Contributor; Aaron Lessen, MD

Educational Pearls:

• A 2026 survey asked Canadian emergency medicine (EM) physicians about their eating and drinking habits while on shift.

• • Among 527 respondents, 35% reported that they never or hardly ever ate during shifts, and 37% said the same about drinking water.

  • Lack of time was the most commonly cited barrier, reported by 91% of respondents.

  • Lack of available food, personal health goals, perceived mental clarity, and emergency department culture were also commonly identified factors.

  • Physicians who did not eat or drink on shift often reported that this negatively affected their work.

  • Years in practice were associated with eating more often while on shift, suggesting that newer physicians may be less likely to eat during shifts.

• A 2023 study by Kontrick et al. found that 89% of US-based EM residency programs did not have a dedicated meal break, which may help explain why early-career physicians are less accustomed to eating during clinical shifts.

• Studies outside of emergency medicine have also suggested that inadequate food and fluid intake can affect fatigue, mood, attention, and cognitive performance, though direct evidence in emergency department physicians and patient care remains limited.

• Future studies could examine whether physician eating and drinking habits during shifts are associated with patient outcomes and broaden the scope of this study to other emergency department providers, nurses, and technicians.

References:

1. Farquhar, Madeleine et al. "A lot on their plates? Examining the on-shift eating and drinking habits of Canadian emergency medicine physicians." CJEM vol. 28,1 (2026): 64-73. doi:10.1007/s43678-025-01044-8

2. Kontrick, Amy V et al. "Do emergency medicine residents have access to healthy food options during work hours?." AEM education and training vol. 7,4 e10890. 17 Jul. 2023, doi:10.1002/aet2.10890

3. Lemaire, Jane B et al. "Physician nutrition and cognition during work hours: effect of a nutrition based intervention." BMC health services research vol. 10 241. 17 Aug. 2010, doi:10.1186/1472-6963-10-241

4. Wittbrodt, Matthew T, and Melinda Millard-Stafford. "Dehydration Impairs Cognitive Performance: A Meta-analysis." Medicine and science in sports and exercise vol. 50,11 (2018): 2360-2368. doi:10.1249/MSS.0000000000001682

Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P

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Contributor; Taylor Lynch, MD

Educational Pearls:

• Thoracotomy

• • Thoracotomy is used in traumatic cardiac arrest to replace conventional CPR with direct access to the chest.

  • Goals include identifying and controlling reversible causes of bleeding, prioritizing blood flow to the heart and brain, and performing open cardiac massage.

• Trauma categories

• • Penetrating trauma: Gunshot wounds and stab wounds.

  • • Has a higher chance of survival because the injury may be localized and directly repairable.

    • Cardiac stab wounds may have the highest survivability because the defect can be visualized, repaired, and treated with blood administration.

  • Blunt trauma: Motor vehicle collisions and falls from height.

  • • Has a much lower chance of survival.

• Western guidelines

• • EMS must witness the patient lose pulses.

  • Penetrating trauma: CPR for less than 15 minutes.

  • Blunt trauma: CPR for less than 10 minutes.

  • Survival decreases to essentially zero beyond these time limits.

• Eastern guidelines

• • Focus on the presence of signs of life in blunt or penetrating trauma.

  • Signs of life may include:

  • • Pupillary response.

    • Measurable blood pressure.

    • Purposeful movement.

• Patient selection

• • Thoracotomy should only be performed when the patient has a reasonable chance of survival.

  • It is a highly morbid procedure with significant occupational risks, including needlestick injury.

  • Appropriate patient selection and timing are essential.

• Procedure

• • Begin on the left side of the chest.

  • Cross-clamp the aorta to restrict blood flow below the heart and prioritize circulation to the heart and brain.

  • Identify and repair visible sources of bleeding involving structures such as the heart or lungs.

  • Perform open cardiac massage as the equivalent of CPR.

  • ACLS medications may still be administered.

References:

1. Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 2006;1:4. Published 2006 Mar 24. doi:10.1186/1749-7922-1-4

2. Rhee, Peter M. ; Acosta, Jose ; Bridgeman, Amy et al. / Survival after emergency department thoracotomy : Review of published data from the past 25 years. In: Journal of the American College of Surgeons. 2000 ; Vol. 190, No. 3. pp. 288-298.

3. Nunn, Andrew ; Prakash, Priya ; Inaba, Kenji et al. / Occupational exposure during emergency department thoracotomy : A prospective, multi-institution study. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 1. pp. 78-84.

4. Burlew CC, Moore EE, Moore FA, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359-1363. doi:10.1097/TA.0b013e318270d2df

5. Seamon MJ, Haut ER, Van Arendonk K, et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;79(1):159-173. doi:10.1097/TA.0000000000000648

Summarized by Steven Fujaros NREMT | Edited by Steven Fujaros & Ahmed Abdel-Hafiz, NREMT-P

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Contributor: Aaron Lessen, MD

Educational Pearls:

• Agitated patients who are intoxicated with methamphetamine pose a unique challenge when selecting a sedative to counter their symptoms. Is there a superior medication?

• A recent study compared the efficacy of commonly used medications for methamphetamine-induced agitation in the emergency department.

• • The study compared IM Droperidol 5mg, IM Olanzapine 10mg, IM Midazolam 5mg, and IM Lorazepam 2mg.

  • The study concluded that Droperidol, Olanzapine, and Midazolam performed similarly, with a median time to adequate sedation of 15 minutes.

  • Lorazepam took the longest, with a median time of 30 minutes to achieve adequate sedation.

  • • Patients who received Lorazepam also required rescue medication more frequently after the initial dose.

• Key takeaway: Droperidol, Olanzapine, and Midazolam may be more effective than Lorazepam for treating methamphetamine-induced agitation.

References:

1. Martel M, Klein LR, Cole JB, et al. Intramuscular droperidol, olanzapine, midazolam, or lorazepam to treat methamphetamine intoxication in the emergency department. Am J Emerg Med. 2021;49:142-148. doi:10.1016/j.ajem.2021.05.045

Summarized by Ashley Lyons, OMS4 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

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