Emergency Care Journal最新文献

{"title":"When the solution is not on the tip but under the tongue","authors":"Erika Poggiali, Lorenzo Ghiadoni, Sossio Serra","doi":"10.4081/ecj.2023.11873","DOIUrl":"https://doi.org/10.4081/ecj.2023.11873","url":null,"abstract":"In the recent letter by Pucciarelli et al.,1 the authors comment on an observation reported by Fabbri et al.2 that the pain is treated correctly only in a very small percentage of patients (3%), even those who experienced severe pain, suggesting as a possible solution of this important unsolved issue the introduction (implementation) of sublingual sufentanil use for pain treatment of trauma patients in the pre-hospital setting. [...]","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135386588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The organization of ambulance decontamination during the COVID-19 pandemic: a process analysis based on the Lean Thinking philosophy","authors":"Guglielmo Imbriaco, Alfonso Flauto","doi":"10.4081/ecj.2023.11646","DOIUrl":"https://doi.org/10.4081/ecj.2023.11646","url":null,"abstract":"The COVID-19 pandemic led to massively increased emergency medical services (EMS) activity. The need to decontaminate emergency vehicles after conveying a suspected or confirmed patient to the hospital represented a critical step, slowing the activities and impacting the number of available ambulances. This brief paper analyzes the flow of EMS processes according to the Lean Thinking management approach, which focuses on reducing waste in a production cycle. The different steps of the whole process (arrival to the Emergency Department, handover phase, decontamination, return to service, and the required transfers) and a series of strategies are discussed. The organization (centralized or delocalized), number, and location of the decontamination centers impact transfers and waiting times and, consequently, the availability of ambulances. Optimizing these processes may lead to a global performance improvement, reducing transfers and time, with greater availability of emergency vehicles.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136059302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the contradiction: balancing patient care and caregiver protection. From heroes to victims","authors":"Tiziana Antonini, Paola Capellini, Giuseppe Scaratti","doi":"10.4081/ecj.2023.11586","DOIUrl":"https://doi.org/10.4081/ecj.2023.11586","url":null,"abstract":"The COVID emergency has accelerated professional and organizational transformations, prompting a re-signification of activity systems, routines, professional visions, concrete daily operations. An unforeseen scenario emerges, highlighting elements of uncertainty, fatigue, and discomfort, linked, on the one hand, to the challenge raised towards the professional identities of the various players, called to deal with the new organizational constraints, to reposition themselves in changing contexts. On the other hand, the challenge refers to the possibility to achieve a good balance between offering services aimed at the promotion and protection of health and, at the same time, to guarantee working safety and security conditions, in increasingly complex contexts in which tensions and contradictions coexist with reduction of resources and requests for more effective services.
 At risk is the possibility to cope with increasing situations of social conflicts (i.e. the no vax manifestations) and events such as those related to the aggressiveness of patients, the verbal and often physical aggression against the health professionals, exposed to the temptation to abandon work and devote oneself to something else. Tackling with patients taken in charge by the Services and with characteristics of aggressive behavior, decidedly above the sustainability thresholds (death threats; screams and insults; raids on the service; stalking; shadowing of operators, ... with situations of requesting emergency intervention by the police, which could only be limited to a light intervention in the absence of an explicit complaint against the person), generates understandable fears and dynamics of avoidance/expulsion. These are, more and more (even though not exclusively) at the basis of resignations and retirement from work. This is in evident contrast with the mission of the health service and therefore with the identification of personnel with the aim of taking care of every user with a need.
 Hence a situation of impasse (disenchantment/impotence/give up/avoidance), having to deal with balancing the threshold of the limit(boundary) and the limit(boundary) of the threshold, defining conditions of survival, of joint elaboration, of collective action agreed. The possibility of conceiving oneself as an emancipatory limit(boundary), avoiding fantasies of ‘expulsive killerage’ and ‘regulatory stiffening’, relies on a collective system alliance, capable of considering both realistic fears with respect to personal safety to be protected, and the elaboration of one's own defensive dynamics in the face of exposure to external aggression.
