Emergency Care Journal
type: channel
description: Emergency Care Journal is the official Journal of the Academy of Emergency Medicine and Care (AcEMC). The journal is an international, peer-reviewed journal dedicated to improve the quality of care by publishing contributions on acute medical care and related medical specialties. The journal welcomes submissions from international contributors and researchers of all specialties involved in acute medical conditions. Emergency Care Journal publishes Original Articles, Review Articles, Opinion Reports, Case Reports, Images in Emergency, Letters to the Editors, Commentaries, Book Reviews, Editorials and other educational information related to the practice, teaching, and environment of emergency medicine. In addition to general topics, ECJ also publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics. Although most of published research is clinical, there is also strong interest for basic science research pertinent to emergency medicine, thus including all clinical, diagnostics and therapeutic areas of medicine involved in the emergency care management. This journal does not apply charge for publication to Authors as it is fully supported by institutional funds (Academy of Emergency Medicine and Care).
publisher: PAGEPress Scientific Publications, Pavia, Italy
language: en
publication name: Emergency Care Journal
issn: 2282-2054
copyright: PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
items: A decalogue for saving Italian emergency departments
items: Clinical-radiological and intraoperative discrepancy in massive pneumatosis intestinalis and portomesenteric venous gas in a patient with septic shock
items: The management of acute isolated vertigo in the emergency department: a mini review
items: Interpersonal skills training for the emergency department – exploring a mentalizing approach
items: A rare trouble in the small bowel
items: Why the magnitude of lung sliding matters: moving beyond a binary interpretation in lung ultrasound
items: Septic source matters: how infection site and microbial etiology affect sepsis prognosis
items: Disaster preparedness of households of educational staff at Yasuj University of Medical Sciences: a descriptive cross-sectional study
items: Effectiveness of plasma versus crystalloids in pre-hospital hemorrhagic shock: systematic review and meta-analysis
items: Professional burnout and workforce attrition in emergency departments: an analysis from Tuscany, Italy
items: Acute hand ischemia after inadvertent intra-arterial injection of crushed zolpidem tablets. A case report and literature review
items: The importance of keeping in the loop about abdominal pain
items: Subacute tuberculous meningitis in immunocompetent patients: a diagnostic challenge in the emergency department
items: Fixed vs. incremental shock energy for atrial fibrillation: electrical cardioversion strategies in the emergency department
items: Prehospital lung ultrasound for acute dyspnoea: a narrative mini-review of diagnostic accuracy, feasibility, and B-line-focused training
items: Persistent hypoxia in a pediatric patient following a house fire
items: Malignant bowel obstruction in patients affected by advanced cancer: clinical and radiologic findings to support decision-making process in the emergency department
items: Maternal generalized tetanus following spontaneous abortion in a vaccinated woman: a rare but persistent threat
items: Prognostic factors of crush syndrome and survival in elderly earthquake survivors: a retrospective study after the 2023 Turkey disaster
items: Spontaneous rupture of a normal spleen: a case report and literature review

A decalogue for saving Italian emergency departments
type: item
description: Section: Reviews Categories: Newsletter Keywords: Emergency department crisis, healthcare reform, crowding, healthcare provider burnout, emergency department work-life balance The COVID-19 pandemic severely impacted Italian Emergency Departments (EDs), leading to drastic staff reductions, chronic overcrowding, widespread burnout, and an exodus of healthcare providers. Consequently, the ED system faces collapse due to relentless overloading. The authors propose a radical decalogue of provocations to drive structural reform and spark scientific debate on the future of emergency care. The core objective is to restore the ED’s mission by strictly limiting access to acute, time-dependent conditions. This requires diverting non-urgent visits to a genuinely operational territorial network, creating distinct, non-ED managed flows for non-acute or destabilized chronic patients. To reach this aim, a single, national, scientifically validated triage system is essential to reliably distinguish between ED-acute patients and those who belong in alternative settings. To address staff retention, the Decalogue demands increased pay, reduced weekly working hours, optimized night work, and structured work diversification between pre-hospital and intermediate care units to make the profession sustainable. Furthermore, the ED must be restored as the hospital's strategic core, with the emergency physician as team leader. Simultaneously, boarding must end by mandating the transfer of stabilized patients out of the ED. System-wide, the network should be rationalized by concentrating resources in equipped referral centers. Finally, the Decalogue calls for legal protection for emergency professionals (with liability resting on healthcare institutions), the establishment of academic chairs in emergency medicine assigned to emergency physicians, and mandatory research for residents. The authors contend that only bold, radical choices can safeguard the ED system and the entire healthcare infras…
subject: Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Emergency department crisis
  topic: keywords
subject: healthcare reform
  topic: keywords
subject: crowding
  topic: keywords
subject: healthcare provider burnout
  topic: keywords
subject: emergency department work-life balance
  topic: keywords
creator: Alessandro Cipriano
creator: Arian Zaboli
creator: Lorenzo Ghiadoni
creator: Gianni Turcato
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-24
publication date: 2026-03-24
doi: 10.4081/ecj.2026.14595

