A 90-year-old woman presented at our emergency department complaining of dyspnea (sO2 88% on room air, respiratory rate 24/min) and severe (NRS 8/10) burning chest pain. Ten years earlier, she had undergone a bilateral radical mastectomy and radio-chemotherapy for breast cancer. In September 2023, she developed some nodules on her chest skin treated with electrochemotherapy, multiple liver lesions, and a bilateral paraneoplastic pleural effusion.
{"title":"Painful burning lesions on the chest wall of a patient with advanced breast cancer","authors":"Erika Poggiali, Etilda Braho, Raffaella Bertè","doi":"10.4081/ecj.2023.12016","DOIUrl":"https://doi.org/10.4081/ecj.2023.12016","url":null,"abstract":"A 90-year-old woman presented at our emergency department complaining of dyspnea (sO2 88% on room air, respiratory rate 24/min) and severe (NRS 8/10) burning chest pain. Ten years earlier, she had undergone a bilateral radical mastectomy and radio-chemotherapy for breast cancer. In September 2023, she developed some nodules on her chest skin treated with electrochemotherapy, multiple liver lesions, and a bilateral paraneoplastic pleural effusion.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"84 17","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138600122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A previously healthy 57-year-old male patient presented to our emergency department for palpitations, dry cough, and non-exertional chest pain. He denied lipothymia or syncope. Blood pressure was 160/90 mmHg, heart rate 76 beats/min, body temperature 36.4°C, respiratory rate was 14 breaths/min, and oxygen saturation 96% on room air. Physical examination revealed symmetrical air entry without wheezing or crackles, and a classical diastolic "tumor plop", not accompanied by another significant murmur at cardiac auscultation. Laboratory tests were all in the normal range, including troponin T (9.1 ng/mL, normal value <14) and C-reactive protein (2.2 mg/dL, normal value <6). An electrocardiogram showed a sinus rhythm and normal ventricular repolarization. Point-of-care ultrasound (POCUS) revealed a floating mass within the left atrium and a normal lung pattern without pleural effusion.
{"title":"What does a floating mass in a young patient's heart do?","authors":"Tommaso Sonnessa, Daniela Vaira","doi":"10.4081/ecj.2023.11717","DOIUrl":"https://doi.org/10.4081/ecj.2023.11717","url":null,"abstract":"A previously healthy 57-year-old male patient presented to our emergency department for palpitations, dry cough, and non-exertional chest pain. He denied lipothymia or syncope. Blood pressure was 160/90 mmHg, heart rate 76 beats/min, body temperature 36.4°C, respiratory rate was 14 breaths/min, and oxygen saturation 96% on room air. Physical examination revealed symmetrical air entry without wheezing or crackles, and a classical diastolic \"tumor plop\", not accompanied by another significant murmur at cardiac auscultation. Laboratory tests were all in the normal range, including troponin T (9.1 ng/mL, normal value <14) and C-reactive protein (2.2 mg/dL, normal value <6). An electrocardiogram showed a sinus rhythm and normal ventricular repolarization. Point-of-care ultrasound (POCUS) revealed a floating mass within the left atrium and a normal lung pattern without pleural effusion.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gianni Turcato, Arian Zaboli, Serena Sibilio, Michael Mian, Francesco Brigo
For patients with sepsis in the Emergency Department (ED), early risk stratification is important to improve prognosis. The study aimed to evaluate the predictive role of estimated plasma volume (ePVS) on admission to the ED. All sepsis patients who were admitted to our ED in 2021, were included in this prospective study. Multivariate models adjusted for patients' clinical characteristics were used to assess the contribution of ePVS to the independent prediction of death at 30 days. A total of 455 septic patients were enrolled and 16.9% of patients died. Patients who survived to 30 days had a mean ePVS of 5.19, while those who died at 30 days had a value of 5.74 (p=0.004). ePVS was an independent risk factor for 30-day mortality with an adjusted OR of 1.211 (95% CI 1.004–1.460, p=0.045). The AUROC of ePVS was 0.619 (95% CI 0.545–0.689). Decision tree analysis showed a predictive role for ePVS in less severe patients. In septic patients, ePVS is an independent predictor of 30-day mortality and may improve risk prediction in less severe patients.
