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: Emerging management strategies for aluminum phosphide poisoning
items: A silent case of aortic dissection: a case report
items: Prehospital spinal and cervical motor restriction in adult trauma patients: a narrative review
items: A legendary chest X-ray
items: Clostridium difficile infection presenting as a leukemoid reaction: a case report and mini-review of the literature
items: The importance of lay descriptors of respiratory symptoms: a retrospective analysis of under-triaged emergency calls
items: Structured simulation-based education in emergency medicine residency programs: Pavia’s proposal for competence development and crisis management (Italy)
items: How to manage a severe form of euglycemic diabetic ketoacidosis caused by SGLT2 inhibitors: a case report and literature review
items: Shiitake mushroom bezoar: a rare cause of small bowel obstruction in Vietnam and lessons in diagnosis and management
items: Methanol poisoning during COVID-19 pandemic: a multicenter study of northern Iran
items: Missed occlusions: diagnostic accuracy of ECG STEMI criteria for identifying occlusive myocardial infarction. A systematic review and meta-analysis
items: Doctor, something is stuck in my eye!
items: A worrying dance in the subcutaneous adipose tissue
items: Hepatic damage associated with dengue infection: insights from the emergency department of a tertiary care centre
items: Refractory ventricular tachycardia: a challenge in an emergency setting. A case report
items: Severe scombroid poisoning complicated by distributive shock, acute respiratory distress syndrome and Kounis syndrome: a case report
items: When arrhythmia hides a tumor: a case of atrial fibrillation unmasking superior vena cava syndrome
items: Acute onset of bilateral mydriasis, headache, and vomiting: a challenging diagnosis
items: Cerebral hyperperfusion syndrome after carotid endarterectomy: case report
items: Accidental ingestion of dishwasher detergent by an elderly patient: a case of successful conservative management

Emerging management strategies for aluminum phosphide poisoning
type: item
description: Section: Original Articles Categories: Newsletter Keywords: Aluminum phosphide, multiple organ dysfunction syndromes, shock, gastric lavage with coconut oil and sodium bicarbonate Aluminum Phosphide (AlP), commonly known as Celphos in India, is a highly toxic pesticide used for grain preservation. Upon contact with moisture, it releases Phosphine gas (PH₃), leading to mitochondrial dysfunction, oxidative stress, and multi-organ failure. With no specific antidote available, AlP poisoning carries a high mortality rate, necessitating prompt life-supportive care. The aim was to evaluate the effectiveness of early gastric lavage with coconut oil and sodium bicarbonate (SBC), combined with antioxidant therapy, in improving survival outcomes in severe AlP poisoning. This retrospective study analyzed clinical cases of AlP poisoning involving the ingestion of 3 to 9 grams of AlP tablets. All patients underwent early gastric lavage within 6 hours of ingestion and received antioxidants (Vitamin E, Glutathione, N-acetylcysteine ), and supportive therapy, including vasopressors and peritoneal dialysis as needed. All patients presented with severe hypotension, metabolic acidosis, and multi-organ dysfunction. Despite presenting in critical condition, three patients survived and one patient succumbed, indicating favorable outcomes following treatment. Early gastric decontamination with coconut oil and sodium bicarbonate (SBC), supplemented by antioxidant therapy, shows promise in reducing mortality in AlP poisoning. Further studies are needed to establish standardized treatment protocols.
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: Aluminum phosphide
  topic: keywords
subject: multiple organ dysfunction syndromes
  topic: keywords
subject: shock
  topic: keywords
subject: gastric lavage with coconut oil and sodium bicarbonate
  topic: keywords
creator: Asif Dabeer Jafri
creator: Aniket Satale
creator: Aarti Sagar
creator: Om Prakash Sanjeev
creator: Ratender Kumar Singh
creator: Kayenaat Rizvi
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-04
publication date: 2025-09-04
doi: 10.4081/ecj.2025.13971

A silent case of aortic dissection: a case report
type: item
description: Section: Case Reports Keywords: Aortic dissection, score, pathways, D-Dimer Type B aortic dissection is a relatively rare clinical condition with, however, a significant clinical impact and therefore an early diagnosis is necessary. The clinical presentation is highly variable depending on the aortic district involved and the presence of signs secondary to hypoperfusion. This peculiarity makes diagnosis even more difficult. We describe the case of a 52-year-old patient who presented to our emergency department with significant chest pain and crisis; his medical history was silent and there were no known cardiovascular risk factors. The ultrasonographic, electrocardiographic, laboratory and semeiological findings and the resulting diagnostic pathways were totally negative. Only advanced diagnostics allowed the diagnosis of aortic dissection. This case allows us to reflect on the interpretation of blood chemistry tests and the application of diagnostic scores/pathways in everyday clinical practice, especially in less defined clinical pictures.
subject: Case Reports
  topic: section
subject: Aortic dissection
  topic: keywords
subject: score
  topic: keywords
subject: pathways
  topic: keywords
subject: D-Dimer
  topic: keywords
creator: Marco Passaretti
creator: Carlo Maino
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-08-22
publication date: 2025-08-22
doi: 10.4081/ecj.2025.13751

