INTRODUCTION:Methamphetamine-associated heart failure with reduced ejection fraction is a serious consequence of methamphetamine use often underrecognized in the emergency department (ED). Point-of-care ultrasound (POCUS) offers rapid, non-invasive cardiac screening for high-risk populations. This study evaluated the diagnostic yield of POCUS for detecting methamphetamine-associated heart failure with reduced ejection fraction in ED patients who use methamphetamine. METHODS:We conducted this prospective cohort study between December 2020-February 2024 at an urban Level I trauma center ED. The primary outcome was diagnostic yield of cardiac POCUS for abnormal left ventricular ejection fraction (LVEF) and abnormal sex-specific left ventricular end-diastolic diameter in patients with methamphetamine use, with secondary analyses assessing associations with use duration and frequency. Diagnostic yield was calculated as the proportion of completed POCUS examinations identifying abnormalities. We used E-point septal separation to calculate LVEF; < 40% was abnormal. Left ventricular end-diastolic diameter abnormality (> 5.8 cm males, > 5.2 cm females) was categorized as mild, moderate, or severe (mild, 5.9-6.3/5.3-5.6; moderate, 6.4-6.8/5.7-6.1; severe, > 6.8/> 6.1 cm males/females). Physician-performed POCUS assessed LVEF and left ventricular end-diastolic diameter in patients with a methamphetamine use history and a comparison group of non-users. RESULTS:Of the 136 enrolled patients, 84 (61.8%) reported methamphetamine use. Among methamphetamine users, diagnostic yield of cardiac POCUS was as follows: reduced LVEF in 22 of 70 with measurable LVEF (31.4% [20.9-43.6%]); any sex-specific left ventricular end-diastolic diameter abnormality in 30 of 84 (35.7% [25.6-46.9%]); and severe sex-specific left ventricular end-diastolic diameter abnormality in 15 of 84 (17.9% [10.4-27.7%]). Corresponding values in non-users were 3 of 52 (5.8% [1.2-16.0%]; P < .001), 10 of 52 (19.2% [9.6-32.5%]; P = .05), and 3 of 52 (5.8% [1.2 - 16.0%]; P = .07), respectively. Longer duration (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.46-25.10) and higher frequency (OR 5.93, 95% CI, 1.52-23.06) of methamphetamine use were associated with reduced LVEF. CONCLUSION:Cardiac point-of-care ultrasound demonstrated a clinically significant diagnostic yield in detecting methamphetamine-associated heart failure with reduced ejection fraction among methamphetamine users in the ED, suggesting POCUS could aid early detection in this population, potentially streamlining management before disease progression.

Background:This original research study evaluates the utility of pulmonary point-of-care ultrasound (POCUS) within the extended focused assessment with sonography in trauma (eFAST) exam to detect asymptomatic COVID-19 in emergency department trauma patients. Specifically, it examines whether lung findings, such as B-lines, pleural thickening, and subpleural consolidations, can indicate a COVID-19 infection. Methods:This retrospective review includes trauma patients aged 18 years or older who underwent eFAST and COVID-19 swab testing at the University of California, Irvine Medical Center, from December 2020 to October 2022. Two blinded reviewers analyzed eFAST scans for more than two B-lines, irregular pleural interface, or subpleural consolidations, with discrepancies resolved by ultrasound fellows. Sensitivity, specificity, and predictive values were calculated with 95% confidence intervals (CIs). Results:A total of 152 patients were included. Of 41 eFAST scans positive for COVID-19 findings, six were confirmed by PCR testing, yielding a positive predictive value of 15.6% (CI: 7.9%-25.6%). Among the 111 eFAST scans negative for COVID-19, 10 were PCR-positive, giving a negative predictive value of 91.0% (CI: 84.1%-95.6%). Sensitivity was 37.5% (CI: 15.2%-64.6%), and specificity was 74.3% (CI: 66.1%-81.4%). Conclusion:Lung POCUS within the eFAST exam is not a reliable tool for detecting asymptomatic COVID-19 infection in trauma patients due to limited sensitivity and low positive predictive value. Standard diagnostic methods, such as PCR testing, and the use of personal protective equipment should remain the primary approach to protect healthcare providers.

