Medicina

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3 pages, 248 KiB

Open AccessEditorial

Editorial for the Special Issue “Emergency Medicine and Emergency Room Medical Issues”

by Pierpaolo Di Micco

Medicina 2023, 59(2), 380; https://doi.org/10.3390/medicina59020380 - 16 Feb 2023

Cited by 1 | Viewed by 1315

Abstract

Together with the “law of entropy”, two of the main reasons for the risk of burnout among physicians who work in emergency departments around the world are the variety of clinical issues presented by patients and the absence of guidelines for managing most [...] Read more.

Together with the “law of entropy”, two of the main reasons for the risk of burnout among physicians who work in emergency departments around the world are the variety of clinical issues presented by patients and the absence of guidelines for managing most of them [...] Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

Research

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9 pages, 425 KiB

Open AccessArticle

Lower Platelet-to-Lymphocyte Ratio Was Associated with Poor Prognosis for Newborn Patients in NICU

by Yanfei Tang, Yiqun Teng, Lingyan Xu, Guangtao Xu, Deqing Chen, Xin Jin, Wanlu Li, Xiuhui Jin, Wen Zhu, Bo Hu, Ruilin Shen and Yuzhang Zhu

Medicina 2022, 58(10), 1397; https://doi.org/10.3390/medicina58101397 - 6 Oct 2022

Cited by 2 | Viewed by 2162

Abstract

Background: Platelet-to-lymphocyte ratio (PLR) is reported to be related to the outcome of intensive care unit (ICU) patients. However, little is known about their associations with prognosis in newborn patients in neonatal ICU (NICU). The aim of the present study was to investigate [...] Read more.

Background: Platelet-to-lymphocyte ratio (PLR) is reported to be related to the outcome of intensive care unit (ICU) patients. However, little is known about their associations with prognosis in newborn patients in neonatal ICU (NICU). The aim of the present study was to investigate the prognostic significance of the PLR for newborn patients in the NICU. Methods: Data on newborn patients in the NICU were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III) database. The initial PLR value of blood examinations within 24 h was analyzed. Spearman's correlation was used to analyze the association of PLR with the length of hospital and ICU stays. The chi-square test was used to analyze the association of PLR with mortality rate. Multivariable logistic regression was used to determine whether the PLR was an independent prognostic factor of mortality. The area under the receiver operating characteristic (ROC) curve was used to assess the predictive ability of models combining PLR with other variables. Results: In total, 5240 patients were enrolled. PLR was negatively associated with length of hospital stay and ICU stay (hospital stay: ρ = −0.416, p < 0.0001; ICU stay: ρ = −0.442, p < 0.0001). PLR was significantly correlated with hospital mortality (p < 0.0001). Lower PLR was associated with higher hospital mortality (OR = 0.85, 95% CI = 0.75–0.95, p = 0.005) and 90-day mortality (OR = 0.85, 95% CI = 0.76–0.96, p = 0.010). The prognostic predictive ability of models combining PLR with other variables for hospital mortality was good (AUC for Model 1 = 0.804, 95% CI = 0.73–0.88, p < 0.0001; AUC for Model 2 = 0.964, 95% CI = 0.95–0.98, p < 0.0001). Conclusion: PLR is a novel independent risk factor for newborn patients in the NICU. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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12 pages, 319 KiB

Open AccessFeature PaperArticle

Mortality Predictors in Severe SARS-CoV-2 Infection

by Mihai Lazar, Ecaterina Constanta Barbu, Cristina Emilia Chitu, Ana-Maria-Jennifer Anghel, Cristian-Mihail Niculae, Eliza-Daniela Manea, Anca-Cristina Damalan, Adela-Abigaela Bel, Raluca-Elena Patrascu, Adriana Hristea and Daniela Adriana Ion

Medicina 2022, 58(7), 945; https://doi.org/10.3390/medicina58070945 - 18 Jul 2022

Cited by 11 | Viewed by 2722

Abstract

Background and Objectives: The severe forms of SARS-CoV-2 pneumonia are associated with acute hypoxic respiratory failure and high mortality rates, raising significant challenges for the medical community. The objective of this paper is to present the importance of early quantitative evaluation of [...] Read more.

Background and Objectives: The severe forms of SARS-CoV-2 pneumonia are associated with acute hypoxic respiratory failure and high mortality rates, raising significant challenges for the medical community. The objective of this paper is to present the importance of early quantitative evaluation of radiological changes in SARS-CoV-2 pneumonia, including an alternative way to evaluate lung involvement using normal density clusters. Based on these elements we have developed a more accurate new predictive score which includes quantitative radiological parameters. The current evolution models used in the evaluation of severe cases of COVID-19 only include qualitative or semi-quantitative evaluations of pulmonary lesions which lead to a less accurate prognosis and assessment of pulmonary involvement. Materials and Methods: We performed a retrospective observational cohort study that included 100 adult patients admitted with confirmed severe COVID-19. The patients were divided into two groups: group A (76 survivors) and group B (24 non-survivors). All patients were evaluated by CT scan upon admission in to the hospital. Results: We found a low percentage of normal lung densities, PaO₂/FiO₂ ratio, lymphocytes, platelets, hemoglobin and serum albumin associated with higher mortality; a high percentage of interstitial lesions, oxygen flow, FiO₂, Neutrophils/lymphocytes ratio, lactate dehydrogenase, creatine kinase MB, myoglobin, and serum creatinine were also associated with higher mortality. The most accurate regression model included the predictors of age, lymphocytes, PaO₂/FiO₂ ratio, percent of lung involvement, lactate dehydrogenase, serum albumin, D-dimers, oxygen flow, and myoglobin. Based on these parameters we developed a new score (COV-Score). Conclusions: Quantitative assessment of lung lesions improves the prediction algorithms compared to the semi-quantitative parameters. The cluster evaluation algorithm increases the non-survivor and overall prediction accuracy.COV-Score represents a viable alternative to current prediction scores, demonstrating improved sensitivity and specificity in predicting mortality at the time of admission. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

12 pages, 1449 KiB

Open AccessArticle

New-Onset Atrial Fibrillation and Early Mortality Rate in COVID-19 Patients: Association with IL-6 Serum Levels and Respiratory Distress

by Gianluca Bagnato, Egidio Imbalzano, Caterina Oriana Aragona, Carmelo Ioppolo, Pierpaolo Di Micco, Daniela La Rosa, Francesco Costa, Antonio Micari, Simona Tomeo, Natalia Zirilli, Angela Sciacqua, Tommaso D’Angelo, Irene Cacciola, Alessandra Bitto, Natasha Irrera, Vincenzo Russo, William Neal Roberts, Sebastiano Gangemi and Antonio Giovanni Versace

Medicina 2022, 58(4), 530; https://doi.org/10.3390/medicina58040530 - 11 Apr 2022

Cited by 14 | Viewed by 2825

Abstract

Background and objectives: COVID-19 is associated with an aberrant inflammatory response that may trigger new-onset cardiac arrhythmias. The aim of this study was to assess the mortality risk in hospitalized COVID-19 patients according to IL-6 serum levels and new-onset atrial fibrillation (AF) [...] Read more.