Prehospital spinal and cervical motor restriction in adult trauma patients: a narrative review
type: item
description: Section: Reviews Categories: Newsletter Keywords: Spinal cord injuries, emergency medical services, spinal motor restriction, spinal immobilization, major trauma The prehospital motor restriction of the cervical and spinal column in trauma patients remains a highly debated topic, with significant variability in clinical practice. With the present study, we aimed to conduct a narrative review of the literature on cervical and spinal motor restriction in prehospital settings, identifying devices used, clinical decision-making tools, and potential complications. A structured search was conducted in four databases (PubMed, ProQuest, CINAHL, Web of Science), including studies on adult trauma patients (≥16 years) with suspected spinal injury in prehospital settings. Screening was performed using Rayyan QCRI, and methodological quality was assessed via the Kmet checklist. A total of 28 studies were included. Evidence highlights that immobilization should not be applied routinely but guided by clinical risk and context. The use of validated protocols, selective motor restriction, and alternative devices (e.g., vacuum mattresses, self-extrication) may improve outcomes and reduce complications. High-fidelity simulation training and clinical audits are recommended to enhance decision-making and protocol adherence in spinal trauma management.
subject: Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Spinal cord injuries
  topic: keywords
subject: emergency medical services
  topic: keywords
subject: spinal motor restriction
  topic: keywords
subject: spinal immobilization
  topic: keywords
subject: major trauma
  topic: keywords
creator: Flavio Gheri
creator: Niccolò Toppi
creator: Nicola Bortoli
creator: Marco Forni
creator: Simone Celi
creator: Roberto Romano
creator: Ilario Bocchi
creator: Giuseppe Coraci
creator: Domenica Petta
creator: Douglas. J. Floccare
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-22
publication date: 2025-09-22
doi: 10.4081/ecj.2025.14088

A legendary chest X-ray
type: item
description: Section: Images in Emergency Keywords: Pneumothorax, buffalo chest syndrome, spontaneous bilateral pneumothorax Buffalo Chest is a rare condition involving bilateral pneumothorax (PNX), either spontaneous or, more commonly, iatrogenic, due to the presence of one or more communicating pathways between the pleural cavities. It is a critical condition that clinicians must be aware of and actively investigate, as it places the patient at high risk for bilateral tension pneumothorax. The name derives from an old legend in which Native Americans were said to be able to kill a buffalo instantly with a single arrow to the chest, as it would induce bilateral tension pneumothorax. Diagnosis is based on imaging and dynamic testing. A chest X-ray typically reveals bilateral pneumothorax, while CT (Computed Tomography) allows both identification of the bilateral PNX and assessment of any communication between the two pleural spaces. However, a definitive diagnosis relies on dynamic tests demonstrating the migration of gas or contrast medium into the contralateral hemithorax after being introduced via a chest drain.
subject: Images in Emergency
  topic: section
subject: Pneumothorax
  topic: keywords
subject: buffalo chest syndrome
  topic: keywords
subject: spontaneous bilateral pneumothorax
  topic: keywords
creator: Gea Nicoletti
creator: Davide Tizzani
creator: Paola Molino
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-22
publication date: 2025-07-22
doi: 10.4081/ecj.2025.13973

Clostridium difficile infection presenting as a leukemoid reaction: a case report and mini-review of the literature
type: item
description: Section: Mini Reviews Categories: Newsletter Keywords: Clostridium difficile Infection (CDI), abscess, leukemoid reaction Clostridium Difficile Infection (CDI) is a prevalent healthcare-associated infection primarily affecting the gastrointestinal tract. However, extraintestinal manifestations, such as abscess formation, are rare and pose significant diagnostic and therapeutic challenges. Furthermore, Clostridium difficile-associated Leukemoid Reactions (LR) are infrequent and often indicative of severe disease with poor prognostic implications. This report presents a rare case of an extraintestinal CDI manifesting as an abscess accompanied by a leukemoid reaction. A 50-year-old male presented with a fever and gait imbalance. Clinical examination revealed a febrile, hemodynamically unstable patient with an inflamed abscess in the right lumbar region. Laboratory investigations demonstrated marked leukocytosis and thrombocytosis. Despite initial empirical antimicrobial therapy with intravenous piperacillin-tazobactam and clindamycin, the patient exhibited persistent fever and progressive leukocytosis. Surgical drainage of the abscess was performed, and microbiological analysis identified Clostridium difficile. The antimicrobial regimen was modified to include intravenous metronidazole and vancomycin, resulting in clinical improvement and subsequent normalization of leukocyte counts. The patient made a complete recovery and was subsequently discharged. This case underscores the importance of considering atypical presentations of CDI, particularly in the absence of classical gastrointestinal symptoms. Early recognition, prompt surgical intervention, and targeted antimicrobial therapy are critical for favorable clinical outcomes. This report highlights the need for heightened clinical awareness regarding atypical presentations of CDI to ensure prompt diagnosis and optimal patient outcomes.
subject: Mini Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Clostridium difficile Infection (CDI)
  topic: keywords
subject: abscess
  topic: keywords
subject: leukemoid reaction
  topic: keywords
creator: Asif Dabeer Jafri
creator: Muktesh Singh
creator: Rehana Ansari
creator: Ratender Kumar Singh
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-01
publication date: 2025-09-01
doi: 10.4081/ecj.2025.13852

