30-Second Takeaway
- Conventional CPR with rescue breathing markedly improves 1‑month survival after drowning OHCAs versus hands‑only or no bystander CPR.
- Tele‑emergency care for urgent or emergent nurse line callers reduces short‑term ED visits and hospitalizations without increasing mortality.
- Ketamine causes more peri‑intubation hemodynamic instability than etomidate but shows no mortality difference in critically ill adults.
- Statewide pediatric QI cut CXRs for common respiratory visits without increasing short‑term ED revisits and with only slight admission changes.
- Geriatric ED care, brief cognitive screening, and violence intervention programs all link to better near‑term outcomes and resource use.
Week ending April 11, 2026
New evidence for ED care: drowning CPR, tele-emergency models, induction drugs, pediatric imaging, geriatric care, violence interventions, and sepsis biology
Conventional CPR with rescue breathing best for drowning cardiac arrests in natural waters
In a Japanese nationwide registry of 3,914 drowning OHCAs in natural water, bystander CPR type strongly influenced 1‑month survival. Survival was lowest with no bystander CPR, higher with hands‑only CPR, and highest with conventional CPR including ventilations. Compared with no CPR, conventional CPR had substantially higher adjusted odds of 1‑month survival, and hands‑only CPR also improved survival. Conventional CPR also outperformed hands‑only CPR on adjusted 1‑month survival, supporting dispatcher emphasis on ventilations when drowning is suspected.
Tele-emergency care after nurse triage cuts short-term ED visits without higher mortality
This national VA cohort examined over 2.5 million nurse advice line calls triaged as urgent or emergent between 2018 and 2024. About one in six eligible calls resulted in a tele‑emergency visit after program implementation. Tele‑emergency care was associated with markedly fewer ED visits and hospitalizations within 7 days, with no difference in 30‑day mortality versus usual care. Effects were strongest for emergent‑acuity calls and did not meaningfully differ by phone versus video or physician versus APC. At the facility level, tele‑emergency implementation modestly reduced ED visits for emergent calls, suggesting limited but real system‑level decongestion.
Ketamine causes more peri-intubation instability than etomidate in critically ill adults
This systematic review and meta‑analysis pooled 10 randomized trials of 4,673 critically ill adults intubated in EDs or ICUs. Nine trials compared ketamine with etomidate; one compared ketamine with midazolam plus sufentanil. Versus etomidate, ketamine increased the risk of postinduction hemodynamic instability, without changing mortality, ventilator‑free days, or ICU‑free days. Against midazolam plus sufentanil, ketamine reduced instability, highlighting dependence on the comparator agent. For ED intubations in unstable patients, etomidate appears more hemodynamically forgiving than ketamine, without clear longer‑term outcome trade‑offs.
Statewide QI program safely reduces pediatric respiratory chest radiographs
This Michigan statewide collaborative analyzed over 114,000 ED visits for pediatric asthma, bronchiolitis, and croup across 39 EDs. A multicomponent QI initiative, with optional financial incentives at some sites, targeted reducing routine CXRs for these conditions. Network‑wide CXR use dropped from about one‑third of visits to about one‑fifth after implementation. Sites tying CXR use to incentives achieved similar absolute reductions, with no increase in 72‑hour respiratory ED revisits and only slight admission increases. These data support ED stewardship efforts to curb routine imaging for uncomplicated pediatric respiratory presentations without obvious short‑term safety harm.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.