 At stake is the lacerating dilemma between the identification with a service that must take charge of the needs (whatever they may be) of a user/patient and, at the same time, with the need to protect one's own and others' (other patients) safety conditions to be able to fulfill the professional task to which one is called.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135106420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal trauma during a rugby tackle","authors":"Sohil Pothiawala, Rebecca Schroll","doi":"10.4081/ecj.2023.11577","DOIUrl":"https://doi.org/10.4081/ecj.2023.11577","url":null,"abstract":"Rugby-related renal trauma is rare and identification of a young patient with renal trauma secondary to sports who requires observation versus further radiological evaluation in the emergency department (ED) poses a diagnostic challenge. We report a case of a 16-year-old girl who presented to the ED with abdominal pain after being tackled during a game of rugby. Examination revealed tenderness over the right lateral lower ribs and right flank. Blood tests were normal and bedside ultrasound did not show any free intraperitoneal fluid. Urinalysis showed gross hematuria. She was pain-free after analgesia but had a syncopal episode in the ED. A computed tomography (CT) scan of the abdomen and pelvis showed a complex right lower pole renal laceration and she was admitted to the Intensive Care Unit. She remained stable and was discharged. Assessment with urinalysis, hematocrit, and creatinine is required during the evaluation of a patient with suspected renal trauma. CT scan is the imaging modality for the diagnosis and grading of renal injury. Conservative treatment is the mainstay of therapy, but some patients require angioembolization of surgical intervention. Patients must discuss with their physician regarding the optimal timing of return to rugby. Rugby-related renal trauma is rare and poses a challenge for emergency physicians regarding their evaluation and management in the ED. AAST-OIS grading of renal trauma on CT imaging helps guide appropriate management decisions.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135736216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sublingual Sufentanil: an option for pre-hospital pain management in trauma patients","authors":"G. Pucciarelli, Enrico Lucenti, Andrea Andreucci, Fabio De Iaco, Vito Torrano, Franco Marinangeli, Giovanni Sbrana","doi":"10.4081/ecj.2023.11665","DOIUrl":"https://doi.org/10.4081/ecj.2023.11665","url":null,"abstract":"","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45057417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of hemorrhagic shock due to massive upper gastrointestinal bleeding: from the differential diagnosis to the correct management","authors":"Beatrice Marziani, M. Spampinato, Fabio Caputo, M. Guarino, Francesco Luppi, Benedetta Perna, Angelina Passaro, Daniele Cariani, Alberto Merighi, Rosario Arena, Roberto De Giorgio","doi":"10.4081/ecj.2023.11540","DOIUrl":"https://doi.org/10.4081/ecj.2023.11540","url":null,"abstract":"Upper Gastro-Intestinal Bleeding (UGIB) spans from minor bleeding to life-threatening events. Identification of early signs of shock, proper management of hemodynamically unstable patients, and correct risk stratification are essential for an appropriate diagnostic workup and therapy. This case reports a young man admitted to the emergency department with haematemesis. His medical history was unremarkable, without any risk factors for gastrointestinal bleeding. A few hours after admission, further episodes of haematemesis occurred, and the patient's condition rapidly deteriorated to irreversible shock. A contrast-enhanced computed tomography (CECT) revealed morphological features of chronic liver disease and oesophagal varices. The patient underwent upper gastrointestinal endoscopy, confirming oesophagal varices with massive bleeding. Although promptly applied, endoscopic hemostasis was ineffective, and the patient died twenty-four hours after admission. Based on this case, we reviewed the diagnostic and therapeutic approaches for patients with massive UGIB and provided a practical approach to this life-threatening emergency.