The importance of lay descriptors of respiratory symptoms: a retrospective analysis of under-triaged emergency calls
type: item
description: Section: Brief Reports Categories: Newsletter Keywords: agonal breathing, dispatch, emergency medical communication centre, emergency medical services, respiratory distress Accurate triage of respiratory emergencies during emergency calls is critical but may be compromised when dispatchers misinterpret lay language. Nonspecific descriptors may be perceived as the presence of breathing despite indicating severe conditions like airway obstruction or agonal breathing. The objective of this study was to identify common descriptors used by callers in underestimated respiratory emergencies and assess how these terms may contribute to under-triage. This retrospective cohort study analysed 382 emergency calls received between 2018 and 2023 at the 118 Emilia Est Emergency Medical Communication Centre in Bologna, Italy. All included calls were initially assigned low-to-moderate urgency for a respiratory problem but were later classified as critical or in cardiac arrest by ambulance crews, requiring advanced life support interventions. Experienced dispatchers independently reviewed audio recordings to identify lay descriptors, dispatcher questioning patterns, and pre-arrival instructions. In 29.3% of cases, callers used vivid, nonclinical language to describe respiratory distress. The most frequent lay term was “phlegm” (n=68), followed by “rattle” (n=22), and “cough” (n=7). Dispatcher questioning remained limited, and prearrival instructions were rare (5.2%). Oxygen saturation was reported in 19.4% of calls. Terms such as “phlegm” may reflect severe respiratory compromise when used by lay callers but are often under-recognized by dispatchers. Training should emphasize the interpretation of informal language and encourage structured follow-up questions to reduce under-triage and improve the early identification of critical respiratory events.
subject: Brief Reports
  topic: section
subject: Newsletter
  topic: category
subject: agonal breathing
  topic: keywords
subject: dispatch
  topic: keywords
subject: emergency medical communication centre
  topic: keywords
subject: emergency medical services
  topic: keywords
subject: respiratory distress
  topic: keywords
creator: Guglielmo Imbriaco
creator: Juliette Masina
creator: Giorgia Ghedini
creator: Gianluca Federiconi
creator: Jihan Samira Kayal
creator: Diana Demaria
creator: Jacopo Davide Giamello
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-04
publication date: 2025-11-04
doi: 10.4081/ecj.2025.14212

Structured simulation-based education in emergency medicine residency programs: Pavia’s proposal for competence development and crisis management (Italy)
type: item
description: Section: Educational Papers Categories: Newsletter Keywords: Medical education, emergency medicine, simulation, residency, specialty training, Italy The growing complexity of Emergency Medicine (EM) - due to overcrowding, boarding, and the expanding social role of emergency departments - requires standardized and structured training models. Simulation in medicine is essential for education, training, and improving patient care. Italian EM residency programs face additional challenges, including variable training quality and limited access to simulation-based education. To address these issues, the University of Pavia has developed a five-year simulation curriculum integrated into its EM residency program. This study presents this model and evaluates its alignment with national and European standards. A descriptive comparative analysis was conducted by aligning the curriculum's learning objectives and simulation activities with the European Society for Emergency Medicine (EUSEM) Core Curriculum and the guidelines set by the Italian Ministry of Education (MIM), incorporating feedback from national associations. Each competency was classified independently as fully, partially, or not covered. The goal of this model is to standardize training quality, increase preparedness for complex emergencies, and promote a reflective professional culture. The curriculum includes more than 25 simulation sessions each year, progressing from foundational procedural and cognitive skills (Years 1–2: ultrasound, ventilation, suturing, ACLS-like scenarios) to complex interdisciplinary simulations (Years 3–4: trauma, pediatrics, resuscitation), culminating in advanced training covering leadership, ethics, medico-legal aspects and maxi-emergencies (Year 5). Training modalities include high- and low-fidelity simulations, peer-to-peer learning, and 3D-printed skill trainers. Feedback is collected after each session and annually. Facilitators are certified through SIMMED, EEDUSIM, and other ac…
subject: Educational Papers
  topic: section
subject: Newsletter
  topic: category
subject: Medical education
  topic: keywords
subject: emergency medicine
  topic: keywords
subject: simulation
  topic: keywords
subject: residency
  topic: keywords
subject: specialty training
  topic: keywords
subject: Italy
  topic: keywords
creator: Bruno Barcella
creator: Marco Bonzano
creator: Stefano Perlini
creator: Francesco Salinaro
creator: Emergency Medicine Simulation Group
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-06
publication date: 2025-11-06
doi: 10.4081/ecj.2025.14010