对于急诊脓毒症患者，早期风险分层对改善预后很重要。该研究旨在评估估计血浆容量(ePVS)在急诊科入院时的预测作用。该前瞻性研究纳入了2021年入住急诊科的所有败血症患者。采用调整患者临床特征的多变量模型来评估ePVS对独立预测30天死亡的贡献。共有455例脓毒症患者入组，16.9%的患者死亡。存活至30天的患者平均ePVS为5.19，而30天死亡的患者平均ePVS为5.74 (p=0.004)。ePVS是30天死亡率的独立危险因素，调整后OR为1.211 (95% CI 1.004-1.460, p=0.045)。ePVS的AUROC为0.619 (95% CI 0.545-0.689)。决策树分析显示ePVS在较轻重症患者中的预测作用。在脓毒症患者中，ePVS是30天死亡率的独立预测指标，并可改善病情较轻患者的风险预测。
{"title":"Estimated plasma volume status can help identify patients with sepsis at risk of death within 30 days in the emergency department","authors":"Gianni Turcato, Arian Zaboli, Serena Sibilio, Michael Mian, Francesco Brigo","doi":"10.4081/ecj.2023.11655","DOIUrl":"https://doi.org/10.4081/ecj.2023.11655","url":null,"abstract":"For patients with sepsis in the Emergency Department (ED), early risk stratification is important to improve prognosis. The study aimed to evaluate the predictive role of estimated plasma volume (ePVS) on admission to the ED. All sepsis patients who were admitted to our ED in 2021, were included in this prospective study. Multivariate models adjusted for patients' clinical characteristics were used to assess the contribution of ePVS to the independent prediction of death at 30 days. A total of 455 septic patients were enrolled and 16.9% of patients died. Patients who survived to 30 days had a mean ePVS of 5.19, while those who died at 30 days had a value of 5.74 (p=0.004). ePVS was an independent risk factor for 30-day mortality with an adjusted OR of 1.211 (95% CI 1.004–1.460, p=0.045). The AUROC of ePVS was 0.619 (95% CI 0.545–0.689). Decision tree analysis showed a predictive role for ePVS in less severe patients. In septic patients, ePVS is an independent predictor of 30-day mortality and may improve risk prediction in less severe patients.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135569680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 20-year-old man presented to the emergency department with a small painful swelling located in the midline of the epigastric region. His medical history included asthma and extramucosal pyloromyotomy for hypertrophic pyloric stenosis when he was a baby. His vital signs were normal. Abdominal ultrasound (US) showed a small hypoechoic formation located in the subcutaneous adipose tissue that penetrated into the abdominal cavity through an orifice of about 7 mm in the linea alba.
{"title":"A small lump in the abdomen","authors":"Massimo Barakat","doi":"10.4081/ecj.2023.11926","DOIUrl":"https://doi.org/10.4081/ecj.2023.11926","url":null,"abstract":"A 20-year-old man presented to the emergency department with a small painful swelling located in the midline of the epigastric region. His medical history included asthma and extramucosal pyloromyotomy for hypertrophic pyloric stenosis when he was a baby. His vital signs were normal. Abdominal ultrasound (US) showed a small hypoechoic formation located in the subcutaneous adipose tissue that penetrated into the abdominal cavity through an orifice of about 7 mm in the linea alba.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135569686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Kazem Rahimi, Edris Heidari, Razieh Montazeralfaraj, Tahmineh Farajkhoda
To maintain the performance of emergency personnel who are at disproportionate risk of infection on the front lines of outbreaks, it is beneficial to understand the factors that promote their willingness to stay or leave their job. This study aims to identify key factors related to emergency workers' willingness to retain. This study identifies key factors related to emergency workers' willingness to be retained or turnover intention during infectious disease pandemics. Following the PRISMA guidelines, a systematic review of the literature was conducted. To obtain the results, three databases, Scopus, PubMed Web of Science, and Google Scholar, were searched for English-speaking studies up to March 2022 that met the established inclusion criteria and were of high quality. Given the heterogeneity of the results, a qualitative synthesis of the results was also undertaken. A narrative synthesis was performed on 34 studies of high and medium quality. The studies examined different and multifaceted factors in three categories: retention, turnover decision, and factors that mediate between turnover intention and retention. The retention of frontline emergency workers during an epidemic is dependent on essential factors such as job satisfaction, organizational commitment, managerial support, psychological well-being, and resilience.
