Much research, both pathophysiological and clinical, has been produced about septic shock during the last 20 years. Nevertheless, many aspects of treatment are still controversial, among these the approach to the administration of fluids and vasopressors. After the first clinical trial on Early goal-directed therapy (EGDT) was published, a liberal approach to the use of fluids and conservative use of vasopressors prevailed, but in recent years a more restrictive use of fluids and an earlier introduction of vasopressors seem to be preferred. Although both treatments are based on sound pathophysiological knowledge, clinical evidence is still inadequate and somehow controversial. In this non-systematic review, recent research on the hemodynamics of septic shock and its treatment with fluids and inotropes is discussed. As a conclusion, general indications are proposed for a practical approach to patients in septic shock.
{"title":"Fluids and vasopressors in septic shock: basic knowledge for a first approach in the emergency department","authors":"D. Coen","doi":"10.4081/ecj.2023.10810","DOIUrl":"https://doi.org/10.4081/ecj.2023.10810","url":null,"abstract":"Much research, both pathophysiological and clinical, has been produced about septic shock during the last 20 years. Nevertheless, many aspects of treatment are still controversial, among these the approach to the administration of fluids and vasopressors. After the first clinical trial on Early goal-directed therapy (EGDT) was published, a liberal approach to the use of fluids and conservative use of vasopressors prevailed, but in recent years a more restrictive use of fluids and an earlier introduction of vasopressors seem to be preferred. Although both treatments are based on sound pathophysiological knowledge, clinical evidence is still inadequate and somehow controversial. In this non-systematic review, recent research on the hemodynamics of septic shock and its treatment with fluids and inotropes is discussed. As a conclusion, general indications are proposed for a practical approach to patients in septic shock.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48751758","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}
S. De Vuono, Sokol Berisha, L. Settimi, P. Cianci, Alessandra Lignani, Gianmarco Lanci, M. Taliani, P. Groff
Background: SARS-CoV-2 related pneumonia is characterized by moderate-to severe hypoxemia often associated with hypocapnia the prognostic role of which is poorely documented. Aims: evaluate if hypocapnia can predict the need for non-invasive mechanical ventilation (NIMV) in this setting. Materials and methods: we prospectively studied 52 subjects with moderate-severe SARS-CoV-2 related pneumonia. All the following data were collected at admission to the Emergency Department and processed by univariate and multivariate analysis: clinical and laboratory data, blood gas analysis in room air and lung ultrasound. Results: 33/52 subjects (63,4%) underwent NIMV. At univariate analysis PaCO2 was inversely associated to the need for NIMV (OR 0,82, CI 95% 0,689-0,976, p .025). At multivariate analysis PaCO2 predicted the need for NIMV independently from age, gender, number of comorbidities, d-dimer, CRP, PaO2 and LUS SCORE (OR 0,838, CI 95% 0,710-0,988, p .035). Conclusions: our data suggest that hypocapnia could be an early predictor of clinical worsening in these patients independently from other known predictors of unfavourable outcome, reflecting the occurrence of a deep and frequent respiratory pattern possibly related to the generation of excessive transpulmonary pressure swings leading to a self-induced lung injury (P-SILI). Further studies are needed for validating these data on greater populations.