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46154818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When infection strikes the heart: identifying and treating non-rheumatic streptococcal myocarditis in a young man with chest pain and concurrent streptococcal pharyngitis","authors":"Matic Mihevc","doi":"10.4081/ecj.2023.11606","DOIUrl":"https://doi.org/10.4081/ecj.2023.11606","url":null,"abstract":"Pharyngitis and tonsillitis are common reasons for seeking medical care. While mostly viral, Streptococcus pyogenescauses 5-20% of adult cases. Non-rheumatic streptococcal myocarditis is a distinct form of myocarditis associated with streptococcal infection and has clinical features resembling acute coronary syndrome. It mainly affects young men and can lead to significant complications, including sudden cardiac death. We present a case of a young man with non-rheumatic streptococcal myocarditis that developed three days after streptococcal pharyngitis. This is the first documented case in which a treatment approach using a combination of benzathine phenoxymethylpenicillin, perindopril, and bisoprolol, followed by extended therapy with extencillin, resulted in a rapid improvement in the patient's cardiac function and general health. The insights gained from this case offer valuable guidance for managing similar conditions in the future.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47652792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right-sided spontaneous, massive hemothorax in a 27-week pregnant lady: a case report","authors":"Pratisha Pradhan, Alok Kumar, Kabita Hada Batajoo, Trishna Shrestha, S. Pradhananga","doi":"10.4081/ecj.2023.11595","DOIUrl":"https://doi.org/10.4081/ecj.2023.11595","url":null,"abstract":"Spontaneous, massive hemothorax due to pulmonary varix is an uncommon, yet catastrophic cause of respiratory distress during pregnancy and postpartum. Presentation is often confused with pulmonary embolism, the treatment of which, worsens the condition. Diagnosis is challenging because of the elusive abnormalities on radiographic and bronchoscopic examination. Currently, there are no treatment guidelines for pulmonary varix. A 23-year-old pregnant lady in her second trimester, with intra-uterine fetal demise, presented to our emergency with dyspnoea, fever, and right-sided chest pain for three days. Chest X-ray and therapeutic thoracocentesis revealed massive right-sided hemothorax and computed tomography suggested pulmonary varix as the cause which was managed with emergency chest tube drainage. Massive, spontaneous hemothorax due to pulmonary varix in pregnancy is a rare occurrence, but it requires timely, multidisciplinary assessment and management for the betterment of the mother and the fetus.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46177524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of cardiotoxicity following intramuscular injection of tropicamide and phenylephrine ophthalmic solution in a drug-addicted young woman","authors":"Antonio Agosti, A. Vercelli, Elena Demichele, Francesco Mariani, Andrea Biagi, Stefano Ferraro, Gianfranco Cervellin, Erika Poggiali","doi":"10.4081/ecj.2023.11320","DOIUrl":"https://doi.org/10.4081/ecj.2023.11320","url":null,"abstract":"We report the case of a 40-year-old woman with a history of an opioid use disorder who presented to our emergency department complaining of palpitations, chest pain, and headache after the intramuscular injection of an ophthalmic solution containing tropicamide and phenylephrine (Visumidriatic Phenylephrine® 100 mg/mL + 5 mg/mL, Visufarma S.p.A., Italy) a few hours earlier for a voluntary purpose. She developed cardiac toxicity with hypertension, tachycardia, and high levels of high-sensitivity cardiac troponin I, which required continuous cardiac monitoring for 48 hours with complete resolution of the cardiac damage without complications. Based on the current literature, this is the first reported case of cardiotoxicity induced by an ophthalmic solution of tropicamide and phenylephrine used intramuscularly for voluntary purposes.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45780967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective serotonin reuptake inhibitors related bleeding risk: case report and review of literature","authors":"Andrea Boccatonda, Damiano D'Ardes, Maria Teresa Guagnano, Francesco Cipollone, Francesca Santilli","doi":"10.4081/ecj.2023.11349","DOIUrl":"https://doi.org/10.4081/ecj.2023.11349","url":null,"abstract":"Gastrointestinal bleedings are relevant side effects in patients during anticoagulant therapy for atrial fibrillation. Direct oral anticoagulants (DOACs) are less correlated with major bleeding events than vitamin K antagonists (VKAs), but concerns are present about the relative risk of gastrointestinal bleeding. Here we report the case of a patient with atrial fibrillation and dementia on DOAC treatment who developed a SSRI-associated thrombocytopenia with subsequent life-threatening bleeding. Physicians should be aware of the possible correlation between SSRI-induced thrombocytopenia and concomitant use of anticoagulant and/or antiplatelet drugs, thus preventing life-threatening bleedings.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135795841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}