Emergency Care Journal 2019-03-23T17:26:39+01:00 Francesca Baccino Open Journal Systems <p><strong>Emergency Care Journal </strong> is the official Journal of the <a href="" target="_blank" rel="noopener">Academy of Emergency Medicine and Care</a> (AcEMC). The journal is an international, peer-reviewed journal dedicated to improve the quality of care by publishing the highest quality science for acute medical care and related medical specialties. The journal welcomes submissions from international contributors and researchers of all specialties involved in acute medical conditions. <strong>Emergency Care Journal</strong> publishes <em>Original Articles, Review Articles, Opinion Reports, Case Reports, Images in Emergency, Letters to the Editors, Commentaries, Book Reviews, Editorials</em> 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.</p> <p>This journal does not apply charge for publication to Authors as it is fully supported by institutional funds (<a href="" target="_blank" rel="noopener">Academy of Emergency Medicine and Care</a>).</p> A ripping bike race: spontaneous coronary dissection complicated by cardiac tamponade, unmasking vascular Ehlers-Danlos in a young man 2019-03-23T17:26:34+01:00 Inne Hendrickx Benjamin Scott <p>Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Typically, it occurs in young women without atherosclerotic risk factors. Clinical presentation ranges from chest pain to myocardial infarction, ventricular fibrillation and sudden death. We report a very rare case of a young man with ST-elevation myocardial infarction caused by SCAD, complicated by hemopericardium and recurrent cardiac tamponade. Due to this acute complication, he was diagnosed as having vascular Ehlers- Danlos syndrome.</p> 2019-02-27T14:50:39+01:00 ##submission.copyrightStatement## The Acute Abdomen Decision Making course for the initial management of non traumatic acute abdomen: A proposition of the World Society of Emergency Surgeons 2019-03-23T17:26:35+01:00 Belinda De Simone Luca Ansaloni Massimo Sartelli Federico Coccolini Ciro Paolillo Massimo Valentino Giorgio Ricci Fausto Catena <p>The Acute Abdomen Decision Making course® (AADM®) was developed by the World Society of Emergency Surgeons (WSES) members with the purpose to teach a systematic and concise method for approaching acute abdomen patient. It was first introduced in 2016. The course explains step by step the clinical reasoning to follow for immediate managing of the acute abdomen in emergency department with a safe and reliable method. We developed this original decision making model AADM following the Advanced Trauma Life Support (ATLS) philosophy in evaluating non-traumatic abdominal pain patient. The A-B-C-D-E-F management of non-traumatic acute abdominal pain is conceived by WSES to make easy and systematic the evaluation of patients in Emergency Department. AADM course teaches how to assess an acute abdomen patient’s diagnosis and determine the therapeutic approach to reduce unnecessary exams and hospitalizations.</p> 2019-02-05T14:21:48+01:00 ##submission.copyrightStatement## Determinants of troponin T and I elevation in old patients without acute coronary syndrome 2019-03-23T17:26:36+01:00 Antonio Di Micoli Chiara Scarciello Stefania De Notariis Mario Cavazza Antonio Muscari <p>Cardiac troponins T and I (cTnT and cTnI) are the main markers of acute myocardial cell damage and then of Acute Coronary Syndrome (ACS) if associated with compatible symptoms. Although their cardio-specificity, the cTn may be increased in various clinical conditions but only few recent studies have reported their trends with age. This is a single-center retrospective observational study on two groups of adults consecutive patients, with age ≥65 years, admitted to the Emergency Department of the Sant'Orsola-Malpighi Hospital of Bologna, Italy, with chest pain as chief complaint. In the first group was dosed cTnT (N=617), in the second group cTnI (N=569). The patients with final ACS’s diagnosis (N=255) or an incomplete report of blood tests (N=17) were excluded. The definitive database included 471 patients in the first group and 443 in the second one. The