Emergency Care Journal

A practice teaching from GIMSI (Italian Multidisciplinary Syncope Group) 2025: yoga as a treatment for recurrent vasovagal syncope

Erika Poggiali, Monica Solbiati, Ivo Casagranda, Lorenzo Ghiadoni — Mon, 10 Mar 2025 00:00:00 +0000

The XII Italian National Congress of GIMSI (Italian Multidisciplinary Syncope Group) has taken place in Milan on February 6-7, 2025. This report summarizes a practice teaching from the congress regarding the role of yoga and physical exercise in managing Vasovagal Syncope (VVS).

VVS is a very common clinical condition with an estimated lifetime prevalence of 35%¹ and a frequent reason for emergency department visits.² Although VVS is not associated with an increased rate of mortality, there is a significant deterioration in the Quality Of Life (QoL) in conjunction with the severity and frequency of recurrences.³

Pharmacological and non-pharmacological therapies, such as elastic compression stocking, dietary modification with oral rehydration salts and increased salt intake, tilt training (also known as standing training), and physical counter-pressure manoeuvres, have demonstrated only limited and modest efficacy, which can be frustrating for both patients and clinicians.^4,5 There is no single uniformly accepted protocol to prevent VVS recurrences and some patients with recurrent syncope end up being submitted to procedures, such as pacemaker implantation or cardioneuroablation. The latter is showing promising results, but it is an invasive manoeuvre, and its long-term effects are unknown.⁶[...]

SEPSIS TRIESTE 2024 - 2nd Edition | Generali Convention Center Trieste, 20 e 21 settembre 2024

The Editors — Thu, 13 Feb 2025 00:00:00 +0000

SEPSIS TRIESTE 2024 - 2^nd Edition, Generali Convention Center Trieste, 20-21 September 2024

Palpitations in a Fontan patient: what now?

Catello Sepe, Cristiano Perani — Fri, 07 Mar 2025 00:00:00 +0000

A 32-year-old male presented to our emergency department with palpitations. His blood pressure was 95/65 mmHg, heart rate 150 beats per minute, oxygen saturation 87% on room air, and body temperature 36°C. The electrocardiogram (EKG) showed paroxysmal supraventricular tachycardia (PSVT). He reported a history of heart surgery – Fontan procedure – during childhood for a complex congenital heart disease (CHD) characterized by a single atrium, a single ventricle, and a single atrioventricular valve. A focused cardiac ultrasound confirmed a single atrium, a single ventricle, no pericardial effusion, and an estimated ejection fraction of 50% (Videos 1 and 2). His current medication regimen included sotalol 80 mg, losartan 12.5 mg, dapagliflozin 10 mg, furosemide 25 mg, and warfarin.

Hikikomori: a world within a room

Icilio Dodi, Marco Pappalardo, Piero Veronese — Fri, 07 Mar 2025 00:00:00 +0000

Dear Editor,

Hikikomori is a condition characterized by prolonged and extreme social withdrawal lasting at least six months, resulting in substantial functional impairment or distress associated with this isolation.¹

While the cultural roots of social withdrawal can be observed in Japanese mythology (e.g., the sun goddess Amaterasu, a paramount deity in Shinto, exemplifies voluntary seclusion), the contemporary phenomenon of hikikomori emerged from what was often termed “truancy” or “school refusal” (futoko) during the 1970s and 1980s. The term “hikikomori” itself was first introduced by the psychologist Fujiya Tomita in 1985.² This term comes from the verb hiki, which means “to pull back”, and komoru, which means “to seclude oneself”.³

However, hikikomori did not gain widespread recognition within Japanese society until the publication of “Shakaiteki Hikikomori-Owaranai Shishunki” (Social Withdrawal: A Never-Ending Adolescence) by the psychiatrist Tamaki Saito in 1998.²[...]

If you hear a new worrisome heart murmur…

Erika Poggiali, Francesco Maria Sacco, Giudy Ragonesi — Thu, 13 Feb 2025 00:00:00 +0000

An 86-year-old woman presented to our emergency department for acute dyspnea without chest pain. She had taken amoxicillin/clavulanate 1 g/q12h for acute bronchitis. She underwent a left nephrectomy for cancer twenty years earlier. Blood pressure, heart rate, peripheral oxygen saturation, respiratory rate, and body temperature were 110/60 mmHg, 112 bpm, 90% with a non-rebreather mask (15 L/min), 25 breaths/min, and 36.5°C, respectively. Arterial blood gas documented pH 7.31, pCO₂ 29 mmHg, pO₂ 49 mmHg, SatO₂ 90%, HCO₃ 14.6 mEq/L, lactates 3.8 mmol/L. Chest examination revealed absent vesicular murmur in the basal regions, crackles in the upper ones, and a pansystolic murmur. A lung ultrasound showed a white lung pattern with a severe pleural effusion and non-collapsible inferior vena cava. Laboratory findings documented WBC 18,610/mm³ with CRP 84 mg/L (n.v.<10), AST 489 U/L (n.v. 11-34), ALT 296 U/L (n.v.<33), and troponin T 5191 ng/L (n.v.<20). ECG and echocardiography are reported in Figure 1 and Video 1, respectively.

Metacognitive awareness in coping with mental health challenges and decision-making among emergency physicians

Albin Joseph, Tony P. Jose — Thu, 20 Mar 2025 00:00:00 +0000

Dear Editor,

We are writing to highlight the importance for emergency physicians to have metacognitive awareness to improve their ability to make decisions under pressure and cope with stressors. Improving well-being and enhancing resilience among emergency physicians and nurses is a critical concern due to heightened attrition rates and increasing psychological issues. [...]