How to manage a severe form of euglycemic diabetic ketoacidosis caused by SGLT2 inhibitors: a case report and literature review
type: item
description: Section: Mini Reviews Categories: Newsletter Keywords: Somatostatin, euglycemic ketoacidosis, EDKA, SGLT2 The use of sodium-glucose cotransporter-2 inhibitors is becoming increasingly widespread not only for the treatment of diabetes mellitus, but also for heart failure and kidney disease. However, these medications can lead to very severe complications, sometimes even fatal, such as Euglycemic Ketoacidosis (EDKA). In this report, we present the case of a 79-year-old woman, affected by type 2 diabetes mellitus on insulin therapy and empagliflozin, who was admitted to our emergency department for a severe EDKA. Treatment with bicarbonates did not improve her condition worsening the hypokalaemia and complicating the administration of insulin. For this reason, we decided to administer octreotide subcutaneously with a rapid resolution of EDKA and an improvement in clinical conditions, demonstrating that octreotide can be an excellent therapeutic option for EDKA. Starting from our experience, we conducted a review of the relevant literature on this issue.
subject: Mini Reviews
  topic: section
subject: Newsletter
  topic: category
subject: Somatostatin
  topic: keywords
subject: euglycemic ketoacidosis
  topic: keywords
subject: EDKA
  topic: keywords
subject: SGLT2
  topic: keywords
creator: Carolina Bologna
creator: Andrea Ferraro
creator: Antonio Augiero
creator: Vincenzo Nuzzo
creator: Giovanna Guiotto
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-13
publication date: 2025-10-13
doi: 10.4081/ecj.2025.14072

Shiitake mushroom bezoar: a rare cause of small bowel obstruction in Vietnam and lessons in diagnosis and management
type: item
description: Section: Case Reports Keywords: Shiitake mushroom bezoar, small bowel obstruction, emergency surgery, case report Small Bowel Obstruction (SBO) caused by shiitake mushroom bezoars is a rare clinical entity, with no prior cases documented in Vietnam despite the frequent consumption of these mushrooms in traditional dishes. We report the case of a 69-year-old male who presented with SBO symptoms after ingesting a whole shiitake mushroom without chewing due to significant molar tooth loss. Computed Tomography (CT) imaging revealed characteristic features of a bezoar, and exploratory laparoscopy confirmed an obstructing shiitake mushroom bezoar, which was removed via enterotomy. This case highlights the diagnostic challenges of radiolucent bezoars and the critical importance of dietary history and characteristic CT findings. Preoperative assessments could facilitate less invasive surgical strategies, reducing the risks associated with enterotomy, such as anastomotic leakage. Clinicians should remain aware of regional dietary practices to enhance diagnostic precision and optimize management strategies, especially in highrisk populations with compromised mastication.
subject: Case Reports
  topic: section
subject: Shiitake mushroom bezoar
  topic: keywords
subject: small bowel obstruction
  topic: keywords
subject: emergency surgery
  topic: keywords
subject: case report
  topic: keywords
creator: Tri-Nhan Pham
creator: Minh-Quang Tran
creator: Phu-Cuong Pham
creator: My-Tran Trinh
creator: Quang-Duy Ngo
creator: Kim-Long Le
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-14
publication date: 2025-07-14
doi: 10.4081/ecj.2025.13766

