with the move toward bolus-based therapy, though the study is far too small to settle safety questions. Lastly, in Prehospital Emergency Care, Gormley and colleagues describe two patients in severe opioid-like withdrawal after stopping concentrated kratom derivatives, 7-hydroxymitragynine and a related compound called MGM-15, which until recently were sold over the counter [10]. Community paramedics working within a prehospital buprenorphine program treated them, with one patient receiving 24 milligrams of buprenorphine in the field and the other needing 32 milligrams of buprenorphine with naloxone, and both patients remained in treatment at thirty days. Two cases cannot define dosing, but the report documents that these products can produce true opioid dependence requiring full-dose buprenorphine induction.
If you only have time for one paper this week, make it the ibuprofen versus ketorolac trial in Internal and Emergency Medicine [8]. It addresses one of the most common analgesic choices in emergency practice with a blinded randomized design, and it reopens the assumption that ketorolac is the default parenteral anti-inflammatory for musculoskeletal pain.
Here is what this week's evidence adds up to in Emergency Medicine. First, prehospital innovations in cardiac arrest, from video-directed advanced life support to ventilation feedback, are improving process and intermediate measures, but none of this week's data shows better survival or neurological outcome, and extracorporeal CPR still rests on small or neutral trials. Second, survivorship after cardiac arrest carries a substantial and measurable burden of fatigue, anxiety and depression at one year, which is well documented in one population cohort but has no tested intervention attached yet. Third, simple tools held up well: the INR outperformed thromboelastography for trauma prognosis and bedside features helped separate stroke mimics, though both come from single-centre retrospective data. Fourth, kidney stone care in the United States is drifting toward more CT and more admission, against guideline direction, while opioid use is falling. And finally, small studies suggest intravenous ibuprofen may match or beat ketorolac for back pain and that bolus hypertonic saline is at least as effective as slow infusion, but both findings need larger confirmation.
That's your roundup for This Week in Emergency Medicine. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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