Emergency Care Journal

Journal Information
ISSN / EISSN : 1826-9826 / 2282-2054
Published by: PAGEPress Publications (10.4081)
Total articles ≅ 514
Current Coverage
DOAJ
ESCI
Archived in
EBSCO
SHERPA/ROMEO
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Latest articles in this journal

, Bruno Barcella, Adriana D'Ercole, Gianpiero Zaccaria, CoSMEU group
Published: 29 March 2022
Emergency Care Journal, Volume 18; https://doi.org/10.4081/ecj.2022.10439

Abstract:
CoSMEU group (Italian Society of Emergency Medicine Residents): Cascio Michela, Ceschi Ludovica, Di Cristoforo Monica, La Spina Letizia, Malacarne Cecilia, Pons Sofia, Silvestri Giulia. Emergency Medicine (EM) is a novel specialty in Italy. It exists only since 2009, and CoSMEU (Coordinamento Specializzandi Medicina d’Emergenza-Urgenza) is the national association of EM residents. On behalf of CoSMEU, we conducted an electronic survey open to all the Italian EM residents, with the aim to assess their awareness about the acquisition of technical skills and clinical knowledge during the academic year 2019-2020. Out of 1666 EM residents, 434 (26%) responded to the survey, in representation of all the 33 medical school programs. For 63.6% of them EM was their first-choice program. A high percentage of EM residents have denounced a lack of education and hands-on opportunities to fully complete their training as planned, in the absence of simulation and certifications, and with not-standardized educational programs across the EM schools. Although the Italian EM and specialty are currently facing a crisis, all the EM residents are working hard to support EM system optimization.
Davide Bastoni,
Published: 29 March 2022
Emergency Care Journal, Volume 18; https://doi.org/10.4081/ecj.2022.10425

Abstract:
An 82-year-old man with a history of end-stage renal disease due to glomerulonephritis requiring haemodialysis, hepatitis C-related liver cirrhosis and hypertensive cardiomyopathy presented with painful and necrotic lesions of both his hands. He had no other symptoms.
, Marie Mitani-Konno, Yusuke Hagiwara, Yukihiro Hasegawa
Published: 29 March 2022
Emergency Care Journal, Volume 18; https://doi.org/10.4081/ecj.2022.10165

Abstract:
The Thyroid Storm (TS) is the severest form of thyrotoxicosis and is associated with a high mortality rate. TS presents with fever, tachycardia, gastrointestinal symptoms, and central nervous system dysfunction and may be overlooked if patients do not present thyrotoxic symptoms or have precipitating factors. We reported a pediatric case of TS with mild proptosis but no obvious precipitating factors in a previously healthy child. A 9-year-old, female patient with a history of attention-deficit hyperactivity disorder presented with the complaint of frequent vomiting. She was alert but lethargic with fever and tachycardia. Physical examination was unremarkable except for coolness in the extremities and a delayed capillary refill time of two seconds. Fluid resuscitation was ineffective in alleviating the tachycardia. Additional history-taking revealed a one-month history of mild proptosis but no other thyrotoxic findings or precipitating factors were found. Markedly elevated thyroxine and triiodothyronine and suppressed thyroid-stimulating hormone on thyroid function tests led to a diagnosis of TS. Methimazole, potassium iodine, bisoprolol, and hydrocortisone were administered. Her vital signs and thyroid functions gradually improved, and she was discharged 18 days after admission without any serious complications. She is currently euthyroid and clinically stable on 5 mg of methimazole at three months after admission. When tachycardia that is resistant to usual resuscitation is found, careful history-taking and physical examination targeting thyroid disorders should be performed to assess for TS.
, Antonella Benvenuti, Bruno Pacciardi, Gabriele Massimetti, Marianna Abelli, Gabriele Sapia, Francesco Pardini, Lucia Massa, Mario Miniati, Gianluca Salarpi, et al.
Published: 29 March 2022
Emergency Care Journal, Volume 18; https://doi.org/10.4081/ecj.2022.10216

Abstract:
This study aims to evaluate clinical correlates of psychiatric comorbidity and length of hospitalization in patients admitted in a general hospital emergency medicine setting. Overall, 160 patients hospitalized for different acute medical pathologies were selected consecutively over 12 months. All subjects were evaluated with proper forms to collect data on medical and psychiatric diagnoses. Levels of C-reactive protein were also measured in all patients. Statistical analyses were conducted with univariate, logistic, and multiple linear regressions. Patients with psychiatric comorbidity had significantly longer hospitalization than did patients with no psychiatric diagnoses (days 10.9±9.5 vs. 6.9±4.5, p<0.005). Agitation and delirium were more frequent in the psychiatry comorbidity study group (p<0.05), as was cognitive impairment (p=0.001). These variables predicted longer hospitalisation (respectively: t=-3.27, p=0.002; t=-2.64, p=0.009; t=-2.85, p=0.006). Psychiatric comorbidity acts as an adjunct factor in determining clinical severity and predicting a more difficult recovery in patients hospitalized in an emergency medicine setting.
, Aysenur Avarisli, Bulent Durdu, Hayrettin Daskaya
Published: 29 March 2022
Emergency Care Journal, Volume 18; https://doi.org/10.4081/ecj.2022.10310