Clinical-radiological and intraoperative discrepancy in massive pneumatosis intestinalis and portomesenteric venous gas in a patient with septic shock
type: item
description: Section: Case Reports Categories: Newsletter Keywords: Pneumatosis intestinalis, portomesenteric venous gas, intestinal ischemia, septic shock, multidetector computed tomography, exploratory laparotomy, second-look surgery Pneumatosis Intestinalis (PI) and Portomesenteric Venous Gas (PMVG) are radiological findings frequently associated with transmural bowel ischemia and poor prognosis. Their presence usually prompts urgent surgical intervention. A 60-year-old man with a past history of small bowel infarction presented with septic shock, abdominal pain, and elevated serum lactate (3.2 mmol/L). Contrast-enhanced CT demonstrated massive intra- and extrahepatic PMVG with a bubble-like intramural gas pattern in the small bowel. Based on the clinical and imaging findings, emergency laparotomy was performed. Intraoperative exploration revealed bowel distension and mucosal edema with petechial hemorrhage, but no evidence of transmural necrosis. A second-look procedure at 48 hours confirmed the absence of necrosis. This case highlights that even massive PI with PMVG and septic shock may not invariably indicate bowel necrosis. Careful correlation of radiological, laboratory, and clinical findings is essential, and surgical exploration remains mandatory in unstable patients to prevent catastrophic outcomes.
subject: Case Reports
  topic: section
subject: Newsletter
  topic: category
subject: Pneumatosis intestinalis
  topic: keywords
subject: portomesenteric venous gas
  topic: keywords
subject: intestinal ischemia
  topic: keywords
subject: septic shock
  topic: keywords
subject: multidetector computed tomography
  topic: keywords
subject: exploratory laparotomy
  topic: keywords
subject: second-look surgery
  topic: keywords
creator: Filomena Pezzullo
creator: Rosita Comune
creator: Mariano Scaglione
creator: Giulia Lassandro
creator: Marco Catalano
creator: Raffaele D'Avino
creator: Luigi Cioffi
creator: Roberto Carbone
creator: Angela Pezzullo
creator: Stefania Tamburrini
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-16
publication date: 2025-12-16
doi: 10.4081/ecj.2025.14256

The management of acute isolated vertigo in the emergency department: a mini review
type: item
description: Section: Mini Reviews Categories: Newsletter Keywords: Vertigo, dizziness, nystagmus, benign paroxysmal positional vertigo, acute peripheral vestibular dysfunction, ischemic stroke Acute vertigo is defined as the sensation of movement of oneself or the environment in the absence of actual motion, and it represents a common reason for admission to the emergency department. This symptom is associated with high healthcare resource utilization and prolonged hospital stays. However, the diagnostic yield of brain imaging in the acute phase remains low, given the limited sensitivity of both CT and MRI in detecting central causes of vertigo. In contrast, clinical examination has proven to be highly accurate and efficient when performed by experienced clinicians. Over recent years, several clinical algorithms have been developed to improve the diagnostic accuracy of emergency physicians in evaluating patients with acute vertigo. Among these, the HINTS and STANDING algorithms have undergone external validation in emergency settings, demonstrating good diagnostic performance. The objective of this review is to provide scientific evidence to support clinical decision-making for physicians assessing adult patients presenting with acute vertigo in the emergency department.
subject: Mini Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Vertigo
  topic: keywords
subject: dizziness
  topic: keywords
subject: nystagmus
  topic: keywords
subject: benign paroxysmal positional vertigo
  topic: keywords
subject: acute peripheral vestibular dysfunction
  topic: keywords
subject: ischemic stroke
  topic: keywords
creator: Simone Vanni
creator: Mattia Ronchetti
creator: Paolo Vannucchi
creator: Giuseppe Pepe
creator: Rudi Pecci
creator: Andrea Pavellini
creator: Lorenzo Pelagatti
creator: Maurizio Paciaroni
creator: Angela Konze
creator: Andrea Castellucci
creator: Marco Manfrin
creator: Andrea Fabbri
creator: Antonio Voza
creator: Peiman Nazerian
creator: Maurizio Bartolucci
creator: Alessandro Riccardi
creator: Pietro Augusto Casani
creator: Società Italiana di Medicina d’Emergenza Urgenza (SIMEU)
creator: Società Italiana di Vestibologia (VIS)
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-25
publication date: 2026-03-25
doi: 10.4081/ecj.2026.14619