背景:SARS-CoV-2相关肺炎的特征是中度至重度低氧血症，常伴有低碳酸血症，其预后作用文献很少。目的:评估低碳酸血症是否可以预测在这种情况下对无创机械通气(NIMV)的需求。材料与方法:前瞻性研究52例中重度SARS-CoV-2相关性肺炎患者。以下所有资料均于急诊科入院时收集，并经单因素和多因素分析处理:临床和实验室资料、室内空气血气分析和肺部超声。结果:33/52例(63.3%)接受了NIMV。在单变量分析中，PaCO2与NIMV需求呈负相关(OR 0.82, CI 95% 0,689-0,976, p .025)。在多变量分析中，PaCO2预测NIMV的需要独立于年龄、性别、合共病数量、d-二聚体、CRP、PaO2和LUS SCORE (OR 0.838, CI 95% 0,710-0,988, p .035)。结论:我们的数据表明，低碳酸血症可能是这些患者临床恶化的早期预测因素，独立于其他已知的不良预后预测因素，反映了深度和频繁呼吸模式的发生，可能与过度的跨肺压波动的产生相关，导致自我诱导的肺损伤(P-SILI)。需要进一步的研究来验证这些数据是否适用于更多的人群。
{"title":"Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia","authors":"S. De Vuono, Sokol Berisha, L. Settimi, P. Cianci, Alessandra Lignani, Gianmarco Lanci, M. Taliani, P. Groff","doi":"10.4081/ecj.2023.11237","DOIUrl":"https://doi.org/10.4081/ecj.2023.11237","url":null,"abstract":"Background: SARS-CoV-2 related pneumonia is characterized by moderate-to severe hypoxemia often associated with hypocapnia the prognostic role of which is poorely documented. \u0000Aims: evaluate if hypocapnia can predict the need for non-invasive mechanical ventilation (NIMV) in this setting. \u0000Materials and methods: we prospectively studied 52 subjects with moderate-severe SARS-CoV-2 related pneumonia. All the following data were collected at admission to the Emergency Department and processed by univariate and multivariate analysis: clinical and laboratory data, blood gas analysis in room air and lung ultrasound. \u0000Results: 33/52 subjects (63,4%) underwent NIMV. At univariate analysis PaCO2 was inversely associated to the need for NIMV (OR 0,82, CI 95% 0,689-0,976, p .025). At multivariate analysis PaCO2 predicted the need for NIMV independently from age, gender, number of comorbidities, d-dimer, CRP, PaO2 and LUS SCORE (OR 0,838, CI 95% 0,710-0,988, p .035). \u0000Conclusions: our data suggest that hypocapnia could be an early predictor of clinical worsening in these patients independently from other known predictors of unfavourable outcome, reflecting the occurrence of a deep and frequent respiratory pattern possibly related to the generation of excessive transpulmonary pressure swings leading to a self-induced lung injury (P-SILI). Further studies are needed for validating these data on greater populations.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44910060","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 48-year-old woman presented to our emergency department with fever and a severe painful erythematous and ecchymotic skin lesion on the third finger of the left hand, that rapidly evolved into haemorrhagic bullae with diffuse swelling and edema of all her left hand, associated with the onset of lymphangitis in her left arm and crescendo-like pain. She denied trauma or insect bite. Her past medical history was unremarkable, except for chilblains with no sequelae. She did not take any medication. She was not a smoker. Laboratory tests showed neutrophilic leucocytosis (WBC 15,000/mm3; N 14,500/mm3), a slight thrombocytopenia (139,000/mm3), elevated C-reactive protein (12 mg/dL, normal value <0.5), increased procalcitonin (1.3 ng/mL, normal value < 0.5) and transaminases (AST 64 U/L; ALT 70 U/L, normal value 0-31). HIV was excluded.
{"title":"A rapidly progressive painful skin lesion","authors":"Erika Poggiali, Giovanni Santilli, A. Vercelli","doi":"10.4081/ecj.2023.11046","DOIUrl":"https://doi.org/10.4081/ecj.2023.11046","url":null,"abstract":"A 48-year-old woman presented to our emergency department with fever and a severe painful erythematous and ecchymotic skin lesion on the third finger of the left hand, that rapidly evolved into haemorrhagic bullae with diffuse swelling and edema of all her left hand, associated with the onset of lymphangitis in her left arm and crescendo-like pain. She denied trauma or insect bite. Her past medical history was unremarkable, except for chilblains with no sequelae. She did not take any medication. She was not a smoker. Laboratory tests showed neutrophilic leucocytosis (WBC 15,000/mm3; N 14,500/mm3), a slight thrombocytopenia (139,000/mm3), elevated C-reactive protein (12 mg/dL, normal value <0.5), increased procalcitonin (1.3 ng/mL, normal value < 0.5) and transaminases (AST 64 U/L; ALT 70 U/L, normal value 0-31). HIV was excluded.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43670511","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}
Nurses have an important role in caring for patients with intentional self-poisoning. This study was attempted to explore the emergency department nurses' perception of caring for patients with intentional self-poisoning. The present qualitative study was performed using phenomenological method. This study was done on 14 emergency department nurses with experience in caring for patients with intentional self-poisoning. Data were collected through semi-structured interviews and transcribed verbatim. Data were analyzed using Colaizzi's method. Following data analysis, two themes and five sub-themes were extracted, which included being reluctant to provide care for patients with intentional self-poisoning (discomfort in providing care, and lack of desire to care for these patients) and comprehensive patient support (providing complete care and emotional support). Given that emergency department nurses are the first medical staff who face with intentional self-poisoning patients and play an important role in the care and treatment of these patients, it is necessary to improve their understanding of caring for these patients. In addition, their comprehensive support for these patients should be strengthened. Psychological support for nurses and training them on how to communicate with intentional self-poisoning patients and their families are also recommended.
