Emergency Care Journal https://www.pagepressjournals.org/index.php/ecj <p><strong>Emergency Care Journal </strong> is the official Journal of the <a href="http://www.acemc.it/sito/home.html" 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="http://www.acemc.it/index.html" target="_blank" rel="noopener">Academy of Emergency Medicine and Care</a>).</p> PAGEPress Scientific Publications, Pavia, Italy en-US Emergency Care Journal 1826-9826 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="http://creativecommons.org/licenses/by-nc/4.0/" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> A ripping bike race: spontaneous coronary dissection complicated by cardiac tamponade, unmasking vascular Ehlers-Danlos in a young man https://www.pagepressjournals.org/index.php/ecj/article/view/7802 <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> Inne Hendrickx Benjamin Scott ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-02-27 2019-02-27 15 1 10.4081/ecj.2019.7802 The Acute Abdomen Decision Making course for the initial management of non traumatic acute abdomen: A proposition of the World Society of Emergency Surgeons https://www.pagepressjournals.org/index.php/ecj/article/view/7767 <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> Belinda De Simone Luca Ansaloni Massimo Sartelli Federico Coccolini Ciro Paolillo Massimo Valentino Giorgio Ricci Fausto Catena ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-02-05 2019-02-05 15 1 10.4081/ecj.2019.7767 Determinants of troponin T and I elevation in old patients without acute coronary syndrome https://www.pagepressjournals.org/index.php/ecj/article/view/7798 <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> Antonio Di Micoli Chiara Scarciello Stefania De Notariis Mario Cavazza Antonio Muscari ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-01-30 2019-01-30 15 1 10.4081/ecj.2019.7798 An Italian pediatric case series of Maldive-imported dengue fever https://www.pagepressjournals.org/index.php/ecj/article/view/7892 <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> Arianna Dondi Francesca Gottardi Marianna Fabi Luciano Attard Giada Rossini Maria Carla Re Marcello Lanari ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-01-24 2019-01-24 15 1 10.4081/ecj.2019.7892 Levobupivacaine combined with dexamethasone for serratus plane block can provide long-lasting analgesia in multiple rib fractures https://www.pagepressjournals.org/index.php/ecj/article/view/7716 <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> Santi Di Pietro Benedetta Mascia Stefano Perlini Giorgio Antonio Iotti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2019-01-24 2019-01-24 15 1 10.4081/ecj.2019.7716 A case of embolic stroke from atrial myxoma https://www.pagepressjournals.org/index.php/ecj/article/view/7815 <p>Not available.</p> Rosanna Varutti Giulio Trillò Rita Piazza Flavio Bassi ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-12-12 2018-12-12 15 1 10.4081/ecj.2018.7815