International Journal of Critical Care and Emergency Medicine is an open access, peer reviewed journal publishing articles on emergency medicine and the intensive care. The Journal provides a platform for authors to contribute their findings and help raise awareness among readers in various aspects of emergency medicine. The journal aims to publish highest quality clinical content via open access platform providing the readers free, immediate and unlimited access.
International Journal of Critical Care and Emergency Medicine is an open journal which accelerates research updates in various aspects such as Acute Injury, Basic Investigations, Cardiology, Cardiopulmonary Resuscitation, Chest Pain Emergency, Clinical Controversies, Critical Care, Disaster Management, Emergency, Emergency Diagnostic and Therapeutic Techniques, Emergency Medicine, First Aid, Healthy Policy and Ethics, Immediate Response to Trauma, Injury and Disease Prevention, Intensive Care, Observational Cohort Studies, Out-of-Hospital Emergency Medical Service, Pharmacology, Pre-Hospital Care, Radiology, Rescue Squad, Sports Medicine, Sudden Illness, Toxicology, Traumatology, Visual Diagnosis in Emergency Medicine, Wound Care Techniques, etc. Original Article, Reviews, Mini Reviews, Short Communications, Case Reports, Clinical Image, Perspectives/Opinions, Letters, Short Note and Commentaries are accepted for publication. All articles published in the journal are subject to a rigorous peer review process. It encourages authors to publish their work in detail.
Articles Search by Keyword | Journal title | Author name | DOI
Open Access DOI:10.23937/2474-3674/1510081
Eliza Miranda Ramos, Matheus Dullius Lima, Valter Aragao do nascimento, Ph.D and Elaine Cristina Fernandes Baez Sarti
Article Type: Research Article | First Published: June 22, 2019
Iatrogenic conditions are those that result from the intervention of the multidisciplinary health team, whether correct or incorrect, justified or not, but which result in detrimental consequences for the patient's health. Few studies have focused on assessing the risks to patients, especially those hospitalized in emergency and intensive care services, and only in the last decades attention has been drawn to the importance of these problems...
Open Access DOI:10.23937/2474-3674/1510080
Adnan A Faraj, FRCS, Parvez Hussain, MRCS and Karthika Velusamy, MBBS
Article Type: Review Article | First Published: June 06, 2019
The management of Garden type 1 and 2 undisplaced proximal femoral intracapsular fracture in elderly patients is controversial. Many options including arthroplasty and fixation have been suggested based on patient's age and cognitive function. We have retrospectively reviewed 85 elderly patients with undisplaced femoral neck fracture. The mean age of the cohort was 81 years. 52 patients were treated with cemented hemi-arthroplasty, 19 with dynamic hip screw fixation, 10 had cannulated screw fixa...
Open Access DOI:10.23937/2474-3674/1510079
Alessandro Graziani, Federica Mirici Cappa, Erica Fiorini, Pierpaolo Casalini and Francesco Albertini
Article Type: Case Report | First Published: June 06, 2019
Splenic Infarction (SI) is a rare event that occurs when the Splenic Artery (SA) or its branches become occluded by embolus or by in situ thrombosis. Most SI events are a result of embolic sources either cardiac or aortic. However malignant hematological disorders and autoimmune diseases are the predominant causes of splenic thrombosis. Massive Splenic Infarction (MSI) results from compromised blood flow to more than half of the spleen. In this paper we describe a case of a previously healthy pa...
Open Access DOI:10.23937/2474-3674/1510078
Sherif Abdelmonem, Tamer Helmy, Iman El Sayed and Salma Ghazal
Article Type: Original Research | First Published: June 06, 2019
We aimed to verify if mean arterial pressure (MAP) at initiation of Propofol infusion and the APACHE score can predict the risk of severe hypotension. A prospective study on 100 patients treated with Propofol during their stay at the Main University Hospital between 2017 and 2018. We estimated relative risks (RRs) of severe hypotension according to MAP and APACHE score categories using a modified Poisson model for binary outcome....
Open Access DOI:10.23937/2474-3674/1510077
Sherif Abdelmonem, PhD, Ghada Abdel Hadi, PhD, Akram Fayed, PhD, Iman El Sayed, PhD and Khaled Mogazy, MD
Article Type: Observational Study | First Published: May 04, 2019
A case-control study was conducted on 159 adult patients admitted to the ICU of a governmental hospital, Alexandria, Egypt. We classified the patients using the Arabic version of Hamilton scale as either depressed or not. Bivariate and multivariate analyses were done to detect the relation between depression and different predictors after controlling the confounding effect of all other factors. The prevalence of depression in the ICU patients was 46.5%. The strongest risk factor for depression w...
Open Access DOI:10.23937/2474-3674/1510076
Arash Peivandi Yazdi, Leila Mashhadi and Mehryar Taghavi Gilani
Article Type: Case Report | First Published: April 15, 2019
Delirium is one of the postsurgical complications in the geriatric population. Its incidence was reported up to 65% following major operations, and it is accompanied with high cost, morbidity and mortality. A 65-year-old man candidate for laparoscopic cholecystectomy under spinal anesthesia. His hypertension was under control with captopril 50 mg daily. In the middle of the surgery, he had cardiac arrest and cardiopulmonary resuscitation was performed. Vital signs improved within 6 minutes, but ...
Open Access DOI:10.23937/2474-3674/1510075
Sinan Cem Uzunget, MD, Zamir Kemal Erturk, MD, Vahide Bilir Ozban, MD and Osman Hakan Guclu, MD
Article Type: Case Report | First Published: April 15, 2019
Glaucopsia is a rare disease that ensue with blue/gray vision or blurring of vision as a result of amine exhalation effect. It is known that the amine vapor forms caused epithelial edema and microcysts formation under the epithelium of the corneal surface. This mechanism is reason of ocular effects. The symptoms of amine effect start 30-90 minutes after exposure and within 4-6 hours and it recovers without any treatment. Amine vapor does not asso...
Open Access DOI:10.23937/2474-3674/1510074
Sellamuthu Subbanna Gounder, Rafeezul bin Mohamed and Baskar Subramani
Article Type: Original Article | First Published: April 12, 2019
Several advancements are made in the field of immunotherapy for enabling an effective cure for cancer. Treatments are being approached with multipronged approach with combination therapies as well as by gene therapy. Cancer incidence however progressing further mainly due to the changes in lifestyle. Epidemiological surveys indicate that cancer incidence is being more predominant in females; in particularly breast cancer is the most common diseas...