Impaired driving remains a leading cause of preventable traffic fatalities among young adults in the United States. In 2023, 30% of teen drivers killed in crashes had measurable blood alcohol levels, and individuals aged 21-24 represented the highest proportion of fatally impaired drivers nationally. The COVID-19 pandemic further compounded this risk by simultaneously accelerating social media engagement and substance use among young people, creating both a challenge and an opening for innovative intervention. The University of California, Irvine (UCI) Virtual Ambassador Program (VAP) was established in 2021 through a partnership between the California Office of Traffic Safety and the UCI Center for Trauma and Injury Prevention Research. The program sought to harness peer-to-peer social media communication, rather than traditional institutional messaging, to promote sober driving behaviors among young adults in Orange County. UCI students were recruited as peer content creators and ambassadors, producing and distributing traffic safety content across Instagram and TikTok from June 2022 to July 2025. Content formats included short-form reels, infographics, and physician testimonials, with selective paid ad boosting to expand reach. Over four years, the program transitioned from faculty oversight to a fully student-run organization, Drive Sober Orange County, adapting its structure and strategy in response to turnover, platform shifts, and real-world feedback. The program produced 130 posts accumulating over 137,000 combined views. TikTok yielded a higher average engagement rate (4.98%) than Instagram (2.07%). Paid ad boosting drove substantially greater reach, with boosted reels averaging 4,883 views versus 348 for non-boosted content, a roughly 14-fold increase, at a cost-per-view as low as $0.013 across $6,398 in total ad spend. Notably, demographic data revealed that adults 65 and older comprised the largest share of ad reach (24.0%), while the intended 18-24 age group represented only 14.2%, highlighting a targeting gap inherent to platform advertising algorithms. The VAP demonstrates that a low-cost, peer-driven social media model can achieve meaningful public health reach within modest grant budgets. The program’s evolution into a student-led organization reflects a shift towards sustainability. Future efforts should prioritize refining paid audience targeting toward younger demographics, building stronger leadership continuity structures, and developing behavioral outcome measures that move beyond engagement metrics to capture real-world impact on driving behavior.

Objective: Terminology used in scientific literature is associated with resource allocation, research prioritization, and public perception. The aim of this study is to describe how research on fentanyl is associated with a change in terminology used to refer to its use.Design: The study utilized bibliometric analysis of 11,982 publications from 2000 to 2023 from Web of Science using the topic search terms “Fentanyl” and “Humans.” These articles were then analyzed via VOSViewer and Microsoft Excel.® Results: Publications adopting nonstigmatizing terminology were more frequently connected to research on substance use treatment, rehabilitation, and medication-assisted treatments (methadone, naltrexone, buprenorphine). The adaptation demonstrated greater connections to these medications, methadone, naltrexone, and buprenorphine, and reflects an emerging focus on fentanyl-specialized addiction medicine.Conclusions: Older publications frequently utilized stigmatizing terminology and lacked a coherent research direction. Conversely, recent adoption of nonstigmatizing language coincides with increased research output focusing on treatment, emergency overdose management, epidemiology, and public health. Notably, the adoption of nonstigmatized terms coincides with increased publications and a new focus on fentanyl-related research.

Background Point-of-care ultrasound (POCUS) is integral to emergency medicine, offering rapid, radiation-free diagnostic information across a wide range of clinical scenarios. However, widespread adoption has exposed significant challenges related to standardization of documentation, quality assurance (QA), image storage, credentialing, and billing. Without a reliable, centralized management system, there is an increased risk of inefficiencies, data loss, missed billing opportunities, and potentially worse patient outcomes. Objective This implementation report describes the planning, deployment, and early outcomes of integrating a middleware, specifically Fujifilm’s Synapse Synchronicity, into our institution’s POCUS workflow. The objective is to evaluate how middleware integration affects documentation, QA, education, compliance, and billing, and to provide practical insights for institutions considering similar system-level transitions. Discussion The integration of a middleware within our institutional Emergency Department has reshaped the clinical, educational, technical, and financial aspects of POCUS. By consolidating a fragmented workflow into a single, cohesive platform, the department has created a scalable, efficient, and high-performing infrastructure. Despite these benefits, substantial challenges emerged, including increased workflow complexity, system delay, login and access barriers, ultrasound image assignment delays, and dependence on reliable network connectivity. Conclusion Middleware integration through Synapse Synchronicity fundamentally restructured the Emergency Department’s POCUS workflow, showing how integrating a centralized ultrasound workflow platform can improve patient care, provider education, and hospital operations. The lessons learned during implementation can serve as a roadmap for other institutions seeking to enhance their POCUS operations while ensuring quality, compliance, and patient-centered care.

The Accreditation Council for Graduate Medical Education’s (ACGME) proposal to mandate 48-month training for all emergency medicine residency programs represents a significant departure from the current system where both 36- and 48-month formats successfully coexist. The ACGME’s justification relies on a methodologically flawed survey that never directly asked program directors about optimal training duration. Instead, it calculated totals by summing individual rotation estimates without considering integrated curricula or practical constraints. Even if these results were to be accepted, directors of three-year programs reported a mean desired duration of only 41.6 months—hardly justifying a universal 48-month mandate. Current evidence contradicts the ACGME’s rationale. Three-year graduates achieve higher board pass rates (93.1% vs 90.8%) and demonstrate equivalent clinical performance to four-year graduates. The mandate would impose substantial financial burdens on trainees—an opportunity cost exceeding $200,000-$250,000—while potentially deterring qualified applicants and discouraging fellowship training. We urge the ACGME to pause implementation and provide compelling evidence that a 48-month mandate is necessary and demonstrably superior to the current model.