{"title":"Emergency department nurses’ perceptions of caring for patients with intentional self-poisoning: a qualitative study","authors":"Salar Sharifi, S. Valiee","doi":"10.4081/ecj.2023.11220","DOIUrl":"https://doi.org/10.4081/ecj.2023.11220","url":null,"abstract":"Nurses have an important role in caring for patients with intentional self-poisoning. This study was attempted to explore the emergency department nurses' perception of caring for patients with intentional self-poisoning. The present qualitative study was performed using phenomenological method. This study was done on 14 emergency department nurses with experience in caring for patients with intentional self-poisoning. Data were collected through semi-structured interviews and transcribed verbatim. Data were analyzed using Colaizzi's method. Following data analysis, two themes and five sub-themes were extracted, which included being reluctant to provide care for patients with intentional self-poisoning (discomfort in providing care, and lack of desire to care for these patients) and comprehensive patient support (providing complete care and emotional support). Given that emergency department nurses are the first medical staff who face with intentional self-poisoning patients and play an important role in the care and treatment of these patients, it is necessary to improve their understanding of caring for these patients. In addition, their comprehensive support for these patients should be strengthened. Psychological support for nurses and training them on how to communicate with intentional self-poisoning patients and their families are also recommended.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47508316","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}
M. Beghi, A. Alamia, Maddalena Alippi, R. Colombo, C. Fraticelli
The aim of the study was to estimate the effect of the COVID- 19 pandemic and response policies on the psychiatric ward admissions in the hospitals referring to the ASST Lariana (province of Como, Italy) and the Hospital of Mendrisio (Canton of Ticino, Switzerland), two similar territories that belong to countries that dealt differently with the pandemic. We compared the two territories for type of admission (voluntary vs. compulsory), the Stringency Index (SI) and the country’s number of admission in Intensive Care Units (ICU). We found a significant reduction in the psychiatric ward admission in the lockdown period in both territories, even in periods with milder lockdown measures. The admission rate’s reduction in the ASST Lariana was significantly associated with the ICU admissions (p<0.001). In the Hospital of Mendrisio, admissions included a weekly seasonality, were significantly correlated with SI (p=0.001) and period (pre-pandemic and pandemic; p<0.001) and we observed also a significant reduction of compulsory admission that is influenced both by the stringency index (p<0.001) and period (p<0.001). The differences between the two territories seem influenced by the different mental health systems.
{"title":"Psychiatric ward admissions during the COVID-19 pandemic in Canton of Ticino (Swiss Confederation) and the province of Como (Italy): a comparison between two different systems of care and outbreak response strategies","authors":"M. Beghi, A. Alamia, Maddalena Alippi, R. Colombo, C. Fraticelli","doi":"10.4081/ecj.2023.11000","DOIUrl":"https://doi.org/10.4081/ecj.2023.11000","url":null,"abstract":"The aim of the study was to estimate the effect of the COVID- 19 pandemic and response policies on the psychiatric ward admissions in the hospitals referring to the ASST Lariana (province of Como, Italy) and the Hospital of Mendrisio (Canton of Ticino, Switzerland), two similar territories that belong to countries that dealt differently with the pandemic. We compared the two territories for type of admission (voluntary vs. compulsory), the Stringency Index (SI) and the country’s number of admission in Intensive Care Units (ICU). We found a significant reduction in the psychiatric ward admission in the lockdown period in both territories, even in periods with milder lockdown measures. The admission rate’s reduction in the ASST Lariana was significantly associated with the ICU admissions (p<0.001). In the Hospital of Mendrisio, admissions included a weekly seasonality, were significantly correlated with SI (p=0.001) and period (pre-pandemic and pandemic; p<0.001) and we observed also a significant reduction of compulsory admission that is influenced both by the stringency index (p<0.001) and period (p<0.001). The differences between the two territories seem influenced by the different mental health systems.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45004301","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}
ABSTRACT A motor vehicle accident (MVA) can result in death or serious injury to the driver and passengers in case the airbags are not deployed. There are, however, several reasons why an airbag can injure a passenger even when there is no accident involved. A 41-year-old female patient who suffered facial bone fractures and an retinal perforation after her air bag deflated during a minor car accident. The complaints of the patient on admission to the emergency department (ED) were facial pain, swelling and redness in the eye. Orbital CT imaging revealed fragmented fracture line displaced into the maxillary sinus at the floor of right orbit, posttraumatic changes in preorbital skin and In the right globe vitreous, an appearance thought to belong to hyperdense hemorrhage. The patient was taken to emergency operation due to corneal perforation in the right eye. All patients who present with air bag-related ocular trauma should undergo a complete ophthalmologic examination because ocular injuries that may be more serious than they initially appear.
