Emergency Care Journal

Journal Information
ISSN / EISSN : 1826-9826 / 2282-2054
Published by: PAGEPress Publications (10.4081)
Total articles ≅ 497
Current Coverage
ESCI
DOAJ
Archived in
EBSCO
SHERPA/ROMEO
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Latest articles in this journal

Giorgio Fiore, Carlo Gaspardone, Silvana Di Maio, Michele Oppizzi, Alberto Margonato
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9806

Abstract:
Acute coronary syndromes can develop with an unusual and challenging presentation. Kounis syndrome is a mostly overlooked Acute Coronary Syndrome (ACS) in the setting of anaphylactic or anaphylactoid reactions in response to an allergic insult that can lead to severe complications including cardiac arrest. A 52-yearold- man presented to the emergency department of our hospital because of acute transient loss of consciousness that developed some minutes after almonds ingestion. The complex diagnostic workup led to the diagnosis of vasospastic Kounis syndrome, an infrequent type of acute coronary syndrome, mostly overlooked, with challenging diagnostic and therapeutic features. Peculiarities on clinical presentation, the approach adopted by the emergency physician and the consultant cardiologist to achieve the correct diagnosis and our proposed management with a brief revision of the literature will be reported. Unusual clinical presentations of acute coronary syndromes represent part of the pitfalls that an emergency physician can face during the everyday practice. Prompt identification of these conditions is always struggling but of crucial importance to improve patient prognosis with a correct diagnostic work-up and therapeutic management.
Beatrice Vergnano, Serena Calcinati, , Annalisa Benini, Maria Rosa Pozzi, Luisa Verga, Jonata Pizzagalli, Paolo Bonfanti, , Giuseppe Foti
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9888

Abstract:
The pathogenesis of COVID-19 appears to be characterized by a dysregulated immune response. During the first pandemic wave in Lombardy, we started to administer glucocorticoids to some patients with severe respiratory failure requiring support with Continuous Positive Airway Pressure (CPAP) therapy. We retrospectively collected data to identify the effect of glucocorticoids in this COVID-19 particular population. With a multidisciplinary consensus, we administered to selected patients with severe COVID-19 disease (PaO2/FiO2 159±71 mmHg) 0,91 mg/kg/die of methylprednisolone equivalent dose after a median of 8 days of hospitalization. In our study we compared 57 patients from the steroid group with 123 from the control group: the event of invasive mechanical ventilation or death was reduced by 43% between steroid group and control group (19.3 % vs. 34.1 % respectively, p=0.001) and mortality was reduced by about 31% between steroid and usual care alone (15.8 % vs. 22.8 % respectively, p=0.011). Corticosteroids in selected COVID-19 patients may have a relevant impact on outcome, better profiling of the heterogeneity of this disease may be essential to guarantee the best treatment choices.
, Saltuk Buğra Kaya, Özge Can Bostan, Ebru Damadoğlu, Gül Karakaya, Ali Fuat Kalyoncu
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9848

Abstract:
The present study aimed to evaluate patients who were referred to adult allergy clinic due to allergic reactions after concomitant multiple intravenous-drug administrations in Emergency Department (ED). Between January 2017 and January 2019, patients admitted to our allergy clinic with hypersensitivity reactions to intravenous drugs administered in ED were included retrospectively. Fifty-seven patients who developed allergic reactions after intravenous drug administration in EDs were evaluated. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) were the most common cause of allergic reactions (n = 40, 70.2%). Skin Prick Tests (SPT) were positive in 6 (10.5%) patients. Drug Provocation Tests (DPT) were positive in 10 (17.5%) patients. No significant correlation was found between the total number of drugs in the intravenous fluid and the degree of allergic reaction (r = -0.145, p = 0.282). There was no statistically significant difference between the degree of allergic reaction and history of atopic disease (p = 0.579). In conclusion, concomitant administration of multiple drugs in intravenous fluids may increase the risk of allergic reactions.
, Roberto Ghezzi, Anna Chiara Cadonici, Paolo Dalino Ciaramella, Chiara Martes, Adriano Basile, Andrea Bellone
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9548

Abstract:
One of the most frequent cause of hypercalcemia is primary hyperparathyroidism, which can lead to systemic involvement and life-threatening conditions. We described a rare case of a parathyroid adenoma rupture with consequent bleeding and respiratory airway compression. An 84-year-old man presented to the emergency department complaining neck swelling and related dysphagia. A computer tomography of the neck revealed an extensive left lateral hematoma, and a neck ultrasonography evidenced a hemorrhagic parathyroid adenoma, later confirmed by a 99 mTc-MIBI scintigraphy. To date only 40 cases of ruptured parathyroid adenomas have been described in literature, however due to the possibility of massive bleeding and compression of the airways this diagnosis should always be ruled out. The rupture of a parathyroid adenoma is a rare, but possibly life-threatening event due to airways compression and hemodynamic instability. Testing for hypercalcemia and hyperparathyroidism is mandatory to obtain a correct diagnosis.
Luca Pierantoni, , Carlotta Biagi, Andrea Scozzarella, Federica Camela, Marcello Lanari
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9615

