1 10 43 https://repository.horizon.ac.id/files/original/73d9fa3c735986238c53d1d47a720cdb.pdf 1c0f0e40bf08e25ee92a03c3c04fe22f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Adapting a novel emergency triage tool to a resource-limited hospital in Nepal Subject The topic of the resource Triage, Emergency department, Quality improvement, Nepal, Global health Description An account of the resource Abstract Background Effective triage is critical for prioritizing emergency care. However, many low- and middle-income countries lack standardized triage systems. Nepal has been working to introduce the WHO’s Interagency Integrated Triage Tool (IITT) into emergency departments nationwide. Still, successful implementation requires context-specific adaptations to address operational realities and resource constraints. Objective This study aimed to collaboratively adapt the IITT for use in the Dhulikhel Hospital Emergency Department by incorporating frontline staff insights to develop a feasible, sustainable triage workflow. Methods Five focus groups composed of doctors, nurses, and paramedics were conducted. Through semi-structured discussions, we explored staff perceptions of areas for improvement in the existing triage processes. Participants then generated site-specific workflow models through iterative brainstorming sessions, progressively refining the design into a final consensus-based model. Results Participants, representing over 80% of clinical staff, identified key barriers to effective triage, including inconsistent communication, unclear handoff responsibilities, and insufficient training. The final triage workflow addressed many critical challenges raised in discussion sessions, provided a standardized and customized triage process, and resulted in high reported confidence in its utility. Conclusion This study demonstrates the value of a bottom-up, staff-centered approach to triage system development and implementation. Our focus group design offers a practical, replicable framework for low-resource emergency departments seeking to implement the IITT or similar protocols into their ED operations. Future efforts should focus on validating the workflow’s impact on patient outcomes and triage efficiency and investing in thorough and longitudinal training to support sustained adoption. Keywords Triage, Emergency department, Quality improvement, Nepal, Global health Creator An entity primarily responsible for making the resource Yael Weiner1*, Claire Therriault1*, Tina Duwal2 , Samjhana Basnet2 , Roshana Shrestha2 and Sanu Krishna Shrestha2* Date A point or period of time associated with an event in the lifecycle of the resource 2025 Contributor An entity responsible for making contributions to the resource Peri Irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Triage, Emergency department, Quality improvement, Nepal, Global health https://repository.horizon.ac.id/files/original/ec0582f1ff22a7f0cb2d2a01f90d3ca1.pdf ac5f526d2285c463ab5a98dbae14c24e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A direct qualitative content analysis on the design, implementation, and evaluation of prehospital earthquake exercises aligned with the HSEEP framework Subject The topic of the resource Preparedness, Prehospital, Earthquake, Exercise Description An account of the resource Abstract Introduction Disaster exercises are a vital strategy for enhancing Emergency Medical Services (EMS) operational preparedness. This study aimed to extract “Golden Keys” for Design, Implementation and Evaluation of earthquake exercises aligning these key components with the internationally recognized Homeland Security Exercise and Evaluation Program (HSEEP) Framework from the perspective of experienced Iranian prehospital technicians. Method A qualitative study was conducted using a directed content analysis. Data were systematically gathered through in-depth semi-structured interviews with 11 prehospital technician that purposefully selected based on their demonstrated expertise in prehospital exercise management. Data analysis was conducted in five steps following Granheim and Lundman’s approach and the study used Lincoln and Guba’s recommendations to assess data trustworthiness. Result After multiple rounds of data analysis and summarization 386 initial codes, 13 subcategories, and five main categories were identified. These main categories included “Exercise Foundation and Program Governance”, “Exercise Design, Coordination, and Control”, “Operational Implementation of the Exercise”, “Performance Evaluation and Capability Assessment” and “Learning, Workforce Empowerment”, and “System Improvement”. Conclusion Earthquake preparedness exercises must be sustained as an ongoing effort to enhance prehospital system resilience. The indicators identified in