Background and objectives: COVID-19 is associated with an aberrant inflammatory response that may trigger new-onset cardiac arrhythmias. The aim of this study was to assess the mortality risk in hospitalized COVID-19 patients according to IL-6 serum levels and new-onset atrial fibrillation (AF) according to PaO²/FiO² stratification. Materials and Methods: 175 COVID-19 patients (25 new-onset AF, 22 other types of AF and 128 no-AF) were included in this single-center, retrospective study; clinical and demographic data, vital signs, electrocardiograms and laboratory results were collected and analyzed. The primary outcome of the study was to evaluate the mortality rate in new-onset AF patients according to IL-6 serum levels and PaO²/FiO² stratification. Results: The incidence of new-onset AF in the study population was 14.2%. Compared to the no-AF group, new-onset AF patients were older with a positive history of chronic kidney disease and heart failure, had higher IL-6, creatinine and urea serum levels whereas their platelet count was reduced. After PaO²/FiO² stratification, 5-days mortality rate was higher in new-onset AF patients compared to patients with other types of AF and no-AF patients, and mortality risk increases 5.3 fold compared to no-AF (p = 0.0014) and 4.8 fold compared to other forms of AF (p = 0.03). Conclusions: New-onset AF is common in COVID-19 patients and is associated with increased IL-6 serum levels and early mortality. Further studies are needed to support the use of IL-6 as an early molecular target for COVID-19 patients to reduce their high rate of mortality. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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12 pages, 482 KiB

Open AccessFeature PaperArticle

Prognostic Effect of Underlying Chronic Kidney Disease and Renal Replacement Therapy on the Outcome of Patients after Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study

by Won Yang, Jae-Guk Kim, Gu-Hyun Kang, Yong-Soo Jang, Wonhee Kim, Hyun-Young Choi and Yoonje Lee

Medicina 2022, 58(3), 444; https://doi.org/10.3390/medicina58030444 - 18 Mar 2022

Cited by 4 | Viewed by 2475

Abstract

Background and Objectives: This study assessed the prognostic value of underlying chronic kidney disease (CKD) and renal replacement therapy (RRT) on the clinical outcomes from out-of-hospital cardiac arrest (OHCA). Materials and Methods: This retrospective study was conducted utilizing the population-based OHCA data of [...] Read more.

Background and Objectives: This study assessed the prognostic value of underlying chronic kidney disease (CKD) and renal replacement therapy (RRT) on the clinical outcomes from out-of-hospital cardiac arrest (OHCA). Materials and Methods: This retrospective study was conducted utilizing the population-based OHCA data of South Korea between 2008 and 2018. Adult (>18 years) OHCA patients with a medical cause of cardiac arrest were included and classified into three categories based on the underlying CKD and RRT: (1) non-CKD group; (2) CKD without RRT group; and (3) CKD with RRT group. A total of 13,682 eligible patients were included (non-CKD, 9863; CKD without RRT, 1778; CKD with RRT, 2041). From the three comparison subgroups, data with propensity score matching were extracted. The influence of CKD and RRT on patient outcomes was assessed using propensity score matching and multivariate logistic regression analyses. The primary outcome was survival at hospital discharge and the secondary outcome was a good neurological outcome at hospital discharge. Results: The two CKD groups (CKD without RRT and CKD with RRT) showed no significant difference in survival at hospital discharge compared with the non-CKD group (CKD without RRT vs. non-CKD, p > 0.05; CKD with RRT vs. non-CKD, p > 0.05). The non-CKD group had a higher chance of having good neurological outcomes than the CKD groups (non-CKD vs. CKD without RRT, p < 0.05; non-CKD vs. CKD with RRT, p < 0.05) whereas there was no significant difference between the two CKD groups (CKD without RRT vs. CKD with RRT, p > 0.05). Conclusions: Compared with patients without CKD, the underlying cause of CKD—regardless of RRT—may be linked to poor neurological outcomes. Underlying CKD and RRT had no effect on the survival at hospital discharge. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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11 pages, 830 KiB

Open AccessArticle

Prognostic Impact of In-Hospital Use of Mechanical Cardiopulmonary Resuscitation Devices Compared with Manual Cardiopulmonary Resuscitation: A Nationwide Population-Based Observational Study in South Korea

by Wonhee Kim, Chiwon Ahn, In-Young Kim, Hyun-Young Choi, Jae-Guk Kim, Jihoon Kim, Hyungoo Shin, Shinje Moon, Juncheol Lee, Jongshill Lee, Youngsuk Cho, Yoonje Lee and Dong-Geum Shin

Medicina 2022, 58(3), 353; https://doi.org/10.3390/medicina58030353 - 27 Feb 2022

Cited by 5 | Viewed by 3680

Abstract

Background and Objectives: This study analyzed the prognostic impact of mechanical cardiopulmonary resuscitation (CPR) devices in out-of-hospital cardiac arrest (OHCA) patients, in comparison to manual CPR. Materials and Methods: This study was a nationwide population-based observational study in South Korea. Data [...] Read more.

Background and Objectives: This study analyzed the prognostic impact of mechanical cardiopulmonary resuscitation (CPR) devices in out-of-hospital cardiac arrest (OHCA) patients, in comparison to manual CPR. Materials and Methods: This study was a nationwide population-based observational study in South Korea. Data were retrospectively collected from 142,905 OHCA patients using the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. We included adult OHCA patients who received manual or mechanical CPR in the emergency room. The primary outcome was survival at discharge and the secondary outcome was sustained return of spontaneous circulation (ROSC). Statistical analysis included propensity score matching and multivariate logistic regression. Results: A total of 19,045 manual CPR and 1125 mechanical CPR cases (671 AutoPulse^TM vs. 305 Thumper^TM vs. 149 LUCAS^TM) were included. In the matched multivariate analyses, all mechanical CPR devices were associated with a lower ROSC than that of manual CPR. AutoPulse^TM was associated with lower survival in the multivariate analysis after matching (aOR with 95% CI: 0.57 (0.33–0.96)), but the other mechanical CPR devices were associated with similar survival to discharge as that of manual CPR. Witnessed arrest was commonly associated with high ROSC, but the use of mechanical CPR devices and cardiac origin arrest were associated with low ROSC. Only target temperature management was the common predictor for high survival. Conclusions: The mechanical CPR devices largely led to similar survival to discharge as that of manual CPR in OHCA patients; however, the in-hospital use of the AutoPulse^TM device for mechanical CPR may significantly lower survival compared to manual CPR. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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15 pages, 337 KiB

Open AccessArticle

Prognostic Impact of Active Cigarette Smoking on Mortality in Patients with Acute Venous Thromboembolic Events, Findings from Real World Data

by Matteo Giorgi-Pierfranceschi, Manuel Monreal, Pierpaolo Di Micco, Iria Francisco, Luis Hernández-Blasco, Olga Madridano, Juan Bosco López-Sáez, Elena Hernando, Jose Meireles, Francesco Dentali and the RIETE Investigators

Medicina 2022, 58(2), 295; https://doi.org/10.3390/medicina58020295 - 15 Feb 2022

Cited by 2 | Viewed by 2519

Abstract

Background and Objectives: The influence of smoking habits on mortality, VTE recurrence, and major bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. Materials and Methods: We used data from the RIETE (Registro Enfermedad TromboEmbólica) [...] Read more.