Open Access DOI:10.23937/2474-3674/1510073
Yao Yu, Yingzuo Shi and Yisen Zhang, MD
Article Type: Short Review | First Published: April 11, 2019
Sepsis is a deadly complication of pediatric infection. Tregs are a typical subset of lymphocytes showing immune suppressive function. Tregs show grateful influence to immune system in neonatal sepsis. The proportion of Tregs relate with inflammatory response, Oxidative stress sepsis and this would be a new curing targeting to immunotherapy. In this short review, we analysis the research findings of Tregs in neonatal sepsis and emphasize the sign...
Open Access DOI:10.23937/2474-3674/1510072
Carme Alejandre, MD, David Vila, PhD, Ana Olego, M Jose Tovar, Angels Llorens, Marta Hernandez, M Paz Larrosa and Elisabeth Esteban, PhD
Article Type: Original Research Article | First Published: April 11, 2019
A total of 220 patients were included, of whom 135 were male (61.4%) with a median age of 2.5 months (IQR 3 days-21 months). Median transfer time was 29 minutes (IQR 13-52 minutes). Sixty-three patients needed non-invasive ventilation (28.6%). The median score before the transfer was 16 (IQR 15-19) and after it 16 (IQR 14-18). In 23 cases (10.5%) patients were accompanied by their parents in the ambulance; no statistically significant differences were observed in the value of the score (p 0.959)...
Open Access DOI:10.23937/2474-3674/1510071
The Quantum Entanglement Dynamics Induced by Non-Linear Interaction between a Moving Nano Molecule and a Two-Mode Field with Two-Photon Transitions Using Reduced Von Neumann Entropy and Jaynes-Cummings Model for Human Cancer Cells, Tissues and Tumors Diagnosis
Alireza Heidari, Jennifer Esposito and Angela Caissutti
Article Type: Research Article | First Published: March 30, 2019
In the current study, an analytical model is presented to analyze interaction between a moving 6-Methoxy-8-[[6-Methoxy-8-[[6-Methoxy-2-Methyl-1-(2-Methylpropyl)-3,4-Dihydro-1H-Isoquinolin-7-yl]Oxy]-2-Methyl-1-(2-Methylpropyl)-3,4-Dihydro-1H-Isoquinolin-7-yl]Oxy]-2-Methyl-1-(2-Methylpropyl)-3,4-Dihydro-1H Isoquinolin-7-ol and a two-mode field in the presence of two-photon transitions and in the coupling regime dependent on intensity for human canc...
Open Access DOI:10.23937/2474-3674/1510070
SE Ibeanusi and J Chioma
Article Type: Research Article | First Published: March 14, 2019
Fractures of the femur in children are not as common as those of adults but presents significant morbidity when they do occur. Such fractures present in diverse pattern in terms of age, causes, season, treatment and outcome. Presentation and treatment is influenced by age of the patients, locality of practice, available resources and experience of treating surgeons. To evaluate the pattern of presentation, treatment and outcome of fractures of th...
Open Access DOI:10.23937/2474-3674/1510069
Kristin Schwab, MD, Jodi Friedman, MD, Michael E Lazarus, MD and Jason P Williams, MD
Article Type: Brief Report | First Published: February 16, 2019
Resident physicians are often required to perform central venous catheter (CVC) or intraosseous catheter (IO) placement when supervision is not readily available. We assessed whether brief CVC and IO simulation-based training increases resident knowledge and comfort performing these procedures unsupervised. Residents were assigned to either a 60-minute CVC training or a control group that received no training; they were also assigned to either a 30-minute IO training or a control group. Both tra...
Open Access DOI:10.23937/2474-3674/1510068
Edward A Ramoska, MD, MPH*, Virat Patel, MD, Alin Gragossian, DO and Romy Nocera, PhD
Article Type: Original Article | First Published: February 14, 2019
We evaluated 545 articles. Almost 60% of them were cohort studies; 17% were randomized controlled trials, 15% were cross-sectional studies and 4% were meta-analyses. The mean number of statistical tests per article was 4.16 (SD = 1.98), with a median of 4 (IQR = 2). The top ten statistical techniques applied (descriptive statistics, confidence intervals, contingency tables, t-tests, epidemiologic statistics, non-parametric tests, regression analysis, power analysis, multiway tables, and non-para...
Open Access DOI:10.23937/2474-3674/1510067
Peter Candik, Adrian Kolesar, Martin Nosal, Matus Pauliny, Frantisek Sabol, Viera Donicova, Viliam Donic and Pavol Torok
Article Type: Original Article | First Published: January 26, 2019
During cardiac surgery, extracorporeal circulation (ECC) causes lung injury. In these inhomogenously affected lungs, the pressure control ventilation (PCV) cannot adequately ventilate differently damaged lung compartments. We invented and used original multilevel lung ventilation method named 3-LV based on alternating 3 or more pressure levels, ventilation frequencies and delivered tidal volumes. The goal of this article is to compare lung mechanics in cardiac surgery patient after ECC using sta...
Open Access DOI:10.23937/2474-3674/1510066
Oshionwu EJ and Nwose EU
Article Type: Commentary | First Published: January 25, 2019
There are several theories on altruism including the concept of pseudo-altruism. The latter constitute divergent opinion around egoism and socioeconomic status (SES). Review has identified that the conflict between altruistic and pseudo-altruistic theoretical approaches can be resolved by combining elements from both concepts. The objective of this commentary is to advance (1) That there is 'benefit to the helping altruistic individual in all altruism theories; and (2) A unifying viewpoint in te...
Open Access DOI:10.23937/2474-3674/1510065
Katsiari M, Ntorlis K, Mathas C and Nikolaou C
Article Type: Original Article | First Published: January 07, 2018
Clinicians are often confronted with the timely discharge decision, in order to avoid readmission and escalation of costs. Aim of the present study was to determine potential risk factors for ICU readmission or death early after ICU discharge. The Intensive Care Unit (ICU) is the designated department in the hospital for the care of the most unstable and sickest patients. Depending on ICU availability, it is possible these intubated and critically ill patients are being hospitalized in other are...