this study provide an actionable, evidence-based framework for EMS managers and policymakers to design, implement, and evaluate exercises aligned with system priorities. Translating exercise outcomes into actionable evidence facilitates informed decision-making targeted resource allocation and evidence-based policy formulation. Future research should focus on contextualizing this framework within localized programs and conducting quantitative validation of the proposed indicators. Keywords Preparedness, Prehospital, Earthquake, Exercise Creator An entity primarily responsible for making the resource Asiye Aminafshar1 , Ali Moradi Chaleshtori2 , Ali Khosravizad3 , Ali Sahebi3* and Hojjat Farahmandnia4* Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01135-y Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Preparedness, Prehospital, Earthquake, Exercise https://repository.horizon.ac.id/files/original/68fd0baff56c8609341d63defff010e0.pdf e53c2ad327398ec9d21d223f9125f12f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Accuracy of ultrasound for intussusception in pediatric emergency presentations: a systematic review and diagnostic meta- analysis Subject The topic of the resource Intussusception, Emergency department, Pediatrics, Surgery, Point-of-care ultrasound Description An account of the resource Abstract Introduction Intussusception is a common cause of acute abdominal emergencies in children. This systematic review and diagnostic meta-analysis aimed to determine the diagnostic accuracy of ultrasound for intussusception in pediatric emergency presentations, providing pooled estimates for sensitivity, specificity, predictive values, and diagnostic odds ratios to inform clinical practice. Methods Adhering to PRISMA-DTA guidelines, a comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science up to July 2025. Bayesian bivariate random-effects meta-analyses were performed to estimate pooled sensitivity, specificity, and other measures, with subgroup and meta-regression analyses to explore heterogeneity. Results A total of 44 studies comprising 4,142 pediatric patients were included in the quantitative synthesis. The pooled sensitivity of ultrasound for diagnosing intussusception was 96.3% (95% credible interval [CrI] 94.9–97.5%), and the pooled specificity was 95.7% (95% CrI 93.3–97.5%). The area under the hierarchical summary receiver operating characteristic curve (AUC) was 0.81–0.82, indicating good discriminative ability. Positive predictive value (PPV) ranged from 54.1% at 5% prevalence to 99.8% at 95% prevalence, while negative predictive value (NPV) decreased from 99.8% to 57.7% across the same prevalence range. The overall certainty of evidence for sensitivity and specificity was rated as high, with moderate certainty for prevalence due to substantial heterogeneity. Conclusion Ultrasound demonstrates excellent diagnostic performance for pediatric intussusception in emergency settings, with high sensitivity and specificity maintained across patient subgroups and operator backgrounds. These findings support the continued use of ultrasound as the first-line diagnostic modality in both high- and low-resource environments and highlight the importance of structured training to optimize its accuracy. Future research should focus on multicenter prospective studies, standardization of ultrasound protocols, and the integration of artificial intelligence to further enhance diagnostic reliability. Creator An entity primarily responsible for making the resource Mohammed Alsabri1,2* , Shree Rath3 , Mohamed Amr Elkarargy4 , Amira A. Aboali5 , Khaled Abouelmagd6 , Abdelaziz Abdelaziz Abdelftah Ramadan7 , Luis L. Gamboa8 , Patrick Yoo9 and Yisha Cheng9 Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01134-z Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Intussusception, Emergency department, Pediatrics, Surgery, Point-of-care ultrasound https://repository.horizon.ac.id/files/original/1bb1d009071e1fc89d112b7382021d29.pdf 106b2b3be19f35c86892834ba87f5637 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Effectiveness of a flipped classroom model for enhancing emergency physicians’ skills in diagnosing high-risk pulmonary embolism with point-of-care ultrasound: a randomized controlled study Subject The topic of the resource Flipped classroom, Point of care ultrasound, High-risk pulmonary embolism Description An account of the resource Abstract Background High-risk pulmonary embolism is a significant cause of morbidity and mortality in the emergency department. Point-of-care ultrasonography is a valuable tool for identifying high-risk pulmonary embolism at the bedside, but many physicians lack proficiency. A flipped classroom model may enhance point-of-care ultrasound training, but its effectiveness compared to