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/index.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> en-US <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> francesca.baccino@pagepress.org (Francesca Baccino) tiziano.taccini@pagepress.org (Tiziano Taccini) Thu, 04 Jul 2019 09:28:37 +0200 OJS 3.1.1.4 http://blogs.law.harvard.edu/tech/rss 60 Actions speak louder: Young female patients with acute ischemic stroke in the emergency department https://www.pagepressjournals.org/index.php/ecj/article/view/8300 <p>The aim was to explore the diagnostic cascade of young females with acute ischemic stroke (AIS) in the emergency department (ED) setting. A retrospective case series study was conducted between the years 2016-2018 in the ED of a tertiary hospital (N=10). We collected socio-demographic data, clinical risk factors and co-morbidities, ED characteristics and medical examination related data. Ten females presenting with AIS were identified. Results show that each case had a variety of characteristics, there are no similar medical background or clear-cut risk factors, and each case has been presented clinically different. All these factors, with the possible added effect of age and sex bias serve as possible hindrance for correct and efficient diagnosis of stroke in young females. In conclusion, clinical presentation of young female with AIS is misleading. Initial examination in the ED setting may appear to be the determining point of impact on the outcome severity in young females.</p> Mor Saban, Tal Shachar, Heli Patito, Lev Zaretsky ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepressjournals.org/index.php/ecj/article/view/8300 Tue, 27 Aug 2019 09:31:43 +0200 Procedural sedation in a tertiary referral trauma centre: A retrospective audit https://www.pagepressjournals.org/index.php/ecj/article/view/8214 <p>Procedural sedation complications are common in Australasian Emergency Departments (EDs). This study aimed to compare procedural sedation complications between The Canberra Hospital ED (TCH ED) and the available Australasian literature and to determine if sedation associated complications were amenable to simple intervention. All procedural sedations performed over two and half years in TCH ED were retrospectively reviewed. Complications were defined as per the previous comparable Australasian study, as those events requiring an intervention. 1793 sedations were reviewed: 1125 (63%) for orthopaedic procedures, other 276 (a collection of painful procedures), 208 suturing and 169 direct current cardioversions. The median age was 29 years with 538 (30%) children under the age of 16 years. The complication rate in the initial six-months was 4.0% dropping to 1.3% after multiple education sessions before rebounding to 3.1% in the last six-months. The overall complication rate was 3.1% (95% CI 2.3-4.0) which is significantly lower (P&lt;0.0001) than the comparable previous major Australian study (7.2%, 95% CI 6.2-8.2). There was significantly less use of Midazolam (10.3% <em>vs</em> 23.8% P&lt;0.00001) and Morphine (1.5% <em>vs </em>7.9% P&lt;0.00001). There was one case of laryngospasm requiring intubation but subsequently discharged at baseline, otherwise no recorded major adverse events. Therefore procedural sedation at TCH ED has a complication rate less than that previously reported and this may be due to evolution of the agents used. The complications seem to be readily amenable to education around prevention, but the benefit of these education sessions appears to decay over time.</p> James Falconer, Drew Richardson ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepressjournals.org/index.php/ecj/article/view/8214 Fri, 23 Aug 2019 12:32:56 +0200 Efficacy and tolerability of fixed association of oxycodone and naloxone in elderly patients with ribs fracture: An 18-month retrospective study https://www.pagepressjournals.org/index.php/ecj/article/view/8119 <p>Blunt chest trauma with isolated or multiple rib fractures constitutes a common presentation in Emergency Department (ED), particularly in elderly people. Rib fractures in the elderly create short- and long-term disabilities with a dramatic impact. Pain management in the elderly could be problematic due to non-steroidal anti-inflammatory drugs (NSAIDs) contraindication or interaction with other drugs. We performed this retrospective study collecting and retrieving all patients aged 65 or older, with a diagnosis of rib(s) fracture(s) during an 18-month period. We analyzed the different treatments chosen, and divided them into subgroups: oxycodone- naloxone, and other treatments (also divided in: codeineacetaminophen; NSAID or Acetaminophen; Tramadol or Tapentadol). A total of 475 elderly patients (aged 65 and older) with single or multiple rib fractures were evaluated in our ED in 18 months: of these 410 patients were considered eligible, with a mean age of 79.28 years (standard deviation 7.83). 185 were male and 225 were female. Our study confirms the efficacy and tolerability of fixed association of oxycodone and naloxone. This association determined the highest and fastest reduction on Numeric Pain Scale reported by patients and is significantly better than other drugs in oral administration.