Emergency Medicine and Emergency Room Medical IssuesⅡ

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (20 February 2024) | Viewed by 24945

Special Issue Editor

Special Issue Information

Dear Colleagues,

After the great impact of first edition, I would like to renew the interest of Medicina together with all its staff to follow a second edition of this Special Issue on emergency room activities.

Hospitals or healthcare institutions are at risk of being overburdened, physicians are at risk of burnout, and emergency departments are clogged up. All previous items are hot topics in the area of emergency medicine; yet, together with several systems to counteract the overbooking of emergency rooms in order to improve hospital discharge (e.g., telemedicine, improvements for access to care for primary care and specialty services), a professional update remains the best resource for physicians, in particular, the ability to manage diagnostic suspects for rare diseases with the chance of early diagnosis and treatment.

For this reason, the daily clinical management of emergency medicine and emergency rooms recognizes great educational merit not only in case series but also in case reports.

We invite colleagues around the world to report their clinical experience with case series or case reports in emergency medicine and/or emergency rooms for this collection of our journal in order to give support to this fundamental area of the daily life of hospital workers.

Clinical contributions regarding acute illnesses, such as infections, thrombosis, bleeding, inflammation, autoimmune diseases, trauma and any type of emergency diagnostic rare procedure, are welcome for this collection.

Dr. Pierpaolo Di Micco
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • emergency room
  • lung failure
  • case reports
  • bleeding
  • COVID-19
  • thrombosis
  • acute rheumatic diseases
  • infection
  • antibiotics
  • anticoagulation
  • arrhythmia
  • antiaggregation

Published Papers (13 papers)

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Editorial

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2 pages, 202 KiB  
Editorial
Editorial for the Special Issue “Emergency Medicine and Emergency Room Medical Issues II”
by Carmine Siniscalchi, Egidio Imbalzano and Pierpaolo Di Micco
Medicina 2024, 60(4), 530; https://doi.org/10.3390/medicina60040530 - 25 Mar 2024
Viewed by 241
Abstract
The variety of clinical issues presented by patients, along with the need for a rapid diagnosis and treatment, represents the main reasons for the risk of burnout among physicians who work in emergency departments [...] Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)

