Emergency Care Journal

Do not move! Spinal immobilization or spinal motor restriction: the long-lasting debate from the Napoleonic Wars to 2024 SIMEU policy statement

2024-06-24T13:16:50+00:00

The management of spinal trauma in the pre-hospital setting is based on techniques of immobilization for prevention of secondary neurological damage in high-risk patients during transportation.¹ Since the ’70s, the traditional form of Preventive Spinal Immobilization (PSI) has been carried out using a long spinal board, head blocks, and immobilization straps often associated with the placement of a cervical collar.² The first documentation of this practice comes from the early 19^th century, when pre-hospital trauma care was introduced on the battlefields of the Napoleonic Wars.³ This strategy is still adopted by many pre-hospital medical services worldwide and taught as the gold standard on many trauma courses. The traditional form of PSI is indeed based more on pragmatism than on high-quality studies supporting its efficacy.³ [...]

A national survey of Italian emergency medicine residents: it's time to stay and play

2024-06-18T14:55:34+00:00

At the end of October 2023, CoSMEU (Italian Society of Emergency Medicine Residents) conducted an electronic survey among the Italian Emergency Medicine (EM) residents. Technical skills, lecture programs, research, and types of employment have been investigated. 421 (21.5.%) residents from all the 34 Italian EM schools responded. Great heterogeneity of training and the lack of opportunities in research about EM topics are reported. The importance of research in EM was recognized by half of those surveyed, but only one-third are actively engaged in the EM scientific community. While one-third of EM residents have accepted a job contract, nearly all of them are against contracts with Calabria Decree from the 2nd year of residency. The ideal workplace is a combination of in-hospital and pre-hospital settings, and almost all of the EM residents believe that the most frightening part of being an EM doctor is the hard-working condition.

Euglycemic diabetic ketoacidosis due to small bowel perforation: a case report

2024-06-19T15:03:04+00:00

Diabetic Ketoacidosis (DKA) is a potentially life-threatening condition that complicates diabetes mellitus. Euglycemic DKA (eDKA) is emerging as a variant in both type 1 and type 2 diabetes mellitus. The rise in its presentation is being caused by newer medicines using SGLT-2 inhibitors, with a complex underlying pathophysiology. Here we report a case of a 70-year-old woman presenting to the emergency department complaining of shortness of breath and abdominal pain. She suffers from type 2 diabetes mellitus and is on oral therapy, including the SGLT-2 inhibitor empagliflozin. Further testing revealed a high-anion-gap metabolic acidosis without elevation of lactate levels and a glucose level of 160 mg/dL. CT imaging of the abdomen showed a small bowel perforation. The case required aggressive medical therapy before surgical repair in the operating room. EDKA is a medical emergency that can be challenging to identify due to its atypical presentation compared to the traditional DKA (which is hyperglycemic). These characteristics can delay effective and timely treatment.

Epidemiology of cycling road injuries-related deaths

2024-05-28T12:53:34+00:00

Dear Editor,

There are now several lines of evidence that millions of people around the world use bicycles as a routine means of transportation. In the US alone, for example, the website Statista estimates that 55 million people use bicycles as a primary or complementary mode of transportation, with a trend that has been steadily increasing over the past decade. In addition to the positive environmental impact of cycling as an alternative means of transportation for reducing pollution, cycling also offers numerous health and wellness benefits. Nevertheless, cycling injuries on the road are still a primary health concern, as collisions with motor vehicles or accidental falls can cause serious harm to cyclists. [...]

Two silent epidemics: air pollution and climate change. “Slow and sustainable medicine” as part of the solution

2024-04-05T10:12:01+00:00

Human health is one of the earliest biosensors of climate change, which increases the frequency and severity of many diseases, as reported by Bellone.¹ In Europe, air pollution is becoming a severe health problem that needs to be addressed by physicians of all specialties as well as governments and the general public.

Unfortunately, it is acknowledged that the Po Valley in Italy is among the most polluted areas in Europe. As physicians practicing in this area, we feel we must remind our colleagues of the increasing impact of the environment on the health of ourselves and our patients. Along with having a substantial negative influence on both human and environmental health, air pollution also has a financial cost since it raises medical expenses and reduces productivity due to missed workdays. We can define this situation as a silent epidemic that affects all people, regardless of age. [...]

Multimarkers approach in chest pain management in Emergency department: a focus on the prognostic role of sST2 and suPAR

2024-06-18T14:35:45+00:00

Chest pain is one of the most prevalent causes of Emergency Department (ED) admission and could be a presenting symptom of Acute Coronary Syndrome (ACS). The aim of this review was to provide an overview of the research about troponin and its limitations and new biomarkers used in patients with cardiovascular diseases, with a special focus on soluble Suppression of Tumorigenicity 2 (sST2) and Soluble Urokinase Plasminogen Activator Receptor (suPAR). In January 2024, a PubMed and Reviews in Cardiovascular Medicine (RCM) search was carried out to identify all relevant papers in the past five years. 80 articles were included in the final review. ssT2 and suPAR are involved in both acute and chronic cardiovascular disease and can predict the risk of adverse events. sST2 and suPAR are promising biomarkers that, in combination with troponin, could help in the management of patients with chest pain in the ED. Further studies are needed to validate their role in management of ACS in this specific setting.