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.

Journal Information

Title: International Journal of Critical Care and Emergency Medicine

ISSN: 2474-3674

Editor-in-chief: Yasushi Shibata

NLM title abbreviation: Int J Crit Care Emerg Med

ICV: 92.83

ISO abbreviation: Int J Crit Care Emerg Med

Other titles: IJCCEM

Category: General Medicine

DOI: 10.23937/2474-3674

Peer review: Double blind

Review speed: 3 weeks

Fast-track review: 10 days

Publication format (s): Electronic and print

Publication policy: Open Access; COPE guide

Publication type(s): Periodicals

Publisher: ClinMed International Library

Country of publication: USA

Language: English

Contact email:

Articles Search by   Keyword   |   Journal title   |   Author name   |   DOI


 Open Access DOI:10.23937/2474-3674/1510160

Therapeutic Plasma Exchange for Acute Pancreatitis Secondary to Hypertriglyceridemia: Case Report and Review of the Literature

Giorgio Berlot, Ariella Tomasini and Michele Contadini

Article Type: Case Report | First Published: 2024/03/30

A patient with acute pancreatitis was admitted to our Intensive Care Unit due to arterial hypotension and hypoxemia that responded to fluid resuscitation and supplemental oxygen; the blood chemistries revealed extremely elevate triglycerides and cholesterol levels. A therapeutic plasma exchange was performed on an emergency basis and determined their sharp decrease. The patient was transferred to a regular ward 6 days later, and a CT-scan obtained after one more week at demonstrated a large pseu...

 Open Access DOI:10.23937/2474-3674/1510159

A Rare Cause of Acute Chest Pain

Cátia Ribeiro Santos, Carolina Roriz and Vera Frazão Vieira

Article Type: Patient Care | First Published: 2024/02/09

Chest pain is one of the most common symptoms for which adults seek medical care, making chest pain the second most common complaint [1]. A central goal in the emergency department is to determine whether acute chest pain is a life-threatening condition for the patient [1,2]. Acute onset of chest may also be seen with disorders such as aortic aneurysm dissection, myocardial infarction, spontaneous pneumothorax, pneumonia, pancreatitis, peptic ulcer perforation, or esophageal perforation....

 Open Access DOI:10.23937/2474-3674/1510158

Systemic Air Embolism: A Rare Complication of Transthoracic Computed Tomography-Guided Lung Biopsy

Patrícia Varela Ramos, Marco Fernandes, António Costa and Paula Rosa

Article Type: Case Report | First Published: 2023/12/09

Systemic air embolism (SAE) is a rare but potentially life-threatening complication of transthoracic computed tomography (CT)-guided lung biopsy [1-6], with reported incidence rates of 0.02-0.07% to 0.21-4.8% [3,5,7,8]. However, the incidence might be underestimated due to failure to diagnose this adverse event in asymptomatic patients as its early recognition is difficult ....

 Open Access DOI:10.23937/2474-3674/1510157

The Missing Tail: An Iatrogenic In-Situ Peripheral Intravenous Catheter Fracture

Aditya Sharma, Rajeshwar Yadav and Swati Pathak

Article Type: Case Report | First Published: 2023/10/28

Securing a peripheral venous line is one of the most common procedures used in hospital settings. Although this is an easier task and a routine exercise, if not done properly, it can have dire consequences. This case report revolves around a 40-year-old man admitted to a super-specialty unit of a tertiary care hospital, while removing a venous catheter, was locally examined for a retained fragment of a peripheral venous catheter when the attending nurse noticed his absent tail. ...

 Open Access DOI:10.23937/2474-3674/1510156

Emergency Airway Management due to Angioedema

Cátia Ribeiro Santos, Simone Costa and Ana Araújo

Article Type: Patient Care | First Published: 2023/10/22

Angioedema evaluation and management should focus on the airway initially because the main concern in the patient in angioedema is airway obstruction. Indeed, airway obstruction can occur in up to 15% of patients with angioedema [1,2]. Angioedema in the emergency department is a common presentation and the threat of asphyxiation can be fatal, therefore, prompt diagnosis and correct treatment are critical....

 Open Access DOI:10.23937/2474-3674/1510155

Methylene Blue in Management of Vasoplegic Shock Secondary to Primidone Overdose

Elizabeth DeMarco, PharmD, BCPS, Matthew Turnipseed, PharmD and Farhan Qadeer, MD

Article Type: Case Report | First Published: 2023/09/13

Vasoplegic shock refractory to vasopressors is associated with significant morbidity and mortality. Catecholamine driven therapies are first-line in the management of vasoplegic shock. Research regarding the use of non-catecholamine agents in the setting of refractory vasoplegic shock is lacking. Methylene blue has multiple off-labelled indications for use, but recently has been suggested to have a role in treating vasoplegic shock....