{"title":"A case of retinal detachment resulting from air bag deployment","authors":"F. Yılmaz, Bora Baltacıoğlu, Erdi Akça, Y. Yavuz","doi":"10.4081/ecj.2023.11039","DOIUrl":"https://doi.org/10.4081/ecj.2023.11039","url":null,"abstract":"ABSTRACT \u0000A motor vehicle accident (MVA) can result in death or serious injury to the driver and passengers in case the airbags are not deployed. There are, however, several reasons why an airbag can injure a passenger even when there is no accident involved. A 41-year-old female patient who suffered facial bone fractures and an retinal perforation after her air bag deflated during a minor car accident. The complaints of the patient on admission to the emergency department (ED) were facial pain, swelling and redness in the eye. Orbital CT imaging revealed fragmented fracture line displaced into the maxillary sinus at the floor of right orbit, posttraumatic changes in preorbital skin and In the right globe vitreous, an appearance thought to belong to hyperdense hemorrhage. The patient was taken to emergency operation due to corneal perforation in the right eye. All patients who present with air bag-related ocular trauma should undergo a complete ophthalmologic examination because ocular injuries that may be more serious than they initially appear.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42384782","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}
M. Ağar, M. Çelik, H. Ulutas, İlham Gülçek, M. Kalkan
Rapunzel syndrome is a form of trichobezoar, a rare form of bezoar, especially seen in individuals with hair pulling (trichotillomania) and hair eating (tricophagia) habits, that extends from the pylorus into to the duodenum, jejunum and even the colon. We report the case of a 37-year-old woman with a trichobezoar in the esophagus, causing esophageal rupture that required an urgent surgical intervention.
{"title":"The esophageal rapunzel syndrome: a case of a trichobezoar in the esophagus","authors":"M. Ağar, M. Çelik, H. Ulutas, İlham Gülçek, M. Kalkan","doi":"10.4081/ecj.2023.11145","DOIUrl":"https://doi.org/10.4081/ecj.2023.11145","url":null,"abstract":"Rapunzel syndrome is a form of trichobezoar, a rare form of bezoar, especially seen in individuals with hair pulling (trichotillomania) and hair eating (tricophagia) habits, that extends from the pylorus into to the duodenum, jejunum and even the colon. We report the case of a 37-year-old woman with a trichobezoar in the esophagus, causing esophageal rupture that required an urgent surgical intervention.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45341372","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}
L. Ghezzi, Francesca Graziano, Giulia Bottani, G. Marullo, N. Capsoni, E. Forni, F. Vincenti, P. Rebora, A. Bellone
In this monocentric, open label, randomized controlled trial we aimed to compare the efficacy of combined High Flow Nasal Cannula (HFNC) and Non invasive Ventilation (NIV) versus HFNC alone in acute hypoxemic respiratory failure (hARF) in patients affected by Community Acquired Pneumonia (CAP). We enrolled 49 patients affected by CAP with moderate to severe hypoxemic respiratory failure (P/F < 300). The patients were randomized into two groups: one has been treated with HFNC alone (group A) while the other received NIV alternated to HFNC every 3 hours (group B). The primary outcome was P/F change from baseline to 21 hours. Secondary outcomes included variation of pH and pCO2, need to continue HFNC or NIV/HFNC after 45 hours, orotracheal intubation, mortality rate, and the devices comfort. Not statistical significant differences between the two arms were shown in the P/F change at 21 hours since baseline, in pCO2 and pH variation, mortality at hospital and at follow-up. We emphasize the importance of combined HFNC with NIV as a first step for severe pneumonia treatment whereas HFNC might represent as the first step treatment in less severe patients and during the NIV intervals.