ABSTRACTBackground and AimsIn the current study, we aimed to identify the association between major and minor electrocardiographic abnormalities and cardiovascular risk factors.MethodsWe used the Tehran cohort study baseline data, an ongoing multidisciplinary, longitudinal study designed to identify cardiovascular disease risk factors in the adult population of Tehran. The electrocardiograms (ECGs) of 7630 Iranian adults aged 35 years and above were analyzed. ECG abnormalities were categorized into major or minor groups based on their clinical importance. Results were obtained by multivariable logistic regression and are expressed as odds ratios (ORs).ResultsA total of 756 (9.9%) participants had major ECG abnormalities, while minor abnormalities were detected in 2526 (33.1%). Males comprised 45.8% of the total population, and 41.8% of them had minor abnormalities. Individuals with older age, diabetes (OR = 1.35; 95% CI: 1.11–1.64), and hypertension (OR = 2.21; 95% CI: 1.82–2.68) had an increased risk of major ECG abnormalities. In contrast, intermediate (OR = 0.69; 95% CI: 0.57–0.84) and high physical activity levels (OR = 0.66; 95% CI: 0.51–0.86) were associated with a lower prevalence of major abnormalities. Male sex, older age, hypertension, and current smoking were also associated with an increased prevalence of ECG abnormalities combined (major or minor).ConclusionMajor and minor ECG abnormalities are linked with important cardiovascular risk factors such as diabetes and hypertension. Since these abnormalities have been associated with poor outcomes, screening patients with cardiovascular risk factors with an ECG may distinguish high‐risk individuals who require appropriate care and follow‐up.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic significantly altered emergency department (ED) utilization patterns. This study quantifies the statistics at a Level I trauma center in Southern California from 14 months before to nine months after the start of the pandemic (January 2019–December 2020). We hypothesized that during the COVID-19 pandemic, changes in ED use patterns impacted patient acuity, as measured by admission rate, mortality rate, ED volume, Emergency Severity Index (ESI), and female:male ratio, even when controlling for COVID-19 cases. Methods: In this study we examined 97,793 ED visits from January 2019–December 2020 at the University of California, Irvine Medical Center in Orange, CA, via an administrative database comprised of anonymized datapoints from the electronic health record. We included all months from January 2019–December 2020 to account for potential secular trends by calendar month. Primary outcome measures were hospital admission rate and all-causes mortality rate among non-COVID-19 patients who presented to the ED. Secondary outcome measures included the mean number of ED visits per month, mean ESI, and female:male ratio among non-COVID-19 patients. Statistical analyses were performed. Results: We found an increase in the mortality rate per ED visit of 0.8859% before the pandemic to 1.2706% (P < .001) during the pandemic. After excluding COVID-19 cases, the mortality rate per ED visit remained elevated at 1.1746% (P < .001), a relative increase of 32.6%. Hospital admission rate increased from 26.0% before the pandemic to 32.3% during the pandemic (P < .001). The mean number of ED visits per month decreased from 4,271.2 ± 193.1 before the pandemic to 3,558.7 ± 437.1 per month during the pandemic (P < .001), a relative decrease of 16.7% when excluding COVID-19 cases. The mean ESI of non-COVID-19 related cases during the pandemic decreased from 2.85 pre-pandemic to 2.84 during the pandemic (P = .03). The female:male ratio decreased from 1.003 pre-pandemic to 0.885 during the pandemic (P < .001). Conclusion: This study reveals a decrease in patient volume with an increase in mortality and admission rate, demonstrating an association between shifts in ED utilization patterns and increased patient acuity during the pandemic. Understanding patients’ emergency care-seeking behavior during this period is essential for preparing for future large-scale public health crises and optimizing ED resource allocation and mobilization based on lessons learned from COVID-19. Overall, these findings highlight the need for further research into the development of strategies to address changes in care-seeking behavior during access-limiting scenarios.