 Open Access DOI:10.23937/2474-3674/1510154

More than a Persistent Urinary Tract Infection: The Usefulness of Ultrasound in the Emergency Department in a Clinical Case

Joaquín Asensio Sánchez and Cristina Asensio Sánchez

Article Type: Clinical Case | First Published: April 13, 2023

A 65-year-old male, hypertensive and non-insulin-dependent type 2 diabetes mellitus as the only personal history of interest, who came to the Emergency Department of our hospital with micturition symptoms consisting of dysuria and pollakiuria associated with mild hematuria and hypogastric pain of 14 days of evolution. The patient did not report fever or any other associated symptoms. In addition, he told us that, at first, he had gone to his Health Center and consulted his Primary Care Physician...

 Open Access DOI:10.23937/2474-3674/1510153

Most Frequent Cause of Dialysis Emergency and Precipitating Factor in Patients with Chronic Kidney Disease Attending the Emergency Department of HGZ 50 in San Luis Potosí, Mexico

Karen Janeth Marroquín Morales and Alberto Ruiz Mondragon

Article Type: Original Article | First Published: February 28, 2023

Chronic kidney disease (CKD) represents a worldwide public health problem, Mexico has a prevalence of 12.2%, of which 52,000 patients are in renal replacement therapy and 80% are treated at the Mexican Social Security Institute, it is associated with early mortality with a higher incidence after 40 years of age. The literature mentions severe metabolic acidosis, severe hyperkalemia and hyperphosphatemia, water overload and uremic syndrome as frequent causes of dialysis urgency. However, the most...

 Open Access DOI:10.23937/2474-3674/1510152

Constrictive Cardiomyopathy Secondary to Calcified Pericardium

Vinaya Sermadevi, MD and Connor S Shaw, DO

Article Type: Case Report | First Published: January 20, 2023

Calcification of the pericardium due to recurrent inflammation is a rare condition which can lead to severe restrictive cardiomyopathy. This case demonstrates severe circumferential pericardial calcification leading to cardiogenic shock and death. It is proposed that the patient’s history of repeat cardiac interventions, including cardiac ablation, and open valve repair procedures precipitated this....

 Open Access DOI:10.23937/2474-3674/1510151

Association of the Meteorological Parameters and Epileptic Seizures

Levent Sahin and Ali Gur

Article Type: Research Article | First Published: January 11, 2023

Climate changes may be among the triggering factors in predicting epileptic seizures. In this study, we aimed to investigate the effects of changes in weather conditions and phases of the moon on epileptic seizures in epilepsy patients. This is a dual-center, cross- sectional, observational study. The patients’ age, sex, medications, and the hours of seizures were recorded. Meteorological data such as daily average temperature, atmospheric pressure, relative humidity, wind speed, and moon cyc...

 Open Access DOI:10.23937/2474-3674/1510150

Factors Affecting Mortality in Patients with Acute Pancreatitis and Serum Calcipressin-1 (RCAN-1) Levels

Emrah Savaş, Mustafa Burak Sayhan, Ömer Salt and İlker Dibirdik

Article Type: Original Article | First Published: November 30, 2022

Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract. AP is a pancreatic disease with high mortality and morbidity, which can cause local and systemic complications This study aimed to determine factors that effect mortality in this patient group and whether serum RCAN-1 level can be used as a novel marker for predicting diagnosis and mortality in patients with AP and to investigate the factors affecting mortality in this patient group....

 Open Access DOI:10.23937/2474-3674/1510149

Reduced Length of Stay after Implementation of a Clinical Pathway following Repair of Ventricular Septal Defect

Tracey L Ogdon, DNP, Rohit S Loomba, MD and Jamie S. Penk, MD

Article Type: Original Article | First Published: November 16, 2022

There is variation in care and hospital length of stay following surgical repair of ventricular septal defects. The use of clinical pathways in a variety of pediatric care settings have been shown to reduce practice variability and overall length of stay without increasing the rate of adverse events....

