Abstract Purpose of Review To provide emergency physicians with a clear, evidence-based, and practical approach to deciding when and how to use albumin in the management of sepsis and septic shock in the emergency department (ED). This review outlines a five-step clinical framework that integrates current guidelines, trial data, and ED-specific considerations to guide albumin use in selected patient populations. Recent Findings Crystalloids remain the first-line fluid resuscitation for sepsis, as recommended by the Surviving Sepsis Campaign (SSC). However, albumin may offer clinical benefit in cases of fluid-refractory hypotension, volume overload, hypoalbuminemia (<2.5 g/dL), septic shock with capillary leak, and in special populations such as patients with cirrhosis, nephrotic syndrome, or burns. Summary Albumin is not a first-line resuscitation fluid, but has a role in specific ED scenarios where crystalloids alone may be insufficient or potentially harmful. A structured, stepwise framework can help emergency physicians identify when albumin may improve hemodynamics, minimize fluid overload, and support vascular integrity. Judicious use—guided by patient characteristics, response to crystalloids, and coordination with critical care teams—can enhance individualized resuscitation strategies in sepsis and septic shock. A summary of recommendations which can be utilized as a quick bedside reference is found in Table 1.

Abstract Purpose of Review This review evaluates the safety and efficacy of ketamine, alone or in combination with other agents, for procedural sedation during fracture reduction in pediatric emergency settings. The goal is to provide clinicians with an updated synthesis of evidence to guide sedation strategies in this common clinical scenario.by synthesizing evidence on outcomes such as adverse events, sedation success, and recovery time. Recent Findings A systematic review and meta-analysis of studies published up to January 2025 showed that the overall adverse event rate associated with ketamine was 24% (95% CI: 16–32%). Ketamine monotherapy was linked with higher rates of vomiting (13%) and agitation (17%), while combination regimens reduced agitation but were associated with a higher rate of severe hallucinations (28%). Airway problems were uncommon, with hypoxia occurring in only 1–5% of cases and no reports of intubation. Fracture reduction success rates were 86% with monotherapy and 99% with combination techniques. Recovery profiles differed: ketamine monotherapy had longer sedation duration (42.6 min) but shorter recovery time (44.1 min), while combinations resulted in shorter sedation (19.7 min) and longer recovery (76.7 min). Redosing was needed in 25% of monotherapy cases. Summary Ketamine is a safe and effective option for procedural sedation in pediatric fracture reduction. While combination regimens enhance procedural success and reduce agitation, they are associated with longer recovery times and more severe hallucinations. Ketamine monotherapy offers a faster recovery but may require redosing. Clinicians should individualize sedation strategies based on patient characteristics and institutional capabilities. Further research is needed to optimize dosing regimens, explore multimodal combinations, and conduct direct comparisons with other sedative agents.

Purpose of ReviewThe purpose of this review is to describe recent advances in dermal wound closure technologies available in the emergency department and to summarize their indications, advantages, limitations and clinical outcomes as compared to traditional wound closure methods.Recent FindingsRecent technological advances in dermal wound closure devices can lead to improved wound closure rates, increased speed of healing, and improved scar cosmesis when compared to conventional closure methods. These techniques may provide clinicians with novel tools to treat patients in the acute care environment, including the potential for live biomonitoring, enhanced drug delivery to wounds, and improved means of addressing serious complications such as acute hemorrhage.SummaryWhile recent breakthroughs in technologies used for skin laceration repair may offer improvements in healing speed, wound closure rates, scar cosmesis, and biomonitoring, there is still need for further investigation into the efficacy, cost effectiveness and indications for use of these methods in the acute care environment.