Journal Description
Emergency Care and Medicine
Emergency Care and Medicine
is an international, peer-reviewed, open access journal on emergency medicine published quarterly online by MDPI.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- Rapid Publication: first decisions in 16 days; acceptance to publication in 5.8 days (median values for MDPI journals in the second half of 2023).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names are published annually in the journal.
- Emergency Care and Medicine is a companion journal of Biomedicines.
Latest Articles
Procedural Sedation in Emergency Department: A Narrative Review
Emerg. Care Med. 2024, 1(2), 103-136; https://doi.org/10.3390/ecm1020014 (registering DOI) - 26 Apr 2024
Abstract
Procedural sedation and analgesia (PSA) in the emergency department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing
[...] Read more.
Procedural sedation and analgesia (PSA) in the emergency department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. The results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. The conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and the adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.
Full article
Open AccessCase Report
Meningococcal Disease Presenting with Acute Myopericarditis and Concurrent Acute Meningitis
by
Amandeep Singh
Emerg. Care Med. 2024, 1(2), 95-102; https://doi.org/10.3390/ecm1020013 (registering DOI) - 26 Apr 2024
Abstract
►▼
Show Figures
Emergency department physicians uncommonly associate myopericarditis with bacterial infection and, even more rarely, encounter myopericarditis caused by meningococcal infection. This case report describes a 38-year-old man who presented with chest pain, electrocardiographic changes, and cardiac biomarkers consistent with acute myopericarditis and rapidly developed
[...] Read more.
Emergency department physicians uncommonly associate myopericarditis with bacterial infection and, even more rarely, encounter myopericarditis caused by meningococcal infection. This case report describes a 38-year-old man who presented with chest pain, electrocardiographic changes, and cardiac biomarkers consistent with acute myopericarditis and rapidly developed central nervous system symptoms that were concerning for acute bacterial meningitis. The diagnosis of Neisseria meningitidis infection was confirmed by blood cultures. Once identified, the patient made a full recovery following a course of intravenous antibiotic therapy. This case underscores the difficulty of diagnosing this rare, but potentially life-threatening, condition in the emergency department.
Full article
Figure 1
Open AccessArticle
Metformin-Associated Lactic Acidosis: Which Elimination Therapy to Use in Case of Haemodynamic Instability? A Retrospective Cohort Study
by
Laurens Heeren, Sandra Verelst, Didier Desruelles and Marc Sabbe
Emerg. Care Med. 2024, 1(2), 87-94; https://doi.org/10.3390/ecm1020012 (registering DOI) - 25 Apr 2024
Abstract
►▼
Show Figures
Introduction: Metformin, a commonly used oral antihyperglycemic drug, poses a rare risk related to the development of metformin-associated lactic acidosis (MALA). The Extracorporeal Treatments in Poisoning (EXTRIP) group recommended intermittent haemodialysis (IHD) as a primary elimination therapy in case of severe metformin poisoning.
[...] Read more.
Introduction: Metformin, a commonly used oral antihyperglycemic drug, poses a rare risk related to the development of metformin-associated lactic acidosis (MALA). The Extracorporeal Treatments in Poisoning (EXTRIP) group recommended intermittent haemodialysis (IHD) as a primary elimination therapy in case of severe metformin poisoning. However, in haemodynamically unstable patients, our previous observations suggested that continuous venovenous haemofiltration (CVVH) might be more effective. This retrospective cohort study aimed to contribute evidence on the use of IHD and CVVH in patients with severe MALA, particularly in haemodynamically unstable patients. Methods: Data from January 2015 to December 2020 were collected from the Leuven University Hospital. Two separate search methods, based on hospital activity records and laboratory criteria, were used to identify patients with MALA. Patients diagnosed with MALA, receiving extracorporeal treatment within 24 h of admission, were included. Patients were categorized into the IHD and CVVH groups. Patient characteristics, treatment details, and outcomes were analysed. Results: Among 358,148 patient records, 35 MALA cases were identified. IHD was chosen as the initial elimination technique in 13 cases, whereas 22 patients were first commenced on CVVH. Patients treated with CVVH were sicker, had more comorbidities and had higher ventilation and vasopressor requirements. CVVH group had longer vasopressor use, longer ICU stays, and higher in-hospital mortality. Discussion: CVVH rather than IHD seems to be the preferred elimination technique in the more critically ill patients with MALA. Due to its retrospective design, this study failed to identify the superior elimination technique in terms of efficacy. Poorer outcomes in the CVVH group are likely attributed to the severity of illness rather than the inferiority of the elimination therapy. We acknowledge the diagnostic challenges regarding MALA. Using metformin assays could be beneficial in managing these patients. Conclusions: This study suggests clinicians’ preference for CVVH in severe cases of MALA with haemodynamic instability.