Research

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10 pages, 603 KiB  
Article
Assessing the Impact of the COVID-19 Pandemic on Pediatric Emergency Department Visits in Taiwan
by Yu-Ting Lee, Yen-Wen Lai, Jiann-Hwa Chen, Wei-Lung Chen, Meng-Yu Wu and Jui-Yuan Chung
Medicina 2024, 60(2), 288; https://doi.org/10.3390/medicina60020288 - 08 Feb 2024
Viewed by 692
Abstract
Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted healthcare systems worldwide. To assess the effects of the pandemic on pediatric emergency department (ED) visits in Taiwan, we conducted a study to evaluate changes in pediatric ED visits during [...] Read more.
Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted healthcare systems worldwide. To assess the effects of the pandemic on pediatric emergency department (ED) visits in Taiwan, we conducted a study to evaluate changes in pediatric ED visits during the COVID-19 pandemic. Materials and Methods: This retrospective study included pediatric patients (age ≤ 18) who visited the ED between 21 January 2019 and 30 April 2019, at three hospitals of the Cathay Health System, and compared them with a corresponding period in 2020. Basic information, including mode of arrival, triage level, disposition, chief complaints, and incidence rates, were analyzed before and during the pandemic. Results: A total of 10,116 patients, with 6009 in the pre-pandemic group and 4107 in the pandemic group, were included in this study. The mean number of daily pediatric ED visits decreased from 60.09 before the pandemic to 40.66 during the pandemic, while ambulance use increased significantly by 2.56%. The percentage of patients with high acuity triage levels (levels 1 and 2) was significantly lower during the pandemic period (0.63% and 10.18%, respectively) than the pre-pandemic period (0.7% and 10.9%, respectively). Additionally, a significantly higher proportion of patients were discharged during the pandemic period (89.36%) than during the pre-pandemic period (88.33%). The proportion of COVID-19-related complaints, such as fever and respiratory tract infections, as well as other complaints including gastrointestinal issues, trauma, and psychological problems, significantly increased during the pandemic. Conclusions: In preparation for future pandemics, we recommend increasing emergency medical service capacity, establishing a non-contagious route for obtaining chronic medication prescriptions, optimizing staff allocation in pediatric emergency departments, and increasing the number of hospital social workers for enhanced support. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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18 pages, 1440 KiB  
Article
Stratification of COVID-19 Patients with Moderate-to-Severe Hypoxemic Respiratory Failure for Response to High-Flow Nasal Cannula: A Retrospective Observational Study
by Gianluca Bagnato, Egidio Imbalzano, Carmelo Ioppolo, Daniela La Rosa, Marianna Chiappalone, Alberta De Gaetano, Valeria Viapiana, Natasha Irrera, Veronica Nassisi, Maria Concetta Tringali, Emanuele Balwinder Singh, Nicola Falcomatà, Vincenzo Russo, William Neal Roberts, Pierpaolo Di Micco and Antonio Giovanni Versace
Medicina 2024, 60(1), 71; https://doi.org/10.3390/medicina60010071 - 29 Dec 2023
Viewed by 671
Abstract
Background and Objectives: In patients with COVID-19, high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are widely applied as initial treatments for moderate-to-severe acute hypoxemic respiratory failure. The aim of the study was to assess which respiratory supports improve 28-day mortality [...] Read more.
Background and Objectives: In patients with COVID-19, high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are widely applied as initial treatments for moderate-to-severe acute hypoxemic respiratory failure. The aim of the study was to assess which respiratory supports improve 28-day mortality and to identify a predictive index of treatment response. Materials and Methods: This is a single-center retrospective observational study including 159 consecutive adult patients with COVID-19 and moderate-to-severe hypoxemic acute respiratory failure. Results: A total of 159 patients (82 in the CPAP group and 77 in the HFNC group) were included in the study. Mortality within 28 days was significantly lower with HFNC compared to CPAP (16.8% vs. 50%), while ICU admission and tracheal intubation within 28 days were significantly higher with CPAP compared to HFNC treatment (32% vs. 13%). We identified an index for survival in HFNC by including three variables easily available at admission (LDH, age, and respiratory rate) and the PaO2/FiO2 ratio at 48 h. The index showed high discrimination for survival with an AUC of 0.88, a negative predictive value of 86%, and a positive predictive value of 95%. Conclusions: Treatment with HFNC appears to be associated with greater survival and fewer ICU admission than CPAP. LDH, respiratory rate, age, and PaO2/FiO2 at 48 h were independently associated with survival and an index based on these variables allows for the prediction of treatment success and the assessment of patient allocation to the appropriate intensity of care after 48 h. Further research is warranted to determine effects on other outcomes and to assess the performance of the index in larger cohorts. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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9 pages, 1093 KiB  
Article
Replacing Potassium in the Emergency Department May Not Decrease the Hospital Mortality in Mild Hypokalemia: A Propensity Score Matching Analysis
