UpToDate®

UpToDate® and Emergency Medicine News are collaborating to present select newly released UpToDate Emergency Medicine content synopses, such as the examples below. UpToDate is the premier evidence-based, clinical support resource used by emergency medicine professionals and healthcare practitioners worldwide to make informed clinical decisions at the point of care. Please note that the examples below are accurate as of the month/year indicated next to each topic excerpt. To ensure you are accessing the most current clinical information, subscribe to UpToDate. For a limited time, you can receive an additional 30 days added to an annual or longer personal subscription term when you visit go.uptodate.com/emn and enter promo code EMN30. This offer is valid through May 31, 2026. Catheter-directed thrombolysis versus anticoagulation in pulmonary embolism (March 2026) In patients with intermediate-high-risk pulmonary embolism (PE; ie, biochemical and imaging evidence of right ventricle [RV] dysfunction), limited data suggest that catheter-directed thrombolysis improves RV function compared with anticoagulation alone, but does not improve mortality. In a recent randomized trial of 544 patients with intermediate-high-risk PE, ultrasound-facilitated, catheter-directed thrombolysis with alteplase reduced the composite outcome of PE-related death, cardiorespiratory decompensation, or symptomatic PE recurrence compared with anticoagulation alone (4 versus 10 percent); this difference was driven primarily by fewer episodes of decompensation (3.7 versus 10.3 percent).1 Major bleeding was numerically higher in the alteplase group (4 versus 2 percent) but was not statistically significant, and the difference in RV size at 48 hours between the two groups was also not significant. Interpretation is limited by low event rates, lack of blinding, and underrepresentation of patients >75 years. However, these data support our practice of performing catheter-directed therapies in patients with intermediate-high-risk PE. Updated international Surviving Sepsis Campaign guidelines (March 2026) The Surviving Sepsis Campaign guidelines have recently been updated.2 The guidelines suggested that, while a mean arterial pressure of 65 mmHg should be targeted, a range of 60 to 70 mmHg is practical for most adults with sepsis. The guidelines also emphasized the importance of screening tools for early detection and management of sepsis, while discouraging both overly aggressive fluid resuscitation and empiric treatment for fungal and anaerobic bacterial infections, especially when suspicion is low. The guidelines encouraged active fluid removal (in the later phases of shock), rapid de-escalation of antimicrobials and, in mechanically ventilated patients, the use of selective digestive tract decontamination to prevent ventilator-associated pneumonia. We agree with these recommendations. AHA/ACC guidelines for pulmonary embolism (March 2026) Several societies, including the American Heart Association/American College of Cardiology (AHA/ACC), have issued joint guidelines for the evaluation and management of pulmonary embolism (PE).3 The guidelines stratify patients by risk of PE-related death to facilitate management. Patients in category A (incidental PE), B (symptomatic PE with a low clinical severity score), and C (symptomatic PE with an elevated clinical severity score) require anticoagulation. Patients in category D (incipient cardiopulmonary failure) and E (cardiopulmonary failure) are candidates for reperfusion therapies (eg, thrombectomy or thrombolysis, if they have a low bleeding risk). We await adoption of this classification and encourage its use to facilitate management. Pediatric sepsis hospitalization and mortality in the United States (March 2026) New estimates of United States sepsis hospitalizations and in-hospital mortality based on a pediatric sepsis event definition derived from the 2024 Phoenix sepsis criteria have been reported using electronic-health record surveillance of clinical data from over 3.9 million pediatric hospitalizations (neonates excluded) from 2016 to 2023. The average annual hospital incidence of sepsis was 1.3 percent (over 18,000 annual cases); overall in-hospital mortality was 10.1 percent (over 1800 annual deaths).4 Annualized national estimates remained stable over the study period. These findings update prior sepsis estimates based upon older definitions of pediatric sepsis and confirm the high burden of pediatric illness due to sepsis in the United States. Persistent symptoms of concussion in young children (March 2026) In a prospective study, 235 young children (median age 2.4 years, 98 percent with a Glasgow Coma Scale (GCS) score of 15) were diagnosed with concussion in the emergency department (ED) based on the GCS score and ≥1 of the following: palpable skull fracture, headache (in verbal patients), altered mental status, or loss of consciousness.5 At one month, 28 percent had persistent symptoms on a parent-reported symptoms score. This rate was significantly higher than in controls with orthopedic injuries undergoing ED evaluation and community children. On adjusted analysis, ED symptom severity was the primary predictor of persistent symptoms. These findings suggest that, similar to older children and adolescents, young children appear to have a significant risk of persistent symptoms of concussion after a mild head injury that appears to be associated with the severity of symptoms at initial evaluation.