Sepsis stands apart from the other emergencies that define time-critical care. While trauma, stroke, and STEMI are anchored by a discrete lesion and a confirmatory test, sepsis offers no such certainty – no single biomarker, no clear identifiable moment of onset, no clean diagnostic threshold. Clinicians are instead asked to recognize a shifting constellation of signs that vary by both pathogen and a fluid host immune response, often without the reassurance of positive cultures. This review examines the paradox at the heart of emergency sepsis care, which is the demand for immediate, decisive treatment of a syndrome that resists reliable, timely characterization.
Aly Drame, Andrés Abarca, Jodine Chase, Mija Ververs
This study aims to prioritize earthquake-prone countries where infant and young child feeding (IYCF) is most likely to be disrupted after an earthquake and to identify preparedness gaps relevant to implementing the Operational Guidance for Infant and Young Child Feeding in Emergencies (OG-IFE). Using secondary data from the Global Earthquake Model Foundation, we analyzed estimated average annual fatalities and average annual area damaged due to earthquakes to identify the top 20 countries globally with the highest value for each indicator. We then assessed these countries’ vulnerability to infant feeding disruptions by examining their exclusive breastfeeding rates. Out of 198 countries assessed, the findings identify 24 countries with either the highest average annual fatalities or the highest average annual area damaged values from earthquakes, and a cohort of 16 countries appears in both categories. This descriptive risk mapping analysis identifies priority countries for targeted OG-IFE preparedness investment and highlights specific gaps. Those gaps include the absence of OG-IFE translations in several high-risk national languages, which can be addressed before major seismic events occur.
Endotracheal intubation is a critical life-saving procedure in emergency medicine. However, data on training characteristics, perceived proficiency, and educational gaps among emergency medicine residents in Saudi Arabia remain limited. This study aimed to describe the demographic and training characteristics of emergency medicine residents in Saudi Arabia, including their self-estimated first-pass success rates, device preferences, and perceived facilitators of intubation, and to compare these factors across postgraduate year levels. A multi-center cross-sectional study was conducted among emergency medicine residents enrolled in the Saudi Board of Emergency Medicine training program across multiple centers in Saudi Arabia. Data were collected using a structured electronic survey distributed between mid-June and mid-September 2025. A total of 100 residents completed the survey, with an even distribution across postgraduate year (PGY) levels. The median self-estimated first-pass success rate was 80% (IQR = 70%–90%). Video laryngoscopy was the preferred device (66%), and the most frequently cited facilitators were proper positioning (85%) and video laryngoscope use (71%). Notably, 19% of residents reported lacking confidence in intubating alone, and 24% perceived insufficient supervised opportunities. A significant association was found between PGY level and intubation confidence (p < 0.001), with 36.7% of PGY-1 residents lacking confidence compared to none among PGY-3 and PGY-4 residents. The perceived importance of good supervision declined significantly with advancing training (p < 0.001), from 66.7% among PGY-1 to 12.5% among PGY-4. Significant differences were also observed in perceptions of sufficient supervised opportunities across PGY levels (p = 0.048), with PGY-2 residents reporting the lowest satisfaction (60.9%) and PGY-3 the highest (95.7%). This study provides a preliminary characterization of intubation training among emergency medicine residents in Saudi Arabia. Although most residents ultimately develop confidence, a notable minority lack confidence and perceive insufficient supervised opportunities. The findings suggest the PGY-2 year may be a transitional phase that could benefit from targeted support. Video laryngoscopy is strongly preferred, though device versatility appears to increase with seniority. It is important to note that these results reflect residents’ self-reported perceptions and should not be equated with objective measures of procedural competence.
Nathan H. Johnson, Nancy G. Casanova, Sara M. Camp, Leopoldo Cancio, Yansong Li, Joe G. N. Garcia
Triage of and evacuation decisions for military service members deployed into combat zones experiencing traumatic injuries are serious challenges for military medical providers. We explored the utility of inflammatory biomarkers in determining injury severity and predicting hospital resource utilization to improve the effectiveness of casualty care. Serum levels of inflammatory cytokines (eNAMPT, IL-6, PSGL-1, ANG-2, IL-1β, IL-1RA, TNF-α, and S100A8) and neurotrauma biomarkers (GFAP, NfL, and tau) were analyzed in trauma-exposed warfighters (n = 39) evacuated to a medical treatment facility. Prior to analysis, outliers were removed via robust regression and outlier removal, with the results analyzed using the Mann–Whitney test, Kruskal–Wallis test w/ Dunn, or Spearman correlation. All the tested biomarkers were significantly elevated (p < 0.0001) in combat casualties vs. healthy controls (n = 46) and exhibited injury type-specific elevations. Serum eNAMPT (p = 0.033) and TNF-α (p = 0.047) were significantly higher in penetrating wounds vs. blunt trauma; IL-1β (p = 0.005) and S100A8 (p = 0.005) were significantly elevated in thermal injures vs. blunt trauma; and GFAP (p < 0.001) and NfL (p = 0.017) were significantly elevated in blunt trauma vs. thermal injury. Statistical correlations between biomarkers and clinical outcomes indicated the following: (i) duration of mechanical ventilatory support correlated with IL-1RA level (p = 0.021); (ii) duration of hospital stay correlated with IL-6 (p = 0.016) and eNAMPT levels (p = 0.046); and (iii) duration of ICU stay correlated with eNAMPT (p = 0.016) and S100A8 (p = 0.017) levels. Our results extend prior reports of innate immune activation following traumatic injury and suggest a diverse panel of inflammatory biomarkers may predict hospital resource utilization to inform prioritization of local resources and evacuation to higher levels of care.