by Wachira Wongtanasarasin and Nattikarn Meelarp
Medicina 2023, 59(11), 1912; https://doi.org/10.3390/medicina59111912 - 29 Oct 2023
Viewed by 980
Abstract
Background: Hypokalemia is associated with considerable morbidity and mortality, highlighting the timely correction of potassium levels as a critical medical consideration. However, the management of mild hypokalemia remains a subject of ongoing debate. This study explores the relationship between potassium replacement in [...] Read more.
Background: Hypokalemia is associated with considerable morbidity and mortality, highlighting the timely correction of potassium levels as a critical medical consideration. However, the management of mild hypokalemia remains a subject of ongoing debate. This study explores the relationship between potassium replacement in the emergency department (ED) and hospital mortality in patients with mild hypokalemia. Methods: This retrospective cohort study was conducted at a tertiary care hospital, including patients who presented to the ED with mild hypokalemia, defined as potassium levels between 3.0 and 3.4 mmol/L, between 2020 and 2021. Patients diagnosed with acute coronary syndrome, diabetic ketoacidosis, hyperglycemic hyperosmolar state, and major cardiac arrhythmias were excluded. The patient cohort was then divided into two groups, based on whether they received potassium replacement in the ED. A propensity score analysis was employed to account for potential pretreatment confounding factors, including age, gender, time on ED arrival, insurance, comorbidities, serum potassium and creatinine levels, and ED length of stay. Subsequently, a multivariable logistic regression analysis, incorporating hospital length of stay and acute comorbidities, was performed post-matching to further adjust for predictive factors. The primary outcome was all-cause hospital mortality. Results: This study included a total of 1931 patients, of which 724 were matched for analysis (362 with potassium replacement and 362 without). The average age was 53.9 years, and most were male (58.5%). After adjusting for confounding factors using propensity score analysis, there was no significant difference in hospital mortality between the potassium replacement and control groups (adjusted odds ratio 0.81, 95% CI 0.36–1.79, p = 0.60). Conclusions: This study’s findings indicate that replacing potassium in the ED may not lower the risk of hospital mortality in patients with mild hypokalemia. Consequently, the customary practice of potassium replacement in hospitalized patients may lack justification, and deferring the replacement until after patients leave the ED could be considered. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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10 pages, 1256 KiB  
Article
An Evaluation of the Hitit Index in Differential Diagnosis of Crimean-Congo Hemorrhagic Fever in the Emergency Department
by Seval Komut, Nurullah Çorakyer, Gülcan Kaplan and Nurcan Baykam
Medicina 2023, 59(10), 1796; https://doi.org/10.3390/medicina59101796 - 09 Oct 2023
Viewed by 1016
Abstract
Background and Objectives: Crimean-Congo Hemorrhagic Fever (CCHF) is a viral zoonotic infection, which is seen over a wide geographic area. The mortality rate is in inverse proportion to the ability of patients to access healthcare services. Therefore, early identification of patients is [...] Read more.
Background and Objectives: Crimean-Congo Hemorrhagic Fever (CCHF) is a viral zoonotic infection, which is seen over a wide geographic area. The mortality rate is in inverse proportion to the ability of patients to access healthcare services. Therefore, early identification of patients is extremely important. The aim of this study was to test the sensitivity and specificity of the Hitit Index in the differentiation of CCHF cases at the time of presentation at the Emergency Department and to evaluate the agreement of this index with molecular (CCHFV RNA) and/or serological diagnostic tests (ELISA-CCHF IgM). Materials and Methods: The patients included were those who presented at the Emergency Department (ED) with the complaint of a tick bite or those identified as potential CCHF cases as a result of complaints and/or laboratory findings. For cases that met the study inclusion criteria, the Hitit Index score was calculated automatically from the parameters included in the index formula uploaded to the automation system in the ED at the time of presentation. Through comparisons of the agreement of the Hitit Index with the CCHFV-RNA and/or IgM results the power of the Hitit Index for differentiation of CCHF cases in ED was evaluated. Results: The data of 273 patients were analyzed. There was a history of tick bite in 236 (86%) cases. Of the evaluated cases, 110 (40.2%) were hospitalized; CCHF positivity was determined in 72 (26.4%). The Hitit Index values calculated in ED and at 24 h after hospitalization were determined to be significant in the prediction of the CCHF cases (p < 0.001, AUC = 0.919 (0.887–0.951); p < 0.001, AUC = 0.902 (0.841–0.962). For a cut-off point of 0 of the Hitit Index evaluated in ED, the classification success was found to have a sensitivity of 75% and specificity of 88% (PPV-NPV). For a cut-off point of 0 of the Hitit Index evaluated at 24 h after hospitalization, the classification success was found to have a sensitivity of 79.7% and specificity of 84% (PPV-NPV). Conclusions: The defined form of the Hitit Index can be used in the differentiation of CCHF cases in ED with high sensitivity and specificity levels. Just as evaluation with the Hitit Index prevents unnecessary hospitalization, it can also contribute to reducing mortality rates with the early identification of CCHF cases. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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9 pages, 1422 KiB  