Methanol poisoning during COVID-19 pandemic: a multicenter study of northern Iran
type: item
description: Section: Original Articles Categories: Newsletter Keywords: Alcohol consumption, methanol poisoning, COVID-19, metabolic acidosis, dialysis During coronavirus disease 2019 (COVID-19) pandemic, Iran experienced the largest methanol mass poisoning outbreak in the history. Despite advancements in the diagnosis and treatment of Methanol Poisoning (MP), mortality rates remain high. In light of the geographical location and increased travel to this northern province, coupled with the rising consumption of illicit and homemade alcoholic beverages and the associated incidence of methanol poisoning, we undertook an analysis of the demographic characteristics, diagnostic procedures, and treatment approaches among patients hospitalized in five designated hospitals within the region. The data collection period for this study spanned from March 2020 to September 2021. This retrospective and descriptive cross-sectional study is a multicenter study in the western part of Mazandaran province over the initial 18 months of the pandemic to provide a more comprehensive view on MP patients. The diagnosis was based on several factors, including a history of alcohol consumption, visual impairment, altered level of consciousness, and the presence of metabolic acidosis in laboratory tests. The study included 82 patients diagnosed with MP, comprising 74 males (90.2%) and 8 females (9.8%), with an average age of 38.20 ± 13.9 years. The majorities (76.8%) resided in urban areas, and most were self-employed. Blurred vision and metabolic acidosis were observed in the majority of the patients. Oral ethanol and dialysis were the primary treatment employed for our patients. Visual complications and severe metabolic acidosis are commonly linked to poor outcomes in MP. A comprehensive analysis of MP patients revealed no significant correlation between treatment type, patient demographics, and outcomes, highlighting the complex and multifaceted nature of this condition.
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: Alcohol consumption
  topic: keywords
subject: methanol poisoning
  topic: keywords
subject: COVID-19
  topic: keywords
subject: metabolic acidosis
  topic: keywords
subject: dialysis
  topic: keywords
creator: Jamileh Divsalar
creator: Seyed Khosro Ghasempouri
creator: Zahra Nekoukar
creator: Amir-Hassan Bordbari
creator: Zakaria Zakariaei
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-10
publication date: 2025-09-10
doi: 10.4081/ecj.2025.14009

Missed occlusions: diagnostic accuracy of ECG STEMI criteria for identifying occlusive myocardial infarction. A systematic review and meta-analysis
type: item
description: Section: Reviews Categories: Newsletter Keywords: STEMI, NSTEMI, occlusive myocardial infarction, acute coronary occlusion, ECG, diagnostic accuracy, meta-analysis The ECG-STEMI criteria are widely used to identify Acute Myocardial Infarction (AMI) patients who need urgent revascularization. However, recent evidence shows that up to one-third of Occlusive Myocardial Infarctions (OMIs) may go undetected using these criteria. While still a cornerstone of current triage protocols, doubts remain about their diagnostic accuracy, particularly their sensitivity in detecting OMI. This systematic review and meta-analysis aimed to assess the diagnostic accuracy of ECG-STEMI criteria in identifying patients with OMI. A comprehensive search of MEDLINE, EMBASE, and Scopus was conducted up to February 2024. Included studies enrolled patients with confirmed AMI and provided data to construct 2×2 tables comparing ECG-STEMI results (index test) with angiographic findings (reference standard) for OMI. Risk of bias was assessed using QUADAS-2. We calculated pooled sensitivity, specificity, diagnostic odds ratio (DOR), and generated SROC curves using random-effects models. Nine studies (11,757 patients) were included. ECG-STEMI criteria showed a pooled sensitivity of 0.635 (95% CI: 0.549–0.713) and specificity of 0.780 (95% CI: 0.645–0.873). The DOR was 5.94 (95% CI: 3.81–9.27), with an AUC of 0.752 (95% CI: 0.714–0.795). Definitions of OMI varied across studies; composite definitions yielded higher specificity and DOR but lower sensitivity than angiographic definitions alone. ECG-STEMI criteria offer high specificity but only moderate sensitivity for detecting OMI, potentially missing one-third of patients needing urgent care. These criteria are more reliable for confirming rather than excluding OMI. Diagnostic accuracy depends on how OMI is defined, highlighting the need for a standardized definition to better assess both current and emerging ECG criteria.
subject: Reviews
  topic: section
subject: Newsletter
  topic: category
subject: STEMI
  topic: keywords
subject: NSTEMI
  topic: keywords
subject: occlusive myocardial infarction
  topic: keywords
subject: acute coronary occlusion
  topic: keywords
subject: ECG
  topic: keywords
subject: diagnostic accuracy
  topic: keywords
subject: meta-analysis
  topic: keywords
creator: Ilaria Costantini
creator: Andrea Breglia
creator: Merisa Pilav
creator: Mirko Zanatta
creator: Maria V. Ventura
creator: Giorgio Ricci
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-02
publication date: 2025-12-02
doi: 10.4081/ecj.2025.14233