在疫情爆发的第一线，应急人员面临着极高的感染风险，为了保持他们的工作表现，了解促使他们愿意留下或离开工作岗位的因素是有益的。本研究旨在找出影响急救人员挽留意愿的关键因素。本研究确定了传染病大流行期间与急救人员留任意愿或离职意愿相关的关键因素。遵循PRISMA指南，对文献进行了系统的综述。为了获得结果，检索了截至2022年3月符合既定纳入标准且高质量的英语研究，检索了Scopus、PubMed Web of Science和Google Scholar三个数据库。鉴于结果的异质性，还对结果进行了定性综合。对34项高、中质量的研究进行叙事综合。这些研究考察了三种不同的、多方面的因素:留任、离职决策以及在离职意向和留任之间起中介作用的因素。疫情期间一线急救人员的保留取决于工作满意度、组织承诺、管理支持、心理健康和复原力等基本因素。
{"title":"A systematic review of the factors influencing retention or turnover intention among emergency personnel in epidemics","authors":"Mohammad Kazem Rahimi, Edris Heidari, Razieh Montazeralfaraj, Tahmineh Farajkhoda","doi":"10.4081/ecj.2023.11644","DOIUrl":"https://doi.org/10.4081/ecj.2023.11644","url":null,"abstract":"To maintain the performance of emergency personnel who are at disproportionate risk of infection on the front lines of outbreaks, it is beneficial to understand the factors that promote their willingness to stay or leave their job. This study aims to identify key factors related to emergency workers' willingness to retain. This study identifies key factors related to emergency workers' willingness to be retained or turnover intention during infectious disease pandemics. Following the PRISMA guidelines, a systematic review of the literature was conducted. To obtain the results, three databases, Scopus, PubMed Web of Science, and Google Scholar, were searched for English-speaking studies up to March 2022 that met the established inclusion criteria and were of high quality. Given the heterogeneity of the results, a qualitative synthesis of the results was also undertaken. A narrative synthesis was performed on 34 studies of high and medium quality. The studies examined different and multifaceted factors in three categories: retention, turnover decision, and factors that mediate between turnover intention and retention. The retention of frontline emergency workers during an epidemic is dependent on essential factors such as job satisfaction, organizational commitment, managerial support, psychological well-being, and resilience.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135569259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Felistus Ndanu Musyoka, Wanja Tenambergen, Job Mapesa, Abdushakur Ndolo, George Agot, Joy China, Lucina Koyio, Carol Ngunu, Martin Mulonzi, Veronica Njeri
This article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emergency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emergency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analysis included forty-six relevant studies meeting the inclusion criteria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the timely provision of these services is paramount. Bystanders play a central role in activating emergency medical services (EMS) and providing cardiopulmonary resuscitation. Prompt calls to EMS by bystanders resulted in reduced PEC response times, improved survival chances, and better neurological outcomes, particularly among out-of-hospital cardiac arrest patients. There is substantial evidence that prompt bystander activation of EMS significantly reduces PEC response times, thereby saving lives and strengthening existing PEC systems. However, further research is necessary to accurately assess the impact of different interventions aimed at enhancing bystander activation of EMS and reducing PEC response times.
本文对灰色文献进行了系统的回顾和分析，以确定和解决关于旁观者激活对院前急救(PEC)反应时间的作用和影响的知识空白。我们对2000年以来在Web of Science、PubMed、Science Direct和Google Scholar数据库中发表的全文文章进行了系统搜索。我们遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目，使用“院前急救反应时间”和“旁观者”作为搜索关键词。使用ROBINS-I工具评估偏倚风险。我们的分析包括46项符合纳入标准的相关研究。然而，我们观察到许多研究报告不足，存在选择和检测偏差的风险。此外，我们在五项研究中发现了方法学和研究设计的弱点。鉴于急诊服务在挽救生命和预防并发症方面的关键作用，及时提供这些服务至关重要。旁观者在启动紧急医疗服务(EMS)和提供心肺复苏中发挥着核心作用。旁观者及时呼叫EMS可缩短PEC反应时间，提高生存机会，改善神经系统预后，特别是院外心脏骤停患者。有大量证据表明，紧急急救系统的快速激活显著减少了PEC的响应时间，从而挽救了生命并加强了现有的PEC系统。然而，需要进一步的研究来准确评估旨在增强旁观者EMS激活和减少PEC反应时间的不同干预措施的影响。
{"title":"Influence of bystander activation on pre-hospital emergency care response time: systematic review","authors":"Felistus Ndanu Musyoka, Wanja Tenambergen, Job Mapesa, Abdushakur Ndolo, George Agot, Joy China, Lucina Koyio, Carol Ngunu, Martin Mulonzi, Veronica Njeri","doi":"10.4081/ecj.2023.11568","DOIUrl":"https://doi.org/10.4081/ecj.2023.11568","url":null,"abstract":"This article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emergency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emergency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analysis included forty-six relevant studies meeting the inclusion criteria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the timely provision of these services is paramount. Bystanders play a central role in activating emergency medical services (EMS) and providing cardiopulmonary resuscitation. Prompt calls to EMS by bystanders resulted in reduced PEC response times, improved survival chances, and better neurological outcomes, particularly among out-of-hospital cardiac arrest patients. There is substantial evidence that prompt bystander activation of EMS significantly reduces PEC response times, thereby saving lives and strengthening existing PEC systems. However, further research is necessary to accurately assess the impact of different interventions aimed at enhancing bystander activation of EMS and reducing PEC response times.