Open Access DOI:10.23937/2474-3674/1510064
Harish Venkatesh, Sanjeev Ramachandran, Atanu Basu and Hari Nair
Article Type: Case Report | First Published: January 05, 2019
We report a unique case of extreme hypernatraemia of 196 mmol/L and severe sepsis in a young 39-year-old adult with Huntington's dementia, which presented a challenge in fluid management. The hypernatraemia was thought to be caused by chronic severe dehydration from poor intake and the sepsis was thought to have started as an inadequately treated urinary tract infection. The patient was initially treated aggressively with hypotonic saline and intravenous antibiotics but was subsequently managed ...
Open Access DOI:10.23937/2474-3674/1510063
Camille R Petri, Brittany L Ranchoff, Amy P Cohen, Amy M Sullivan, Richard M Schwartzstein and Margaret M Hayes
Article Type: Brief Report | First Published: January 04, 2019
Many hospitals in the United States employ overnight intensivist coverage for their medical intensive care units, but little is known about the effect of this staffing model on trainee education, and the learning that occurs overnight. This study examined the educational interactions occurring between residents and overnight intensivists in the context of the overnight multidisciplinary learning environment....
Open Access DOI:10.23937/2474-3674/1510062
Is it Always Necessary to Take Blood Cultures before Starting Antibiotics in the Emergency Department? A Review of Usefulness of Blood Cultures in Community-Acquired Pneumonia, Cellulitis, Urinary Tract Infection and Pyelonephritis
Koh Nan Jun, Quek Hui Yu and Lateef F
Article Type: Review Article | First Published: January 03, 2019
Routine blood cultures are commonly taken in patients who present to the Emergency Department (ED) with suspicion of infection. This is also in conjunction with treatment guidelines for severe community-acquired pneumonia, acute meningitis and bacteraemia, etc. The above practice has become a major area of resource utilisation, despite many studies showing poor yield of these cultures. The poor yield of blood cultures is financially costly for patients, and even more so for hospitals. Hidden cos...
Open Access DOI:10.23937/2474-3674/1510061
S Cacho Garcia, D Pena Otero and M Eguillor Mutiloa
Article Type: Review Article | First Published: January 03, 2019
Immobilization is one of the most used procedures to prevent spinal cord injury in multiple trauma patients in prehospital setting. However, its protocolary use has historical principles rather than a scientific origin. Although this technique restricts the movement of the injured spine, there is no evidence supporting its use in all patients suffering from trauma. The concept of multiple trauma includes all those patients who have traumatic injuries that affect at least two or more organs (or m...
Open Access DOI:10.23937/2474-3674/1510060
Berman Zoe, Pearl Joshua and Wiesel Ory
Article Type: Case Report | First Published: December 12, 2018
Lung cancer is an aggressive disease with projections estimating that more than 150,000 Americans will die in 2018 from lung cancer. Mortality is associated with advanced stage of disease and metastatic disease. While the major sites of metastases are the solid organs, the rate of soft tissue metastases has been reported as 0.75-9%. In an asymptomatic patient who is a nonsmoker, there is low likelihood to diagnose early lung cancer unless found i...
Open Access DOI:10.23937/2474-3674/1510059
Sunder Balasubramaniam, Rachel Yanlin Chen, Deng Tianshu and Teo Li Tserng
Article Type: Retrospective Study | First Published: December 12, 2018
The humble chest X ray (CXR) is an important factor in the assessment of the patient with traumatic injury. The Advanced Trauma Life Support (ATLS) programme recommends performing a CXR as part of the secondary survey, and this is widely used in Singapore. All general hospitals that receive trauma patients in Singapore have resuscitation bays capable of rapidly obtaining a CXR film using either a fixed radiology machine or a portable machine kept...
Open Access DOI:10.23937/2474-3674/1510058
Jolien De Meyer, Jolien De Pryck and Said Hachimi-Idrissi
Article Type: Original Article | First Published: December 01, 2018
Every year ischemic stroke takes many lives and leaves millions of people with neurological deficits. Currently the only approved therapy is recombinant tissue plasminogen activator, which should be administered within a narrow time window of 4.5 hours. Stem cell therapy was first initiated in several preclinical studies with promising results and lately in some clinical trials. Our research consists of 2 systematic reviews where preclinical and clinical studies were pooled. We provide a systemi...
Open Access DOI:10.23937/2474-3674/1510057
Wee Ming Tay, TS Go and LT Teo
Article Type: Research Article | First Published: November 24, 2018
To evaluate the incidence of venous thromboembolism (VTE) in Asian trauma patients and the relation to use of chemoprophylaxis with low molecular weight heparin (LMWH). The Tan Tock Seng trauma database between December 2011 and December 2012 was reviewed. All trauma patients with an injury severity score of 9 or more were included. All medical records were screened for Duplex ultrasound (US) of lower limbs, any computed tomography pulmonary angiogram (CTPA) performed and whether there was use o...
Open Access DOI:10.23937/2474-3674/1510056
Yonatan Gershinsky, David Leibowitz and Shaden Salameh
Article Type: Case Report | First Published: November 21, 2018
Postpartum cardiomyopathy is an important cause of heart failure in young women with an increasing rate in recent years. It may occur from the last month of pregnancy and up to five months after delivery. The etiology remains unclear and the disease has a high level of morbidity and mortality. Complications include CHF, arrhythmias, cardiogenic shock and thromboembolism. Treatment is similar to the treatment for CHF. Bromocriptine has shown encouraging preliminary results but is not standard the...
Open Access DOI:10.23937/2474-3674/1510055
Surekha Tayade, Neha Gangane, Poonam Shivkumar, Dinesh Baswal, Apurva Ratnu, Himanshu Bhushan and Jaya Kore
Article Type: Research Article | First Published: November 19, 2018
To analyze the requirement of High Dependency Unit (HDU) and Intensive care Unit (ICU) in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome. Retrospective observational study was carried out from October 2016 to September 2017 in Kasturba Hospital, Mother and Child Health Wing, Mahatma Gandhi Institute of Medical Sciences Sewagram placed in rural central India. Data rel...