Full article
Figure 1
Open AccessReview
Video Laryngoscopy vs. Direct Laryngoscopy in Adult Patients with Difficult Airways Who Require Emergency Intubation
by
Iktimal Alwan, Maria Alwan, Ibrahim Mahgoub, Ansam Eghzawi, Abeer Gharaibeh and Anita V. Goyal
Emerg. Care Med. 2024, 1(2), 77-86; https://doi.org/10.3390/ecm1020011 - 15 Apr 2024
Abstract
►▼
Show Figures
This review compares the efficacy of video laryngoscopy (VL) with that of direct laryngoscopy (DL) in adult patients with difficult airways who require emergency intubation. Intubation and laryngoscopy are critical in emergency settings, and VL has emerged as an alternative to DL, particularly
[...] Read more.
This review compares the efficacy of video laryngoscopy (VL) with that of direct laryngoscopy (DL) in adult patients with difficult airways who require emergency intubation. Intubation and laryngoscopy are critical in emergency settings, and VL has emerged as an alternative to DL, particularly in difficult airway cases and when performed by non-experienced practitioners. VL demonstrates advantages such as a wider field of view, enhanced glottic visibility, and higher first-pass success rates, particularly in difficult airway scenarios. However, it also presents limitations, including potential view obstruction and technical complexity. While the evidence points to the advantages of VL, particularly in achieving higher first-pass success rates and minimizing adverse events in adult patients with difficult airways, the inconclusive findings from randomized trials emphasize the importance of future research in refining practices and improving patient outcomes.
Full article
Figure 1
Open AccessBrief Report
Irrigation and Débridement of the Thumb Flexor Sheath for Tenosynovitis—An Anatomic Study for the Optimisation of Surgical Techniques in Cadaveric Specimens
by
James W. Grant, Louis LeBlond and Stephanie J. Woodley
Emerg. Care Med. 2024, 1(2), 69-76; https://doi.org/10.3390/ecm1020010 - 09 Apr 2024
Abstract
►▼
Show Figures
Background: Treatment of a flexor tendon sheath infection of the thumb usually involves prompt surgical irrigation and debridement (ID). There are few descriptions of this procedure despite the unique anatomy of the thumb flexor sheath. The aim of this study was to
[...] Read more.
Background: Treatment of a flexor tendon sheath infection of the thumb usually involves prompt surgical irrigation and debridement (ID). There are few descriptions of this procedure despite the unique anatomy of the thumb flexor sheath. The aim of this study was to investigate thumb flexor sheath ID and explore the relevant anatomy. Methods: The current ID technique was performed on eight embalmed cadaveric hands. Coloured latex was injected into the sheath, and the surrounding region was dissected. Outcomes of interest were the distribution of latex, the success of the procedure, and the anatomy of the radial bursa. Results: Latex was successfully injected into all specimens, although A1 pulley stenosis caused significant resistance to flow. Latex filled the radial bursa (four specimens), reached the distal boundary of the transverse carpal ligament (three), or did not pass the A1 pulley (one); in addition, latex was found in the deep spaces of the hand and wrist (five specimens). The radial bursa was located at a median (range) of 33.2 (23.9–34.5) mm proximal to the carpometacarpal joint and at 7.8 (0–14.0) mm distal to the distal border of the pronator quadratus. Conclusion: These findings contribute to the existing body of knowledge on the anatomy of the thumb flexor sheath and radial bursa, and will help guide hand surgeons to perform thorough ID for infection. A modified surgical technique is presented, which may help further inform the treatment of pyogenic flexor tenosynovitis and other serious hand conditions.
Full article
Figure 1
Open AccessBrief Report
Survival Factors Associated with Toilet-Related Out-of-Hospital Cardiac Arrest
by
Yoshio Tanaka, Takahisa Kamikura, Hitoshi Owada and Hideo Inaba
Emerg. Care Med. 2024, 1(2), 61-68; https://doi.org/10.3390/ecm1020009 - 30 Mar 2024
Abstract
►▼
Show Figures
Objective: To identify the factors associated with a neurologically favourable survival of out-of-hospital cardiac arrest (OHCA) occurring in toilets. Methods: We retrospectively compared neurologically favourable 1-month survival rates and survival-related factors for 330,849 non-emergency medical service-witnessed OHCAs that occurred in toilets with those
[...] Read more.