 Open Access DOI:10.23937/2474-3674/1510148

An Evaluation of Pediatric Airway Management Training for Suspected/Confirmed COVID-19 Patients Utilizing Medical Simulation at King Fahad Medical City, Riyadh, Saudi Arabia

Sawsan Alyousef, MD, CAPB, FCCP, Raed Khafajeh, Ali Alharbi, Aseel Alayed, Najd Fawaz Alnojaidi and Abdulaziz Alsoqati

Article Type: Brief Report | First Published: November 07, 2022

The novel coronavirus disease 2019 (COVID-19) can be transmitted to clinicians involved in their care, particularly during aerosol-generating procedures. In spite centers for disease control and prevention (CDC) had put clear standards for precaution when dealing with such patients but unfortunately several health care providers had lost their lives around the world....

 Open Access DOI:10.23937/2474-3674/1510146

What Happens When it Comes to Triage? A Study Evaluating the Effects of a Prioritisation of Intensive Care Unit Patients in Case of Scarce Resources

Hannes Lienhart MD, EMDM, Wolfgang List MD, Klaus Rheinberger PhD, and Moran Bodas PhD MPH

Article Type: Brief Report | First Published: October 31, 2022

Comparison of the SOFA score with a newly developed “triage score” and evaluation of the consequences of simulated triage of ICU patients on the outcome. Retrospective explorative data analysis of 213 patients treated on Intensive Care Units of community hospitals in Western Austria during the first and second wave of the COVID-19 pandemic....

 Open Access DOI:10.23937/2474-3674/1510146

What Happens When it Comes to Triage? A Study Evaluating the Effects of a Prioritisation of Intensive Care Unit Patients in Case of Scarce Resources

Hannes Lienhart MD, EMDM, Wolfgang List MD, Klaus Rheinberger PhD, and Moran Bodas PhD MPH

Article Type: Brief Report | First Published: October 31, 2022

Comparison of the SOFA score with a newly developed “triage score” and evaluation of the consequences of simulated triage of ICU patients on the outcome. Retrospective explorative data analysis of 213 patients treated on Intensive Care Units of community hospitals in Western Austria during the first and second wave of the COVID-19 pandemic....

 Open Access DOI:10.23937/2474-3674/1510145

Euglycemic Diabetic Keto Acidosis Presentation in Association with SGLT-2 Inhibitor- Dapagliflozin

Lajeesh Jabbar Vettikkat MBBS, MRCEM, FRCEM, FEBEM, DCH and Yoosuf Viju Cheriyalingal Paramba MBBS, MRCEM, FRCEM

Article Type: Case Report | First Published: August 24, 2022

Euglycemic Diabetic Keto Acidosis is a rare form of DKA seen in patients who are taking SGLT-2 inhibitor medication for the treatment of diabetes mellitus. It is a life-threatening condition and should be diagnosed early. The absence of hyperglycemia poses challenges to the treating Emergency physicians in diagnosing this entity at an early stage....

 Open Access DOI:10.23937/2474-3674/1510144

Anaerobic Lung Abscess with Complex Empyema

Joseph Shiber, MD, FACEP, FCNS, FCCM

Article Type: Clinical Image | First Published: August 11, 2022

A 51-year-old man with advanced ALS and home mechanical ventilator dependence presented with fever, tachycardia, hypotension and leukocytosis. Chest radiograph showed a large left pleural effusion (Figure 1) and an unenhanced chest CT confirmed a loculated effusion with gas bubbles (Figure 2) and large air-fluid level (Figure 3)....

 Open Access DOI:10.23937/2474-3674/1510143

Comparison of High-Dose, Short-Term Steroid and Low-Dose Long Term Steroid Use in ARDS Caused by COVID-19

Suna KOC, MD and Ilke KUPELI, MD

Article Type: Original Article | First Published: March 19, 2022

We aimed to compare the 15-day continuous hemodynamic, laboratory and clinical course of patients with ARDS due to COVID-19 who received short-term highdose and long-term low-dose systemic methylprednisolone. Two hundred and two patients were recorded to be diagnosed with ARDS due to COVID 19 in the intensive care unit between June 1, 2020 and February 1, 2021. Patients were received systemic methylprednisolone for the short or long term and high or low doses were applied. Age, gender, APACHE II...

 Open Access DOI:10.23937/2474-3674/1510142

Chest X-Ray Findings in Asthma Exacerbation and the Association with Acute Asthma Management among Children

Gul Sher, Fernanda E Kupferman and Mohamed Gaffoor

Article Type: Original Article | First Published: March 19, 2022

The National Heart and Lung Institute’s guidelines advise against routine use of chest X-ray (CXR) for acute asthma exacerbation. Despite this recommendation, unnecessary CXR are still being performed. The objective of this study is to assess the association between abnormal CXR findings and the severity of asthma exacerbation and its impact on acute asthma management. A retrospective chart review was performed of all pediatric patients 2-17 years of age who presented to the emergency departme...