Interpersonal skills training for the emergency department – exploring a mentalizing approach
type: item
description: Section: Brief Reports Categories: Newsletter Keywords: Mentalizing skills, emergency department, interpersonal skills training, attitudes, relational difficulties Patients with significant relational difficulties may present to the Emergency Department (ED) in crisis. If negative attitudes and responses arise from ED staff, this adversely impacts patients’ outcomes. There is currently no established approach to training ED staff in interpersonal skills. Mentalizing Skills (MZ Skills) is a short training course in interpersonal skills that has shown promise within mental health settings, but has not yet been explored in the ED. We therefore conducted an evaluation of MZ Skills within an ED to explore if this approach may be useful and acceptable. Outcomes were assessed using established self-report outcome scales. A hundred and seven (107) clinicians were trained in MZ Skills. From pre- to post- training, staff knowledge about mentalizing theory and practice improved (n=97; effect size 1.07); attitudes improved to a smaller degree. We suggest, pending further evaluation, that MZ skills could offer an acceptable approach for training ED staff in interpersonal dynamics.
subject: Brief Reports
  topic: section
subject: Newsletter
  topic: category
subject: Mentalizing skills
  topic: keywords
subject: emergency department
  topic: keywords
subject: interpersonal skills training
  topic: keywords
subject: attitudes
  topic: keywords
subject: relational difficulties
  topic: keywords
creator: Jon Patrick
creator: Bernadette Gallagher
creator: Damien Hicks
creator: Kate Pestell
creator: Claire MacLean
creator: Emma-Beth Wilson
creator: Edward James
creator: Benjamin Clarke
creator: Adam Polnay
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-20
publication date: 2026-01-20
doi: 10.4081/ecj.2026.14344

A rare trouble in the small bowel
type: item
description: Section: Images in Emergency Categories: Newsletter Keywords: Jejunal diverticulitis, diverticula, small bowel, abdominal pain, computed tomography, abdominal surgery A 69-year-old woman presented to the emergency department with acute lower abdominal pain, peritonism and fever (body temperature 38.5 °C). Her past medical history was unremarkable. Laboratory tests revealed an increase of white blood cells (18.17 x 109/L; normal values 3.6-10.5 x 109/L), neutrophils (16.05 x 109/L; normal values 1.5-7.7 x 109/L), C-reactive protein (31.79 mg/dL; normal values < 0.5 mg/dL) and lactate dehydrogenase (315 U/L; normal values < 248 U/L) levels. Abdominal contrast-enhanced computed tomography (CT) scan showed a large outpouching filled by fecaloid material on the mesenteric side of a jejunal loop in the left lumbar region with stranding of adjacent fat (red arrow).
subject: Images in Emergency
  topic: section
subject: Newsletter
  topic: category
subject: Jejunal diverticulitis
  topic: keywords
subject: diverticula
  topic: keywords
subject: small bowel
  topic: keywords
subject: abdominal pain
  topic: keywords
subject: computed tomography
  topic: keywords
subject: abdominal surgery
  topic: keywords
creator: Massimo Barakat
creator: Mario Capone
creator: Ludovica Lotrecchiano
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-18
publication date: 2025-12-18
doi: 10.4081/ecj.2025.14621

Why the magnitude of lung sliding matters: moving beyond a binary interpretation in lung ultrasound
type: item
description: Section: Letters to the Editor Categories: Newsletter Keywords: Lung sliding amplitude, pleural motion, point-of-care ultrasound Dear Editor, Lung sliding has traditionally been assessed in a binary manner—present or absent—primarily to exclude pneumothorax in point-of-care lung ultrasound. However, emerging evidence suggests that this qualitative approach may overlook clinically meaningful information contained in the magnitude of pleural motion itself. Recent studies increasingly indicate that the amount of lung sliding, rather than its mere presence, reflects underlying lung mechanics and regional ventilation patterns.[...]
subject: Letters to the Editor
  topic: section
subject: Newsletter
  topic: category
subject: Lung sliding amplitude
  topic: keywords
subject: pleural motion
  topic: keywords
subject: point-of-care ultrasound
  topic: keywords
creator: İlker Şirin
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-16
publication date: 2026-02-16
doi: 10.4081/ecj.2026.14802

Septic source matters: how infection site and microbial etiology affect sepsis prognosis
type: item
description: Section: Original Articles Categories: Newsletter Keywords: In-hospital mortality, sepsis, septic shock, septic source Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Despite advances in critical care, mortality remains high. This study assesses the relationship between septic source, microbial etiology, and in-hospital mortality. This prospective observational study was conducted at the St. Anna University Hospital of Ferrara, Italy, from October 2021 to February 2022. Adult patients with suspected sepsis and a qSOFA score ≥ 2 were included. Data collected included vital signs, laboratory values, septic source classification, microbial etiology, and in-hospital mortality. Statistical analyses were performed using SPSS and jamovi, with an alluvial diagram to visualize relationships. Of 200 screened patients, 187 were included (mean age 85.0±9.6 years). In-hospital mortality was 27.3%. The most common septic sources were urinary (43.3%) and respiratory (28.9%), followed by miscellaneous (11.8%), abdominal (7.0%), and undefined (9.1%). Undefined sources had the highest mortality (58.8%), followed by respiratory (31.5%) and urinary sepsis (22.2%) (p=0.002). Microbial etiology varied by source, with negative cultures (50.3%) being the most common result. No direct association between microbial etiology and mortality was found (p=0.470), but mortality differed when analyzed in conjunction with septic source. The alluvial diagram highlighted complex interactions between infection site, microbial etiology, and survival demonstrating that the septic source significantly impacts in-hospital mortality (p=0.012). Septic source significantly impacts in-hospital mortality, with undefined infections carrying the highest risk. The interplay between microbial etiology and infection site influences outcomes. Early infection source identification and tailored antimicrobial strategies are crucial for improving sepsis management.
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: In-hospital mortality
  topic: keywords
subject: sepsis
  topic: keywords
subject: septic shock
  topic: keywords
subject: septic source
  topic: keywords
creator: Matteo Guarino
creator: Giacomo Maroncelli
creator: Francesco Luppi
creator: Chiara Donati
creator: Camilla Bandini
creator: Anna Costanzini
creator: Martina Maritati
creator: Carlo Contini
creator: Roberto De Giorgio
creator: Michele Domenico Spampinato
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-17
publication date: 2026-03-17
doi: 10.4081/ecj.2026.14647