Objective: To identify the factors associated with a neurologically favourable survival of out-of-hospital cardiac arrest (OHCA) occurring in toilets. Methods: We retrospectively compared neurologically favourable 1-month survival rates and survival-related factors for 330,849 non-emergency medical service-witnessed OHCAs that occurred in toilets with those that occurred elsewhere using a nationwide database. Results: Compared to outpatient or hospital admission, OHCA was more likely to be associated with toilets (crude odds ratio [cOR] [95% confidence interval [CI]]: 2.52 [2.48–2.57]). The neurologically favourable 1-month survival rate for OHCA occurring in toilets (1.8%) was significantly lower than that in other places (2.9%) (cOR [95% CI]: 0.60 [0.53–0.68]). Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use were minimal in toilets. Neither bystander CPR (adjusted OR [95% CI]: 1.19 [0.91–1.75]) nor AED use (adjusted OR [95% CI]: 2.05 [0.65–6.41]) was associated with improved neurologically favourable 1-month survival in toilets. Conclusions: Despite the poor neurologically favourable survival rate of OHCA in toilets, the provision of bystander CPR and AED was not associated with survival. Potential contributing factors include low rates of bystander intervention and delayed patient detection. To address this issue, focusing particular attention on unwell patients who use the toilets is crucial, and preventive approaches should be promoted.
Full article
Figure 1
Open AccessEditorial
Traumatic Cardiac Arrest: Navigating the Spectrum of Fundamentals and Advances
by
Francisco Epelde
Emerg. Care Med. 2024, 1(1), 59-60; https://doi.org/10.3390/ecm1010008 - 13 Mar 2024
Abstract
Traumatic Cardiac Arrest (TCA) arises from severe trauma, both blunt and penetrating, leading to the sudden cessation of cardiac activity [...]
Full article
Open AccessReview
Resuscitative Endovascular Balloon Occlusion of the Aorta in Non-Traumatic Out-of-Hospital Cardiac Arrest: A State-of-the-Art Review
by
Andrea Breglia, Pietro Pettenella, Laura Cervino, Claudio Fossa and Mirko Zanatta
Emerg. Care Med. 2024, 1(1), 46-58; https://doi.org/10.3390/ecm1010007 - 01 Mar 2024
Abstract
►▼
Show Figures
Out-of-hospital cardiac arrest (OHCA) is one of the most important causes of death worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an interesting new device that has been developed as a bridge therapy to treat trauma patients with non-compressible torso hemorrhage.
[...] Read more.
Out-of-hospital cardiac arrest (OHCA) is one of the most important causes of death worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an interesting new device that has been developed as a bridge therapy to treat trauma patients with non-compressible torso hemorrhage. REBOA has also been tested in non-traumatic OHCA, but the results are inconclusive. The aim of this review is to describe the state of the art in the use of REBOA for the management of non-traumatic out-of-hospital cardiac arrest. We performed a state-of-the-art review of the literature, searching for the therapeutic role of REBOA in the management of non-traumatic OHCA. We interviewed PubMed, Central, and Embase, and searched for citations before May 2023 using these criteria: “non-traumatic out-of-hospital cardiac arrest” and “resuscitative endovascular balloon occlusion of the aorta”. We selected only observational studies because controlled trials have not been published yet. All studies demonstrated the feasibility of REBOA placement in the management of non-traumatic OHCA and the improvement of all perfusion markers. Although some important uncertainties still remain, REBOA has the potential to become a new cornerstone in the therapy of OHCA and change the management of cardiac arrest, especially in remote locations which require a long time for scene arrival and an even longer time for metropolitan hospital arrival, where an ECPR is available.
Full article
Figure 1
Open AccessCase Report
Asymptomatic Intestinal Ischemia Secondary to Thrombosis of the Spleno-Mesenteric Portal Axis: Usefulness of Laparoscopic Approach for Diagnosis and Therapeutical Decisions—Case Report and Review of the Literature
by
Simone Gianazza, Marika Morabito, Davide Inversini, Sabrina Garbarino, Marta Ripamonti, Giuseppe Ietto and Giulio Carcano
Emerg. Care Med. 2024, 1(1), 39-45; https://doi.org/10.3390/ecm1010006 - 07 Feb 2024
Abstract
►▼
Show Figures
Mesenteric Venous Thrombosis (MVT) is a rare but often lethal form of ischemia. The diagnosis may be difficult for the clinician due to its mild symptoms with a great discrepancy between the pain suffered by the patients and the clinical observation. The non-specificity
[...] Read more.