standard teaching remains unclear. Methods Emergency physicians and residents at a single academic centre were randomized to either a flipped classroom or standard teaching after a baseline assessment of their ability to identify high-risk pulmonary embolism using a database of ultrasound clips. The flipped classroom group completed an online module, while the standard teaching group attended an in-person seminar. Both groups participated in an in-person workshop and subsequently underwent post-training testing. The primary outcome was the difference in final test scores. Statistical analysis included Student’s t-test for mean comparisons, while Fisher’s exact test and one-way ANOVA were used to assess differences between teaching methods, with significance set at p≤0.05. Results A total of 30 participants completed the study (15 in the flipped classroom and 15 in the standard teaching group). Most (80%) reported low baseline confidence in identifying high-risk pulmonary embolism with point-of- care ultrasound. There were no significant differences in baseline scores between the groups (65.0% ± 24.7% for the flipped classroom vs. 64.3% ± 24.9% for standard teaching, p=0.93). Both groups demonstrated significant improvement in scores on final testing (standard teaching: 11% increase, p=0.02; flipped classroom: 7.3% increase, p=0.03). However, there was no significant difference in final test scores between the two groups (75.3% ± 20.1% for standard teaching vs. 72.3% ± 21.4% for the flipped classroom, p=0.65). Creator An entity primarily responsible for making the resource Noman Ali1,2*, Alan Tan2 , Salman Muhammad Soomar1,3, Dominick Shelton2 , Rob Simard2 and Jordan Chenkin2 Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01129-w Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text https://repository.horizon.ac.id/files/original/e03a6663b84a4b7870b147d07a3661bd.pdf 6a2a117925ccc62929d45be58c53f631 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Blunt trauma-induced abdominal wall hernia with small bowel incarceration: case report and review of the literature Subject The topic of the resource Traumatic abdominal wall hernia, Blunt trauma, Bowel obstruction, Mesh repair, Case report Description An account of the resource Abstract Background Traumatic abdominal wall hernia (TAWH) is a rare sequela of blunt abdominal trauma, characterized by disruption of the abdominal musculature and fascia without skin penetration. Diagnosis may be challenging and delayed, with complications such as bowel incarceration or strangulation requiring urgent intervention. This report describes a TAWH complicated by bowel obstruction, followed by a narrative review of relevant literature. Case presentation A 69-year-old male presented with acute abdominal pain, vomiting, and a right flank mass, three days after a road traffic accident. Physical examination revealed a tender, irreducible swelling with overlying abrasions and ecchymosis. Laboratory results were unremarkable. Contrast-enhanced computed tomography (CT) demonstrated an anterior abdominal wall defect containing dilated small bowel loops with features of obstruction and possible strangulation. Emergency exploratory laparotomy revealed incarcerated but viable bowel loops within a traumatic defect. The loops were reduced, and a preperitoneal mesh repair was performed. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 3. Conclusion TAWH, though rare, should be suspected in patients with localized swelling after blunt trauma. Prompt imaging and timely surgical repair are essential to prevent life-threatening complications. Keywords Traumatic abdominal wall hernia, Blunt trauma, Bowel obstruction, Mesh repair, Case report Creator An entity primarily responsible for making the resource Imen Ben Ismail1*, Marwen Sghaier1 , Hakim Zenaidi1 , Houssem Messoudi2 , Saber Rebii1 and Ayoub Zoghlami1 Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01127-y Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Traumatic abdominal wall hernia, Blunt trauma, Bowel obstruction, Mesh repair, Case report https://repository.horizon.ac.id/files/original/dcbf068a5fe60b266d24fced404f1245.pdf 6f82e5d7e44e5d1c5f872a6cfd494a5d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Acute management of spontaneous intracerebral hemorrhage (ICH) in the emergency department Subject The topic of the resource Acute intracerebral hemorrhage, Blood pressure management, Anticoagulation reversal Description An account of the resource Background Spontaneous intracerebral hemorrhage (ICH) is a catastrophic form of stroke affecting more than 3.3 million individuals worldwide each year and accounting for approximately 10–20% of all strokes globally. Although less common than acute ischemic stroke, ICH carries a