Disaster preparedness of households of educational staff at Yasuj University of Medical Sciences: a descriptive cross-sectional study
type: item
description: Section: Original Articles Categories: Newsletter Keywords: Disasters, preparedness, household, university staff Disaster preparedness in households of educational staff plays a crucial role in effective disaster management and training strategies. Accordingly, this study was designed to assess the level of disaster preparedness among households of educational staff at Yasuj University of Medical Sciences. A descriptive cross-sectional study was conducted with 214 randomly selected participants, including faculty members, administrative, and service staff. Data were collected using demographic forms and a household disaster preparedness questionnaire. Statistical analysis was performed using SPSS version 23. The overall household preparedness score was low at 21.3%. Faculty members and educational instructors had the highest preparedness level with a mean score of 24%, while other groups scored lower. Household disaster preparedness was suboptimal and influenced by socioeconomic factors. Enhancing resilience requires transitioning from theoretical education to practical interventions, including simulation drills, financial subsidies for supplies, and psychological support to empower staff.
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: Disasters
  topic: keywords
subject: preparedness
  topic: keywords
subject: household
  topic: keywords
subject: university staff
  topic: keywords
creator: Amir Abass Tabesh
creator: Roqayeh Parsaei
creator: Seyed Javad Sadat
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-20
publication date: 2026-02-20
doi: 10.4081/ecj.2026.14251

Effectiveness of plasma versus crystalloids in pre-hospital hemorrhagic shock: systematic review and meta-analysis
type: item
description: Section: Reviews Keywords: Pre-hospital hemorrhagic shock, plasma, crystalloids, resuscitation, mortality The impact of prehospital plasma transfusion on survival after major trauma remains uncertain. We conducted a systematic review and meta-analysis (PROSPERO CRD420251027516) following PRISMA 2020 standards. Randomized and comparative observational studies published through [March 8, 2025] were included; alerts/hand-searches to April 15, 2025. Primary outcomes were 24-hour and 28–30-day mortality. Pooled Odds Ratios (ORs) were estimated using random-effects models with restricted maximum likelihood and Hartung–Knapp adjustment. Risk of bias was assessed with RoB 2 and ROBINS-I, and certainty of evidence appraised by GRADE. Three randomised trials (n=760) and two observational cohorts were included. Mortality at 28–30 days did not differ between pre-hospital plasma and crystalloids (OR 0.92; 95% CI 0.49–1.72; I²=50.6%). Twenty-four-hour mortality was not meta-analysed due to heterogeneity. Secondary outcomes showed no clinically significant differences. Observational cohorts were not pooled due to endpoint misalignment and risk of bias. Certainty of evidence ranged from low to very low across outcomes, primarily due to imprecision and inconsistency. Current evidence shows no survival benefit of prehospital plasma over crystalloid resuscitation. The findings remain uncertain, and routine plasma use should be restricted to controlled research or highly structured trauma systems until adequately powered multicenter trials with standardized outcomes confirm benefit. In Emergency Medical Services (EMS) settings, crystalloids remain the pragmatic first-line fluid.
subject: Reviews
  topic: section
subject: Pre-hospital hemorrhagic shock
  topic: keywords
subject: plasma
  topic: keywords
subject: crystalloids
  topic: keywords
subject: resuscitation
  topic: keywords
subject: mortality
  topic: keywords
creator: Ruben Gorla
creator: Luciano Zito
creator: Rosaria Valentina Sciara
creator: Viviana Maria Sarpini
creator: Caterina Lombardo
creator: Patrick Crocco
creator: Maurizio Sarpini
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-13
publication date: 2026-01-13
doi: 10.4081/ecj.2026.14597