Abstract:
COVID-19 critically ill patients usually require prone positioning for the treatment of respiratory failure caused by Acute Respiratory Distress Syndrome (ARDS). Prone position provides a better ventilation-perfusion compatibility, resulting in a significant improvement in oxygenation and a decrease in mortality, but prolonged prone positioning may cause Meralgia Paresthetica (MP), one of the most common mononeuropathies of the lower limb. The early diagnosis of MP is crucial to avoid a permanent damage with pain and disability, and to start immediately the correct treatment. In this article, we report a rare case of MP in a critically ill COVID-19 patient with ARDS, with the main aim to create awareness for MP among the medical team working.
Antonio Agosti, Silvia Bricchi, Francesca Rovati, Mara Vancea Opris, Davide Giulio Ponzi, Francesco Mariani, Nicola Morelli, Andrea Magnacavallo, Andrea Vercelli,
Published: 29 March 2022
Emergency Care Journal, Volume 18; https://doi.org/10.4081/ecj.2022.10292

Abstract:
We report the case of a 32-year-old Italian man admitted to our emergency room for visual disturbances with blurred vision, anisocoria and temporal headache suddenly occurred in absence of other neurological symptoms. A diagnosis of Datura stramoniuminduced anticholinergic toxicity was done. With our work, we want to highlight the importance of a meticulous clinical examination, including papillary diameter and reflexes, combined with a detailed history of the patient in the emergency room. Anticholinergic toxicity is a medical emergency. The diagnosis is always clinical, and it can represent a challenge for the emergency clinicians because it can mimic several neurological diseases, including acute stroke and seizures, but early diagnosis is crucial to avoid severe complications and management errors.
, Paolo Malerba, Jordan Giordani, Deborah Stassaldi, Carlo Aggiusti, Giuliana Martini, Giulia Arenare, Chantale Premoli, Giulia Bosio, Marco Lancelotti, et al.
Published: 20 December 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.10032

Abstract:
We describe the case of a 64 years-old woman admitted to the Emergency Department of the ASST-Spedali Civili of Brescia with fever and gastrointestinal symptoms 10 days after the first dose of ChAdOx1 nCov-19 vaccine. Laboratory investigations showed severe thrombocytopenia and high D-dimer, while an abdominal CT scan reported a partially occluding thrombosis of the superior mesenteric artery. Following treatment with fondaparinux, immunoglobulins and high dosage steroid therapy, we observed a rapid improvement of patient’s conditions. An ELISA assay showed the presence of antibodies against heparin PF4-complex. Subsequent abdominal CT-scan showed the superior mesenteric artery thrombosis resolution, and the patient was finally discharged after 12 days of hospitalization. Several reports pointed to the venous system as the main district affected by Vaccine-Induced Thrombotic Thrombocytopenia (VITT), while a peculiar feature of this report is the involvement of the mesenteric arterial system. Further investigation of VITT’s pathophysiological mechanisms is mandatory to develop preventive strategies and effective treatments.
, Greta Barbieri, Veronica Salvatore, Francesco Salinaro
Published: 20 December 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.10304

Abstract:
Dear Editors, The COVID-19 pandemic has highlighted several and wellknown limits of the Italian national health system, including the weakness of the territorial medical services and the absence of dedicated structures for patients affected by chronic or end-stage diseases in need of long hospitalization, or with social difficulties.
, , Andrea Tenci, Giorgio Ricci, Massimo Zannoni, Christoph Scheurer, Anton Wieser, Antonio Maccagnani, Antonio Bonora, Norbert Pfeifer
Published: 20 December 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.10284

Abstract:
Closed chest traumas are frequent consequences of falls in the elderly. The presence of concomitant oral anticoagulant therapy can increase the risk of post-traumatic bleeding even in cases of trauma with non-severe dynamics. There is limited information about the differences between vitamin K antagonists and direct oral anticoagulants in the risk of post-traumatic bleeding. To assess differences in the risk of developing intra-thoracic hemorrhages after chest trauma with at least one rib fracture caused by an accidental fall in patients over 75 years of age taking oral anticoagulant therapy. This study involved data from four emergency departments over two years. All patients on oral anticoagulant therapy and over 75 years of age who reported a closed thoracic trauma with at least one rib fracture were retrospectively evaluated. Patients were divided into two study groups according their anticoagulant therapy. Of the 342 patients included in the study, 38.9% (133/342) were treated with direct oral anticoagulants and 61.1% (209/342) were treated with vitamin K antagonist. A total of 7% (24/342) of patients presented intrathoracic bleeding, while 5% (17/342) required surgery or died as a result for the trauma. Posttraumatic intrathoracic bleeding occurred in 4.5% (6/133) of patients receiving direct oral anticoagulants and 8.6% (18/209) of patients receiving vitamin K antagonist. Logistic regression analysis, revealed no difference in the risk of intrathoracic haemorrhages between the two studied groups. Direct oral anticoagulants therapy presents a risk of post-traumatic intrathoracic haemorrhage comparable to that of vitamin K antagonist therapy.
Daniele Coen, Ivo Casagranda, Mario Cavazza, Gianfranco Cervellin, Lorenzo Ghiadoni, Roberto Lerza
Published: 20 December 2021
Emergency Care Journal, Volume 17; https://doi.org/10.4081/ecj.2021.10331

Abstract:
Since a few years ago health systems in the western countries have a new problem to face: being a Medical Doctor (MD), especially a hospital or a general practice physician, is less and less appealing for the young generations.
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