Background and Objectives: The influence of smoking habits on mortality, VTE recurrence, and major bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. Materials and Methods: We used data from the RIETE (Registro Enfermedad TromboEmbólica) registry to compare mortality, VTE recurrence, and major bleeding risk in smoking versus non-smoking patients with acute VTE. Results: 50,881 patients (43,426 non-smoking and 7455 smoking patients) were included. After a median follow-up of 8.8 months, 7110 patients died (fatal PE 292 and fatal bleeding 281), 3243 presented VTE recurrence, and 1579 had major bleeding. At multivariate analysis, smoking behavior was associated with a higher hazard of death, (HR: 1.28; 95% CI: 1.19–1.40). The risk of VTE recurrence was marginally increased in smoking patients compared to non-smoking patients (1.14; 95% CI: 1.02–1.27). Major bleeding did not differ in smoking and non-smoking patients (1.15; 95% CI: 0.96–1.38). The presence of cancer did not appear to influence the association between smoking habits and death (HR: 1.34; 95% CI: 1.22–1.47 in cancer patients and HR: 1.23; 95% CI: 1.04, 1.45 in non-cancer patients, respectively) Conclusions: the risk of death after an acute episode of VTE appeared to be higher in smoking than in non-smoking patients and this risk is higher between patients presenting PE at the onset of symptoms. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

11 pages, 1564 KiB

Open AccessArticle

The Effectiveness of Mobile Cloud 12-Lead Electrocardiogram Transmission System in Patients with ST-Segment Elevation Myocardial Infarction

by Toyonori Arinaga, Yasunori Suematsu, Ayumi Nakamura, Tomoki Imaizumi, Yohsuke Hanaoka, Toshimitsu Takagi, Hidenobu Koga, Hironori Tanaka, Yasuhiko Shokyu and Shin-ichiro Miura

Medicina 2022, 58(2), 247; https://doi.org/10.3390/medicina58020247 - 6 Feb 2022

Cited by 4 | Viewed by 2330

Abstract

Backgroundand Objectives: Delay of reperfusion therapy is related to high mortality in cases of ST-segment elevation myocardial infarction (STEMI). Guidelines emphasize that the first-medical-contact-to-balloon (FMCTB) time should be within 90 min. A mobile cloud-based 12-lead electrocardiogram (MC-ECG) transmission system might be [...] Read more.

Backgroundand Objectives: Delay of reperfusion therapy is related to high mortality in cases of ST-segment elevation myocardial infarction (STEMI). Guidelines emphasize that the first-medical-contact-to-balloon (FMCTB) time should be within 90 min. A mobile cloud-based 12-lead electrocardiogram (MC-ECG) transmission system might be useful in such cases, especially in rural areas. Materials and Methods: From April 2019 to June 2021, both an MC-ECG transmission system and the conventional method in which a physician checks the ECG in a hospital (Conventional) were used for transport by emergency medical services in Shin-Yukuhashi Hospital, Fukuoka, Japan. During this period, 8684 consecutive patients were transported to this hospital. Among them, we investigated 48 STEMI patients. The MC-ECG group (n = 23) and the Conventional group (n = 25) were enrolled. Results: There was no significant difference in FMCTB time between the MC-ECG and Conventional groups (MC-ECG: 72.0 (60.5–107) min vs. Conventional: 80.0 (63.0–92.0) min, p = 0.77). The length of hospital stay in the MC-ECG group was significantly shorter than that in the Conventional group (12.0 (10.0–15.0) days vs. 16.0 (12.0–19.0) days, p = 0.039). The logistic regression model showed that patients’ non-use of MC-ECG was associated with a risk of more than 15-day length of hospital stay with an adjusted odd ratio of 0.08 (95% CI: 0.013–0.55, p = 0.0098). Conclusions: Using the MC-ECG, the length of hospital stay in patients with STEMI was significantly reduced. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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9 pages, 539 KiB

Open AccessArticle

Association of ABO Blood Type with Bleeding Severity in Patients with Acute Gastroesophageal Variceal Bleeding

by Wei-Yu Lin, Ming-Yuan Hong, Chih-Hao Lin, Peng-Peng Chang, Shao-Chung Chu and Chia-Lung Kao

Medicina 2021, 57(12), 1323; https://doi.org/10.3390/medicina57121323 - 3 Dec 2021

Cited by 3 | Viewed by 2383

Abstract

Background and Objectives: ABO blood types have been implicated as potential risk factors for various hemorrhagic diseases. No study has investigated the association between gastroesophageal variceal bleeding and ABO blood types. We aimed to evaluate the impact of ABO blood types on [...] Read more.

Background and Objectives: ABO blood types have been implicated as potential risk factors for various hemorrhagic diseases. No study has investigated the association between gastroesophageal variceal bleeding and ABO blood types. We aimed to evaluate the impact of ABO blood types on mortality and bleeding risk in acute gastroesophageal variceal bleeding. Materials and Methods: This is a retrospective observational study. Patients presenting with acute gastroesophageal varices bleeding diagnosed by endoscopy were enrolled, and were divided by blood type into a type O group and non-type O group. The outcomes were death within 30 days and the proportion of further bleeding. We used generalized linear mixed-effects models to analyze the outcomes. Results: A total of 327 patients and 648 records of emergency room visits were included. The 30-day mortality was 14.8% (21 of 142 patients) in the type O group, and 16.2% (30 of 185 patients) in the non-type O group (p = 0.532). Further bleeding within 30 days occurred in 34 cases (12.6%) in the type O group, and in 26 cases (6.9%) in the non-type O group (p = 0.539). Conclusions: There was no significant difference in blood transfusion volume in 24 h, recurrent bleeding rates, or mortality between patients with blood type O and those with non-type O. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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9 pages, 286 KiB

Open AccessArticle

Impact of Personal Protective Equipment on Out-of-Hospital Cardiac Arrest Resuscitation in Coronavirus Pandemic

by Hye-Young Ko, Jong-Eun Park, Da-Un Jeong, Tae-Gun Shin, Min-Seob Sim, Ik-Joon Jo, Gun-Tak Lee and Sung-Yeon Hwang

Medicina 2021, 57(12), 1291; https://doi.org/10.3390/medicina57121291 - 24 Nov 2021

Cited by 9 | Viewed by 2145

Abstract

Background and Objectives: This retrospective study evaluated the clinical impact of enhanced personal protective equipment (PPE) on the clinical outcomes in patients with out-of-hospital cardiac arrest. Moreover, by focusing on the use of a powered air-purifying respirator (PAPR), we investigated the medical [...] Read more.