disproportionate burden of morbidity and mortality, with 30-day case fatality rates approaching 40–50%. Therapeutic advances for ICH have progressed more slowly than for ischemic stroke, and management remains largely supportive. Patients frequently present to the emergency department (ED) in critical condition, making early recognition and rapid, guideline-concordant intervention essential to improving outcomes. Review This narrative review summarizes the most recent American Heart Association/American Stroke Association (AHA/ASA) guidelines for the acute management of spontaneous ICH, with emphasis on practical ED application. Hypertension remains the most important modifiable risk factor, particularly in younger patients, while cerebral amyloid angiopathy predominates in older adults. Additional risk factors include anticoagulant and antiplatelet therapy, alcohol and illicit drug use, smoking, advanced age, and genetic predisposition. Primary brain injury results from hematoma mass effect and elevated intracranial pressure, followed by secondary injury driven by edema, inflammation, and oxidative stress. Because hematoma expansion commonly occurs within the first hours after symptom onset and strongly predicts mortality, early ED management prioritizes rapid neuroimaging, controlled blood pressure reduction, timely anticoagulation reversal, seizure management, metabolic and temperature control, and prompt neurosurgical consultation when indicated. Emerging evidence supports bundled, time-sensitive care pathways to reduce delays and optimize outcomes. Conclusion Optimal ICH outcomes depend on rapid, structured, guideline-concordant ED care focused on limiting hematoma expansion and secondary injury. Standardized workflows and bundled interventions represent effective strategies for improving survival and functional outcomes while avoiding premature prognostication in the acute phase. Keywords Acute intracerebral hemorrhage, Blood pressure management, Anticoagulation reversal Creator An entity primarily responsible for making the resource Madeleine Puissant1 and Latha Ganti2* Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01126-z Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Acute intracerebral hemorrhage, Blood pressure management, Anticoagulation reversal https://repository.horizon.ac.id/files/original/f3a16924a291ab58c262d5923e472796.pdf 6f82e5d7e44e5d1c5f872a6cfd494a5d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Acute management of spontaneous intracerebral hemorrhage (ICH) in the emergency department Subject The topic of the resource Acute intracerebral hemorrhage, Blood pressure management, Anticoagulation reversal Description An account of the resource Background Spontaneous intracerebral hemorrhage (ICH) is a catastrophic form of stroke affecting more than 3.3 million individuals worldwide each year and accounting for approximately 10–20% of all strokes globally. Although less common than acute ischemic stroke, ICH carries a disproportionate burden of morbidity and mortality, with 30-day case fatality rates approaching 40–50%. Therapeutic advances for ICH have progressed more slowly than for ischemic stroke, and management remains largely supportive. Patients frequently present to the emergency department (ED) in critical condition, making early recognition and rapid, guideline-concordant intervention essential to improving outcomes. Review This narrative review summarizes the most recent American Heart Association/American Stroke Association (AHA/ASA) guidelines for the acute management of spontaneous ICH, with emphasis on practical ED application. Hypertension remains the most important modifiable risk factor, particularly in younger patients, while cerebral amyloid angiopathy predominates in older adults. Additional risk factors include anticoagulant and antiplatelet therapy, alcohol and illicit drug use, smoking, advanced age, and genetic predisposition. Primary brain injury results from hematoma mass effect and elevated intracranial pressure, followed by secondary injury driven by edema, inflammation, and oxidative stress. Because hematoma expansion commonly occurs within the first hours after symptom onset and strongly predicts mortality, early ED management prioritizes rapid neuroimaging, controlled blood pressure reduction, timely anticoagulation reversal, seizure management, metabolic and temperature control, and prompt neurosurgical consultation when indicated. Emerging evidence supports bundled, time-sensitive care pathways to reduce delays and optimize outcomes. Conclusion Optimal ICH outcomes depend on rapid, structured, guideline-concordant ED care focused on limiting hematoma expansion and secondary injury. Standardized workflows and bundled interventions represent effective strategies for