Article
A Motorcycle Paramedic Increases the Survival Rate of Patients after OHCA
by Mateja Škufca Sterle and Matej Podbregar
Medicina 2023, 59(10), 1708; https://doi.org/10.3390/medicina59101708 - 24 Sep 2023
Viewed by 1219
Abstract
Background and Objectives: Despite advancements in modern medicine, the survival rate of patients after out-of-hospital cardiac arrest (OHCA) remains low. The proportion of OHCA patients who could be saved under ideal circumstances is unknown. A significant portion of patients experience cardiac arrest due [...] Read more.
Background and Objectives: Despite advancements in modern medicine, the survival rate of patients after out-of-hospital cardiac arrest (OHCA) remains low. The proportion of OHCA patients who could be saved under ideal circumstances is unknown. A significant portion of patients experience cardiac arrest due to irreversible conditions. The survival of patients with reversible causes depends on the prompt initiation of basic life support (BLS) and early defibrillation. In order to increase the chances of survival, the motorcycle paramedic (MP) project was implemented in Ljubljana in 2003. The MP is equipped with an AED. In the case of OHCA with a shockable rhythm, he performs defibrillation before the arrival of the emergency medical team (EMT). The aim of this study was to evaluate whether the MP, by reducing response times to OHCA patients, increases the survival and outcome of these patients compared to the EMT. Materials and Methods: A retrospective analysis of OHCA cases within the area covered by Ljubljana Emergency Medical Service (EMS) was conducted for the period from January 2003 to December 2022. Instances where the MP arrived at the scene before the EMT were considered MP interventions and classified as the MP group; all other interventions were classified as the EMT group. Results: Between January 2003 and December 2022, the EMT performed resuscitation on 3352 patients. In 316 cases, the MP was simultaneously activated and arrived at the scene before the EMT. The response time in the MP group was shorter compared to the EMT group (7.7 ± 4.1 min vs. 9.9 ± 6.5 min, p < 0.001). In 16 patients, return of spontaneous circulation (ROSC) was achieved before the arrival of the EMT. The MP group had a higher ROSC rate, a larger proportion of patients were discharged from the hospital and there were more patients with a good neurological outcome compared to the EMT group (44.3% vs. 36.9%, p = 0.009; 18.7% vs. 13.0%, p = 0.005; 15.9% vs. 10.6%, p = 0.004, respectively). Conclusion: This study has demonstrated that the implementation of the MP into the EMS in Ljubljana has resulted in shorter response times, an increased survival rate and improved neurological outcome for OHCA patients. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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9 pages, 957 KiB  
Article
A Comprehensive Analysis of the Radiation Exposure and the Diagnostic Benefit of PanCT in Pediatric Cases with Multiple Trauma
by Seval Komut and Çağatay Evrim Afşarlar
Medicina 2023, 59(7), 1228; https://doi.org/10.3390/medicina59071228 - 30 Jun 2023
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Abstract
Background and Objectives: The primary objective of this study was to obtain quantitative data, taking into account the amount of radiation exposure, about the clinical and diagnostic benefit obtained from panCT in pediatric trauma cases. Thus, we aim to create greater awareness [...] Read more.
Background and Objectives: The primary objective of this study was to obtain quantitative data, taking into account the amount of radiation exposure, about the clinical and diagnostic benefit obtained from panCT in pediatric trauma cases. Thus, we aim to create greater awareness in all physicians and primarily emergency medicine physicians regarding correct selection in terms of the patient group where this effective radiological method is to be applied, and to protect children from the adverse effects of radiation. Materials and Methods: The computed tomography (CT) images were retrieved from the hospital radiological archive system (PACS). The effective dose (Ed) was calculated using the standardized method including the tissue weighted parameters. The radiological pathologies determined as a result of CT imaging of the cases were categorized according to clinical significance in accordance with the Modified CT Colonography Reporting and Data System (C-RADS). Results: The data for a total of 268 patients were analyzed, comprising 89 (33.2%) females and 179 (66.8%) males with a mean age of 8.81 ± 5.21 years. The mean Ed was determined to be 18.14 ± 10.44 mSv. The Ed was determined to be statistically significantly higher in the 1–5 years age group than in the 15–18 years age group (p = 0.024). A statistically significant difference was determined between the age groups in terms of the pathologies determined (p = 0.028). Conclusions: In order to prevent performing unnecessary CT imaging, trauma teams in Emergency Departments (ED) should work in harmony and individual decision-making should be based on the severity of the trauma mechanism, the severity of the predicted injury, and the clinical status of the injured child. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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9 pages, 761 KiB  
Article