Mesenteric Venous Thrombosis (MVT) is a rare but often lethal form of ischemia. The diagnosis may be difficult for the clinician due to its mild symptoms with a great discrepancy between the pain suffered by the patients and the clinical observation. The non-specificity of the laboratory tests and the challenge in computed tomography (CT) scan in distinguishing when an ischemia is occurring lead to the risk of an unrecognized diagnosis, especially considering that an early onset of treatment is largely fundamental for better outcomes. Also, the choice between the surgical approach and the anticoagulation may be a pitfall for the clinicians. The treatment choice requires a multidisciplinary approach. Emergency exploration by laparoscopy allows clinicians to reach the correct diagnosis and the real-time assessment of the intestinal infarction extension, playing a double diagnostic and therapeutic role in those doubtful and tricky cases. Here, a 77-year-old male with a completely asymptomatic bowel ischemia secondary to a Mesenteric Venous Thrombosis was submitted to a laparoscopic approach.
Full article
Figure 1
Open AccessBrief Report
A Ten-Year before–after Study on the Impact of the Affordable Care Act Health Insurance Expansion on Emergency Department Visits in California, U.S.
by
Theodore C. Chan, Jesse J. Brennan and Edward M. Castillo
Emerg. Care Med. 2024, 1(1), 31-38; https://doi.org/10.3390/ecm1010005 - 29 Jan 2024
Abstract
►▼
Show Figures
The Affordable Care Act (ACA) implemented in the U.S. aimed to improve healthcare access by expanding insurance coverage. To study the impact of ACA on Emergency Departments (Eds), we conducted a multi-center observational retrospective study of ED visits from all nonfederal acute care
[...] Read more.
The Affordable Care Act (ACA) implemented in the U.S. aimed to improve healthcare access by expanding insurance coverage. To study the impact of ACA on Emergency Departments (Eds), we conducted a multi-center observational retrospective study of ED visits from all nonfederal acute care hospitals in California over a 10-year period (2009 and 2018), 5 years before and after ACA implementation. Primary outcome measures included total ED visits, health insurance, disposition, and diagnoses, including ambulatory-care-sensitive conditions (ACSCs), and were analyzed each year to assess for trends during the 10-year study period. Overall, ED visits increased from 8,475,330 (30,791/100,000 population) in 2009 to 11,389,384 in 2018 (37,255/100,000 population), an increase of 21.0%, with the largest increase in 2014, the first year of ACA. The payer mix also dramatically changed, with a significant drop in uninsured patient visits (21.5% to 7.8%) and an increase in government-funded Medicaid visits (18.9% to 35.7%). There was a slight decrease in visits resulting in hospitalization or transfer (21.2% to 18.1% of all D visits) and ASCS visits (173.2 to 144.3 per 1000 ED visits). In conclusion, ED visits increased significantly in California following ACA, with a decrease in uninsured patients and small decreases in both hospitalizations/transfers.
Full article
Figure 1
Open AccessCase Report
Ischemic-Hemorrhagic Stroke in New Onset Type 1 Diabetes Mellitus with Diabetic Ketoacidosis in a Two-Year-Old Toddler: The First Reported Case in Indonesia
by
Anita Halim, Felicia Harsono, Sisilia Orlin and Gilbert Sterling Octavius
Emerg. Care Med. 2024, 1(1), 24-30; https://doi.org/10.3390/ecm1010004 - 27 Dec 2023
Abstract
►▼
Show Figures
Cerebral edema accounts for 90% of intracerebral complications in diabetic ketoacidosis (DKA). Stroke has been reported to account for 10% of intracerebral complications of DKA in children. It may be underrecognized because its presentation may be subtle. This case report aims to raise
[...] Read more.
Cerebral edema accounts for 90% of intracerebral complications in diabetic ketoacidosis (DKA). Stroke has been reported to account for 10% of intracerebral complications of DKA in children. It may be underrecognized because its presentation may be subtle. This case report aims to raise awareness of stroke presentation and risk factors in pediatric DKA. A previously healthy two-year-old female presented to the emergency department one day before admission with loss of consciousness and was diagnosed with DKA. The recognition of left hemiparesis was on the 9th day of hospitalization. After 14 days of hospitalization, the patient had recurrent seizures. Computed tomography and angiography revealed subacute ischemic transformative to subacute hemorrhagic stroke. During the follow-up, the symptoms of hemiparesis improved with routine physiotherapy, with some partial palsy of the third cranial nerve remaining. Risk factors for stroke in the patient were the severity of dehydration during DKA, younger age of onset, delayed DKA treatment, and iron deficiency anemia. Suspicion of stroke is necessary even if a subtle neurologic deficit occurs.