observed differences between clinical parameters, patients with cTnT≤14ng/L and those with cTnT&gt;14ng/L (N=207, 44%) are: older age, greater prevalence of diabetes, lower values of Hb e ALT, higher values of white blood cells, INR, glycemia, urea, creatinine, BNP e PCR. In multiple logistics regression (N=333) only 4 variables resulted independently associated to cTnT increase: age (P&lt;0.0001), PCR (P=0.01), creatinine (P=0.02) and urea (P=0.04), R<sup>2</sup>=0.30. The differences between patients with cTnI≤40ng/L and those with cTnI&gt;40ng/L (N=46, 10%) are: older age, Hb values equal and higher values of white blood cells, INR, glycemia, urea, creatinine, total bilirubin, AST, BNP e PCR. In multiple logistics regression (N=259) the only 4 variables independently associated to increase of cTnI are age (P&lt;0.0001), glycemia (P=0.004), PCR (P=0.01) and white blood cells (P=0.02), R<sup>2</sup>=0.17. Furthermore, the number of patients with high level of cTn significantly increase by age (cTnT: 65-74 years 22.2%, 75-84 years 48.5%, ≥85 years 79.5%; cTnI: 65-74 years 4.3%, 75-84 years 8.1%, ≥85 years 22.5%, P&lt;0.0001). In our study, cTnI showed fewer false positives than cTnT and seems to be less influenced by kidney failure. Furthermore, the acute phase of inflammation was associated with the rise of troponins. High cTn values were found in elderly subjects, without acute coronary syndromes, particularly cTnT. Then the age seems to be the most important factor related to this highelevated troponin levels.</p> 2019-01-30T14:08:02+01:00 ##submission.copyrightStatement## An Italian pediatric case series of Maldive-imported dengue fever 2019-03-23T17:26:37+01:00 Arianna Dondi Francesca Gottardi Marianna Fabi Luciano Attard Giada Rossini Maria Carla Re Marcello Lanari <p>Dengue is a mosquito-borne disease frequently imported in Europe, where autochthonous outbreaks are potential since recent spreading of the vector. Primary infections usually produce a selflimited febrile syndrome. Secondary infections with different serotype, especially in children, may lead to a severe shock syndrome with plasma leakage and hemorrhagic features. We report a case series of 4 children infected with viral serotype 3 during a journey to the Maldive Islands, who developed symptoms after returning to Italy. Once diagnosed, they were admitted to hospital, followed with clinical and laboratory monitoring and treated supportively; they developed no complications. Dengue endemic areas are popular touristic destinations. Vector eradication may be incomplete where tourist resorts share water tanks with local dwellings. Diagnostic tests should be available in our hospitals for early recognition of cases. Awareness of a primary infection may help prevent re-exposure, avoiding a reinfection with a potentially severe clinical course.</p> 2019-01-24T12:32:54+01:00 ##submission.copyrightStatement## Levobupivacaine combined with dexamethasone for serratus plane block can provide long-lasting analgesia in multiple rib fractures 2019-03-23T17:26:38+01:00 Santi Di Pietro Benedetta Mascia Stefano Perlini Giorgio Antonio Iotti <p>Serratus plane block (SPB) is a technique of regional anesthesia that has recently been proposed to treat pain in rib fractures. In this context, SPB is currently performed using a variety of local anesthetics at different concentrations and dilutions, reporting a duration of pain control up to 12 hours following the procedure. To the best of our knowledge, the addition of dexamethasone to the local anesthetic for this specific regional block has never been documented. Here we report three patients that were treated for multiple rib fractures with SPB, which included combined dexamethasone and levobupivacaine. Interestingly, the obtained pain control lasted between 23 to 45 hours following the block, thus helping to minimize the opioid use in our patients.</p> 2019-01-24T12:24:39+01:00 ##submission.copyrightStatement## A case of embolic stroke from atrial myxoma 2019-03-23T17:26:39+01:00 Rosanna Varutti Giulio Trillò Rita Piazza Flavio Bassi <p>Not available.</p> 2018-12-12T11:46:16+01:00 ##submission.copyrightStatement##