</p> Alessandro Riccardi, Beatrice Spinola, Pierangela Minuto, Marco Licenziato, Valeria Ghiglione, Roberto Lerza ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepressjournals.org/index.php/ecj/article/view/8119 Fri, 09 Aug 2019 08:12:13 +0200 Cyanide intoxication by apricot kernels: A case report and literature review https://www.pagepressjournals.org/index.php/ecj/article/view/8256 <p>Acute cyanide intoxication is a serious healthcare problem due to its potentially life threatening and fatal toxic effects. Ingestion of cyanide containing foods is an important source of cyanide poisoning and apricot kernels contain significant amounts of such cyanogenic compounds. Herein we report a previously healthy 4- year-old boy admitted to our emergency department with complaints of vomiting and sudden onset of unconsciousness after ingestion of apricot kernels. He was diagnosed as acute cyanide poisoning and treated with a specific antidote; hydroxocobalamin. Our report concludes with previous cases of cyanide poisoning after ingestion of apricot kernels and a quick look at sources, manifestations and treatment of acute cyanide poisoning.</p> Faruk Ekinci, Dincer Yildizdas, Alper Ates, Naime Gökay ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepressjournals.org/index.php/ecj/article/view/8256 Wed, 07 Aug 2019 15:10:55 +0200 Use of ultrasound for the assessment of dehydration in pediatric patients with mild to moderate dehydration https://www.pagepressjournals.org/index.php/ecj/article/view/8151 <p>Management of children with acute gastroenteritis is based upon dehydration estimation. There is no clinical or paraclinical tool which exactly estimates the dehydration degree. Recently ultrasonographic parameters as inferior vena cava (IVC) diameter and aorta (AO) have been used in some studies for this purpose. This study aims to evaluate the efficacy of ultrasound in detecting mild and moderate degrees of dehydration in children. The study was performed in the emergency department of Dr. Sheikh’s Children Hospital, Mashhad, Iran. Children with mild to moderate degrees of dehydration according to World health Organization (WHO) clinical scale were enrolled. Their inferior vena cava diameters, aorta and IVC/AO ratio were measured before and after fluid therapy using ultrasound. Ultrasound was performed by two pediatric sonographers. 36 patients (mean age of 16.94±11.02 months) entered the study. 11 patients had mild and 25 moderate dehydration according to WHO clinical scale. All 11 patients with mild dehydration received oral rehydration. 13 patients in the moderate dehydration group received intravenous rehydration because of oral intolerance to fluids and recurrent vomiting. IVC diameter and IVC/AO ratio after fluid therapy in children with both mild and moderate dehydration degrees was significantly greater (P&lt;0.001). However, we did not observe any significant difference in aorta diameter before and after fluid therapy. Using Receiver Operating Characteristic (ROC) curve, the proper cut-off point of IVC/AO ratio to differentiate patients with moderate dehydration from mild dehydration is equal to 0.782 with sensitivity and specificity equal to 88% and 45.45% respectively. Further, the area under the ROC curve for this cut-off is equal to 0.569. In conclusion, ultrasonography cannot differentiate between mild and moderate dehydration degrees, but studies with larger population of patients should be performed.</p> Yalda Ravanshad, Anoush Azarfar, Seied Ali Alamdaran, Mitra Naseri, Gholamreza Sarvari, Sepideh Bagheri, Armin Vahabi Sani ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepressjournals.org/index.php/ecj/article/view/8151 Mon, 05 Aug 2019 10:17:28 +0200 Out-of-hospital cardiac arrest survival in Athens: Data from a Greek public hospital https://www.pagepressjournals.org/index.php/ecj/article/view/8249 <p>Although out-of-hospital cardiac arrests (OHCA) are a major cause of mortality internationally, data regarding survival in Greece remains scarce and inconclusive. The aim of this study is to assess the immediate and 24-hour survival of OHCA sufferers during a 5-year period in a public hospital in Athens. A retrospective study was conducted on all cardiac arrests that were transferred to our hospital during a five-year period (2011-2015). Our primary objective was to calculate return of spontaneous circulation (ROSC) and 24-hour survival ratios. Our secondary objective was to estimate 30-day survival. Demographic data was also collected. 283 OHCA were included in the study. The mean age was 67.2 years and the male: female ratio was 2. Medical history was available for 33.6% of patients. 72.1% of cases were transferred to the emergency department by ambulance and 2.8% by private means of transport. Cardiopulmonary resuscitation was attempted on 57.6% of cardiac arrests, 8.6% regained ROSC and 6.1% survived for 24 hours. The 30-day survival was expected to be less than 3.5%. In our institution, ROSC, 24-hour and expected 30-day survival were lower than the European average and in accordance with the recent prospective Eureca One study. However, data from our institution cannot be generalised and multicenter studies are required in order to clarify OHCA outcomes in Greece.</p> Zisimangelos S. Solomos, Maria S. Tatsi, Victoria E. Psomiadou, Angeliki D. Tsifi, Dimitrios S. Theodoridis, Aikaterini P. Petropoulou, Konstantinos G. Miltiadou ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepressjournals.org/index.php/ecj/article/view/8249 Tue, 09 Jul 2019 14:46:56 +0200