Open Access DOI:10.23937/2474-3674/1510054
Domingo Daga-Ruiz, Jonathan Pérez-Vacas, Fernando Segura-Gonzalez, Gonzalo Moratalla-Cecilia, Araceli Puerto-Morlan, Pilar Nuevo-Ortega and Alba Fernandez-Porcel
Article Type: Original Article | First Published: November 16, 2018
We designed this Observational prospective cohort study to assess the safety, effectiveness and efficiency of the introduction of Regional Citrate Anticoagulation (RCA) as election strategy for Continuous Renal Replacement Therapies (CRRT). All patients in need of CRRT without contraindications to the use of RCA were included. It was necessary to adapt and implement the original RCA protocol, for the first time in a Spanish ICU. A total of 90 patients between October 2016 and October 2017 were i...
Open Access DOI:10.23937/2474-3674/1510053
Sergey Motov, Jefferson Drapkin, Antonios Likourezos, Peter Flom, Catsim Fassassi, John Marshall and Ronald Simon
Article Type: Case series | First Published: November 12, 2018
We compare analgesic efficacy and safety of sub-dissociative dose ketamine (SDK) to morphine for managing acute traumatic pain in geriatric emergency department (ED) patients. A subset of geriatric patients from a randomized double-blind trail experiencing moderate to severe acute traumatic pain who received SDK at 0.3 mg/kg or morphine at 0.1 mg/kg by short intravenous infusion over 15 minutes was analyzed at 15, 30, 60, 90, and 120 minutes post-medication administration. Primary outcome was re...
Open Access DOI:10.23937/2474-3674/1510052
Catsim Fassassi and Ronald Simon
Article Type: Case report | First Published: November 02, 2018
35-year-old woman with a past psychiatric history and alcohol abuse was found unresponsive on the bathroom floor by her boyfriend. EMS was called, and chest compressions were commenced by the boyfriend while awaiting EMS arrival. EMS found the patient to be in PEA and continued CPR on scene and during transport. ROSC was achieved while en route to the hospital. On arrival to the ED she was initially normotensive but quickly decompensated requirin...
Open Access DOI:10.23937/2474-3674/1510051
Shieh Mei Lai, Poongkulali Anaikatti, Pravin Thiruchelvam, Siang Chew Chai, Thon Hon Yong, Yew Seong Goh, Sheldon Lee, Rahul Goswami, Charlene Jin Yee Liew and Pak Liang Goh
Article Type: Original Article | First Published: October 12, 2018
To assess the safety and efficacy of an Emergency Department Chest Pain Protocol in ruling out Acute Coronary Syndrome in a regional hospital in Singapore. An audit was carried out of the cases admitted to our Short Stay Unit (SSU) under the Chest Pain Protocol from June to November 2014. Patients presenting with chest pain and possible acute coronary syndrome, but with normal initial electrocardiogram (ECG) and troponin level, could undergo this rule-out protocol, which comprised serial ECGs an...
Open Access DOI:10.23937/2474-3674/1510050
Caitlin Gilman and Tanya Chadha
Article Type: Case Report | First Published: October 12, 2018
The patient is an 8-year-old Caucasian male with no significant past medical history referred to the emergency department by his pediatrician for possible appendicitis. The day prior to presentation, his mother noted decreased energy and appetite. He went to sleep soon after arriving home from school and woke up twice overnight with non-bloody, non-bilious emesis. He began complaining of right-sided back and abdominal pain in the morning and was brought to his pediatrician, where he was immediat...
Open Access DOI:10.23937/2474-3674/1510049
Julie Kalabalik and Ayse Elif Ozdener
Article Type: Review Article | First Published: October 12, 2018
There is increased interest in the role of the gastrointestinal (GI) or gut microbiome and its role in prevention and treatment of disease. The gut microbiome alone consists of approximately 400 strains of bacteria, fungi, and parasites. Anaerobes are the predominant type of microorganism in the GI tract with Firmicutes and Bacteroidetes being the dominant phyla. The gut microbiome is involved in metabolism, host protection, and immune function. It plays an important role in metabolism of nondig...
Open Access DOI:10.23937/2474-3674/1510048
Salvador Diaz-Lobato, Jose Manuel Carratala Perales, Jose miguel Alonso Inigo, Sagrario Mayoralas Alises, Barbara Segovia, Noelia Escalier, Maria Ines Mattioli, Ana Jaureguizar and Diurbis Velasco
Article Type: Original Article | First Published: October 12, 2018
High-flow nasal cannula oxygen therapy (HFNC) has revolutionized the treatment of patients with respiratory failure in different settings. Several mechanisms of action explain us why HFNC has become a first line therapy for these patients. Some authors have referred to the adverse effects that can occur when we use HFNC and its limitations. However, there are numerous aspects that we should consider when prescribing this treatment and that are no...
Open Access DOI:10.23937/2474-3674/1510047
Lilian T Mselle and Halima Msengi
Article Type: Research Article | First Published: October 12, 2018
Studies in Tanzania have reported that many hospitals in the country have no intensive care unit (ICU) where critically ill patients could be managed thus critically ill patients are cared for with other non-critical patients. The aim of this study is to describe nurses and physicians' experience of caring critically ill patients in the general wards at the Regional hospital. A descriptive qualitative design was used. Purposeful sampling method was used to enroll 10 nurses and 5 physicians worki...
Open Access DOI:10.23937/2474-3674/1510046
Talayeh Rezayat, Igor Barjaktarevic, Ian Mecham, Lisa Yee, Ramy Salah, Lisa Zhu, Kereat Grewal, Jody Anderson, Nicholas J Jackson, David Elashoff and Elizabeth Turner
Article Type: Research Article | First Published: October 06, 2018
Rapid assessment and treatment of the critically ill in shock is crucial to survival. The RUSH (Rapid Ultrasound in Shock and Hypotension) exam uses Ultrasound (US) to determine the etiology of undifferentiated shock, but data to demonstrate impact of focused US on clinical outcomes is sparse. This study aimed to assess the clinical impact of early incorporation of the RUSH US exam in the care of patients with new onset shock on a population leve...