Professional burnout and workforce attrition in emergency departments: an analysis from Tuscany, Italy
type: item
description: Section: Brief Reports Categories: Newsletter Keywords: Emergency medicine, burnout, workforce attrition, Italy, healthcare management, boarding Emergency Departments (EDs) in Italy are facing a severe workforce crisis characterized by high attrition rates and difficulty in recruiting new physicians. This study aims to analyse the demographic characteristics, professional satisfaction, and underlying drivers of burnout among ED physicians in Italy, with a specific focus on the Tuscany region. We conducted a cross-sectional survey of 336 medical doctors working in Emergency Medicine. We have distributed an ad hoc questionnaire to investigate demographic profiles, employment status, specific sources of professional distress, and intentions to leave the field. The respondents were predominantly senior specialists (46% with >5 years of experience), while residents accounted for approximately 20% of the sample. The workforce is significantly aging, with 46 % of respondents over 60 years old. High levels of dissatisfaction were reported: the primary drivers of burnout were excessive workload (65 %), inadequate salary (61%), inappropriate ED visits (60%), and the phenomenon of boarding (55 %). Consequently, a significant proportion of physicians expressed an intention to leave the Emergency Department due to compromised work-life balance and structural inefficiencies. The study highlights a critical instability in the Italian Emergency Medicine workforce, driven by an aging population of specialists and systemic organizational failures rather than purely clinical stressors. Urgent interventions addressing salary, workload distribution, and hospital overcrowding (boarding) are essential to prevent further attrition and ensure the sustainability of the emergency healthcare system.
subject: Brief Reports
  topic: section
subject: Newsletter
  topic: category
subject: Emergency medicine
  topic: keywords
subject: burnout
  topic: keywords
subject: workforce attrition
  topic: keywords
subject: Italy
  topic: keywords
subject: healthcare management
  topic: keywords
subject: boarding
  topic: keywords
creator: Francesco Pepe
creator: Tommaso Ferri
creator: Matteo Borselli
creator: Alessia Bemi
creator: Ersilia De Curtis
creator: Valentina Lami
creator: Ilaria Melara
creator: Alessio Prota
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-06
publication date: 2026-03-06
doi: 10.4081/ecj.2026.14675

Acute hand ischemia after inadvertent intra-arterial injection of crushed zolpidem tablets. A case report and literature review
type: item
description: Section: Mini Reviews Categories: Newsletter Keywords: Hand ischemia, intraarterial injection, drug abuse, zolpidem, microcrystalline cellulose We report the case of a 26-year-old man with a history of drug addiction who presented to our emergency department with forearm pain and signs of acute ischemia following an inadvertent intra-arterial injection of zolpidem tablets dissolved in tap water. Although relatively rare, this occurrence carries a high risk of inducing acute limb ischemia, which can lead to severe complications such as amputation or even death. The pathophysiology of limb ischemia is multifactorial, influenced by factors including the site of injection, the physicochemical properties of the drug, and the volume injected. Symptoms can range from severe pain without visible lesions to acral ischemia. In all suspected cases of intra-arterial injection, it is crucial to gather information regarding the time of injection, the type of drug used, and whether microcrystalline cellulose is present in the formulation. Current literature underscores the importance of timely diagnosis and a multidisciplinary approach in reducing the risk of amputation. In this case, the immediate combination therapy, including ketamine, iloprost, anticoagulation, and antibiotics was effective in treating the patient.
subject: Mini Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Hand ischemia
  topic: keywords
subject: intraarterial injection
  topic: keywords
subject: drug abuse
  topic: keywords
subject: zolpidem
  topic: keywords
subject: microcrystalline cellulose
  topic: keywords
creator: Erika Poggiali
creator: Davide Lonati
creator: Tommaso Sonnessa
creator: Monica Carnovale
creator: Valentina Maria Negrini
creator: Carlo Alessandro Locatelli
creator: Claudia Galluzzo
creator: Andrea Vercelli
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
doi: 10.4081/ecj.2026.14763

The importance of keeping in the loop about abdominal pain
type: item
description: Section: Images in Emergency Categories: Newsletter Keywords: Bowel obstruction, abdominal pain, closed-loop obstruction, computed tomography, small bowel A 59-year-old Italian woman presented to our emergency department with worsening crampy pelvic abdominal pain, accompanied by severe nausea and vomiting. She experienced constipation 24 hours after the onset of symptoms but denied having a fever or any urinary issues. Her medical history included an appendectomy and a hysterectomy performed 10 years prior. Upon examination, her abdomen was tender, and she rated her pain as severe (10/10). Point-of-care ultrasound revealed fluid-filled, dilated small bowel loops with increased parietal thickening and free fluid between bowel loops, along with a “caliber jump” observed between the swollen loops upstream and the collapsed loops downstream of the obstruction. All laboratory tests were within normal limits, including lactate levels. The patient was treated with intravenous morphine and crystalloids. A computed tomography (CT) scan of the abdomen was immediately performed afterward and showed the so called “bunch of grapes sign” (panel A, red circle) and multiple dilatated small bowel loops (panel B).
subject: Images in Emergency
  topic: section
subject: Newsletter
  topic: category
subject: Bowel obstruction
  topic: keywords
subject: abdominal pain
  topic: keywords
subject: closed-loop obstruction
  topic: keywords
subject: computed tomography
  topic: keywords
subject: small bowel
  topic: keywords
creator: Erika Poggiali
creator: Chiara Minelli
creator: Claudia Caborni
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-06
publication date: 2026-02-06
doi: 10.4081/ecj.2026.14623