 Open Access DOI:10.23937/2474-3674/1510141

Cardiovascular Collapse, Progressive Lactic Acidosis, Pulmonary Hypertension and Polyuria: Think Thiamine Deficiency!

Gul Sher, MBBS, Mona Nourani, DO, Kristen Beebe, PA-C, Peggy Fullenkamp Oomens, MS, RDN, CNSC, Megan Land, MD and Alexander Ngwube, MD

Article Type: Original Article | First Published: March 13, 2022

Shock is a pathological condition characterized by imbalance between oxygen demand and supply. Irrespective of the cause, shock leads to a state of energy failure due to a decrease in adenosine triphosphate (ATP) production, creation of lactic acidosis, and as a consequence, multiple organ dysfunction. Lactic acidosis is an ominous finding in critically ill patients. The severity and increased duration of lactic acidosis are associated with increased mortality. Lactic acidosis can result from hy...

 Open Access DOI:10.23937/2474-3674/1510140

Transient Asystole Linked to Dexmedetomidine Infusion

Noelle Provenzano, DO, Olivia Johnson, PharmD, BCCCP, Aaron Brophy, DO and Jaber Monla-Hassan, MD

Article Type: Case Report | First Published: February 17, 2022

Five adult medical, critically ill patients developed bradycardia leading to asystole while receiving dexmedetomidine infusion. This is a case series of five adult patients obtained from the medical intensive care unit in a community teaching hospital between May 2019 through August 2020. These patients were each receiving dexmedetomidine infusion while on invasive mechanical ventilation leading to periods of asystole that resolved after stopping dexmedetomidine infusion in all five patients. Th...

 Open Access DOI:10.23937/2474-3674/1510139

Hyperglycemic Crisis: A Serious Complication of Unknown Type II Diabetes Mellitus in Adolescent

Elisa, MD and Pratiwi Woro R, MD PhD

Article Type: Case Report | First Published: February 11, 2022

Hyperglycemic crisis is life threatening condition in diabetic patients. Traditionally, diabetic ketoacidosis (DKA) has been associated with decompensated type 1 diabetes (T1D) and Hyperosmolar Hyperglycemic State (HHS) became a hallmark of type 2 diabetes (T2D). However, DKA is increasingly being reported in patients with T2D. We reported a case of DKA with some features of HHS, as an initial presentation, in a boy with unknown T2D at young age. Prompt diagnosis and acute critical care approach...

 Open Access DOI:10.23937/2474-3674/1510138

Emergency Medical Rescue Services in Dhaka City, Bangladesh: A Situational Analysis and Needs Assessments

Mohammad Mojahidul Hossain, Axel Kroeger, Kamelia Pervin, George Norwood, Be-Nazir Ahmed, Manzur Kadir Ahmed and Hans-Joerg Busch

Article Type: Original Article | First Published: February 10, 2022

Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (EMRS) is a global public health concern, also in Dhaka city, Bangladesh. The study aimed at contributing to improve the EMRS in Dhaka city by assessing and identifying major shortcomings with possible solutions. The study was conducted in July/August 2017, after analyzing medical and relevant records, a one week observational study was conducted in 4 purposively selected hospitals in Dhaka city. The Mode of tran...

 Open Access DOI:10.23937/2474-3674/1510137

Effectiveness of a Protective Ventilatory Strategy Using Prone Decubitus in Patients with Severe Acute Respiratory Syndrome (SARS) after Covid-19: Integrate Review

Daniela Alves de Moraes Ribeiro and Fabrício Vieira Cavalcante

Article Type: Review Article | First Published: February 05, 2022

The main objective of the present study is to investigate the effectiveness of the ventilatory strategy in decubitus in the prone position in patients with severe acute respiratory syndrome triggered by Covid-19. This is an integrative literature review combined with the snowball technique, based on the following question: “What are the effects of the protective ventilatory strategy in prone decubitus in patients with SARS secondary to Covid-19? PUBMED and Academic Google were used as database...