Background and Objectives: This retrospective study evaluated the clinical impact of enhanced personal protective equipment (PPE) on the clinical outcomes in patients with out-of-hospital cardiac arrest. Moreover, by focusing on the use of a powered air-purifying respirator (PAPR), we investigated the medical personnel’s perceptions of wearing PAPR during cardiopulmonary resuscitation. Materials and Methods: According to the arrival time at the emergency department, the patients were categorized into a conventional PPE group (1 August 2019 to 20 January 2020) and an enhanced PPE group (21 January 2020, to 31 August 2020). The primary outcomes of this analysis were the return of spontaneous circulation (ROSC) rate. Additionally, subjective perception of the medical staff regarding the effect of wearing enhanced PPE during cardiopulmonary resuscitation (CPR) was evaluated by conducting a survey. Results: This study included 130 out-of-hospital cardiac arrest (OHCA) patients, with 73 and 57 patients in the conventional and enhanced PPE groups, respectively. The median time intervals to first intubation and to report the first arterial blood gas analysis results were longer in the enhanced PPE group than in the conventional PPE group (3 min vs. 2 min; p = 0.020 and 8 min vs. 3 min; p < 0.001, respectively). However, there were no significant differences in the ROSC rate (odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.38–1.67; p = 0.542) and 1 month survival (OR 0.38, 95% CI: 0.07–2.10; p = 0.266) between the two groups. In total, 67 emergent department (ED) professionals responded to the questionnaire. Although a significant number of respondents experienced inconveniences with PAPR use, they agreed that PAPR was necessary during the CPR procedure for protection and reduction of infection transmission. Conclusion: The use of enhanced PPE, including PAPR, affected the performance of CPR to some extent but did not alter patient outcomes. PAPR use during the resuscitation of OHCA patients might positively impact the psychological stability of the medical staff. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

10 pages, 789 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Emergency Department Workload and Emergency Care Workers’ Psychosocial Stress in the Outbreak Area

by In-Hwan Yeo, Yun-Jeong Kim, Jong-Kun Kim, Dong-Eun Lee, Jae-Young Choe, Chang-Ho Kim, Jung-Bae Park, Kang-Suk Seo, Sin-Yul Park, Suk-Hee Lee, Jae-Kyung Cho and Sang-Hun Lee

Medicina 2021, 57(11), 1274; https://doi.org/10.3390/medicina57111274 - 19 Nov 2021

Cited by 4 | Viewed by 2546

Abstract

Background and Objectives: Due to the unexpected spread of coronavirus disease 2019 (COVID-19), there was a serious crisis of emergency medical system collapse. Healthcare workers working in the emergency department were faced with psychosocial stress and workload changes. Materials and Methods: This [...] Read more.

Background and Objectives: Due to the unexpected spread of coronavirus disease 2019 (COVID-19), there was a serious crisis of emergency medical system collapse. Healthcare workers working in the emergency department were faced with psychosocial stress and workload changes. Materials and Methods: This was a cross-sectional survey of healthcare workers in the emergency department in Daegu and Gyeongbuk, Korea, from November 16 to 25, 2020. In the survey, we assessed the general characteristics of the respondents; changes in the working conditions before and after the COVID-19 pandemic; and resulting post-traumatic stress disorder, depression and anxiety statuses using 49 questions. Results: A total of 529 responses were collected, and 520 responses were included for the final analyses. Changes in working conditions and other factors due to COVID-19 varied by emergency department level, region and disease group. Working hours, intensity, role changes, depression and anxiety scores were higher in the higher level emergency department. Isolation ward insufficiency and the risk of infection felt by healthcare workers tended to increase in the lower level emergency department. Treatment and transfer delay were higher in the fever and respiratory disease groups (M = 3.58, SD = 1.18; M = 4.08, SD = 0.95), respectively. In all the disease groups, both treatment and transfer were delayed more in Gyeongbuk than in Daegu. Conclusions: Different goals should be pursued by the levels and region of the emergency department to overcome the effects of the COVID-19 pandemic and promote optimal care. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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11 pages, 610 KiB

Open AccessArticle

Comparison of the Clinical Process and Outcomes in Patients after Coronavirus Infection 2019 Outbreak

by Sung-Jin Bae, Ho-Sub Chung, Myeong Namgung, Yoon-Hee Choi, Jin-Hong Min and Dong-Hoon Lee

Medicina 2021, 57(10), 1086; https://doi.org/10.3390/medicina57101086 - 11 Oct 2021

Cited by 9 | Viewed by 1777

Abstract

Background and Objectives: The coronavirus infection 2019 (COVID-19) pandemic has affected emergency department (ED) management. Its viral transmission necessitates the use of isolation rooms and personal protective equipment for treating suspected patients, such as those with fever. This delays the time until [...] Read more.

Background and Objectives: The coronavirus infection 2019 (COVID-19) pandemic has affected emergency department (ED) management. Its viral transmission necessitates the use of isolation rooms and personal protective equipment for treating suspected patients, such as those with fever. This delays the time until the first encounter with the patients, thereby increasing the length of stay (LOS) in the ED. We aimed to compare delays in the ED LOS and clinical processes between the COVID-19 period and pre-COVID-19 period. Moreover, we intended to evaluate if the aforementioned delay affected patient outcomes. Materials and Methods: We conducted a single-center, retrospective study in Korea. Patients with fever were compared between the “COVID-19 period” from March 2020 to August 2020 and the “pre-COVID-19 period” from March 2019 to September 2019. We compared the overall ED LOS and individual time variable, including initial diagnostic tests (laboratory tests, radiography), specific diagnostic test (computed tomography), and treatment processes (antibiotics). A logistic regression analysis was conducted to identify the association between hospital admission and patient data. Results: We enrolled 931 and 749 patients during pre- and COVID-19 periods, respectively. Patients with fever remained in the ED for a longer duration during the COVID-19 period (pre-COVID-19:207.7 ± 102.7 min vs. during COVID-19: 223.5 ± 119.4 min, p = 0.004). The total time for performing laboratory tests and radiography displayed significant differences between the two periods, particularly from the time of patient arrival in the ED to the time of issuing the order. The time until antibiotic administration was delayed in the COVID-19 period (pre-COVID-19:195.8 ± 103.3 min vs. during COVID-19: 216.9 ± 108.4 min, p = 0.003). The logistic regression analysis for hospital admission identified ED LOS as an independent factor in both periods. Conclusions: The delay until encountering patients with fever resulted in longer ED LOS during the COVID-19 period; however, it possibly did not increase the hospital admission rates. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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8 pages, 781 KiB

Open AccessArticle

Necessity of Immediate MRI Imaging in the Acute Care of Severely Injured Patients

by Daniel Popp, Maximilian Kerschbaum, Daniel Mahr, Claudius Thiedemann, Antonio Ernstberger, Isabel Wiesinger, Wolf Bäumler, Volker Alt and Andreas Schicho

Medicina 2021, 57(9), 982; https://doi.org/10.3390/medicina57090982 - 18 Sep 2021

Cited by 4 | Viewed by 2212

Abstract

Background and Objectives: The standard diagnostic procedure for a patient with a suspected polytrauma injury is computed tomography (CT). In individual cases, however, extended acute imaging using magnetic resonance imaging (MRI) can provide valuable and therapy-relevant information. The aim of our cohort [...] Read more.