Epidemiology and Outcome of Acute Appendicitis during and before the COVID-19 Pandemic: A Retrospective Single-Center Analysis
by Moonho Won and Chiwon Ahn
Medicina 2023, 59(5), 902; https://doi.org/10.3390/medicina59050902 - 08 May 2023
Viewed by 1133
Abstract
Background and Objectives: We investigated epidemiological factors and outcomes, including the development of complications, for patients with appendicitis according to three sequential coronavirus disease 2019 (COVID-19) pandemic periods, divided by specific time points. Materials and Methods: This observational study included patients [...] Read more.
Background and Objectives: We investigated epidemiological factors and outcomes, including the development of complications, for patients with appendicitis according to three sequential coronavirus disease 2019 (COVID-19) pandemic periods, divided by specific time points. Materials and Methods: This observational study included patients with acute appendicitis who arrived at a single-center between March 2019 and April 2022. The study divided the pandemic into three periods: period A as the first phase of the pandemic (from 1 March 2020 to 22 August 2021), period B as the time period the medical system stabilized (from 23 August 2021 to 31 December 2021), and period C as the time period of the exploration of patients with COVID-19 in South Korea (from 1 January 2022 to 30 April 2022). Data collection was based on medical records. The primary outcome was presence or absence of complications and the secondary outcomes were the time taken from ED visit to surgical intervention, the presence and time of the first administration of antibiotics, and the hospital stay time. Results: Of 1,101 patients, 1,039 were included, with 326 and 711 patients before and during the pandemic, respectively. Incidence of complications was not affected during the pandemic (before the pandemic 58.0%; period A 62.7%; period B,55.4%; and period C 58.1%; p = 0.358). Time from symptom onset to emergency department (ED) arrival significantly decreased during the pandemic (before the pandemic 47.8 ± 84.3 h; pandemic 35.0 ± 54 h; p = 0.003). Time from ED visit to the operating room was statistically significantly increased during the pandemic (before the pandemic 14.3 ± 21.67 h; period A 18.8 ± 14.02 h; period B 18.8 ± 8.57 h; period C 18.3 ± 12.95 h; p = 0.001). Age and time from symptom onset to ED arrival were variables affecting the incidence of complications; however, they were not affected during the pandemic (age, OR 2.382; 95% CI 1.545–3.670; time from symptom onset to ED arrival, OR 1.010, 95% CI 1.006–1.010; p < 0.001). Conclusions: This study found no differences in postoperative complications or treatment durations between pandemic periods. The incidence of appendicitis complications was significantly influenced by age and the duration between the onset of symptoms and arrival at the emergency department, but not by the pandemic period itself. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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17 pages, 1680 KiB  
Article
Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals—A Qualitative Analysis
by Ling Tiah, Mui Teng Chua, Win Sen Kuan, Alina Tan, Eileen Tay, Rakhee Yash Pal and Chaoyan Dong
Medicina 2023, 59(3), 456; https://doi.org/10.3390/medicina59030456 - 24 Feb 2023
Viewed by 1847
Abstract
Background and Objectives: End-of-life care in the emergency department (ED) is gaining importance along with the growth in the ageing population and those with chronic and terminal diseases. To explore key stakeholders’ perspectives and experiences regarding end-of-life care in the ED. Materials [...] Read more.
Background and Objectives: End-of-life care in the emergency department (ED) is gaining importance along with the growth in the ageing population and those with chronic and terminal diseases. To explore key stakeholders’ perspectives and experiences regarding end-of-life care in the ED. Materials and Methods: A descriptive qualitative study was conducted from November 2019 to January 2020. Study participants were recruited from the EDs of three tertiary hospitals and community care settings in Singapore through purposive sampling. Data collection included focus group discussions with 36 ED staff, 16 community healthcare professionals, and one-on-one semi-structured interviews with seven family members. Results: Three main themes and several subthemes emerged from the data analysis. (1) Reasons for ED visits were attributed to patients’ preferences, families’ decisions, limited services and capabilities in the community, and ease of access. (2) Barriers to providing end-of-life management in the ED included: conflicting priorities of staff, cramped environment, low confidence, ineffective communication, and lack of standardised workflows. (3) Discussion about continuity of end-of-life care beyond the ED uncovered issues related to delayed transfer to inpatient wards, challenging coordination of terminal discharge from the ED, and limited resources for end-of-life care in the community. Conclusions: Key stakeholders reported challenges and shared expectations in the provision of end-of-life care in the ED, which could be optimised by multidisciplinary collaborations addressing environmental factors and workflows in the ED. Equipping ED physicians and nurses with the necessary knowledge and skills is important to increase competency and confidence in managing patients attending the ED at the end of their lives. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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Review