{"title":"High flow nasal cannula combined with non-invasive ventilation versus high flow nasal cannula alone in patients with acute hypoxemic respiratory failure due to pneumonia: a randomized controlled trial","authors":"L. Ghezzi, Francesca Graziano, Giulia Bottani, G. Marullo, N. Capsoni, E. Forni, F. Vincenti, P. Rebora, A. Bellone","doi":"10.4081/ecj.2023.11088","DOIUrl":"https://doi.org/10.4081/ecj.2023.11088","url":null,"abstract":"In this monocentric, open label, randomized controlled trial we aimed to compare the efficacy of combined High Flow Nasal Cannula (HFNC) and Non invasive Ventilation (NIV) versus HFNC alone in acute hypoxemic respiratory failure (hARF) in patients affected by Community Acquired Pneumonia (CAP). We enrolled 49 patients affected by CAP with moderate to severe hypoxemic respiratory failure (P/F < 300). The patients were randomized into two groups: one has been treated with HFNC alone (group A) while the other received NIV alternated to HFNC every 3 hours (group B). The primary outcome was P/F change from baseline to 21 hours. Secondary outcomes included variation of pH and pCO2, need to continue HFNC or NIV/HFNC after 45 hours, orotracheal intubation, mortality rate, and the devices comfort. Not statistical significant differences between the two arms were shown in the P/F change at 21 hours since baseline, in pCO2 and pH variation, mortality at hospital and at follow-up. We emphasize the importance of combined HFNC with NIV as a first step for severe pneumonia treatment whereas HFNC might represent as the first step treatment in less severe patients and during the NIV intervals.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48648511","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}
Antoine-Laurent de Lavoisier (1743-1794), the recognized father of modern chemistry, was the discoverer of both oxygen and hydrogen, as well as the first scientist to understand the importance of oxygen in animal respiration. Following his discoveries, researchers have tried to measure oxygenation of both blood and tissues for the next two centuries. [...]
{"title":"Takuo Aoyagi, inventor of pulse oximetry: the great scientist passed away three years ago, in the middle of the first wave of COVID-19 pandemic","authors":"G. Cervellin","doi":"10.4081/ecj.2023.11307","DOIUrl":"https://doi.org/10.4081/ecj.2023.11307","url":null,"abstract":"Antoine-Laurent de Lavoisier (1743-1794), the recognized father of modern chemistry, was the discoverer of both oxygen and hydrogen, as well as the first scientist to understand the importance of oxygen in animal respiration. Following his discoveries, researchers have tried to measure oxygenation of both blood and tissues for the next two centuries. [...]","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47591062","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}
Clarissa Anna De Rosa, G. Cristiano, Mario Guarino
Diaphragmatic Dysfunction (DD) is a clinical condition in which the diaphragm becomes weak or paralyzed, because of muscle strength reduction. It can be due to muscular issues or loss of proper innervation, but, also, to pulmonary hyperinflation or air trapping, such as in Chronic Obstructive Pulmonary Disease (COPD). DD impacts on COPD induced dyspnea, determining its progressive worsening, but levosimendan, an inodilator better known as Ca2+ sensitizer, may limit this phenomenon and diaphragmatic ultrasound assessment can be useful in monitoring its effect. Here, we show the case of a 77-year-old woman admitted to the Emergency department for acute exacerbation of chronic dyspnea in COPD, related to right ventricular failure and DD, which did not respond to medical therapy and non-invasive mechanical ventilation but did experience a favorable outcome after intravenous administration of levosimendan.
{"title":"Ultrasound assessment of diaphragmatic dysfunction and its improvement with levosimendan in patients with chronic obstructive pulmonary disease","authors":"Clarissa Anna De Rosa, G. Cristiano, Mario Guarino","doi":"10.4081/ecj.2023.11248","DOIUrl":"https://doi.org/10.4081/ecj.2023.11248","url":null,"abstract":"Diaphragmatic Dysfunction (DD) is a clinical condition in which the diaphragm becomes weak or paralyzed, because of muscle strength reduction. It can be due to muscular issues or loss of proper innervation, but, also, to pulmonary hyperinflation or air trapping, such as in Chronic Obstructive Pulmonary Disease (COPD). DD impacts on COPD induced dyspnea, determining its progressive worsening, but levosimendan, an inodilator better known as Ca2+ sensitizer, may limit this phenomenon and diaphragmatic ultrasound assessment can be useful in monitoring its effect. Here, we show the case of a 77-year-old woman admitted to the Emergency department for acute exacerbation of chronic dyspnea in COPD, related to right ventricular failure and DD, which did not respond to medical therapy and non-invasive mechanical ventilation but did experience a favorable outcome after intravenous administration of levosimendan.","PeriodicalId":51984,"journal":{"name":"Emergency Care Journal","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45342169","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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