Emergency Care Journal 2019-05-22T17:31:59+02:00 Francesca Baccino Open Journal Systems <p><strong>Emergency Care Journal </strong> is the official Journal of the <a href="" target="_blank" rel="noopener">Academy of Emergency Medicine and Care</a> (AcEMC). The journal is an international, peer-reviewed journal dedicated to improve the quality of care by publishing the highest quality science for acute medical care and related medical specialties. The journal welcomes submissions from international contributors and researchers of all specialties involved in acute medical conditions. <strong>Emergency Care Journal</strong> publishes <em>Original Articles, Review Articles, Opinion Reports, Case Reports, Images in Emergency, Letters to the Editors, Commentaries, Book Reviews, Editorials</em> and other educational information related to the practice, teaching, and environment of emergency medicine. In addition to general topics, ECJ also publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics. Although most of published research is clinical, there is also strong interest for basic science research pertinent to emergency medicine, thus including all clinical, diagnostics and therapeutic areas of medicine involved in the emergency care management.</p> <p>This journal does not apply charge for publication to Authors as it is fully supported by institutional funds (<a href="" target="_blank" rel="noopener">Academy of Emergency Medicine and Care</a>).</p> The importance of staff's attitudes in the care of individuals with mental health problems in the emergency department 2019-05-22T17:31:54+02:00 Marco Piccinelli <p>Not available.</p> 2019-05-08T08:55:04+02:00 ##submission.copyrightStatement## Case of a floating right atrial thrombus successfully treated with fibrinolysis 2019-05-22T17:31:55+02:00 Chloé Bernard Olivier Bouchot Marjolaine Georges Marie Catherine Morgant <p>Mobile right atrial thrombi are at high risk of causing massive pulmonary embolism and are a medical emergency. This type of thrombus is identified in about 4-18% of pulmonary embolism cases. The presence of a free-floating embolic mass in right atrial or ventricle is often mortal: the death rate can reach 27%. Although surgery is commonly indicated, fibrinolysis is a therapeutic alternative. Here, a 58-year-old man presented to the emergency department for acute dyspnea associated with a painful right leg. Initial exams showed a shunt effect on blood gases with increased brain natriuretic peptide. Transthoracic echography (TTE) found a free-floating thrombus in the right atrium with signs of pulmonary hypertension and right ventricular dysfunction. Bilateral pulmonary embolism was confirmed by computed tomography angiography. Because there were signs of acute cor pulmonale and no contraindications, treatment with systemic fibrinolysis was decided. The treatment was delivered in intensive care unit and a cardiac surgical team was available. Subsequent clinical improvement was observed. TTE follow up at 12 hours revealed complete thrombus dissolution. There were no complications, in particular no hemorrhage. The patient was discharged after eleven days. At 6 months of follow-up, outcomes with oral anticoagulation therapy were satisfactory. Scintigraphy found good symmetrical perfusion of both lungs with stackable ventilation. TTE at 1 year showed preserved left and right ventricular function with no sign of pulmonary arterial hypertension and no thrombus recurrence. Systemic fibrinolysis appears to be a good alternative to surgery in this case.</p> 2019-05-03T10:51:52+02:00 ##submission.copyrightStatement## Simultaneous bilateral spontaneous pneumomediastinum and pneumothorax in a cannabis user 2019-05-22T17:31:56+02:00 Sevilay Vural Ahmet Tuğrul Zeytin Şeyhmus Kaya Barış Öztürk <p>Cannabis – the most commonly used illegal drug – also has some medical applications. Cannabis is being legalised more and more in the Western world, however it is not a safe substance as many people think. It can cause detrimental acute and chronic lung injuries such as bullous lung disease, chronic bronchitis, chronic obstructive pulmonary disease, pneumothorax, pneumomediastinum, pulmonary emphysema. A clear mechanism for acute pulmonary pathologies has not been established, but pneumothorax and/or pneumomediastinum can be considered as a typical presentation in cannabis users. We present a cannabis user case with simultaneous pneumomediastinum and bilateral spontaneous pneumothorax.