Background and Objectives: The standard diagnostic procedure for a patient with a suspected polytrauma injury is computed tomography (CT). In individual cases, however, extended acute imaging using magnetic resonance imaging (MRI) can provide valuable and therapy-relevant information. The aim of our cohort study was to find such cases and to describe their characteristics in order to be able to give possible recommendations for MRI application in acute trauma situations. Materials and Methods: In the study period from 2015–2019, an evaluation of the imaging performed on polytrauma patients was carried out. The specific diagnostic and therapeutic criteria of the MRI group were further defined. Results: In total, 580 patients with an ISS ≥16 (injury severity score) were included in the study. Of these 580 patients, 568 patients received a CT scan and 12 patients an MRI scan as part of the initial diagnostic. Altogether, 66.67% of the MRIs took place outside of regular service hours. The main findings for MRI indications were neurological abnormalities with a focus on myelon injuries. Further MRI examinations were performed to rule out vascular injuries. All in all, 58.3% of the MRIs performed resulted in modified therapeutic strategies afterward. Conclusions: MRI in the context of acute diagnostic of a severely injured patient will likely remain reserved for special indications in the future. However, maximum care hospitals with a high flow of severely injured patients should provide 24/7 MR imaging to ensure the best possible care, especially in neurological and blunt vascular injuries. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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12 pages, 1138 KiB

Open AccessArticle

Features of Patients Receiving Extracorporeal Membrane Oxygenation Relative to Cardiogenic Shock Onset: A Single-Centre Experience

by Dong-Geum Shin, Sang-Deock Shin, Donghoon Han, Min-Kyung Kang, Seung-Hun Lee, Jihoon Kim, Jung-Rae Cho, Kunil Kim, Seonghoon Choi and Namho Lee

Medicina 2021, 57(9), 886; https://doi.org/10.3390/medicina57090886 - 27 Aug 2021

Cited by 3 | Viewed by 2012

Abstract

Background and Objectives: Extracorporeal membrane oxygenation (ECMO) can be helpful in patients with cardiogenic shock associated with myocardial infarction, and its early use can improve the patient survival rate. In this study, we report a mortality rate-difference analysis that examined the time and [...] Read more.

Background and Objectives: Extracorporeal membrane oxygenation (ECMO) can be helpful in patients with cardiogenic shock associated with myocardial infarction, and its early use can improve the patient survival rate. In this study, we report a mortality rate-difference analysis that examined the time and location of shock occurrence. Materials and Methods: We enrolled patients who underwent ECMO due to cardiogenic shock related to myocardial infarction and assigned them to either a pre- or post-admission shock group. The primary outcome was the 1-month mortality rate; a subgroup analysis was conducted to assess the effect of bailout ECMO. Results: Of the 113 patients enrolled, 67 (38 with pre-admission shock, 29 with post-admission shock) were analysed. Asystole was more frequently detected in the pre-admission shock group than in the post-admission group. In both groups, the commonest culprit lesion location was in the left anterior descending artery. Cardiopulmonary resuscitation was performed significantly more frequently and earlier in the pre-admission group. The 1-month mortality rate was significantly lower in the pre-admission group than in the post-admission group. Male sex and ECMO duration (≥6 days) were factors significantly related to the reduced mortality rate in the pre-admission group. In the subgroup analysis, the mortality rate was lower in patients receiving bailout ECMO than in those not receiving it; the difference was not statistically significant. Conclusions: ECMO application resulted in lower short-term mortality rate among patients with out-of-hospital cardiogenic shock onset than with in-hospital shock onset; early cardiopulmonary resuscitation and ECMO might be helpful in select patients. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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5 pages, 266 KiB

Open AccessArticle

The Angiotensin Converting Enzyme Deletion/Deletion Genotype Is a Risk Factor for Severe COVID-19: Implication and Utility for Patients Admitted to Emergency Department

by Anna Annunziata, Antonietta Coppola, Valentina Di Spirito, Rosa Cauteruccio, Antonella Marotta, Pierpaolo Di Micco and Giuseppe Fiorentino

Medicina 2021, 57(8), 844; https://doi.org/10.3390/medicina57080844 - 20 Aug 2021

Cited by 10 | Viewed by 2547

Abstract

Background and objective: Insertion/deletion polymorphisms of angiotensin-converting enzyme (ACE) have been previously described in association with adult respiratory distress syndrome (ARDS) and correlated to outcome. The ACE deletion/deletion(D/D)genotype represents a marker of thrombosis in subjects apparently without predisposing factors and/or traditional thrombophilic [...] Read more.

Background and objective: Insertion/deletion polymorphisms of angiotensin-converting enzyme (ACE) have been previously described in association with adult respiratory distress syndrome (ARDS) and correlated to outcome. The ACE deletion/deletion(D/D)genotype represents a marker of thrombosis in subjects apparently without predisposing factors and/or traditional thrombophilic alterations and increases the risk of venous thromboembolism in subjects in whom a thrombogenic condition occurs. Thrombosis seems to play a role very early in the disease caused by SARS-CoV-2, in particular in those with severe COVID-19 pneumonia. The counterbalance between angiotensin-converting enzyme (ACE) and ACE2 activities in COVID-19 disease may play a crucial role in the thrombo-inflammatory process. We hypothesised that a genetic predisposition could condition the severity and complications of SARS-CoV-2 infection. Materials and methods: We conducted a spontaneous, single centre observational study in the Sub-Intensive Care Unit of A.O.R.N. Ospedali dei Colli, Cotugno Hospital, Naples (Italy). In this study, we performed genetic screening for ACE D/D genotype and other thrombophilic mutations in 20 patients affected by ARDS related to COVID-19 pneumonia, compared to 19 age- and sex-matched healthy controls. Results: All tested patients had multiple polymorphisms and, in particular, a significantly higher prevalence of ACE D/D polymorphism in severe COVID-19 patients Conclusion: We found that the majority of patients who tested positive for ACE D-D genotype and who were not associated with other risk factors for VTE showed an evolution to ARDS. This finding could have a predicting role in the selection of patients more prone to developing severe COVID-19 during clinical observation in emergency department. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

Review

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14 pages, 789 KiB

Open AccessReview

Emergency General Surgery and COVID-19 Pandemic: Are There Any Changes? A Scoping Review

by Eleni Karlafti, Evangelia Kotzakioulafi, Dimitrios-Christos Peroglou, Styliani Gklaveri, Petra Malliou, Aristeidis Ioannidis, Stavros Panidis, Smaro Netta, Christos Savopoulos, Antonios Michalopoulos and Daniel Paramythiotis

Medicina 2022, 58(9), 1197; https://doi.org/10.3390/medicina58091197 - 1 Sep 2022

Cited by 6 | Viewed by 2285

Abstract

Background and Objectives: The pandemic of SARS-CoV-19 has affected the overall spectrum of General Surgery, either in the case management part, or in the type of cases. The purpose of this review is to gather all the parameters affected and to compare [...] Read more.

