Emergency Care Journal 2020-03-31T20:48:51+00:00 Francesca Savio 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> Changing Emergency Department and hospital organization in response to a changing epidemic 2020-03-31T20:48:47+00:00 Daniele Coen Ciro Paolillo Mario Cavazza Gianfranco Carvellin Andrea Bellone Stefano Perlini Ivo Casagranda <p>The world is facing a new pandemic that sets the national health systems, their structures and professionals in a crisis never experienced before. (...)</p> 2020-03-17T17:16:27+00:00 ##submission.copyrightStatement## Pulmonary hypertension: when the acute event leads to diagnosis. Case report in a patient with Ehlers-Danlos syndrome. 2020-03-31T20:48:48+00:00 Gianmarco Secco Anna Giulia Falchi Francesco Salinaro Chiara Blatti Bianca Giacomuzzi Moore Stefano Perlini <p>Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a pulmonary vascular pathology caused by the chronic obstruction of the major pulmonary arteries, usually being the consequence of recurrent episodes of pulmonary embolism. Such events are usually unknown; the delay in such a diagnosis can therefore lead to a deterioration of the clinical picture, worsening the overall prognosis.&nbsp; This is a case of a 55-year-old man who came to the Emergency Room (ER) because of an acute exacerbation of chronic dyspnea, that he experienced for several years, in the absence of an explanatory diagnosis. Acute pulmonary embolism was diagnosed in the setting of the ER, with bedside echography resulting to be crucial to the work up. A multidisciplinary approach allowed proper treatment, management and a favourable outcome.</p> 2020-03-17T14:20:33+00:00 ##submission.copyrightStatement## Deep learning in Emergency Medicine: Recent contributions and methodological challenges 2020-03-31T20:48:49+00:00 Francesco Faita <p>In the last few years, artificial intelligence (AI) technology has grown dramatically impacting several fields of human knowledge and medicine in particular. Among other approaches, deep learning, which is a subset of AI based on specific computational models, such as deep convolutional neural networks and recurrent neural networks, has shown exceptional performance in images and signals processing. Accordingly, emergency medicine will benefit from the adoption of this technology. However, a particular attention should be devoted to the review of these papers in order to exclude overoptimistic results from clinically transferable ones. We presented a group of studies recently published on PubMed and selected by keywords ‘deep learning emergency medicine’ and ‘artificial intelligence emergency medicine’ with the aim of highlighting their methodological strengths and weaknesses, as well as their clinical usefulness.</p> 2020-03-17T12:23:14+00:00 ##submission.copyrightStatement## Anticoagulation therapy in older patients at risk for syncopal and not-syncopal fall and/or frailty. An AcEMC-GIMSI multidisciplinary consensus document 2020-03-31T20:48:50+00:00 Ivo Casagranda Andrea Ungar Carolina Prevaldi Pasquale Abete Sergio Biagioni Attilio Del Rosso Michele Diamanti Alessandra Fanciulli Stefano Fumagalli Raffaello Furlan Roberto Lerza Carlo Locatelli Roberto Maggi Chiara Mussi Filippo Numeroso Filippo Rabajoli Sophie Testa Marco Tomaino Michele Brignole <p>In aged patients, the most frequent indications for anticoagulation are atrial fibrillation (AF) and venous thromboembolism for stroke and systemic embolism prevention. Despite systemic anticoagulation recommended by current guidelines for patients over 65 years, in clinical practice up to 50 % of elderly patients do not receive maintenance anticoagulation therapy. This is particularly evident in frail subjects at risk of syncopal and not-syncopal fall, fearing intracranial bleeding following a fall. As the risk of bleeding associated with falls is still debated, the boards of the Academy of Emergency Medicine and Care (AcEMC) and the Italian Multidisciplinary Working Group on Syncope (GIMSI), in order to write a consensus document, submitted to a panel of experts eight statement which could represent as many controversial topics for anticoagulant prescription in patients over 75 years. The Delphi method was used to obtain consensus between 15 physicians from different medical specialties; some of them were expert in syncope management and worked in a Syncope Unit. All had experience in prescribing oral anticoagulation. A questionnaire was sent on the appropriateness of oral anticoagulation in eight clinical situations where the risk of fall is present (frailty, cognitive impairment, previous falls, absence of caregiver, chronic renal impairment, nonvalvular AF with HAS-BLED score ≥3 or CHA2DS2-VASc score ≥3). All experts completed the questionnaire within three rounds and the consensus was reached on many but not all statements, leaving room for debate on some clinical situations. The consensus document gives useful advice for elderly patients’ management, who need oral anticoagulant therapy but are at risk of syncopal or not-syncopal fall. Nonetheless, there are some unresolved issues where an individual decision should be taken by the physician in agreement with the patient.</p> 2020-03-16T15:25:54+00:00 ##submission.copyrightStatement## What we have learned from the Rigopiano tragedy 2020-03-31T20:48:50+00:00 Antonella Pescini Paola D’alfonso <p>On the afternoon of 18 January 2017, a major avalanche occurred on Gran Sasso d’Italia massif, destroying an hotel in Rigopiano, and killing twenty-nine people. A staff of psychologists trained in emergency psychology was involved to assist the families of the missing persons without ever abandoning them for eight consecutive days. Particular care was posed to identify an appropriate setting where families and psychologists could interact, favoring emotional containment and protection of intimacy in moments of intense pain. It was considered paramount that the team shared their intervention method, and that nobody operated individually, because this would support both families and members of the professional group. The long waiting for news about the missing persons’ fate was a suspended time, during which the psychologists engaged in emotional rescue were called to express their empathy understanding and sharing silence. Once the bodies were retrieved, the recognition of corpses required the sharing of a common operational strategy to face lucid or contradictory communications, and the alternate feelings of disbelief, anger, or guilt. As a consequence of the Rigopiano tragedy, in the year 2018 the Abruzzo region wrote a new plan for maxi health emergencies, recognizing psychological suffering among the needs to be met in case of disaster.</p> 2019-12-23T13:59:17+00:00 ##submission.copyrightStatement## EMDR intervention after a disaster: The Morandi Bridge collapse 2020-03-31T20:48:51+00:00 Isabel Fernandez Chiara Callerame <p>Survivors involved in natural or man-made disasters can develop a range of psychological problems including Post-Traumatic Stress Disorder (PTSD), depression, other forms of psychological distress, and a poor quality of life. Therefore, the principal focus of early psychological interventions, according to World Health Organization, is to provide a rapid and effective therapeutical approach like EMDR therapy. The EMDR approach enables the assimilation and integration of the various aspects of a traumatic experience at a somatic, sensorial, cognitive, behavioral and emotional level. In this article will be presented data of 47 patients collected after the partial collapse of Morandi bridge, in Genoa, in August 2018. Survivors were treated applying the Recent Traumatic Episode Protocol (R-TEP); in order to evaluate the effect of the traumatic event and to monitor the intervention outcome, the Impact of Event Scale- Revised (IES-R) was administered to each person pre and after EMDR treatment. Results show that regardless the number of sessions and the time elapsed after the disaster in which they were performed, EMDR significantly reduced participants’ IES-R scores from pre-treatment to posttreatment. Clinical implications and limits of the study will be discussed.</p> 2019-12-19T15:40:51+00:00 ##submission.copyrightStatement##