 Open Access DOI:10.23937/2474-3674/1510136

Need for Trauma Intervention and Improving Under-Triaging in Geriatric Trauma Patients: Under-Triaged or Misclassified

Gabriel Beam, MSN, RN, Kimberly Gorman, DNP, AG-ACNP-BC, CNL, CCRN, CNRN, TCRN, Siddhartha Nannapaneni, MD, Jami Zipf, BSN, RN, Thomas Simunich, MS, MBA and Russell Dumire, MD

Article Type: Original Research | First Published: January 24, 2022

Combining the Need for Trauma Intervention (NFTI) calculation with the Cribari Matrix Method (CMM) more accurately determines appropriate triage, particularly of geriatric trauma patients. These patients (>/= age 65 years) have comorbidities, increased frailty, and decreased overall functional capacity. The CMM alone does not address their increased risk of mortality secondary to inappropriate or suboptimal care; performance improvement efforts to decrease the risk of under-triage have prompted ...

 Open Access DOI:10.23937/2474-3674/1510135

A Case of Wernicke’s Encephalopathy in a Post-Bariatric Surgery Patient in a Community Emergency Department

Daniel S Steinberg, MD and Christopher Wilbert, MD

Article Type: Case Report | First Published: January 23, 2022

A 22-year-old woman with a history of idiopathic intracranial hypertension who presented to our emergency department with acute onset strabismus and bilateral sixth nerve palsy in the setting of recent sleeve gastrectomy and vomiting. Further testing revealed multiple vitamin deficiencies, including thiamine, leading to a diagnosis of Wernicke’s encephalopathy. Her symptoms resolved after vitamin and nutritional repletion. Incidence of similar presentations is increasing in the setting of risi...

 Open Access DOI:10.23937/2474-3674/1510134

Using Point-of-Care Ultrasound for Early Identification of Central Retinal Artery Occlusion

Farhan Qadeer, MD, Ramzan Judge, PharmD, BCCCP and Alina Chiccarine

Article Type: Case Report | First Published: January 22, 2022

Central Retinal Artery Occlusion (CRAO) is the partial or complete blockage of the central retinal artery presenting as acute painless monocular vision loss with increased risk in those with cardiovascular disease. Diagnosis of CRAO requires a dilated fundoscopic exam performed by an Ophthalmologist. In resource limited hospitals, access to these expertise and resources may be difficult. Early recognition of CRAO in the emergency department (ED) can lead to reduced negative consequences and redu...

 Open Access DOI:10.23937/2474-3674/1510133

Modified HScore Predicts Increased Length of Stay but not Mortality in ICU Patients with COVID-19- A Retrospective Cohort Study

Jaskirat K Gill, MD, Megan G Anders, MD, MS, Adnan T Bhutta, MD, Miranda Gibbons, BS, Peter Rock, MD MBA, Thomas Scalea, MD and Ali Tabatabai, MD

Article Type: Cohort Study | First Published: January 12, 2022

Hemophagocytic Lymphohistiocytosis (HLH) is an acute and rapidly progressive systemic inflammatory disorder that can be classified into primary HLH (pHLH), which is a pediatric disease, and secondary HLH (sHLH), which can be associated with infection, malignancy, systemic diseases or drugs. The disease is characterized by cytopenia, excessive cytokine production, and hyperferritinemia, and clinically presents with ongoing fevers, lymphadenopathy, hepatosplenomegaly, and multiorgan failure. Of th...

 Open Access DOI:10.23937/2474-3674/1510132

Lung Recruitment Guided by Ultrasonography in Unilateral Lung Injury

Roosevelt Santos Nunes, Larissa Christina Pires Barrientto, Viviane Barbosa Silva, Kamila da Grazia Iazzetta, Taiana Bertacini Almas de Jesus and Gil Cezar Teixeira Alkmin

Article Type: Case Report | First Published: December 18, 2021

Atelectasis is a common problem in the critical care setting and when it causes acute life-threatening hypoxemia it is necessary its re-expansion. Ultrasonography is capable to diagnose atelectasis at the bedside and accurately assesses lung aeration changes after reexpansion maneuver. We describe a case in which a male patient receiving mechanical ventilation developed acute hypoxemia due atelectasis, being applied recruitment maneuver guided by ultrasonography combined with lateral decubitus p...

 Open Access DOI:10.23937/2474-3674/1510131

Acute Delirium and Difficult Sedation Weaning in ICU Thiamine Deficiency Maybe a Possible not Uncommon Cause

Magdy Khames Aly, Ms

Article Type: Case Report | First Published: December 10, 2021

This is a case of 54-years-old critically ill H1N1 ARDS patient with prolonged ventilation and sedation and difficult weaning from sedation and mechanical ventilation. The case gives spotlight on not uncommon cause of delirium and failure of weaning in critically ill patients which is Vitamin B1 deficiency and how it is underestimated and should be put in mind while management those patients. Thiamine is a water-soluble vitamin that is absorbed in the jejunum by 2 processes. When the thiamine le...