Background and Objectives: The pandemic of SARS-CoV-19 has affected the overall spectrum of General Surgery, either in the case management part, or in the type of cases. The purpose of this review is to gather all the parameters affected and to compare these changes between the pandemic period and the corresponding time frame of the previous year. Materials and Methods: A review of literature in two electronic databases (PubMed and Scopus) was performed examining studies during the pre-pandemic (March to May 2019) and pandemic (March to May 2020) period about emergency surgeries. The differences in case presentation in emergency rooms, patient characteristics, length of hospitalization, type of surgery, complications and mortality rate were compared. Results: The comparison of the studies revealed significant results highlighting the differences between the two time periods for each parameter. There has been observed an overall decrease in the number of cases presented for emergency and urgent surgery. In terms of age, sex, and BMI, there were no significant variations amongst the patients. About the length of hospitalization, the patients hospitalized longer during the pandemic period. In terms of pathologies, the most common types of surgery were appendectomy, gastrointestinal, and colorectal resection. Mortality did not differ between the two study periods. Conclusions: COVID-19 affected a large part of Emergency General Surgery mainly concerns the type of operations performed. The hospitalization of patients, the complications that may have arisen and the recognition of emergencies were the most important issues faced by health care officials in hospitals during the period of COVID-19; however, there were parameters like mortality and patients’ characteristics that did not appear to differ with pre-pandemic era. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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8 pages, 673 KiB

Open AccessReview

Cardiac Biomarkers in Patients with Acute Pulmonary Embolism

by Luc Janisset, Maxime Castan, Géraldine Poenou, Raphael Lachand, Patrick Mismetti, Alain Viallon and Laurent Bertoletti

Medicina 2022, 58(4), 541; https://doi.org/10.3390/medicina58040541 - 14 Apr 2022

Cited by 8 | Viewed by 3704

Abstract

Pulmonary embolism is a frequent and potentially fatal disease. The major challenge of initial management lies in prognostic stratification. Since 2014, the European recommendations on the diagnosis and management of acute pulmonary embolism are based on assessing the risk stratification regarding hemodynamic status [...] Read more.

Pulmonary embolism is a frequent and potentially fatal disease. The major challenge of initial management lies in prognostic stratification. Since 2014, the European recommendations on the diagnosis and management of acute pulmonary embolism are based on assessing the risk stratification regarding hemodynamic status first, then on a combined risk assessment model using a clinical score, an imaging evaluation of right heart size and the concentration of a serum cardiac biomarker. Usual biomarkers cover cardiac ischemia (troponin and derivates) and dilatation (BNP and derivates). The aim of this review is to offer a practical update on the role of the Troponins and BNPs families of biomarkers and the prognosis of pulmonary embolism, and furthermore, to provide a brief overview of their place in current management. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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Other

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6 pages, 645 KiB

Open AccessCase Report

A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels

by Ming-Jin Chung, Yan-Chiao Mao, Chia-Tien Hsu, Mu-Chi Chung, Tsai-Jung Wang, Tung-Min Yu, Po-Yu Liu, Pin-Kuei Fu and Chia-Ming Hsieh

Medicina 2022, 58(11), 1630; https://doi.org/10.3390/medicina58111630 - 11 Nov 2022

Cited by 8 | Viewed by 3536

Abstract

Chlorfenapyr is a new contact and stomach insecticide derived from natural pyrroles secreted by Streptomyces spp. It is a pro-insecticide and acts after metabolic transformation to its active metabolite tralopyril. Tralopyril is an uncoupler of oxidative phosphorylation in the mitochondria of the target [...] Read more.

Chlorfenapyr is a new contact and stomach insecticide derived from natural pyrroles secreted by Streptomyces spp. It is a pro-insecticide and acts after metabolic transformation to its active metabolite tralopyril. Tralopyril is an uncoupler of oxidative phosphorylation in the mitochondria of the target insects and of experiment animals, leading to the disruption of adenosine triphosphate synthesis and death. Several fatal human poisonings had been reported and no blood chlorfenapyr or tralopyril measurements were available. The treatment remains supportive. A 32-year-old healthy man ingested 200 mL of 10% chlorfenapyr as a suicide attempt. Unfortunately, he succumbed at 157 h post-ingestion, shortly after having fever and seizures. His serum level of chlorfenapyr at 4 h post-exposure was 77.4 ng/mL, and was undetectable at 113 and 156 h, respectively. The serum levels of tralopyril were 723.6, 14,179, and 9654.2 ng/mL at 4, 113, and 156 h post-ingestion, respectively. The delay in the rise of serum tralopyril levels was noticeable, which seems to correlate with the patient’s signs and symptoms. The information may have therapeutic implications in the management of this deadly poisoning. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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7 pages, 2114 KiB

Open AccessCase Report

Prediction of Compartment Syndrome after Protobothrops mucrosquamatus Snakebite by Diastolic Retrograde Arterial Flow: A Case Report

by Yueh-Tseng Hou, Meing-Chung Chang, Ching Yang, Yu-Long Chen, Po-Chen Lin, Giou-Teng Yiang and Meng-Yu Wu

Medicina 2022, 58(8), 996; https://doi.org/10.3390/medicina58080996 - 26 Jul 2022

Cited by 2 | Viewed by 3759

Abstract

Post-snakebite compartment syndrome (PSCS) is an uncommon but dangerous condition. Compartment syndrome-like symptoms after snakebite by Protobothrops mucrosquamatus (P. mucrosquamatus) are not effective in guiding fasciotomy. Objective evaluation of intracompartmental pressure measurements in patients with suspected PSCS is recommended. However, there [...] Read more.

Post-snakebite compartment syndrome (PSCS) is an uncommon but dangerous condition. Compartment syndrome-like symptoms after snakebite by Protobothrops mucrosquamatus (P. mucrosquamatus) are not effective in guiding fasciotomy. Objective evaluation of intracompartmental pressure measurements in patients with suspected PSCS is recommended. However, there is a lack of consensus regarding PSCS and indications for surgical intervention, including the threshold value of chamber pressure. In addition, intracompartmental pressure measurements may not be readily available in all emergency service settings. Measuring intracompartmental pressure in all snakebite patients for early diagnosis of PSCS is impractical. Therefore, identifying risk factors, continuous real-time monitoring tools, and predictive factors for PSCS are important. Sonography has proved useful in identifying the location and extension of edema after a snakebite. In this study, we attempted to use point-of-care ultrasound to manage PSCS in real-time. Here, we describe a rare case of snakebite from P. mucrosquamatus. PSCS was considered as diastolic retrograde arterial flow (DRAF) was noted in the affected limb with a cobblestone-like appearance in the subcutaneous area, indicating that the target artery was compressed. The DRAF sign requires physicians to aggressively administer antivenom to salvage the limb. The patient was administered 31 vials of P. mucrosquamatus antivenom, and fasciotomy was not performed. DRAF is an early sign of the prediction of PSCS. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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11 pages, 2045 KiB