Full article
Figure 1
Open AccessReview
Addressing Challenges in EMS Department Operations: A Comprehensive Analysis of Key Issues and Solution
by
Abdullah Basnawi
Emerg. Care Med. 2024, 1(1), 11-23; https://doi.org/10.3390/ecm1010003 - 20 Dec 2023
Abstract
Background: Emergency medical services (EMS) are essential in providing timely medical attention and transportation to people in need during times of crisis. Effective EMS operations are crucial for delivering prompt and effective healthcare. However, the landscape of EMS operations is constantly evolving, posing
[...] Read more.
Background: Emergency medical services (EMS) are essential in providing timely medical attention and transportation to people in need during times of crisis. Effective EMS operations are crucial for delivering prompt and effective healthcare. However, the landscape of EMS operations is constantly evolving, posing a number of challenges that require rigorous research and innovative solutions. Objectives: To highlight the key challenges facing EMS departments in their daily operations and discuss potential solutions. Methods: A narrative literature review was conducted. Relevant studies were identified by searching electronic databases, such as PubMed, MEDLINE, CINAHL, and Google Scholar. Results: The main challenges facing EMS departments include an increasing demand for services, limited resources, aging infrastructure, technological advancements, and regulatory compliance. Operational-level solutions that can be used to address these challenges include investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations. Conclusion: EMS departments today face a variety of challenges. However, there are a number of approaches that can be taken to address these challenges. By investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations, EMS departments can improve their operations and provide the best possible care to patients.
Full article
Open AccessArticle
Knowledge of and Attitude towards First Aid Measures among Drivers in Sharjah
by
Amjad Mohamadiyeh, Mohammed Ra’a Said, Banan Al-Dabbagh, Rana Saeed, Furqan Al-Haboobi, Maitha AlJuwaied, Sarra Shorbagi and Amal Hussein
Emerg. Care Med. 2024, 1(1), 3-10; https://doi.org/10.3390/ecm1010002 - 08 Dec 2023
Abstract
Injury is an important cause of mortality and morbidity. First aid is the immediate assistance provided to a suddenly injured or sick person until professional help arrives or that person has recovered. Many lives would be saved if proper first aid was provided
[...] Read more.
Injury is an important cause of mortality and morbidity. First aid is the immediate assistance provided to a suddenly injured or sick person until professional help arrives or that person has recovered. Many lives would be saved if proper first aid was provided early. In the Middle East, there are limited studies that explore knowledge and practices towards first aid needed during RTA. The aim of this study is to investigate the knowledge and attitude towards first aid among drivers in Sharjah. A cross-sectional study was conducted through a self-administered questionnaire written in Arabic and the English language. Participants were 18 years or older holding a driving license in the city of Sharjah. Paramedics and certified participants with a certification from authorized organizations were excluded. A non-proportional convenient sampling method was used. A total of 343 participants completed the questionnaires. The majority of the study participants were less than 40 years old, and (56.76%) were males. Most participants (94.2%) indicated that they know the term ‘First Aid’. However, (49.7%) of the participants knew the number to call for an ambulance, and (52.43%) of the participants indicated that the victim should be moved to the hospital without an ambulance. With regard to attitude, (34.86%) were not willing to provide first aid in the case of RTA. The main reason was lack of knowledge, followed by fear of legal consequences. Most participants (83.78%) were willing to participate in first aid classes to improve their knowledge and attitude. Most participants are aware of the basic terms of first aid; however, they are not willing to provide first aid in cases of RTA due to lack of knowledge and fear of legal consequences. Based on these findings, we recommend providing first aid classes to new drivers so that they can obtain certification.
Full article
Open AccessEditorial
Emergency Care and Medicine, 2023
by
Raimundas Lunevicius
Emerg. Care Med. 2024, 1(1), 1-2; https://doi.org/10.3390/ecm1010001 - 05 Sep 2023
Abstract
The most recent global emergency medicine 56-question survey highlighted challenges and gaps in providing emergency care [...]
Full article
Highly Accessed Articles
Latest Books
E-Mail Alert
News
Topics
Conferences
Special Issues
Special Issue in
Emergency Care and Medicine
Emergency Medicine Update: Cardiopulmonary Resuscitation
Guest Editor: Sasa RajsicDeadline: 31 December 2024