Open Access DOI:10.23937/2474-3674/1510045
Amit K Asati, Rajnish Gupta and D Behera
Article Type: Original Article | First Published: September 28, 2018
Sepsis is one of major causes of mortality in non-cardiac ICU patients. The screening of the patients for sepsis needs a careful evaluation of criteria and confirmation of infection. SIRS criteria for identification of patients with sepsis is not alone sufficient. Lactate has been shown to be a very important severity marker in sepsis cases and has been found to be more useful for predicting the outcome of sepsis than common severity scores such ...
Open Access DOI:10.23937/2474-3674/1510044
John Blixt, Shazia Raheem and Stephen Bujarski
Article Type: Case Report | First Published: September 22, 2018
Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant, has been associated with severe cardiotoxicity in massive overdoses. Treatment is usually supportive. Over the past decade, intravenous lipid emulsion has been gaining interest in the treatment of intoxications with lipophilic substances. We report a case of refractory pulseless electrical activity cardiac arrest following a massive overdose of venlafaxine successfully treated with intravenous lipid emulsion infusi...
Open Access DOI:10.23937/2474-3674/1510043
Xuelu Zhou and Shangjun Zhou
Article Type: Research Article | First Published: August 29, 2018
In 113 publications 984 cases (including our eight cases) were retrieved. An annual incidence in China has been estimated between 0.002/million and 0.2/million male populations. The commonest causes were coitus and masturbation. Clinical features were the classical triad of "cracking" sound, immediate detumescence and pain. Swelling, ecchymosis and deformity were present in the majority of patients. Diagnosis was made mainly on clinical grounds; ...
Open Access DOI:10.23937/2474-3674/1510042
Srihari Cattamanchi, Lucas C Carlson, Felicity Gonzalez and Anbrasi Edward
Article Type: Original Article | First Published: August 16, 2018
Extensive evidence from high-income countries has demonstrated the value of quality improvement (QI) methods yet reports of their use in LMICs are markedly limited. We aim to explore how QI can be implemented in the setting of an LMIC to remove barriers to timely antibiotic therapy for severe sepsis....
Open Access DOI:10.23937/2474-3674/1510041
Sevtap Gursoy, Kadriye Kart Yasar, N Didem Sari, Nuray Kuvat and Savas Ozturk
Article Type: Case Report | First Published: August 11, 2018
Sphingomonas paucimobilis is an aerobic, non-fermentative gram-negative motile bacterium that may be an unusual infectious agent for immunocompromised host. Intravascular instrumentations are commonly applied in the hemodialysis patients. These procedures have an increased risk for infection with unusual, rare and opportunistic pathogens....
Open Access DOI:10.23937/2474-3674/1510040
Mikio Shiozawa, Alan Kawarai Lefor, Naohiro Sata, Yoshikazu Yasuda and Hideo Nagai
Article Type: Original Research Article | First Published: August 06, 2018
In June 2000, the Miyakejima volcano suddenly erupted, forcing evacuation of all inhabitants. We undertook this study to evaluate the effects on the health of inhabitants after their returning to the island 4 years after the eruption. We examined 269 inhabitants, who visited the Miyakejima Central Clinic, and specifically discussed symptoms related to exposure and anxiety related to the disaster....
Open Access DOI:10.23937/2474-3674/1510039
Chihiro Nakano, Toru Yamagishi, Norio Kodaka, Kayo Watanabe, Kumiko Kishimoto, Takeshi Oshio, Kumiko Niitsuma, Nagashige Shimada and Hiroto Matsuse
Article Type: Original Article | First Published: July 30, 2018
Most cases of pneumothorax comprise primary spontaneous pneumothorax (PSP), which usually occurs in young, tall men and results from rupture of subpleural blebs or bullae. Secondary spontaneous pneumothorax (SSP), on the other hand, is associated with an underlying lung disease, such as emphysema or asthma; acute or chronic infections; lung cancer; and congenital disease, including cystic fibrosis, catamenial pneumothorax, and lymphangioleiomyoma...
Open Access DOI:10.23937/2474-3674/1510038
Daniel Sermoneta, Francesco Favi, Carlo Salvadori, Marco Coniglio and Francesco Saverio Mari
Article Type: Original Article | First Published: July 30, 2018
Foreign body ingestion is a very common reason for access to the Emergency Department and in most cases, it doesn't cause symptoms; in case of fishbones, intestinal perforation is rare but possible. In this report, besides the typical picture of bowel perforation, we found atypical symptoms due to the specific location. ...
Open Access DOI:10.23937/2474-3674/1510037
Shahla Siddiqui and Robin Choo
Article Type: Original Article | First Published: July 14, 2018
Over the last decade an increasing number of elderly patients are being admitted to the Intensive care units across the World. With a rapidly ageing population Asian countries face a tremendous burden of care for these patients. Family expectations have also increased with more demanding aggressive life support even in the older patients. Patients are generally getting less frail as they age and with the improvement in technology and advancements in medical science the outcomes of these patients...
Open Access DOI:10.23937/2474-3674/1510036
Article Type: Case Report | First Published: June 21, 2018
The acute management of broad complex tachycardias in the Emergency Department (ED) can often pose a significant challenge, not just for the more inexperienced of doctors. This is often due to the potentially lethal nature of this arrhythmia, the perceived complexity of ECG interpretation or handling of antiarrhythmic drugs. Whilst most doctors are aware that broad complex tachycardias are in the vast majority of cases related to structural abnor...
Open Access DOI:10.23937/2474-3674/1510035
Jaspreet Singh, Shankar K Thampi, Amit Alam, Rajiv Jauhar, Apoor Patel, and Avneet Singh
Article Type: Case Report | First Published: June 15, 2018
Specific criteria have been developed for the diagnosis of acute myocardial infarction in patients with right ventricular pacing, but not for patients with bi-ventricular pacing. We present a case of a patient with a biventricular implantable cardioverter defibrillator (BiVICD), who presented with symptoms consistent with acute coronary syndrome (ACS), new ST elevations of the inferior leads, and was found to have acute occlusion of right coronar...
Open Access DOI:10.23937/2474-3674/1510034
Bree Kramer and Christopher Heard
Article Type: Research Article | First Published: June 14, 2018
Noise exposure is an important factor in the management of intensive care patients. There are many different causes of noise in the ICU such as equipment, monitors, staff, family plus other additional sources. Patients in the ICU are exposed to these noise sources for 24 hours a day with no respite. The noise levels can vary significantly during the day as well as significantly between patient bed-spaces. There are detrimental effects from excess...