Subacute tuberculous meningitis in immunocompetent patients: a diagnostic challenge in the emergency department
type: item
description: Section: Case Reports Categories: Newsletter Keywords: Meningitis, hydrocefalus, tuberculosis Tuberculous meningitis is a rare but severe form of extrapulmonary tuberculosis, often diagnosed late due to its subacute and non-specific clinical symptoms. This report describes a 42-year-old immunocompetent man with tuberculous meningitis, diagnosed in the emergency room, presenting with acute hydrocephalus and typical basal meningeal enhancement on MRI. PCR confirmed the diagnosis for Mycobacterium tuberculosis on gastric aspirate. Early treatment with antituberculosis drugs, corticosteroids, and neurosurgical intervention led to a positive outcome. This case emphasizes the importance of maintaining a high index of suspicion for tuberculous meningitis, even in immunocompetent patients, and highlights the need for early multidisciplinary management to reduce mortality and neurological complications.
subject: Case Reports
  topic: section
subject: Newsletter
  topic: category
subject: Meningitis
  topic: keywords
subject: hydrocefalus
  topic: keywords
subject: tuberculosis
  topic: keywords
creator: Alessandro Bufi
creator: Stefano De Vuono
creator: Laura Settimi
creator: Cinzia Fares
creator: Lorenzo Vannocchi
creator: Giuseppe Batori
creator: Chiara Urbini
creator: Paolo Groff
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-27
publication date: 2026-02-27
doi: 10.4081/ecj.2026.14774

Fixed vs. incremental shock energy for atrial fibrillation: electrical cardioversion strategies in the emergency department
type: item
description: Section: Original Articles Categories: Newsletter Keywords: Atrial fibrillation, electrical cardioversion, emergency department, magnesium sulphate The optimal strategy for Electrical Cardioversion (ECV) in Atrial Fibrillation (AF) remains debated. We evaluated the impact of shock energy protocols on ECV outcomes in the Emergency Department (ED). This retrospective observational study included patients presenting with AF to the EDs in Trieste between January 2024 and April 2025. Patients undergoing ECV were classified according to initial shock energy: <200 J (incremental) or ≥200 J (fixed). Among 350 patients, overall ECV success was 92.6%, with 88.6% restoring sinus rhythm after the first shock. No significant difference in overall success was observed between incremental and fixed strategies (91.4% vs. 90.3%), although incremental energy achieved more first-shock conversions (88.1% vs. 77.4%). Magnesium sulphate premedication showed no significant association with ECV success (87.5% in patients who received magnesium vs. 93.2% in those who did not). Beta-blocker premedication was associated with lower success compared with no premedication (80% vs. 94.5%). Higher C-reactive protein levels were linked to failed cardioversion. These findings support individualized ECV strategies in the ED, with clinical judgment guiding energy selection and adjunctive therapies.
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: Atrial fibrillation
  topic: keywords
subject: electrical cardioversion
  topic: keywords
subject: emergency department
  topic: keywords
subject: magnesium sulphate
  topic: keywords
creator: Giulia Barbante
creator: Ugo Giulio Sisto
creator: Francesca Carrozzo
creator: Elena Caliandro
creator: Nicola Artusi
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-16
publication date: 2026-02-16
doi: 10.4081/ecj.2026.14658

Prehospital lung ultrasound for acute dyspnoea: a narrative mini-review of diagnostic accuracy, feasibility, and B-line-focused training
type: item
description: Section: Mini Reviews Categories: Newsletter Keywords: Dyspnoea, emergency medical services, lung ultrasound, point-of-care ultrasonography, prehospital care Lung Ultrasound (LUS) is increasingly used in prehospital emergency care for acute respiratory distress. By identifying artefacts such as B-lines, clinicians can rapidly differentiate “dry” from “wet” lung patterns to guide early treatment, although adoption in the field remains uneven. We conducted a narrative literature review to assess the usefulness of LUS for prehospital evaluation of respiratory distress. A secondary aim was to examine whether focused training on B-line detection improves patient management and limits early symptom progression. Sixteen articles were included. Overall, LUS showed high diagnostic performance for the differential diagnosis of dyspnoea. Using an eight-zone scan, the presence of ≥3 B-lines in at least two thoracic zones reached 94.2% sensitivity and 77.5% specificity for acute heart failure. LUS is rapid, non-invasive, and feasible in the field when performed by trained personnel; targeted education for paramedics and nurses improved diagnostic accuracy and shortened time to therapy in several studies. LUS is a useful, feasible tool for prehospital assessment and early management of acute respiratory distress. Structured theoretical–practical training and protocolised integration of LUS into prehospital pathways are recommended.
subject: Mini Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Dyspnoea
  topic: keywords
subject: emergency medical services
  topic: keywords
subject: lung ultrasound
  topic: keywords
subject: point-of-care ultrasonography
  topic: keywords
subject: prehospital care
  topic: keywords
creator: Sara Fantini
creator: Emma Baglioni
creator: Lucia Fabbri
creator: Sara Montemerani
creator: Moris Rosati
creator: Lorenzo Righi
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-06
publication date: 2026-02-06
doi: 10.4081/ecj.2026.14443