Doctor, something is stuck in my eye!
type: item
description: Section: Images in Emergency Keywords: Dirofilariasis, conjunctiva, filariasis, microfilariae, nematode, parasites, zoonosis A 62-year-old Italian woman presented to our emergency room with complaints of redness and a foreign body sensation in her left eye since the day before. Her vision was unaffected, and she she felt well otherwise. She had no previous history of similar episodes, ocular trauma, or foreign body incidents, and there was no record of any systemic illnesses or recent travel. She lived with her pet dog. Laboratory tests, including C-reactive protein and eosinophil count, resulted all normal. On ocular examination, her visual acuity was 20/20 in both eyes. Diffuse conjunctival congestion was noted in the left eye and a large live nematode was visualized in the temporal part of the bulb under the conjunctiva (Video 1). The cornea anterior chamber and the fundus examination were unremarkable.
subject: Images in Emergency
  topic: section
subject: Dirofilariasis
  topic: keywords
subject: conjunctiva
  topic: keywords
subject: filariasis
  topic: keywords
subject: microfilariae
  topic: keywords
subject: nematode
  topic: keywords
subject: parasites
  topic: keywords
subject: zoonosis
  topic: keywords
creator: Erika Poggiali
creator: Alessandro Dacrema
creator: Andrea Vercelli
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-22
publication date: 2025-07-22
doi: 10.4081/ecj.2025.14036

A worrying dance in the subcutaneous adipose tissue
type: item
description: Section: Images in Emergency Categories: Newsletter Keywords: Dirofilariasis, filariasis, nematode, parasites, zoonosis, subcutaneous tissue, ultrasonography, filarial dance sign A 37-year-old woman presented to the emergency department with a mild painful swelling in the anterior abdominal wall at the right iliac fossa; there was no associated itching or rash. Five months earlier she underwent right mastectomy for infiltrating ductal carcinoma, which was still under treatment with chemotherapy (doxorubicin, cyclophosphamide, paclitaxel, pertuzumab and trastuzumab). Her vital signs and blood exams were normal. Ultrasonography (US) showed a 8 x 5 mm sized anechoic lesion with multiple internal thin structures, which presented parallel echogenic borders and anechoic centers, in the subcutaneous adipose tissue (Figure 1, red arrow). These structures exhibited wriggling motion during real-time imaging (Video 1).
subject: Images in Emergency
  topic: section
subject: Newsletter
  topic: category
subject: Dirofilariasis
  topic: keywords
subject: filariasis
  topic: keywords
subject: nematode
  topic: keywords
subject: parasites
  topic: keywords
subject: zoonosis
  topic: keywords
subject: subcutaneous tissue
  topic: keywords
subject: ultrasonography
  topic: keywords
subject: filarial dance sign
  topic: keywords
creator: Massimo Barakat
creator: Matteo Marcucci
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-10
publication date: 2025-10-10
doi: 10.4081/ecj.2025.14431

Hepatic damage associated with dengue infection: insights from the emergency department of a tertiary care centre
type: item
description: Section: Original Articles Categories: Newsletter Keywords: Dengue fever, dengue hepatitis, dengue hemorrhagic fever, dengue shock syndrome Liver involvement is a common but variable manifestation of dengue virus infection. This study aimed to evaluate the clinical and biochemical spectrum of dengue hepatitis and its correlation with disease severity in patients presenting to a tertiary care center. A retrospective cross-sectional study was conducted at a tertiary care center from July 2024 to December 2024, including 130 adult patients with laboratory-confirmed dengue infection. Dengue hepatitis was categorized as mild, moderate, or severe based on serum transaminase levels. Disease severity was assessed according to both the World Health Organization (WHO) 1997 and WHO 2009 classification criteria. Laboratory parameters were analyzed in relation to hepatitis severity. Among the 130 patients, 113 (87%) had elevated liver enzymes. Aspartate Aminotransferase Levels (AST) were consistently higher than Alanine Aminotransferase (ALT). Severe dengue hepatitis was significantly associated with WHO 2009 disease severity classification (p<0.001). Total bilirubin levels were significantly elevated in patients with more severe hepatitis, while no significant correlation was observed between platelet count and hepatitis severity. Patients presenting with warning signs and severe dengue had higher frequencies of moderate-to-severe hepatitis. We conclude that hepatic involvement in dengue infection is common and correlates with disease severity. Elevated transaminases, particularly AST, and rising bilirubin levels may serve as early markers of severe dengue. Integration of liver function monitoring into clinical assessment protocols is essential for the timely management of dengue hepatitis.
subject: Original Articles
  topic: section
subject: Newsletter
  topic: category
subject: Dengue fever
  topic: keywords
subject: dengue hepatitis
  topic: keywords
subject: dengue hemorrhagic fever
  topic: keywords
subject: dengue shock syndrome
  topic: keywords
creator: Alka Verma
creator: Asif Dabeer Jafri
creator: Amit Goel
creator: Ajay Mishra
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-04
publication date: 2025-11-04
doi: 10.4081/ecj.2025.14168