improving survival and functional outcomes while avoiding premature prognostication in the acute phase. Keywords Acute intracerebral hemorrhage, Blood pressure management, Anticoagulation reversal Creator An entity primarily responsible for making the resource Madeleine Puissant1 and Latha Ganti2* Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01126-z Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Acute intracerebral hemorrhage, Blood pressure management, Anticoagulation reversal https://repository.horizon.ac.id/files/original/f5bc0f7ac4dedca371e2082dabc31fa9.pdf 0ef8fc857b64bd741cebab508a1c6fe1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Designing a model for hospital preparedness against chemical weapons of mass destruction terrorist incidents: a mixed- method study Subject The topic of the resource Preparedness model, Hospital, Preparedness, Terrorist incidents, Chemical, Weapons of mass destruction Description An account of the resource Abstract Introduction Health systems play a pivotal role in managing chemical weapons of mass destruction (WMD) terrorist incidents, particularly in reducing casualties and facilitating crisis management. The growing recognition of the need for precise and effective preparedness in these sectors underscores the importance of this research. The present study aimed to identify the essential components of hospital preparedness and to develop and validate a comprehensive model for hospital readiness in response to chemical WMD terrorist incidents. Methods This study was conducted in 2025 using a three-phase exploratory sequential mixed-methods approach. First, a scoping review was conducted in accordance with Arksey and O’Malley’s methodological framework and the PRISMA guideline to identify key components of hospital preparedness for chemical WMD terrorist incidents. Second, a qualitative study was conducted using semi-structured interviews, and the data were analyzed through a conventional content analysis approach to further identify preparedness components. Third, the components derived from the previous two phases were integrated and validated through two rounds of the Delphi technique. Ultimately, a comprehensive hospital preparedness model was developed. Results Following integration of the scoping review and qualitative findings by an expert panel, 88 preparedness components were identified. After two rounds of the Delphi technique, 82 preparedness components were finalized and classified into 16 subcategories and seven main categories: specialized training and empowerment; psychological support and ethical considerations; security measures; specialized clinical and therapeutic processes; optimal management of surge capacity; integrated information and communication management; and contingency strategic management and planning. Finally, based on the Delphi assessment, the proposed preparedness model was approved by the expert panel. Conclusions Hospitals facing chemical terrorism require a comprehensive preparedness strategy encompassing specialized training, psychological support, and robust clinical systems. Effective management, intersectoral Creator An entity primarily responsible for making the resource Zoha Dorri1 , Leila Mohammadinia2,3, Azadeh Fatehpanah1,4, Farzan Madadizadeh5 , AbbasAli Dehghani Tafti1 and Samaneh Mirzaei1,6* Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01124-1 Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Preparedness model, Hospital, Preparedness, Terrorist incidents, Chemical, Weapons of mass destruction https://repository.horizon.ac.id/files/original/25ad5b65c6e4ad16d0d888a28cb8c295.pdf 3685009b49a648f55da7c8346e0ccb5d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Severe anaphylaxis following off-label rectal use of injectable diazepam in a febrile seizure: a case report and clinical implications Subject The topic of the resource Febrile seizure, Rectal diazepam, Propylene glycol, Pediatric anaphylaxis, Off-label use, Excipient hypersensitivity, Emergency medicine, Description An account of the resource Abstract Background Off-label rectal administration of intravenous diazepam is commonly practiced for acute seizure management in children when FDA-approved rectal gels (e.g., Diastat® AcuDial) are inaccessible—particularly in low-resource settings like Vietnam. However, such injectable formulations often contain excipients not validated for mucosal use, including propylene glycol and sodium benzoate, which may induce hypersensitivity reactions. Reports of anaphylaxis in this context remain exceedingly rare. Case presentation We describe a case of suspected grade III anaphylaxis in a 14-month-old girl with complex febrile seizure who received 2 mg rectal diazepam (injectable formulation, Vidipha, Vietnam). Within five minutes