Persistent hypoxia in a pediatric patient following a house fire
type: item
description: Section: Case Reports Categories: Newsletter Keywords: Heuristics, adult learning, anchoring bias, congenital heart disease, pediatric emergency medicine A 5-year-old female presented to the pediatric emergency department from a community emergency department for persistent hypoxia in the setting of inhalational exposure due to a house fire. The patient had refractory hypoxia despite routine interventions in the referring emergency department. After a thorough physical exam, and further lab work-up, it was determined that the child had complex congenital heart disease that was yet undiagnosed, and her hypoxia was unrelated to her inhalational exposure. This case demonstrates the risk of anchoring bias and premature closure in the emergency department. By maintaining a broad differential diagnosis, this patient received the appropriate care for her complex congenital heart condition. Providers should self-evaluate for early closure and anchoring bias to minimize morbidity and mortality risk to patients. Through an understanding of adult learning and thought-processing patterns, providers can assess their biases and maintain broad differential diagnoses when presented with information contrary to their first impression.
subject: Case Reports
  topic: section
subject: Newsletter
  topic: category
subject: Heuristics
  topic: keywords
subject: adult learning
  topic: keywords
subject: anchoring bias
  topic: keywords
subject: congenital heart disease
  topic: keywords
subject: pediatric emergency medicine
  topic: keywords
creator: Lauren E. Howard
creator: Nicholas Hobart-Porter
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-04
publication date: 2025-12-04
doi: 10.4081/ecj.2025.13980

Malignant bowel obstruction in patients affected by advanced cancer: clinical and radiologic findings to support decision-making process in the emergency department
type: item
description: Section: Original Articles Categories: Newsletter Keywords: Malignant bowel obstruction, End of Life care, gastrointestinal cancer, gynecological cancer, Emergency Department Malignant Bowel Obstruction (MBO) is an often preterminal complication of gastrointestinal and gynecological cancers. We tried to identify clinical and radiological parameters suggesting early providing of End of Life (EOL) care protocols in this kind of patients at Emergency Department (ED) presentation. We retrospectively analyzed 60 ED patients admitted for MBO in a one-year period, identifying a Bad Prognosis Group (BPG) (died or transferred to EOL care centers) and a Good Prognosis Group (GPG) (prosecution of treatment with curative intent). Predictors of bad prognosis were: time of onset of symptoms, Eastern Cooperative Oncology Group performance status (ECOG), Charlson Comorbidity Index (CCI), past intestinal obstruction, previous abdominal surgery and therapeutic strategy adopted. Computed tomography scan studies were reviewed by expert radiologists. CCI ≥ 4 (p=0,030), ECOG score ≥ 2 (p=0,016), no large bowel occlusion (p=0,045), mesenteric infiltration retraction (p=0,047) and extraperitoneal metastases (p=0,049) confirmed independent predictive value of bad prognosis at multivariate analysis. Identifying clinical and radiological criteria at ED evaluation can be useful to better identification of those MBO patients who may benefit from early providing EOL care protocols.
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: Malignant bowel obstruction
  topic: keywords
subject: End of Life care
  topic: keywords
subject: gastrointestinal cancer
  topic: keywords
subject: gynecological cancer
  topic: keywords
subject: Emergency Department
  topic: keywords
creator: Alberto Manno
creator: Elena Rodolfino
creator: Benedetta Gui
creator: Roberto Iezzi
creator: Viola De Luca
creator: Camilla Panico
creator: Andrea Benicchi
creator: Michele Cosimo Santoro
creator: Francesco Franceschi
creator: Marcello Candelli
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-18
publication date: 2026-02-18
doi: 10.4081/ecj.2026.14760

Maternal generalized tetanus following spontaneous abortion in a vaccinated woman: a rare but persistent threat
type: item
description: Section: Mini Reviews Categories: Newsletter Keywords: Post-abortal tetanus, Clostridium tetani, trismus, human tetanus immunoglobulin Tetanus is a life-threatening, preventable infection caused by the neurotoxin of Clostridium tetani. Despite global vaccination initiatives, cases of adult and maternal tetanus still occur even in individuals with prior immunization. A 21-year-old female presented 15 days after a spontaneous home abortion with fever, trismus, neck stiffness, generalized rigidity, and stimulus-induced spasms. She had received the complete tetanus vaccination. Examination revealed risus sardonicus, opisthotonus, and autonomic instability. Laboratory investigations revealed mild anemia and elevated liver enzymes, and protective anti-tetanus IgG levels, while neuroimaging, abdominal imaging, and cultures were unremarkable. She received human tetanus immunoglobulin, antibiotics, benzodiazepines, magnesium sulfate, baclofen, and intensive supportive care, including mechanical ventilation and vasopressors. Despite intensive care unit care, the patient’s condition worsened, resulting in death on day 10. Tetanospasmin irreversibly blocks inhibitory neurons, causing uncontrolled muscle spasms and autonomic dysfunction. Diagnosis is clinical; laboratory tests are often non-contributory. Management focuses on neutralizing circulating toxin, preventing bacterial proliferation, controlling spasms, and providing intensive supportive care. Even with intensive management, mortality remains high, primarily due to respiratory failure and autonomic dysfunction. Maternal generalized tetanus may occur following spontaneous abortion outside a healthcare setting, even in previously vaccinated individuals with protective antibody levels, and carries a high risk of mortality.
subject: Mini Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Post-abortal tetanus
  topic: keywords
subject: Clostridium tetani
  topic: keywords
subject: trismus
  topic: keywords
subject: human tetanus immunoglobulin
  topic: keywords
creator: Asif Dabeer Jafri
creator: Ratender Kumar Singh
creator: Ishank Jaiswal
creator: Om Prakash Sanjeev
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-03-11
publication date: 2026-03-11
doi: 10.4081/ecj.2026.14630