Refractory ventricular tachycardia: a challenge in an emergency setting. A case report
type: item
description: Section: Case Reports Keywords: Resuscitation, electrical storm, ventricular tachycardia, refractory arrhythmia, cardiac sarcoidosis The incidence of electrical storms or Ventricular Tachycardia (VT) storms is increasing due to the growing use of Implantable Cardioverter Defibrillators (ICDs), higher rates of ischemic heart disease, non-compliance with anti-arrhythmic medications, and misuse of other drugs. Timely recognition, accurate rhythm identification, and prompt intervention are critical in saving lives. We present a case of a middle-aged male with a prior diagnosis of idiopathic VT who arrived at the Emergency Department (ED) with palpitations. During his ED stay, he experienced refractory VT, which was managed through anti-arrhythmic medications and multiple synchronized cardioversions. Further investigation led to a diagnosis of cardiac sarcoidosis, and he was successfully treated.
subject: Case Reports
  topic: section
subject: Resuscitation
  topic: keywords
subject: electrical storm
  topic: keywords
subject: ventricular tachycardia
  topic: keywords
subject: refractory arrhythmia
  topic: keywords
subject: cardiac sarcoidosis
  topic: keywords
creator: Tanvi Desai
creator: Sarbari Swaika
creator: Aviral Srivastava
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-07-22
publication date: 2025-07-22
doi: 10.4081/ecj.2025.13916

Severe scombroid poisoning complicated by distributive shock, acute respiratory distress syndrome and Kounis syndrome: a case report
type: item
description: Section: Case Reports Keywords: Scombroid syndrome, Kounis syndrome, epinephrine, histamine, distributive shock Scombroid syndrome is a histamine-induced foodborne illness that can mimic anaphylaxis. Although typically self-limiting, scombroid syndrome can, in rare cases, lead to severe complications. The uniqueness of this clinical case lies in the unusually severe presentation of scombroid syndrome, which typically follows a benign course. This is particularly noteworthy given the concurrent presence of severe respiratory symptoms, shock, and Kounis syndrome. We present a case of a 59-year-old woman who developed severe scombroid poisoning after ingesting improperly stored canned tuna. Her presentation was complicated by distributive shock, acute respiratory distress, and ECG changes suggestive of Kounis syndrome. Management required high-dose intravenous epinephrine, non-invasive ventilation, and intensive hemodynamic monitoring. Coronary CT angiography later excluded obstructive coronary disease. This case highlights the potential severity of scombroid syndrome, its overlap with allergic coronary syndromes, and the diagnostic challenges they pose. Prompt recognition and tailored therapy are essential. Clinicians should be aware that improperly stored fish can precipitate life-threatening systemic reactions, requiring management beyond standard antihistamine treatment.
subject: Case Reports
  topic: section
subject: Scombroid syndrome
  topic: keywords
subject: Kounis syndrome
  topic: keywords
subject: epinephrine
  topic: keywords
subject: histamine
  topic: keywords
subject: distributive shock
  topic: keywords
creator: Lorenzo Pelagatti
creator: Francesco Gambassi
creator: Alessandra Ieri
creator: Yari Bardacci
creator: Simone Vanni
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-01
publication date: 2025-09-01
doi: 10.4081/ecj.2025.13919

When arrhythmia hides a tumor: a case of atrial fibrillation unmasking superior vena cava syndrome
type: item
description: Section: Case Reports Categories: Newsletter Keywords: Superior vena cava syndrome, atrial fibrillation, venous congestion signs, small-cell lung carcinoma Superior Vena Cava Syndrome (SVCS) is typically caused by thoracic malignancies and may present with a wide range of symptoms, from mild facial edema to severe respiratory compromise. Atrial Fibrillation (AF), although common, is rarely the initial manifestation of SVCS. We report the case of a 65-year-old woman who presented to the emergency department with new-onset AF, and in whom physical examination revealed signs of venous congestion suggestive of SVCS. Imaging studies confirmed a right hilar mass with vascular invasion, thrombosis of the internal jugular vein, and complete obstruction of the superior vena cava. Histological analysis confirmed small-cell lung carcinoma. The patient underwent endovascular stenting and chemoradiotherapy. This case highlights the importance of thorough physical examination in emergency settings and suggests that new-onset AF in the presence of venous congestion may be an early clue to an underlying structural pathology such as SVCS.
subject: Case Reports
  topic: section
subject: Newsletter
  topic: category
subject: Superior vena cava syndrome
  topic: keywords
subject: atrial fibrillation
  topic: keywords
subject: venous congestion signs
  topic: keywords
subject: small-cell lung carcinoma
  topic: keywords
creator: Sara Iommi-Diez
creator: Jorge Campos Bas
creator: Santiago Almanzo
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-24
publication date: 2025-09-24
doi: 10.4081/ecj.2025.13961

