Richard J. Gawel

Context: Ultrasound-guided nerve blocks (UGNBs) are increasingly used in the emergency department (ED) to provide effective, opioid-sparing analgesia. Although their use is well described in adult emergency medicine, the scope, indications, and safety of UGNBs in pediatric emergency medicine remain less well defined. Objective: To characterize the published literature describing emergency physician-performed UGNBs in pediatric emergency medicine to identify trends and directions for future research. Data Sources: We electronically searched the PubMed/MEDLINE, Scopus, Embase, and Wiley Cochrane libraries from database inception through March 23, 2026. Study Selection: We included original studies describing UGNBs performed in pediatric patients by emergency physicians in the ED. Data Extraction: Three authors independently reviewed included articles and abstracted data on study characteristics, patient populations, UGNB types, clinical indications, anesthetics and adjuvants, and reported adverse events. Results: From an initial database search of 5917 unique articles, 37 articles were included encompassing 440 pediatric patients who received 462 UGNBs. Twenty-one different UGNB types were described, most commonly femoral nerve blocks (8 articles, 22%; 128 blocks, 28%) and fascia iliaca compartment blocks (3 articles, 8.1%; 124 blocks, 27%) for hip and femur fracture analgesia. Two self-limited UGNB-related adverse events (0.5%) were reported, with no long-term sequelae. Study designs were heterogeneous, with substantial variability in reporting practices and frequent inclusion of mixed adult-pediatric cohorts. Conclusions: Emergency physician-performed UGNBs are increasingly reported in pediatric emergency medicine. Reported complication rates are low. The overall heterogeneous and limited evidence base highlights the need for larger, prospective studies to better define the role of UGNBs in pediatric emergency care.

Research is important to advance the field of emergency medicine and improve patient care. As such, emergency medicine residents are required to complete a scholarly project during their training. This experience provides an opportunity to enhance their exposure to research, expanding their skillset as both producers and consumers of the medical literature. However, the process may be overwhelming to launch, especially for residents. This Educator's Blueprint will provide 10 strategies for navigating and optimizing the resident research experience. These strategies include providing structured training, creating a research‐supportive environment, selecting a project using resident‐centric FINER criteria, identifying a research mentor, creating mosaic research experiences, setting expectations, empowering residents, selecting team members for sustainability, providing scaffolding and support during the writing stage, and explaining the peer review process and normalizing rejection or revisions. These strategies will help guide faculty seeking to enhance their learners' research experience.

Background: Acute limb ischemia (ALI) is a vascular emergency associated with significant pain that can be challenging to manage, especially in opioid-tolerant patients. Case Report: A 44-year-old man with opioid use disorder presented with ALI of the right hand not amenable to surgical intervention after self-injection of fentanyl. Despite high-dose opioids, he continued to experience refractory pain. Point of care ultrasound (POCUS)-guided radial and median nerve blocks performed in the emergency department provided substantial relief. Discussion: This case illustrates the novel use of POCUS-guided upper extremity regional anesthesia by emergency physicians to manage ALI pain. POCUS-guided regional anesthesia may be a safe, effective adjunct in select patients, though patients must be closely monitored for complications.

Introduction: Breakthrough pain is frequently experienced by patients with gastrointestinal malignancies and is a common reason for presenting to the emergency department (ED). After ruling out acute pathology, ED management typically consists of intravenous opioids, though high doses of opioids can be associated with potentially severe adverse events and complications in certain high-risk populations. Regional anesthesia strategies, such as the erector spinae plane block (ESPB), have shown to be effective for several etiologies of non-malignant visceral abdominal pain. This case series sought to evaluate whether the ESPB can be effective for ED patients with breakthrough pancreatic and hepatobiliary cancer pain. Case Report: Three patients with breakthrough hepatopancreatobiliary cancer pain underwent successful ESPBs performed by an emergency medicine physician in the ED. All patients reported considerable reduction in their pain. Two patients with cancer of the pancreatic head reported complete pain relief and were able to be discharged from the ED. The third patient with metastatic colorectal cancer involving the hepatobiliary system was admitted for further medical work-up, though did not require any additional analgesics for nearly 13 hours after the block. Conclusions: The ESPB appears to be a safe and effective strategy for managing breakthrough pain related to pancreatic and hepatobiliary malignancy in the ED.