Open AccessSystematic Review

Efficacy of Quantitative Pupillary Light Reflex for Predicting Neurological Outcomes in Patients Treated with Targeted Temperature Management after Cardiac Arrest: A Systematic Review and Meta-Analysis

by Jae-Guk Kim, Hyungoo Shin, Tae-Ho Lim, Wonhee Kim, Youngsuk Cho, Bo-Hyoung Jang, Kyu-Sun Choi, Min-Kyun Na, Chiwon Ahn and Juncheol Lee

Medicina 2022, 58(6), 804; https://doi.org/10.3390/medicina58060804 - 15 Jun 2022

Cited by 3 | Viewed by 2700

Abstract

Background and objectives: This study aims to evaluate the usefulness of the quantitative pupillary light reflex as a prognostic tool for neurological outcomes in post-cardiac arrest patients treated with targeted temperature management (TTM). Material and Methods: We systematically searched MEDLINE, EMBASE, [...] Read more.

Background and objectives: This study aims to evaluate the usefulness of the quantitative pupillary light reflex as a prognostic tool for neurological outcomes in post-cardiac arrest patients treated with targeted temperature management (TTM). Material and Methods: We systematically searched MEDLINE, EMBASE, and the Cochrane Library (search date: 9 July 2021) for studies on post-cardiac arrest patients treated with TTM that had measured the percent constriction of pupillary light reflex (%PLR) with quantitative pupillometry as well as assessed the neurological outcome. For an assessment of the methodological quality of the included studies, two authors utilized the prognosis study tool independently. Results: A total of 618 patients from four studies were included in this study. Standardized mean differences (SMDs) were calculated to compare patients with good or poor neurological outcomes. A higher %PLR measured at 0–24 h after hospital admission was related to good neurological outcomes at 3 months in post-cardiac arrest patients treated with TTM (SMD 0.87; 95% confidence interval 0.70–1.05; I² = 0%). A higher %PLR amplitude measured at 24–48 h after hospital admission was also associated with a good neurological outcome at 3 months in post-cardiac arrest patients treated with TTM, but with high heterogeneity (standardized mean difference 0.86; 95% confidence interval 0.40–1.32; I² = 70%). The evidence supporting these findings was of poor quality. For poor neurological outcome, the prognosis accuracy of %PLR was 9.19 (pooled diagnostic odds ratio, I² = 0%) and 0.75 (area under the curve). Conclusions: The present meta-analysis could not reveal that change of %PLR was an effective tool in predicting neurological outcomes for post-cardiac arrest patients treated with TTM owing to a paucity of included studies and the poor quality of the evidence. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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5 pages, 1194 KiB

Open AccessCase Report

A Rare Case of Effusive-Constrictive Pericarditis Caused by Streptococcus agalactiae: Emergency Surgical Treatment

by Annarita Iavazzo, Giovanni Battista Pinna, Maria Grazia Romeo, Emilio Mileo, Emanuele Pilato and Luigi Di Tommaso

Medicina 2022, 58(6), 699; https://doi.org/10.3390/medicina58060699 - 25 May 2022

Cited by 3 | Viewed by 2482

Abstract

A 70-year-old male patient was admitted to the emergency room in cardiac arrest. The patient was resuscitated and then referred to our cardiac surgery department, where he was diagnosed with suspected effusive constrictive pericarditis. A failed trial of TEE-guided pericardiocentesis led to the [...] Read more.

A 70-year-old male patient was admitted to the emergency room in cardiac arrest. The patient was resuscitated and then referred to our cardiac surgery department, where he was diagnosed with suspected effusive constrictive pericarditis. A failed trial of TEE-guided pericardiocentesis led to the decision of surgical intervention. Sternotomy was performed and revealed pericardial thickening and very dense adhesions involving the pericardium and both pleurae, suggesting a neoplastic disease. An extensive pericardiectomy and bilateral pleural decortication were performed. After surgery, the patient improved significantly and was discharged from the intensive care unit 24 h later. Pericardial thickening, dense adhesions, the amount and color of pericardial fluid and the aspect of epicardial tissue increased our suspicion of neoplastic disease. Histological samples were sent to be analyzed immediately; a few days later, they were unexpectedly negative for any neoplastic disease but showed a group-B-hemolytic Streptococcus agalactiae infection, which causes pericarditis in extremely rare cases. Postoperatively, the patient, under intravenous antibiotic and anti-inflammatory therapy, remained asymptomatic and was discharged ten days after the surgery. At the three-month follow-up, transthoracic echocardiography showed a normal right and left ventricular function with no pericardial effusion. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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8 pages, 17548 KiB

Open AccessCase Report

Successful Management Foreign Body Aspiration Associated with Severe Respiratory Distress and Subcutaneous Emphysema: Case Report and Literature Review

by José Juan Gómez-Ramos, Alejandro Marín-Medina, Alexandro Azael Castillo-Cobian and Oscar Gabriel Felipe-Diego

Medicina 2022, 58(3), 396; https://doi.org/10.3390/medicina58030396 - 7 Mar 2022

Cited by 2 | Viewed by 3553

Abstract

The presence of a foreign body in the airway is a potentially life-threatening clinical condition that requires urgent medical attention. We present a case of a 12-year-old boy who presented in the emergency room with a history of an episode of choking after [...] Read more.

The presence of a foreign body in the airway is a potentially life-threatening clinical condition that requires urgent medical attention. We present a case of a 12-year-old boy who presented in the emergency room with a history of an episode of choking after aspiration of a foreign body, followed by severe respiratory distress and subcutaneous emphysema. Chest radiography revealed hyperinflation data, pneumothorax, and subcutaneous emphysema data. The flexible bronchoscope examination showed the presence of an inorganic foreign body impacted on the carina with tracheal lesions and laryngeal edema. It was necessary to perform a tracheostomy for its definitive extraction. The gold standard in the treatment of foreign body aspiration is bronchoscopy; although, in children, the technique adopted continues to be controversial, flexible bronchoscopy can be effective and very useful. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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5 pages, 1056 KiB

Open AccessCase Report

Bacterial Pericarditis Caused by Penetration of a Migrated Biliary Stent from the Lateral Segment of the Liver: A Case Report

by Hsiao-Yun Chao, Chih-Huang Li and Shou-Yen Chen

Medicina 2022, 58(1), 132; https://doi.org/10.3390/medicina58010132 - 15 Jan 2022

Cited by 6 | Viewed by 2101

Abstract

Endoscopic biliary stent insertion is a well-established procedure that is indispensable in the management of various benign and malignant biliary disorders, and one that helps prevent mortality related to invasive surgical procedures. We report a rare case of the distal migration of a [...] Read more.