Prognostic factors of crush syndrome and survival in elderly earthquake survivors: a retrospective study after the 2023 Turkey disaster
type: item
description: Section: Original Articles Categories: Newsletter Keywords: Crush syndrome, earthquake, geriatrics, trauma The 2023 Kahramanmaraş earthquake in southern Turkey exposed critical knowledge gaps in trauma complications among geriatric populations. Limited data exist on injury patterns, systemic sequelae, and outcomes in elderly earthquake survivors, particularly those developing crush syndrome. This study analyzes clinical profiles, complications, and mortality risks in elderly patients (≥65 years), comparing those with and without crush syndrome to identify age-specific vulnerabilities. This study was conducted as a single-center retrospective study. 138 patients aged 65 and over who were hospitalized with earthquake-related injuries between February and March 2023 were analyzed, and patients with and without earthquake-related crush syndrome were compared. Demographic, clinical, and laboratory data were used. Of the 138 patients included in the study, 63.8% (n=88) were female, and the mean age was 73.3±7.7 years. 42% (n: 58) of the patients developed crush syndrome. A total of 44.2% underwent surgery, 42.0% developed crush syndrome, 73.9% were discharged, and 8.7% died. In those with crush syndrome, calcium (p=0.03), platelet (p=0.02), lymphocyte (p=0.05) levels were lower; lactate dehydrogenase (p<0.01), creatinine kinase (p<0.01), white blood cell (p<0.01), neutrophil (p<0.01), monocyte (p=0.05) levels were higher and found to be statistically significant. In addition, crush syndrome was seen more in those with upper extremity fractures (p=0.01) and acute renal failure (p=0.02), hemodialysis (p=0.01), fasciotomy (p=0.01), and amputation (p<0.01) were more common in those with crush syndrome. The study highlights significant differences in clinical and laboratory parameters among elderly earthquake survivors with crush syndrome, including higher rates of acute renal failure, hemodialysis, and surgical interventions. These findings underscore the critical need for ea…
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: Crush syndrome
  topic: keywords
subject: earthquake
  topic: keywords
subject: geriatrics
  topic: keywords
subject: trauma
  topic: keywords
creator: Deniz Gezer
creator: Seval Müzeyyen Ecin
rights: Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-14
publication date: 2026-01-14
doi: 10.4081/ecj.2026.14433

Spontaneous rupture of a normal spleen: a case report and literature review
type: item
description: Section: Mini Reviews Categories: Newsletter Keywords: Atraumatic spleen rupture, spontaneous spleen rupture, splenectomy, abdominal pain Spontaneous spleen rupture is a rare condition that occurs in less than 1% of cases without any identifiable underlying medical issues. Emergency clinicians should always include spontaneous spleen rupture in the differential diagnosis of abdominal pain, as timely diagnosis and intervention are crucial for improving patient prognosis and preventing fatal outcomes. Clinical manifestations may include pain in the epigastric region or the left upper quadrant, tachycardia, and shock. Some patients may show signs of an acute abdomen upon physical examination while maintaining stable vital signs. Point-of-care ultrasound and abdominal computed tomography play a pivotal role in the diagnosis. Standard guidelines for the treatment have not been established. While splenectomy remains the mainstay of treatment, some selected hemodynamically stable patients may be suitable candidates for splenic artery embolization. In this minireview, we will begin by discussing the case of a 53-year-old man who experienced left lower back pain for five days, initially misdiagnosed as renal colic, and we will then conclude by examining the current literature on this important topic.
subject: Mini Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Atraumatic spleen rupture
  topic: keywords
subject: spontaneous spleen rupture
  topic: keywords
subject: splenectomy
  topic: keywords
subject: abdominal pain
  topic: keywords
creator: Erika Poggiali
creator: Camilla Botti
creator: Piergiorgio Turchio
creator: Giancarlo Giannone
creator: Mauro Filosa
creator: Elisa Moschini
creator: Andrea Vercelli
creator: Peiman Nazerian
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-17
publication date: 2025-12-17
doi: 10.4081/ecj.2025.14521