Acute onset of bilateral mydriasis, headache, and vomiting: a challenging diagnosis
type: item
description: Section: Case Reports Categories: Newsletter Keywords: Bilateral mydriasis, endocranial hypertension, angle-closure glaucoma Bilateral fixed mydriasis is a rare condition that can arise from a variety of causes (neurological, pharmacological, toxic or metabolic, para-infectious/autoimmune conditions, and traumatic injuries). We report a 65-year-old woman presenting to the emergency department with bilateral mydriasis and complaining of acute severe headache associated with blurry vision, photophobia, vomiting, and a recent history of fever with respiratory symptoms. All preliminary medical investigations aimed at identifying possible causes of endocranial hypertension as well as intracranial lesions or expansive processes, while focusing on findings consistent with meningoencephalitis. The diagnosis of acute bilateral angle-closure glaucoma was established through a wide range of radiological and laboratory exams, and with the help of different consultants. This unusual case highlights two interesting aspects: the importance of a multidisciplinary diagnostic work-up for challenging clinical presentations, and the critical relevance of a re-evaluation diagnostic strategy to avoid clinical mistakes.
subject: Case Reports
  topic: section
subject: Newsletter
  topic: category
subject: Bilateral mydriasis
  topic: keywords
subject: endocranial hypertension
  topic: keywords
subject: angle-closure glaucoma
  topic: keywords
creator: Antonella Cianci
creator: Beatrice Marziani
creator: Tommaso Bachechi
creator: Camilla Bandini
creator: Francesca Cuoghi
creator: Michele Domenico Spampinato
creator: Chiara Pesci
creator: Roberto De Giorgio
creator: Matteo Guarino
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-09-11
publication date: 2025-09-11
doi: 10.4081/ecj.2025.14053

Cerebral hyperperfusion syndrome after carotid endarterectomy: case report
type: item
description: Section: Case Reports Categories: Newsletter Keywords: Cerebral hyperperfusion syndrome, carotid endarterectomy, carotid stenting Prevention of disability from cerebrovascular accident through carotid endarterectomy, neurovascular stenting, and endovascular treatment of stroke are among the most promising treatments for neurovascular diseases. Cerebral hyperperfusion syndrome is a rare complication of these procedures, and this case report illustrates a patient with this condition after carotid endarterectomy. The mechanism of hyperperfusion is thought to be from chronic compensatory small vessel dilation to maintain cerebral perfusion in the context of vascular stenosis. Treatment is largely supportive with strict blood pressure control. As treatment options for neurovascular reperfusion become mainstay, emergency clinicians need to be appraised to post procedural complications such as cerebral hyperperfusion.
subject: Case Reports
  topic: section
subject: Newsletter
  topic: category
subject: Cerebral hyperperfusion syndrome
  topic: keywords
subject: carotid endarterectomy
  topic: keywords
subject: carotid stenting
  topic: keywords
creator: David Fine
creator: John Teijido
creator: Laurie Benson
creator: Matthew Treat
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-15
publication date: 2025-10-15
doi: 10.4081/ecj.2025.14255

Accidental ingestion of dishwasher detergent by an elderly patient: a case of successful conservative management
type: item
description: Section: Case Reports Categories: Newsletter Keywords: Caustic ingestion, mediastinitis, esophageal perforation, intoxication, toxicity Accidental ingestion of household cleaning products is a common reason for visits to the emergency department. The broad spectrum of clinical symptoms, along with a higher prevalence in vulnerable patients, complicates the correct management of these cases. We present the case of a 91-year-old man with dementia who was admitted after accidentally ingesting dishwasher detergent. He complained of chest pain and a sensation of upper airway obstruction. Initially, the patient’s vital signs were stable, and radiological imaging results were negative, but his condition quickly deteriorated, leading to esophageal perforation complicated by mediastinitis. The patient was managed by a multidisciplinary team that included emergency physicians, otolaryngologists, toxicologists, endoscopists, and surgeons with a good outcome. This case demonstrates how a coordinated, multidisciplinary strategy, coupled with careful monitoring, can lead to a successful conservative treatment outcome in an elderly patient with numerous comorbidities and a complex medication regimen.
subject: Case Reports
  topic: section
subject: Newsletter
  topic: category
subject: Caustic ingestion
  topic: keywords
subject: mediastinitis
  topic: keywords
subject: esophageal perforation
  topic: keywords
subject: intoxication
  topic: keywords
subject: toxicity
  topic: keywords
creator: Maria Floresta
creator: Annamaria Venturi
creator: Eleonora Tubertini
creator: Loredana Mele
creator: Jacopo Fantini
creator: Fabrizio Giostra
rights: Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-15
publication date: 2025-10-15
doi: 10.4081/ecj.2025.14278