Open Access DOI:10.23937/2474-3674/1510033
Teresa A Hand and Debkumar Chowdhury
Article Type: Case Report | First Published: June 06, 2018
Carbon monoxide poisoning can present in subtle ways with a variable range of symptoms from mild headaches to profound neurological impairment. The primary aim of this article is to highlight the importance of early detection of carbon monoxide poisoning through meticulous clinical assessment. The secondary aim of this article is to review the current treatment strategies. ...
Open Access DOI:10.23937/2474-3674/1510032
Jean-Michel Liet, Alexis Chenouard, Sebastien Faraj, Armelle Garenne and Pierre Bourgoin
Article Type: Case Report | First Published: June 06, 2018
Managing mechanical ventilation in patients with bronchopleural fistula (BPF) can be hazardous, especially in case of large air leaks and underlying parenchymal lung disease. The fistulous tract offers low airflow resistance, and air escapes through the BPF to the detriment of the tidal volume, jeopardizing the minute ventilation and oxygenation. ...
Open Access DOI:10.23937/2474-3674/1510031
Jose Luis Vazquez Martinez, Aida Lopez de Pedro, Ana Coca Perez, Raul Montero Yeboles and Cesar Perez-Caballero Macarron
Article Type: Case Report | First Published: January 31, 2018
Bilateral diaphragmatic paresis following cardiac surgery is rare. We present a case in which several extubation attempts failed in an infant after cardiac surgery. Point-of-care ultrasonography (POCUS) showed a slight but symmetric decrease of diaphragmatic motion, confirmed by fluoroscopy. Phrenic electromyography (EMG) was informed inconsistently as normal. After eight weeks of non-invasive ventilation the patient was weaned to room air, revea...
Open Access DOI:10.23937/2474-3674/1510030
Haruka Kuno, Harumi Gomi, Kazutaka Fukushima, Yukiko Kodama, Taijiro Shirokawa, Kousei Miura, Shijima Taguchi, Norio Takayashiki and Takao Kanai
Article Type: Case Report | First Published: November 24, 2017
Gas gangrene is a rare, life-threatening deep skin infection typically related to contaminated wounds, although it may occur without injury. Non-traumatic gas gangrene due to Clostridium spp. is most commonly caused by Clostridium septicum....
Open Access DOI:10.23937/2474-3674/1510029
Article Type: Case Report | First Published: November 22, 2017
As initial therapy for cerebral sinus thrombosis, heparin injection and subsequent oral anticoagulant, namely warfarin, has been recommended. We treated a patient with cerebral sinus thrombosis with edoxaban alone as an outpatient. This is the first report of cerebral sinus thrombosis being treated with edoxaban alone....
Open Access DOI:10.23937/2474-3674/1510028
Article Type: Case Report | First Published: October 26, 2017
Agenesis of the bilateral internal carotid arteries is a rare disease. There have been few case reports of subjects who developed cerebral infarction, intracranial hemorrhage or subarachnoid hemorrhage. We experienced a rare case of agenesis of the bilateral internal carotid arteries in which the patient developed vertigo....
Open Access DOI:10.23937/2474-3674/1510027
Article Type: Review Article | First Published: May 17, 2017
Allergic asthma and rhinitis, Atopic Dermatitis (AD), urticaria and gastrointestinal allergy, are common diseases of infants and children. It was recently estimated that 14% of children suffer from AD, 8% from food allergy, and 12% from asthma. The cumulated incidence of these diseases in adolescents has been estimated between 25-35%, while the prevalence is about 20%....
Open Access DOI:10.23937/2474-3674/1510026
Saiprasad Narsingam, Benjamin S Abella, Anne V Grossestreuer and Paul S Chan
Article Type: Original Research | First Published: May 15, 2017
Targeted temperature management (TTM) improves outcomes in patients with Out-of-Hospital cardiac arrest (OHCA) due to Shockable rhythms. The frequency with which TTM is used for Non-Shockable cardiac arrest rhythms and for In-Hospital cardiac arrest (IHCA) is unknown....
Open Access DOI:10.23937/2474-3674/1510025
Jennifer Li, Simon Turner, Gordon Finlayson, Basil Nasir, John Yee and Anna McGuire
Article Type: Case Report | First Published: May 12, 2017
Although rare, spontaneous esophageal perforation or "Boerhaave syndrome", carries a high case fatality rate. The 'classic' presentation of chest pain, vomiting and subcutaneous emphysema is actually uncommon clinically, with the literature reporting variable initial presentations....
Open Access DOI:10.23937/2474-3674/1510024
Manuel Pinero Zapata, Miriam Martinez Villanueva, Francisco V Aviles Plaza, Cesar Cinesi Gomez, Aurelio Luna Maldonado and Maria E Legaz Moreno
Article Type: Research Article | First Published: May 11, 2017
The mid-regional fragment of the peptide complex Pro-adrenomedullin (MR-proADM) is a ubiquitous biomarker tissue distribution in the human body with increased levels in the course of certain diseases of great importance for vital engagement and whose clinical course is often associated with dyspnoea....
Open Access DOI:10.23937/2474-3674/1510023
Antonio Giovanni Solimando, Antonella Argentiero, Anna Ruckdeschel, MaxBittrich, Andreas Schneider, Rodolfo Sbrojavacca, Angelo Vacca, Georg Fritz and Hermann Einsele
Article Type: Case Report | First Published: February 25, 2017
Acute heart failure (AHF) represents a heterogeneous clinical syndrome, comprising new or worsening signs and symptoms on a background of stable chronic heart failure (HF), as well as new-onset HF. In either clinical picture, urgent care is crucial. Given the variety of clinical scenario, stratifying patient subgroups on a pathophysiologic base can help direct appropriate therapy. ...
Open Access DOI:10.23937/2474-3674/1510022
Beatriz Oyanguren, Araceli Alonso-Canovas, Alicia de Felipe and Jaime Masjuan
Article Type: Case Report | First Published: February 18, 2017
Five patients with CAE were admitted to our Emergency Department (A-E). All experienced loss of consciousness (LOC). Chest radiograph showed thoracic bullae. Brain computed tomography (CT) showed subarachnoid bubbles (A), intraparenchymal bubbles (B), global hypoperfusion (C), or no abnormalities (D, E). With supportive treatment, four survived, while B died. Including ours, 18 cases of CAE during commercial flights have been reported. LOC and dy...