</p> 2019-04-29T12:07:53+02:00 ##submission.copyrightStatement## Critical issues and opportunities of emergency psychiatry in Italian emergency departments 2019-05-22T17:31:57+02:00 Carlo Fraticelli Ilaria Casolaro Massimiliano Nigro <p>In Italy emergency physicians are the front line of care for patients with medical conditions such as trauma, heart attacks, strokes or psychiatric disorders. Triage represents the first clinical contact with the person to determine urgency of care, and includes initial risk assessment and determination of observation level. It is necessary to undertake mental health triage for all service users on entry to the Emergency Department (ED), alongside physical health triage. The recourse to emergency services for psychiatric complaints is increasing and ED providers are often the first contact a patient will have with psychiatric care. The organization of Italian EDs is constantly evolving under the pressure of various external forces (population aging, increasing use of new substances, immigration, choices of economic policy, and technological development). The psychiatric emergency service contact represents a key to addressing the presenting problem and it is a critical link for continuity of care. The management of psychiatric disorders is an evolving issue in Italy as in other countries. Research increasingly suggests the importance of specific training for EDs teams in order to provide appropriate handling in acute settings. Psychiatrists and ED physicians can – and should – play a fundamental role in promoting a targeted and shared training for emergency services to deal with crisis according to evidence-based medicine. Service organization, legal issues, safety, training and education are not well defined and established and still imply improvisation, while they deserve attention as fundamental prerequisite to implement specific treatment guidelines.</p> 2019-04-29T11:41:27+02:00 ##submission.copyrightStatement## An health economic evaluation of using N-terminal pro brain natriuretic peptide for the management of acute heart failure: A pilot study in an Indonesian tertiary referral hospital 2019-05-22T17:31:57+02:00 Prima Almazini Bambang Budi Siswanto Markus Meyer Mardiati Nadjib Isman Firdaus Ahmad Fuady Paola Antonini Salvatore Di Somma <p>Heart failure represents a major health problem and economic burden also in development countries such as Indonesia. Based on current guidelines, the use of natriuretic peptides can improve diagnosis, risk stratification, and decrease in hospital length of stay. However, mostly due to the related high costs, many Indonesian physicians currently do not routinely use these biomarkers in their daily clinical practice. By comparing the results of guidance with N-terminal pro brain natriuretic peptide (NT-proBNP) and without NT-proBNP, this pilot study was aimed to determine the clinical effectiveness and costs of using natriuretic peptides in the management of acute heart failure (AHF) patients admitted at National Cardiovascular Center Harapan Kita Hospital, a tertiary referral hospital in Jakarta, Indonesia. This was an health economic evaluation using a single-blind, randomized controlled trial. AHF patients adjudicated following European Society of Cardiology guidelines were randomly assigned to the 2 groups: NT-proBNP group (group A) and control group (group B). In the group A, NT-proBNP level was obtained at admission and pre-discharge, with the target of achieving a decrease of ≥30%. Randomised patients were followed up to 90 days post-discharge to assess short-term outcomes and costs. In total, one hundred and twelve patients were enrolled, of whom 56 were randomized in group A and 56 patients in group B. Compared to Group B, in Group A the total costs of patients management resulted to be significantly higher (P&lt;0.05), while no significant difference between the 2 groups was observed for inhospital length of stay, total mortality rate, rehospitalization, and emergency department visits within 90 days post-discharge. In this pilot study for the management of AHF at an Indonesian National Cardiovascular Center, the routine use of NT-proBNP compared to the non use, at hospital admission and discharge resulted into a significant increase of medical cost without any evident favourable impact on patients outcomes. Larger study in greater Asia Pacific populations should be performed to confirm these preliminary results.</p> 2019-04-29T11:31:54+02:00 ##submission.copyrightStatement## A ripping bike race: spontaneous coronary dissection complicated by cardiac tamponade, unmasking vascular Ehlers-Danlos in a young man 2019-05-22T17:31:59+02:00 Inne Hendrickx Benjamin Scott <p>Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Typically, it occurs in young women without atherosclerotic risk factors. Clinical presentation ranges from chest pain to myocardial infarction, ventricular fibrillation and sudden death. We report a very rare case of a young man with ST-elevation myocardial infarction caused by SCAD, complicated by hemopericardium and recurrent cardiac tamponade. Due to this acute complication, he was diagnosed as having vascular Ehlers- Danlos syndrome.</p> 2019-02-27T14:50:39+01:00 ##submission.copyrightStatement##