ACEP Now (Formerly ACEP News)

By | on August 26, 2026 | Uncategorized Jahnavi Curlin, MD, MPH, is the newest member of ACEP Now’s editorial team. Dr. Curlin is a third-year emergency medicine resident at the University of California, San Francisco Fresno (UCSF), training in California’s Central Valley. As the 2026–27 Resident Fellow, Dr. Curlin will oversee the “Resident Voice” column while contributing the perspective of emergency medicine residents to the editorial board.

Case: A 74-year-old woman with hypertension and stage 3 chronic kidney disease presents to the emergency department (ED) with fever, vomiting, dysuria, and right flank pain. She is confused, mottled, and has delayed capillary refill. Her temperature is 39.1°C, heart rate 116 beats per minute, blood pressure 84/50 mmHg, respiratory rate 20 breaths per minute, and oxygen saturation 95 percent on room air.

A colleague of mine retired last year at age 58. Healthy by standard measures, still intellectually sharp, and still enjoying the work, he left because he was tired — but in a way that sleep no longer fixed. After 26 years of emergency medicine, 15 of them working primarily nights, he did not burn out dramatically. He just ran out of reserve. I have been thinking about that distinction ever since.

A 43-year-old female with a past medical history of bipolar disorder and hypothyroidism presented to the emergency department with three days of nausea, vomiting, and coffee-ground emesis. Her home medications were divalproex sodium and sertraline; she additionally reported starting semaglutide 0.25 mg by subcutaneous injection three days prior.

Imagine that it is 2 a.m., and a patient presents with sweating, vomiting, and an inability to sleep, afraid of what will happen without the next tablet or shot. Until recently, the product that kept them feeling this way may have been purchased from a gas station, smoke shop, or online and was marketed for “calm,” “focus,” pain relief, or as an alternative to alcohol dependence. Countless patients present this way. Many of them were not seeking an opioid. They were marketed one.

The call came in as they always do—brief, detached, clinical. Adult female, unresponsive, possible overdose. By the time she arrived in my bay, the paramedics had pushed multiple rounds of naloxone with no meaningful response. We moved fast. Airway, access, dextrose, flumazenil, a full tox screen. She was polypharmacy. We adjusted. She stabilized. By the time she was admitted to the intensive care unit, intubated and sedated, the acute crisis was over.

The 5th Circuit Court has ruled in favor of the Texas Medical Association, siding with ACEP advocacy and dealing a firm blow to insurance companies. What they said: The court determined that the insurer calculation known as the Qualified Payment Amount (QPA) cannot include “ghost rates,” which artificially lower reimbursement rates.

Fluid resuscitation remains a cornerstone of sepsis management. Yet one of the most common interventions in emergency medicine has also been the subject of persistent debate: Which crystalloid should we use in the initial resuscitation of children with suspected sepsis? Historically, normal saline (NS) has been the default fluid for pediatric septic shock. It is readily available, familiar to clinicians, inexpensive, and compatible with many medications.

In 2018, a previously healthy 4-year-old girl sought care multiple times for recurrent back and hip pain. Prior evaluations, including radiographs and orthopedic assessment, failed to identify a cause. On December 16, 2018, she presented to the emergency department (ED) with recurrent atraumatic back pain, currently rated as 2 out of 10 but up to a 9 out of 10.

In 2021, I was the most burned out I had ever been in my career. Burnout peaked during the pandemic for many emergency physicians. At first, I thought receiving my first COVID-19 vaccine would be more than just protection against the virus; perhaps it was the shot I needed to come out of the burnout fog as well. Although I use the term “burnout,” it was a much deeper level of exhaustion; it was more of a soul-level existential crisis.