Emergency Care Journal

Extreme nutritional neglect leading to cardiac arrest in a child: a rare presentation of severe acute malnutrition in England

Ashley Reed — 2024-12-17

This case report from England describes an 8-year-old girl who suffered severe health complications culminating in cardiac arrest due to profound neglect and malnutrition. The patient presented with cardiac arrest, which was attributed to her severe wasting. Upon admission, her body mass index measured 12.8 kg/m2 (z-score ranging between -2 and -3), indicative of severe malnutrition. The patient presented with respiratory, renal, and hepatic failure, in addition to disseminated intravascular coagulation. Resuscitative measures were administered, and she underwent 162 hours of ventilation in the paediatric intensive care unit. Despite the gravity of her initial presentation, the patient exhibited a notable recovery. Paediatric cardiac arrest stemming from extreme nutritional neglect is a rare occurrence in England. This case underscores the paramount importance of prompt intervention and comprehensive medical oversight. The patient's relatively favourable recovery underscores the potential for positive outcomes when timely and appropriate medical interventions are employed.

A modern management model for patients with acute and subacute psychiatric problems in the emergency department of Trento (Northern Italy)

Mjriam Sano' — 2024-12-16

In Italy, over 86% of patients with mental disorders have one emergency department visit per year, with 6–9% having two visits and approximately 2% having three visits. It is not significant to include those with four or more visits in this data set. In the context of the COVID-19 pandemic, there has been a notable increase in the utilisation of emergency services for psychiatric concerns. In our emergency department (ED), we observed a 10% increase in admissions for psychiatric problems, psychomotor agitation, behavioural disorders, and drug intoxication between 2022 and 2023. We present an organisational management model that has been found to be effective for patients with minor psychiatric problems, those who repeatedly present to the emergency department, and/or those with discontinuous referrals to the relevant mental health centre or acute episodes. One possible strategy could be to consider directing psychiatric emergencies that can be deferred to territorial crisis management from the Trento emergency department to the mental health centre.

A red and warm abdomen. What’s the matter?

Erika Poggiali — 2024-11-21

An 83-year-old woman presented to our emergency department for a fever with nausea and an itching skin rash on her abdomen for two days. She suffered from obesity, Parkinson disease, and depression in treatment with Levodopa/Benserazide and Pramipexole, respectively. She underwent mastectomy for left breast cancer ten years earlier. She denied any allergies or use of antibiotics. Her vital signs were blood pressure 120/65 mmHg, heart rate 72 bpm, peripheral oxygen saturation 94% in room air, respiratory rate 18/min, and body temperature 36.2 °C. Examination of her abdomen revealed an extensive red warm rash without blisters or blebs, with a slight skin oedema confirmed by point-of-care ultrasound, that excluded a subcutaneous abscess, pneumoniae, liver and kidney damage, and cholecystitis. Laboratory findings showed WBC 12,400/mm³ (N 59.5%) and CRP 131 mg/L (n.v. < 5). Procalcitonin was 0.3 ng/mL (n.v. < 0.5). SARS-CoV-2 infection was excluded.

Triage nurse staffing: a study on the need for model improvements

Arian Zaboli — 2024-11-08

This study addresses the challenge of determining appropriate nurse staffing levels for triage in Emergency Departments (EDs). It evaluates whether existing nurse staffing models, typically designed for other hospital settings, can be effectively applied to triage. The research was conducted at Merano Hospital’s ED from January 1, 2021, to November 30, 2022, and involved an analysis of data from patient triage assessments. The findings indicate that standard ward staffing models are not easily adaptable to the triage environment, underscoring the need for a more systematic approach to calculating triage nurse staffing. The current Italian ministerial guidelines do not account for the unique demands and complexities of the triage setting.

Optimizing ambulance nurse performance in southern Tuscany: insights from a Delphi study

Christian Ramacciani Isemann — 2024-11-06

This study aims to enhance the performance of ambulance nurses in Southern Tuscany through a Delphi method analysis. Conducted from January to December 2022, the research engaged 16 expert participants from a Tuscan health agency. Data on 89 interventions performed by "India" ambulances, which are nurse-led emergency vehicles, were collected. The Delphi method facilitated structured communication among the experts over three rounds, resulting in consensus on nine key intervention proposals. These proposals span areas including staff training, measurement and data collection methods, technologies and materials, and work environments. Key recommendations include prioritizing high-fidelity simulation training, improving data collection for clinical risk, and standardizing equipment across all emergency units. The study highlights the importance of continuous professional development, technological integration, and supportive work environments to optimize the effectiveness of pre-hospital emergency care. These findings provide a practical roadmap for enhancing the competencies and performance of ambulance nurses, ultimately improving patient outcomes in emergency situations.

No evidence of "weekend effect" for complications of medical and surgical care

Camilla Mattiuzzi — 2024-10-15

We performed an electronic search in CDC WONDER online database (years 2018-2022) to explore whether the higher risk of dying during the weekends may be related to complications of medical and surgical care. One-way ANOVA and Tukey's HSD multiple comparison test revealed no significant variation in mean number of deaths during the seven days of the week in the US. No significant difference was observed between the mean number of deaths during the weekend and those recorded during the weekdays (675±130 vs. 711±112; p=0.339). The mean ratio of mortality due to complications of medical and surgical care to the total number of deaths was not significantly different on weekends and weekdays (151 vs. 158×100,000 deaths; p=0.255). The results of this analysis suggest that the so-called “weekend effect” may not be apparently attributable to complications of medical and surgical care and may hence be more related to patient-specific factors.