Endoscopic biliary stent insertion is a well-established procedure that is indispensable in the management of various benign and malignant biliary disorders, and one that helps prevent mortality related to invasive surgical procedures. We report a rare case of the distal migration of a biliary stent outside the abdomen to the pericardium, inducing constrictive pericarditis and septic shock. This case alerts clinicians to be aware of potential adverse events that can lead to unfavorable patient outcomes. Such adverse events can be effectively avoided through early detection and intervention. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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8 pages, 3190 KiB

Open AccessCase Report

A Rare Evolution to Pneumopericardium in Patient with COVID-19 Pneumonia Treated with High Flow Nasal Cannula

by Giorgio Emanuele Polistina, Maurizia Lanza, Camilla Di Somma, Anna Annunziata and Giuseppe Fiorentino

Medicina 2021, 57(10), 1122; https://doi.org/10.3390/medicina57101122 - 18 Oct 2021

Cited by 4 | Viewed by 1915

Abstract

Infection with severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (COVID-19) which was revealed an official pandemic by the World Health Organization on 11 March 2020. The current pandemic, the third of this decade, is the worst in terms of suffering [...] Read more.

Infection with severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (COVID-19) which was revealed an official pandemic by the World Health Organization on 11 March 2020. The current pandemic, the third of this decade, is the worst in terms of suffering and deaths related. COVID-19 represents an unprecedented challenge for medical communities and patients around the world. High-resolution computed tomography of the chest (HRCT) is a fundamental tool in both management and diagnosis of the disease. Imaging plays an essential role in the diagnosis of all the manifestations of the disease and its complications and the correct use and interpretation of imaging tests are essential. Pneumomediastinum has been reported rarely in COVID-19 patients. We were one of the first groups to share our experiences in uncommon parenchymal complications of COVID-19 with spontaneous pneumothorax and pneumomediastinum, but also with new-onset bronchiectasis and cysts. A finding of pneumopericardium is also unusual. We hereby report a rare case of spontaneous pneumopericardium in a patient with COVID-19 pneumonia treated only with a high-flow nasal cannula (HFNC). Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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6 pages, 532 KiB

Open AccessCase Report

Possible Adrenal Involvement in Long COVID Syndrome

by Ciro Salzano, Giovanna Saracino and Giuseppe Cardillo

Medicina 2021, 57(10), 1087; https://doi.org/10.3390/medicina57101087 - 11 Oct 2021

Cited by 24 | Viewed by 5545

Abstract

Background: A significant number of patients with COVID-19 experience prolonged symptoms, known as Long COVID. The most frequent symptoms are fatigue and cognitive dysfunction. We describe a patient suffering from Long COVID in whom adrenal involvement was highlighted. Methods: The patient [...] Read more.

Background: A significant number of patients with COVID-19 experience prolonged symptoms, known as Long COVID. The most frequent symptoms are fatigue and cognitive dysfunction. We describe a patient suffering from Long COVID in whom adrenal involvement was highlighted. Methods: The patient described Long COVID symptoms that persist 3 months after the negativization of the molecular swab test. The main symptoms were weakness, brain fog, dizziness, and muscular and joint pain. All routine lab panels for inflammation, anemia, and thyroid and liver function were conducted. Moreover, salivary cortisol and DHEA-S determinations were used to compute the adrenal stress index (ASI). Results: All tests were negative, except the ASI that showed very low levels of free cortisol. The patient started hydrocortisone acetate supplementation. Conclusion: Long COVID symptoms could be explained by an adrenal involvement, due to a COVID-19 action on adrenal glands and by a iatrogenic side effect of high glucocorticoid therapy during the COVID-19 infection. Salivary cortisol determination is effective for establishing a correct recovery plan. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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9 pages, 561 KiB

Open AccessBrief Report

Pathophysiology of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) and Vaccine-Induced Thrombocytopenic Thrombosis (VITT) and Their Diagnostic Approach in Emergency

by Pierpaolo Di Micco, Giuseppe Camporese, Giuseppe Cardillo, Corrado Lodigiani, Novella Carannante, Anna Annunziata, Giuseppe Fiorentino, Vincenzo Russo and Egidio Imbalzano

Medicina 2021, 57(10), 997; https://doi.org/10.3390/medicina57100997 - 22 Sep 2021

Cited by 8 | Viewed by 3380

Abstract

SARS-CoV-2 induced a pandemic that is reported to have started in Asia and was then extended to other countries in the world. Main clinical aspects of this viral infection have been lung injuries with severe pneumonia requiring prolonged hospitalization and associated morbidities such [...] Read more.

SARS-CoV-2 induced a pandemic that is reported to have started in Asia and was then extended to other countries in the world. Main clinical aspects of this viral infection have been lung injuries with severe pneumonia requiring prolonged hospitalization and associated morbidities such as venous thromboembolism and/or superinfection by bacteria, fungus or other pests. Immediately there was a need to develop a sustainable therapeutic strategy, such as vaccination. Vaccines against Covid-19, in fact, exert a protective action for common people and reduce viral diffusion. Yet, vaccination of a large number of people raises the question of a well-known complication of several types of vaccines; this complication is immune thrombocytopenia, which is sometimes associated with thrombosis as well. In this short review, we summarized mechanisms involved in the pathogenesis of vaccine-induced prothrombotic immune thrombocytopenia and vaccine-induced thrombocytopenic thrombosis. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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Open AccessBrief Report

Pneumomediastinum and Pneumothorax as Relevant Complications of Sub-Intensive Care of Patients with COVID-19: Description of a Case Series

by Maria Gabriella Coppola, Marina Lugarà, Stefania Tamburrini, Pasquale Madonna, Claudio Panico, Giuseppe Noschese and Eduardo Pone

Medicina 2021, 57(9), 919; https://doi.org/10.3390/medicina57090919 - 1 Sep 2021

Cited by 4 | Viewed by 2655

Abstract

Lung failure has been the most common cause of hospitalization for COVID-19. Yet, bilateral interstitial pneumonia has not been the only cause of lung failure of these inpatients, and frequently they develop other illnesses associated with COVID-19. Pulmonary embolism has been the most [...] Read more.

Lung failure has been the most common cause of hospitalization for COVID-19. Yet, bilateral interstitial pneumonia has not been the only cause of lung failure of these inpatients, and frequently they develop other illnesses associated with COVID-19. Pulmonary embolism has been the most looked for in the world, but rarely other pneumological diseases, such as pneumothorax and pneumomediastinum, have been described and associated with a worsening prognosis. We here report our clinical experience associated with the occurrence of pneumothorax and pneumomediastinum in a cohort of inpatients hospitalized in our division of medicine in a regular ward or in a sub-intensive ward. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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6 pages, 1699 KiB

Open AccessCase Report

Tension Hemothorax in Aortic Rupture: A Case Report

by Jana Pometlová, Roman Madeja, Jiří Demel, Renata Ječmínková, Václav Procházka, Miroslav Kitka and Leopold Pleva

Medicina 2021, 57(8), 790; https://doi.org/10.3390/medicina57080790 - 31 Jul 2021

Cited by 2 | Viewed by 2233

Abstract

Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: [...] Read more.

Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage. Full article

(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)

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