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135968441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Temporomandibular joint (TMJ) dislocation is a distressing condition that requires prompt management in the emergency setting. This retrospective study aimed to assess the success rate of TMJ reduction performed by emergency physicians (EPs) and evaluate the commonly used reduction techniques and sedative choices. The EPs achieved an overall success rate of 86.29% in reducing the dislocations. Among the successful reductions, 68.21% were accomplished in the first attempt, with only 7.29% requiring three or more attempts. Procedural sedation and analgesia were commonly employed, with midazolam (34.44%) and fentanyl (21.85%) being the most frequently used in successful cases. The Classic intraoral technique (29.14%) was the preferred method for successful reductions. No significant differences were observed in drug utilization or reduction techniques between the groups of successful and failed reductions. The findings demonstrate the high competence of EPs in managing acute TMJ dislocations in the emergency department. The study provides valuable insights into the commonly employed reduction techniques and sedative choices, offering important guidance for emergency medical practice.
{"title":"Unraveling the intricacies of acute temporomandibular joint dislocation in emergency department: a multidimensional exploration of reduction techniques and success rate by emergency physicians","authors":"S S Vijay Kumar, Shabbir Shekhli, Anila Jose","doi":"10.4081/ecj.2023.11643","DOIUrl":"https://doi.org/10.4081/ecj.2023.11643","url":null,"abstract":"Temporomandibular joint (TMJ) dislocation is a distressing condition that requires prompt management in the emergency setting. This retrospective study aimed to assess the success rate of TMJ reduction performed by emergency physicians (EPs) and evaluate the commonly used reduction techniques and sedative choices. The EPs achieved an overall success rate of 86.29% in reducing the dislocations. Among the successful reductions, 68.21% were accomplished in the first attempt, with only 7.29% requiring three or more attempts. Procedural sedation and analgesia were commonly employed, with midazolam (34.44%) and fentanyl (21.85%) being the most frequently used in successful cases. The Classic intraoral technique (29.14%) was the preferred method for successful reductions. No significant differences were observed in drug utilization or reduction techniques between the groups of successful and failed reductions. The findings demonstrate the high competence of EPs in managing acute TMJ dislocations in the emergency department. The study provides valuable insights into the commonly employed reduction techniques and sedative choices, offering important guidance for emergency medical practice.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"154 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136358330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Folie à deux is a rare psychiatric syndrome in which one individual transmits a psychotic symptom to another. In this report, we present a case of folie à deux. The case suggests a possible correlation with neglect, which may have played a role in the development of the symptoms. A 21-year-old Swiss boy and his mother were found to share the same delusional beliefs, forming a case of folie à deux (shared psychotic disorder). The boy had suffered neglect from his parents and was being cared for by his mother, who had no history of mental disorder. The close relationship between the boy and his mother, the family history of first-degree psychosis, and the boy’s experience of neglect may have increased his vulnerability to early-onset psychosis and folie à deux.
{"title":"Shared psychotic disorder: a case report in Switzerland","authors":"Daniele Mastromo, Aldo De Pietra","doi":"10.4081/ecj.2023.11599","DOIUrl":"https://doi.org/10.4081/ecj.2023.11599","url":null,"abstract":"Folie à deux is a rare psychiatric syndrome in which one individual transmits a psychotic symptom to another. In this report, we present a case of folie à deux. The case suggests a possible correlation with neglect, which may have played a role in the development of the symptoms. A 21-year-old Swiss boy and his mother were found to share the same delusional beliefs, forming a case of folie à deux (shared psychotic disorder). The boy had suffered neglect from his parents and was being cared for by his mother, who had no history of mental disorder. The close relationship between the boy and his mother, the family history of first-degree psychosis, and the boy’s experience of neglect may have increased his vulnerability to early-onset psychosis and folie à deux.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134945798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vincenza Clelia Alvich, Marco Valentini, Debora Monti, Stefano Perlini, Francesco Salinaro
Acute pulmonary embolism (PE) is a challenging and potentially fatal cardiovascular disorder. In high-risk patients, percutaneous catheter embolectomy may be considered when thrombolysis is contraindicated or has failed. We hereby discuss the case of a 60-year-old man who was found unconscious on the ground with signs of head trauma and respiratory failure. He was found to have a massive pulmonary embolism and multiple basilar skull fractures associated with slight subdural and subarachnoid hemorrhages. His acute treatment required a multidisciplinary discussion and approach. EkoSonic™ Endovascular System (EKOS) thrombolysis was successfully performed. The patient required intensive care unit (ICU) monitoring and treatment for 31 days. Upon discharge, henoxaparin 4000 UI twice per day was prescribed as anticoagulant, without any evidence of pulmonary hypertension or severe neurological sequelae.