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13 pages, 2485 KiB  
Review
Effectiveness of Intranasal Analgesia in the Emergency Department
by Christian Zanza, Francesco Saglietti, Jacopo Davide Giamello, Gabriele Savioli, Davide Maria Biancone, Mario Giosuè Balzanelli, Benedetta Giordano, Anna Chiara Trompeo and Yaroslava Longhitano
Medicina 2023, 59(10), 1746; https://doi.org/10.3390/medicina59101746 - 29 Sep 2023
Viewed by 1225
Abstract
In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the [...] Read more.
In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992–2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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Other

5 pages, 1622 KiB  
Case Report
Aflibercept for Gastrointestinal Bleeding in Hereditary Hemorrhagic Telangiectasia: A Case Report
by Bernat Villanueva, Adriana Iriarte, Raquel Torres-Iglesias, Miriam Muñoz Bolaño, Pau Cerdà and Antoni Riera-Mestre
Medicina 2023, 59(9), 1533; https://doi.org/10.3390/medicina59091533 - 24 Aug 2023
Cited by 2 | Viewed by 1102
Abstract
Herein, we present the first described hereditary hemorrhagic telangiectasia (HHT) patient treated with aflibercept for severe GI involvement after tachyphylaxis to bevacizumab, with promising results. HHT is a rare genetic disease characterized by systemic vascular malformations. Gastrointestinal telangiectasia is one of the major [...] Read more.
Herein, we present the first described hereditary hemorrhagic telangiectasia (HHT) patient treated with aflibercept for severe GI involvement after tachyphylaxis to bevacizumab, with promising results. HHT is a rare genetic disease characterized by systemic vascular malformations. Gastrointestinal telangiectasia is one of the major involvements that can produce chronic severe iron-deficiency anemia. Nowadays, support treatment with iron replacement therapy, red blood cell transfusions, and antiangiogenic drugs—mainly bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF)—are the main therapeutic options for this complication. The evidence of alternative drugs in patients with failure to this approach, such as tachyphylaxis to bevacizumab, is scarce. Aflibercept is a VEGF inhibitor with antiangiogenic properties approved for the treatment of different types of cancer and ocular neovascularization diseases. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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9 pages, 6325 KiB  
Case Report
A Rare and Easily Overlooked Case of Bilateral Traumatic Testicular Dislocation and an Alternative Viewpoint on Delayed Management
by Ming-Wei Hsu, Po-Fan Hsieh and Li-Hsien Tsai
Medicina 2023, 59(5), 892; https://doi.org/10.3390/medicina59050892 - 06 May 2023
Cited by 1 | Viewed by 1329
Abstract
The incidence of traumatic testicular dislocation is rare, and it is usually overlooked in an initial diagnosis. We present a case of bilateral dislocated testes after a traffic accident that was treated via orchidopexy one week later. No testicular complications had occurred by [...] Read more.
The incidence of traumatic testicular dislocation is rare, and it is usually overlooked in an initial diagnosis. We present a case of bilateral dislocated testes after a traffic accident that was treated via orchidopexy one week later. No testicular complications had occurred by the time of the follow-up visit. Generally, surgery is often postponed owing to a late diagnosis or another major organ injury, and the adequate timing of surgery is still under debate. We performed a review of past cases, which showed similar testicular outcomes irrespective of surgical timing. Delayed intervention may be a feasible decision after a patient’s hemodynamic status is stable for surgery. To prevent delayed diagnosis, scrotal examination should not be overlooked in any patients presenting with pelvic trauma to the emergency department. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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10 pages, 2734 KiB  
Case Report
Ph-Positive B-Cell Acute Lymphoblastic Leukemia Occurring after Receipt of Bivalent SARS-CoV-2 mRNA Vaccine Booster: A Case Report
by Shy-Yau Ang, Yi-Fang Huang and Chung-Ta Chang
Medicina 2023, 59(3), 627; https://doi.org/10.3390/medicina59030627 - 21 Mar 2023
Cited by 1 | Viewed by 11605
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a universal emergency public health issue. A large proportion of the world’s population has had several spike antigen exposures to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and/or COVID-19 vaccinations in a relatively short-term period. [...] Read more.
The coronavirus disease 2019 (COVID-19) pandemic is a universal emergency public health issue. A large proportion of the world’s population has had several spike antigen exposures to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and/or COVID-19 vaccinations in a relatively short-term period. Although sporadic hematopoietic adverse events after COVID-19 vaccine inoculation were reported, there is currently no sufficient evidence correlating anti-spike protein immune responses and hematopoietic adverse events of vaccinations. We reported the first case of Ph-positive B-cell acute lymphoblastic leukemia (ALL) occurring after a bivalent mRNA COVID-19 vaccine inoculation. The otherwise healthy 43-year-old female patient had a total of six spike antigen exposures in the past 1.5 years. Informative pre-vaccine tests and bone marrow study results were provided. Although the causal relationship between bivalent vaccinations and the subsequent development of Ph–positive B-cell ALL cannot be determined in the case report, we propose that anti-spike protein immune responses could be a trigger for leukemia. Clinicians must investigate the hematopoietic adverse events closely after COVID-19 vaccinations. Further pre-clinical studies to investigate the safety of bivalent mRNA COVID-19 vaccine are required. Full article
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical IssuesⅡ)
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