Open Access DOI:10.23937/2474-3674/1510021
Ephraim B Winzer and Axel Linke
Article Type: Case Report | First Published: January 25, 2017
In patients with stable coronary artery disease percutaneous coronary intervention (PCI) effectively improves symptoms in the absence of any effect on prognosis. In contrast, in patients with acute coronary syndrome (ACS) PCI significantly reduces the risk of acute myocardial infarction and death as compared to conservative, noninvasive strategy....
Open Access DOI:10.23937/2474-3674/1510020
Ramiro Galvez-Valdovinos, Ernesto Marin Y Santillan and Gustavo Lopez-Ambriz
Article Type: Case Report | First Published: September 12, 2016
A 39-year-old man with abdominal pain, fever and general poor state. Physical examination showed fever, Tachycardia, Left basal hypoventilation and acute surgical abdomen. A Abdominal X-Ray showed accumulation of calcifications in mesogastric. The laboratory test showed leukocytosis and the abdominal CT-Scan showed the cause of the acute surgical abdomen. The laparoscopic surgery was recommended and performed....
Open Access DOI:10.23937/2474-3674/1510019
Mirko Zanatta, Piero Benato and Vito Cianci
Article Type: Review Article | First Published: July 20, 2016
The mission of pre-hospital medical service is to provide rapid and high quality life support. The development of specific protocols, the availability of new diagnostic tools have determined a significant improvement of pre-hospital care. The use of ultrasound in the pre-hospital medical service is a new and reliable diagnostic device....
Open Access DOI:10.23937/2474-3674/1510018
Arlene Muzira Nakanwagi, Stephen C Kijjambu, Peter Ongom and Tonny Stone Luggya
Article Type: Research Article | First Published: July 04, 2016
Intestinal Obstruction is the impairment of normal flow of intestinal contents from mouth to anal canal with aetiology that varies depending on various factors. Understanding aetiology of a country's surgical services has proven to aid better planning for its emergency surgical conditions. Mulago, which is Uganda's National Referral Hospital, is resource constrained with a surgical burden of 33% due to acute abdomen with Intestinal Obstruction. T...
Open Access DOI:10.23937/2474-3674/1510017
Martin D Rosenthal, Cameron Rosenthal, Jayshil Patel, Janeen Jordan, Kristina Go and Frederick A Moore
Article Type: Review Article | First Published: July 04, 2016
Arginine is a conditional amino acid that has a wide breadth of metabolic activity and applications when supplemented. During critical illness, high stressed states, and increased metabolic demand arginine becomes an essential amino acid. It is during this time that supplementation benefits the host. Arginine supplementation during sepsis, however, has remained controversial as there is theoretical harm stemming from arginine serving as a substra...
Open Access DOI:10.23937/2474-3674/1510016
Jean A Klastersky
Article Type: Commentary | First Published: July 03, 2016
Chemotherapy-induced neutropenia in patients with cancer were comprehensively discussed recently by Bennett et al. While similar appraisals are available in the literature, evaluation of the problem on a national basis is useful for practicing physicians as it take into consideration local aspects relating to microbiological epidemiology and general medical practice that can modulate international guidelines....
Open Access DOI:10.23937/2474-3674/1510015
Rose Allen and Eve Butler
Article Type: Research Article | First Published: May 03, 2016
Background: Moral distress can affect critical care nurses caring for complex patients. It can result in job dissatisfaction, loss of capacity for caring, and nurse turnover, resulting in a negative impact on quality care. Aim: This study purpose was to determine how moral distress impacts critical care nurses (adult and pediatric) and to implement improvement strategies to reduce moral distress, improve job satisfaction, and retention. Theoretic...
Open Access DOI:10.23937/2474-3674/1510014
Jonathan W Kamrud, Lori L Boland, Carol L Frazee, Tyler G Kinzy, Paul A Satterlee and Charles J Lick
Article Type: Research Article | First Published: May 02, 2016
Mechanical compression devices purportedly improve the quality of chest compressions by minimizing interruptions and maintaining optimal rate and depth, but this claim has not been objectively substantiated using transthoracic impedance (TTI) recordings from applied setting cardiac arrests. In this study, we use TTI data to compare chest compression quality metrics from the manual versus mechanical compression phases of out-of-hospital cardiac ar...
Open Access DOI:10.23937/2474-3674/1510013
Nissar Shaikh, Tasneem Mehesry, Gulzar Hussain, Arshad Chanda, Ali Belkhair, Syed Sheikh, Faisal Malmstrom and Marcus AE
Article Type: Research Article | First Published: April 08, 2016
Extubation failure increases morbidity and mortality in intensive care. Laryngeal edema which developed post extubation is one of the major risk factor for extubation failure. Post extubation laryngeal edema occurs in up to 37% of the extubations. Steroids are commonly used pre extubation to prevent development of laryngeal edema. Aim of this study was to find whether steroids can prevent post extubation laryngeal edema and types of patients who ...
Open Access DOI:10.23937/2474-3674/1510012
Satoshi Kazuma, Yoshiki Masuda, Hiroomi Tatsumi, Kanako Takahashi, Shinichiro Yoshida, Maiko Honma, Hitoshi Imaizumi and Michiaki Yamakage
Article Type: Case Report | First Published: February 26, 2016
A 54-year-old female weighing 62 kg had hemoptysis with an unidentified focus 4 months before and had been followed in the Department of Respiratory Medicine. Angiographic embolization was performed for a right bronchial artery ramification suspected of being the bleeding focus by bronchofiberscopy, but there were few effects. Right middle lobectomy was performed to control the persistent hemoptysis, and tracheal extubation was performed on the s...
Open Access DOI:10.23937/2474-3674/1510011
Andrea M Pakula, Jannet Gannon, Lisa Mundy, Kathleen Berns, Anita Stoltenberg and Beth A Ballinger
Article Type: Literature Review | First Published: January 30, 2016
The decision to transport a critically ill patient is based on the need for diagnostic or therapeutic procedures that are not available within the intensive care unit. Most commonly this type of transport is within the home facility and is for procedures such as imaging or for operative intervention. Theoretically, intra-hospital transfers are safer than the transfers to another institution, as transfers outside of the home facility tend to requi...