Abstract:
High Flow Nasal Cannula (HFNC) is a noninvasive technique for respiratory support increasingly used in the pediatric wards for the management of respiratory failure. Few data are reported about the safety of HFNC. We describe the case of a 3-months-old infant admitted for acute bronchiolitis Respiratory Syncyctial Virus-related and treated with HFNC for severe respiratory distress. 12 hours after the beginning of HFNC a subcutaneous swelling of the neck, attributable to subcutaneous emphysema, became clinically evident. Radiological imaging showed pneumomediastinum with air leaking up to the neck. Patient was moved to PICU where he further worsened due to a mediastinal shift requiring drainage and mechanical ventilation. He was then progressively weaned from ventilation and was discharged from the hospital. Pneumomediastinum may occur during HFNC, particularly in moderate-severe cases of acute bronchiolitis. Patients undergoing HFNC should be strictly monitored in order to promptly recognize this complication and treat the child appropriately.
, Fabio Tansini, Konstantinos Christodoulakis, Manuela Giovini, Andrea Magnacavallo, Andrea Vercelli
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9847

Abstract:
We describe the case of a 68-year-old man with a known history of hypertension and diabetes mellitus presented to our Emergency Department, complaining of hematuria and vomiting in the last 12 hours, stypsis and urinary incontinence in the last week, and worsening hyporexia in the last 6 months. Bedside ultrasound documented a slight right pleural effusion with B lines in the middle and basal right field, gastrectasis, dilated fluid-filled bowel loops, potential signs of gas in the upper right quadrant, grade 3 bilateral hydronephrosis, and bladder globe. Abdominal CT scan confirmed the bilateral hydroureteronephrosis and showed the right kidney with Emphysematous Pyelonephritis (EPN) with extension into the perinephric and muscular planes for 24 cm, and initial EPN in the left kidney. A RT-PCR nasopharyngeal swab for SARS CoV-2 was negative. A diagnosis of ileum paretic, acute renal failure and urosepsis due to EPN was made.
, Naime Meriç Konar, Hacı Mehmet Çalışkan, Bedriye Müge Sönmez, Burak Çelik
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9812

Abstract:
People who emigrated from Turkey to European countries for work are called expatriate. It was aimed to analyze demographic characteristics of expatriate patients who presented to the emergency department, to compare satisfaction levels of emergency departments between their country of residence and Turkey, and to identify the factors that affect patient satisfaction. This descriptive study was conducted with questionnaires filled by face-to-face interviews in 150 expatriate patients who were living abroad, came to Turkey for vacation/annual permit and applied to the emergency department with any complaint. We found a statistically significant difference when we evaluated expatriate patients’ monthly average number of emergency department applies and their views on priority to apply to emergency departments for health problems, the cleanliness of emergency departments, attitude of doctors, security and receptionist/nursing staff towards patients in Turkey and in their country of residence. It has been found that expatriates prefer the emergency department more in our country and they are more satisfied in their country of residence in terms of the cleanliness of emergency department, attitude of doctors, security and receptionist/ nursing staff.
, Riccardo Brandolini, Laura Biondi, Claudia Corsini, Carlo Fraticelli, Rosa Sant'Angelo, Giovanni De Paoli
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9827

Abstract:
The aim was to study the number of accesses to the Emergency Room (ER) requiring psychiatric evaluation in the four months following the lockdown period for the COVID-19 outbreak (May 4th, 2020-August 31th, 2020). The study is a retrospective longitudinal observational study of the ER admissions of the Hospitals of Cesena and Forlì (Emilia Romagna region) leading to psychiatric assessment. Sociodemographic variables, history for medical comorbidities or psychiatric disorders, reason for ER admission, psychiatric diagnosis at discharge and measures taken by the psychiatrist were collected. An increase of 9.4% of psychiatric assessments was observed. The difference was more pronounced in the first two months after lockdown, with a 21.7% increase of number of ER accesses, while after two months numbers were the same as those of the year before. Admission with anxiety symptoms and history of psychiatric disorder decreased significantly. Moreover, there is an age trend with an increasing age of admission.
, Rachel O'Brien, Polly L. Black, Steff Lewis, Hannah Ensor, Matt Wilkes, Christopher McCann, Stewart Whiting
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.9711

Abstract:
Continuous novel ambulatory monitoring may detect deterioration in Emergency Department (ED) patients more rapidly, prompting treatment and preventing adverse events. Single-centre, open-label, prospective, observational cohort study recruiting high/medium acuity (Manchester triage category 2 and 3) participants, aged over 16 years, presenting to ED. Participants were fitted with a novel wearable monitoring device alongside standard clinical care (wired monitoring and/or manual clinical staff vital sign recording) and observed for up to 4 hours in the ED. Primary outcome was time to detection of deterioration. Two-hundred and fifty (250) patients were enrolled. In 82 patients (32.8%) with standard monitoring (wired monitoring and/or manual clinical staff vital sign recording), deterioration in at least one vital sign was noted during their four-hour ED stay. Overall, the novel device detected deterioration a median of 34 minutes earlier than wired monitoring (Q1, Q3 67,194; n=73, mean difference 39.48, p<0.0001). The novel device detected deterioration a median of 24 minutes (Q1, Q3 2,43; n=42) earlier than wired monitoring and 65 minutes (Q1, Q3 28,114; n=31) earlier than manual vital signs. Deterioration in physiology was common in ED patients. ED staff spent a significant amount of time performing observations and responding to alarms, with many not escalated. The novel device detected deterioration significantly earlier than standard care.
Published: 21 September 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.10135

Abstract:
What should be an Emergency Physician? A doctor and a man accustomed to extreme and courageous choices, able to decide quickly, capable of brilliant intuitions and strong standpoints, guided by great determination, self-awareness, enlightened by deep convictions and clear ideas, and an empathy that allows him to never lose his humanity and always know which side to stand on… I worked and had the privilege of being a friend of a great doctor with these characteristics.
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