{"title":"Concomitant high-risk pulmonary embolism and subdural hematoma: endo-vascular system thrombolysis as a possible solution to a difficult challenge","authors":"Vincenza Clelia Alvich, Marco Valentini, Debora Monti, Stefano Perlini, Francesco Salinaro","doi":"10.4081/ecj.2023.11558","DOIUrl":"https://doi.org/10.4081/ecj.2023.11558","url":null,"abstract":"Acute pulmonary embolism (PE) is a challenging and potentially fatal cardiovascular disorder. In high-risk patients, percutaneous catheter embolectomy may be considered when thrombolysis is contraindicated or has failed. We hereby discuss the case of a 60-year-old man who was found unconscious on the ground with signs of head trauma and respiratory failure. He was found to have a massive pulmonary embolism and multiple basilar skull fractures associated with slight subdural and subarachnoid hemorrhages. His acute treatment required a multidisciplinary discussion and approach. EkoSonic™ Endovascular System (EKOS) thrombolysis was successfully performed. The patient required intensive care unit (ICU) monitoring and treatment for 31 days. Upon discharge, henoxaparin 4000 UI twice per day was prescribed as anticoagulant, without any evidence of pulmonary hypertension or severe neurological sequelae.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135481060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review explores the role of precision medicine in the management of bleeding disorders and anticoagulation therapy, with a focus on the use of visco-elastic tests such as Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM). These tests provide real-time, dynamic insight into a patient's coagulation status, guiding the choice between three-factor prothrombin complex concentrate (PCC3) and four-factor PCC (PCC4), as well as the use of activated four-factor PCC (FEIBA). The specific ROTEM tests, INTEM and EXTEM, further enhance our understanding of the intrinsic and extrinsic coagulation pathways. Moreover, the use of tranexamic acid (TXA) and fibrinogen, guided by these visco-elastic tests, has shown promise in trauma patients. TXA has been associated with survival benefit when administered immediately or within 3 hours of injury. Fibrinogen, a key factor in clot formation, can be monitored and supplemented as needed to optimize hemostasis. In conclusion, the practice of precision medicine, with the aid of TEG and ROTEM, offers the potential to enhance the safety and efficacy of PCC therapy, TXA administration, and fibrinogen supplementation. These tools are invaluable in tailoring therapy to the specific needs of each patient, potentially optimizing patient outcomes and minimizing the risk of adverse events.
{"title":"Precision medicine in hemostasis: a review of prothrombin complex concentrates and the role of viscoelastic tests in tailoring therapy","authors":"Iacopo Cappellini, Franco Lai, Simone Magazzini, Guglielmo Consales","doi":"10.4081/ecj.2023.11500","DOIUrl":"https://doi.org/10.4081/ecj.2023.11500","url":null,"abstract":"This review explores the role of precision medicine in the management of bleeding disorders and anticoagulation therapy, with a focus on the use of visco-elastic tests such as Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM). These tests provide real-time, dynamic insight into a patient's coagulation status, guiding the choice between three-factor prothrombin complex concentrate (PCC3) and four-factor PCC (PCC4), as well as the use of activated four-factor PCC (FEIBA). The specific ROTEM tests, INTEM and EXTEM, further enhance our understanding of the intrinsic and extrinsic coagulation pathways. Moreover, the use of tranexamic acid (TXA) and fibrinogen, guided by these visco-elastic tests, has shown promise in trauma patients. TXA has been associated with survival benefit when administered immediately or within 3 hours of injury. Fibrinogen, a key factor in clot formation, can be monitored and supplemented as needed to optimize hemostasis. In conclusion, the practice of precision medicine, with the aid of TEG and ROTEM, offers the potential to enhance the safety and efficacy of PCC therapy, TXA administration, and fibrinogen supplementation. These tools are invaluable in tailoring therapy to the specific needs of each patient, potentially optimizing patient outcomes and minimizing the risk of adverse events.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135738821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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