BACKGROUND:Research demonstrates that Point-of-care ultrasound (POCUS) improves clinical outcomes for patients. Improving clinician satisfaction with POCUS should promote utilization into everyday practice, leading to improved clinical outcomes. Despite this benefit, there are still barriers to use including POCUS workflow. This project was undertaken to improve the functionality of the existing POCUS workflow and move toward an "encounter-based" system by automating worklist generation. It aimed to streamline the POCUS workflow, primarily determine if there was improved clinician satisfaction with the new workflow, and secondarily determine the change in revenue generation from decreased errors in data entry. METHODS:A new workflow was created which automatically populated every registered Emergency Department (ED) patient into the worklist upon patient registration. Clinician feedback on their use of the new workflow was sought via survey after implementation. The number of medical record number (MRN) entry errors prior to and following implementation was manually reviewed and calculated. RESULTS:There was a strong preference for the new workflow, with 36 of 38 (94.7%) clinicians finding it to be more convenient and 37 of 38 (97.4%) finding it to be preferable to use compared to the old workflow. Implementation also resulted in a 36% reduction in database studies containing an MRN data entry error. CONCLUSIONS:An "encounter-based" workflow is strongly preferred over manual data entry for POCUS workflow among clinicians. Additionally, there was no cost to the intervention and the total data entry errors were significantly reduced, allowing for improved quality review and increased revenue.

Introduction: Food and housing insecurity in childhood is troublingly widespread. Emergency departments (ED) are well positioned to identify and support food- and housing-insecure children and their families. However, there is no consensus regarding the most efficient screening tools or most effective interventions for ED use. Objective: In this cross-sectional study we aimed to investigate the implementation of a food/ housing insecurity screening tool and resource referral uptake in a pediatric ED. Methods: During the study period (March 1–December 9, 2021), there were 67,297 ED visits at the study institution, which is a freestanding children’s hospital. Caregivers of patients presenting to the ED were approached for participation in the study; 1,908 families participated (2.8% of all ED visits during the study period) and were screened for food and housing insecurity. Caregiver surveys included demographic, food and housing insecurity, caregiver/patient health status, and healthcare utilization questions. Caregivers who screened positive for food and/or housing insecurity received printed materials with food and/or housing resources. We analyzed data using descriptive statistics, one-way analysis of variance, and the Pearson chi-squared test. Results: A total of 1,908 caregivers were surveyed: 416 (21.8%) screened positive for food and/or housing insecurity. Of those who screened positive, 147/416 completed follow-up surveys. On follow-up, 44 (30.0%) no longer screened positive for food and/or housing insecurity, while 15 (10.2%) reported using at least one resource referral. The most frequently reported referral utilization barrier was loss or reported non-receipt of the referral. Conclusion: This study demonstrates high food- and housing-insecurity rates among families presenting to a pediatric ED, emphasizing the urgency and necessity of screening and intervening in this environment. The food and housing insecurity change between baseline and follow-up reported here and the overall low resource uptake highlights challenges with ED-based screening and intervention efficacy.

Although alcohol has been illegal in Iran for over four decades, its consumption persists. This study aims to determine the prevalence and determinants of alcohol consumption in Tehran, the Middle East’s third-largest city, using data from the Tehran Cohort Study (TeCS). Our study encompasses data from 8420 individuals recorded between March 2016 and March 2019. We defined alcohol use as the lifetime consumption of alcoholic beverages and/or products. We calculated the age- and sex-weighted prevalence of alcohol use in addition to crude frequencies. We also determined the weighted prevalence of alcohol use in both genders. Multivariable logistic regressions were employed to investigate the adjusted odds ratios for the determinants of alcohol use. The mean age of participants was 53.8 ± 12.7 years. The lifetime prevalence of alcohol use was 9.9

INTRODUCTION:Hemorrhage continues to be the leading cause of preventable death in trauma, and tourniquet application has been associated with survival. The purpose of our study was to evaluate the efficacy of telesimulation (TeleSIM) versus in-person training (SIM) for teaching tourniquet application for life-threatening hemorrhage control. METHODS:We performed a prospective randomized study of participants enrolled in a Stop The Bleed course at a university medical school. The TeleSIM group completed the course with an instructor streaming live from an off-site location. The SIM group completed the course in the standard fashion with a live instructor present. The primary endpoint was the successful application of a combat application tourniquet to a bleeding extremity in a simulation scenario. We also evaluated the time for successful tourniquet application according to training modality. Participants' thoughts, feelings, and attitudes pertaining to their experience in the course were obtained via a postcourse survey. RESULTS:Ninety-four of 97 (96.9%) eligible subjects participated in the study. There was no difference in the proportion of participants in each group who successfully applied a combat application tourniquet during their simulation scenario: TeleSIM group, 100% (95% CI, 92.5-100.0); SIM group, 100% (95% CI, 92.7-100.0). We also observed no significant difference in the mean time it took the participants to apply a tourniquet regardless of their training modality. Both groups reported their learning modality as an effective way to learn hemorrhage control. CONCLUSION:A telesimulation-based instructional delivery design is an effective way to teach tourniquet application for hemorrhage control.