of administration, she developed generalized urticaria, apnea, cyanosis, and hypotonia. Emergency treatment included intramuscular epinephrine, corticosteroids, antihistamines, and mechanical ventilation. She made a full recovery. The diazepam preparation used contained approximately 40% propylene glycol and also included sodium benzoate— both of which have been reported as potential triggers of non–IgE-mediated hypersensitivity reactions, particularly when delivered via mucosal routes. Conclusion This case underscores the potential for life-threatening adverse events following off-label rectal use of injectable diazepam. Emergency clinicians should be aware of excipient-related risks and prioritize safer alternatives such as intranasal midazolam. There is an urgent need for regulatory efforts to improve access to mucosal-safe, pediatric-appropriate benzodiazepine preparations in resource-limited healthcare systems. Keywords Febrile seizure, Rectal diazepam, Propylene glycol, Pediatric anaphylaxis, Off-label use, Excipient hypersensitivity, Emergency medicine, Case report Creator An entity primarily responsible for making the resource Ninh Xuan Nguyen1*, Ngoc Tien Pham1 , Huong Thi Thanh Le1 , Quoc Viet Tran1 , Hang Ngoc Thuy Tran1 , Thi Kim Thanh Vo1 and Chuong Thi Ngoc Dang2 Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01123-2 Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Febrile seizure, Rectal diazepam, Propylene glycol, Pediatric anaphylaxis, Off-label use, Excipient hypersensitivity, Emergency medicine, https://repository.horizon.ac.id/files/original/73ffd661e9ef7c1b22af690d67cdd546.pdf 0ffdc432109e833757985135f7dfe584 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Volume 19 Issue 1 2026 Contributor An entity responsible for making contributions to the resource PERI IRAWAN Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Evaluation of immunochromatography- based urine drug screening and blood drug concentrations in suspected acute poisoning: insights into negative urine drug screening results Subject The topic of the resource Antipsychotic agents, Benzodiazepines, Drug evaluation, Chromatography Description An account of the resource Abstract Background Immunochromatography-based urine drug screening (UDS) can have false-positive or false-negative results; thus, interpretation of results requires careful evaluation. A UDS-negative result simply indicates that target drugs were not detected in urine and does not rule out acute poisoning. This study aimed to determine the presence of drugs in the blood and blood drug concentrations in suspected cases of acute poisoning with UDS-negative results. Methods In this single-center, retrospective, observational study, we included 501 patients who attended Tokai University Hospital Advanced Emergency Medical Center, Japan, between January 1, 2014 and December 31, 2023 and were diagnosed with acute poisoning with negative UDS results. The primary outcome included the detection rate of UDS items and non-UDS items in blood samples. The secondary outcome included the classification of blood drug concentrations (below therapeutic range, within therapeutic range, above therapeutic range). Blood drug concentrations were measured using a gas chromatography–mass spectrometer and liquid chromatography–tandem mass spectrometer. Results Blood drug concentrations were detected in 498 (99.4%) of the 501 participants. Despite negative UDS results in urine, UDS items were detected in blood samples of 239 patients (58.8%). Non-UDS items were detected in 430 participants (86.3%). Benzodiazepines were the most commonly detected UDS items, with many cases exhibiting blood drug concentrations above the therapeutic range. In non-UDS items, non-benzodiazepine hypnotics, antipsychotics, and over-the-counter (OTC) medications were often detected. Conclusion This study demonstrates that negative UDS results do not rule out the presence of drugs in acute poisoning cases. Moreover, a comprehensive evaluation, including physical and laboratory findings, is essential for accurate diagnosis and treatment. Creator An entity primarily responsible for making the resource Rie Yamamoto1*, Yukari Maki1 , Yuri Iketani1 , Tomoatsu Tsuji1 , Takeshi Saito1 and Seiji Morita1 Source A related resource from which the described resource is derived https://doi.org/10.1186/s12245-026-01119-y Date A point or period of time associated with an event in the lifecycle of the resource 2026 Contributor An entity responsible for making contributions to the resource peri irawan Format The file format, physical medium, or dimensions of the resource pdf Language A language of the resource english Type The nature or genre of the resource text Antipsychotic agents, Benzodiazepines, Drug evaluation, Chromatography