Open Access DOI:10.23937/2474-3674/1510010
Yiheng Wang, Lixian He, Xiaoling Hu, Zhigang Zhou, Hong Zhou
Article Type: Case Report | First Published: January 30, 2016
The authors report an inadvertent late migration of right jugular catheter and the unexpected complications. Postoperative computed tomography reveals bilateral pleural effusion and pneumomediastinum. We speculate that the migration during the maintenance or multiple attempts of placing a guidewire damaged the wall of right brachiocephalic vein or superior vena cava, and punctured through right pleura and anterior mediastinal leading into the com...
Open Access DOI:10.23937/2474-3674/1510009
Gonzalo Hernandez, Concepcion Vaquero Collado, Susana Garcia Plaza, Ana Villasclaras Pacheco, Candido Pardo Rey, Eugenia de la Fuente O'Connor, Rafael Cuena, Paloma Gonzalez Arenas, Rafael Fernandez
Article Type: Original Research Article | First Published: December 31, 2015
Oxygen delivery after extubation is the cornerstone treatment to maintain adequate oxygenation and avoid reintubation. Oxygen is usually delivered through low-flow nasal prongs; when necessary, flow is increased or patients are switched to a high-flow face mask. Some other interventions after extubation focus on specific causes of reintubation; for example, high risk patients are administered prophylactic corticosteroids before planned extubation...
Open Access DOI:10.23937/2474-3674/1510008
Relationship Between Isolating Multi-Drug Resistant A. Baumannii and K. Pneumoniae in Bronchial Aspirate and Subsequently in Blood Cultures: Evaluation of Colistin Aerosol Therapy in Intensive Care Patients
Distasi Maria Antonietta, Del Gaudio Tito, Malcangi Annarita and Pirronti Angela
Article Type: Research Article | First Published: December 30, 2015
Klebsiella pneumoniae (K. pneumoniae) and Acinetobacter baumannii (A. baumannii) are multiresistant pathogens most frequently found in patients hospitalized in the Intensive Care of our hospital. We found the highest rate of positivity in the bronchial aspirates, often followed by a similar observation in blood culture. We carried out a study to evaluate the reduction of sepsis that developed after the detection of these microorganisms in bronchi...
Open Access DOI:10.23937/2474-3674/1510007
Daniel Saenz-Abad, Jose Antonio Gimeno-Orna, Maria del Carmen Lahoza-Perez, Elena Rivero-Sanz, Marta Jordan-Domingo, Artur Juan-Arribas, Maria del Mar Becerra-Mayor and Cristina Baquer-Sahun
Article Type: Original Research | First Published: October 30, 2015
This is a case-control retrospective analytical study. The cases were patients deceased during hospitalization and controls where those discharged in the same time period. Patients were age-matched and the final outcome of the study was hospital mortality. Rapid Emergency Medicine Score (REMS) and Charlson comorbidity index as well as blood analysis (full blood count, glucose, renal function, ions) were determined. Abnormal glucose levels (dysgly...
Open Access DOI:10.23937/2474-3674/1510006
Tobias Willich and Andreas Goette
Article Type: Review Article | First Published: October 01, 2015
This review provides an overview of the available therapeutic options for acute care and management of malignant ventricular arrhythmias (VA) such as ventricular tachycardia (VT), ventricular fibrillation (VF) and electrical storm (ES). As therapeutic options antiarrhythmic drug (AAD) therapy, implantable cardioverter defibrillator therapy (ICD), radiofrequency catheter ablation (RFA) and neuroaxial modulation like stellate ganglion blockade or r...
Open Access DOI:10.23937/2474-3674/1510005
Carol Ann Kelly and Dave Lynes
Article Type: Non-systematic Review | First Published: September 14, 2015
Oxygen's image, together with its reputation, is changing. No longer is it regarded as a benign panacea for all clinical presentations; indeed it is now increasingly evident that oxygen has the potential to contribute to clinical deterioration and mortality. There is an emerging recognition that oxygen is a drug when administered as a therapeutic intervention and should be used with caution. Contemporary guidelines offer criteria and directives f...
Open Access DOI:10.23937/2474-3674/1510004
Bethany Radin DO, H Neal Reynolds, Uttam K Bodanapally and David Dreizin
Article Type: Research Article | First Published: August 31, 2015
Objective: To review the spectrum of scenarios in which cerebral fat embolism syndrome (CFES) may present, the clinical presentation, traditional diagnostic criteria, and current diagnostic technologies. Methods: Three cases are presented representing Classical presentation (CFES presenting after Intramedullary rods for long bone fractures), Atypical presentation (CFES presenting after long bone fractures without intramedullary rods), and Unexpec...
Open Access DOI:10.23937/2474-3674/1510003
oortje Godijn, Simone M Smits and Peter HJ van der Voort
Article Type: Original Article | First Published: August 14, 2015
In the intensive care unit (ICU) physicians are challenged to predict patient outcome when patients are admitted. Over the years, several tools have been developed for this purpose. Examples are the Acute Physiology and Chronic Health Evaluation (APACHE) and Sepsis Related Organ Failure Assessment (SOFA) scoring systems....
Open Access DOI:10.23937/2474-3674/1510002
Julie Kalabalik and Jesse B. Sullivan
Article Type: Review Article | First Published: July 30, 2015
Alcohol consumption plays a role in the development of over 200 diseases and conditions in individuals worldwide, including liver cirrhosis, cancers, traumatic injury, and alcohol dependence. In hospitalized patients with alcohol use disorders (AUD), up to 25% will develop acute alcohol withdrawal syndrome (AWS). In critically ill patients, presence of AWS is associated with increased duration of mechanical ventilation, prolonged intensive care u...
Open Access DOI:10.23937/2474-3674/1510001
Ivan Ortega Deballon
Article Type: Editorial | First Published: July 18, 2015
Determination of death, the exact moment that a person's death occurs, has been a constant challenge throughout human being history. What we already know is that death usually does not occur abruptly, at a specific time and for all parts of the body simultaneously. Human resistance to degradation by lack of oxygen varies depending on the type of cell and organ. It is possible, for example, for successful cornea transplants from deceased individua...
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