 Open Access DOI:10.23937/2474-3674/1510130

Acupuncture Induced Multiorgan Failure

Nageswar Bandla, Andreea Mihai and Stephen Lord

Article Type: Case Report | First Published: December 10, 2021

Dating back to 100 BC, acupuncture has been performed safely for centuries for a wide range of medical conditions. Although a technically invasive procedure, reports of adverse incidents in the medical literature are thankfully very rare. We present a case of acupuncture induced multisensitive Staphylococcus aureus (MSSA) bacteraemia and septic shock, resulting in multiorgan failure and a prolonged intensive care stay. This case report serves to remind clinicians that although the overall risk o...

 Open Access DOI:10.23937/2474-3674/1510128

Dexamethasone versus Methylprednisolone in Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis

Divyansh Bajaj, MD, Ankit Agrawal, MD, Manasvi Gupta, MD, Gaurav Manek, MD, Kurt Hu, MD and Umesha Boregowda, MD

Article Type: Original Research | First Published: November 18, 2021

The COVID-19 pandemic has led to millions of deaths throughout the world. Several randomized controlled trials have demonstrated that steroids reduce mortality in severe COVID-19 infection. The Center for Disease Control and Prevention has recommended dexamethasone as the first line of treatment. However, methylprednisolone is being used as the steroid of choice in many countries worldwide. We sought to perform a systematic review and metaanalysis to compare the outcomes with the use of these tw...

 Open Access DOI:10.23937/2474-3674/1510129

Post-Intensive Care Syndrome in Newborns from a Nutritional and Neuromotor Perspective

Júnea Regina Pires Drews, Janaina Aparecida Campos, Polianna de Brito Guimarães, Romilda Maria Vidigal Trandafilov and Natascha Savernini

Article Type: Original Research | First Published: November 20, 2021

Premature newborns who need prolonged hospital stays may develop Post-Intensive Care Syndrome, which, as the term itself suggests, is characterized by post-hospital changes that manifest themselves in the physical, cognitive and/or nutritional fields. The advance of care in recent decades has provided greater survival for the newborns, thus allowing initial studies to characterize signs and symptoms which may indicate, in the future, the risk of developing PICS. Given the above, the aim of this ...

 Open Access DOI:10.23937/2474-3674/1510127

Use of Tranexamic Acid Prevents Intubation in ACE Inhibitor- Induced Angioedema

Ramzan Judge, Stephanie Kolaski and Farhan Qadeer

Article Type: Case Report | First Published: September 11, 2021

ACE-I, a common antihypertensive medication, regulates blood pressure by inhibiting angiotensinconverting enzyme (ACE). This inhibition prevents the formation of angiotensin II from angiotensin I, a peptide hormone that causes vasoconstriction. ACE is also involved in the degradation of bradykinin, a potent mediator of vasodilation. When ACE is inhibited, the arteriolar smooth muscle relaxes and increases blood flow, leading to increased vasodilation of blood vessels, vascular permeability, and ...

 Open Access DOI:10.23937/2474-3674/1510126

COVID-19 Pneumonia: Guiding the Decision to Intubate Based on Work of Breathing Assessment Independent of Oxygenation

Amin Nadeem, Philip Fanapour, Mylene Apigo, Sunyoung Kim, Sanish George, Muhammad Khan, Azib Shahid, Charmi Patel, Ria Carnate and Raúl J Gazmuri

Article Type: Original Article | First Published: August 04, 2021

In most patients, COVID-19 pneumonia initially causes significant hypoxemia but without substantial impairment of lung compliance that would increase the work of breathing (WOB). Once adequate oxygenation is established, a tool to determine WOB independent of oxygen needs can guide the decision to intubate for invasive mechanical ventilation (IMV). We monitored oxygen requirements and WOB in 10 patients admitted with severe COVID-19 pneumonia (radiographic evidence of extensive lung disease with...

 Open Access DOI:10.23937/2474-3674/1510125

Knowledge, Attitude and Practices of ICU Nurses on Catheter Related Bloodstream Infection (CRBSI)

Nur Aimi Safura Binti Azlan and Khin Thandar Aung

Article Type: Original Article | First Published: July 23, 2021

Bloodstream infections (BSIs) are associated with insertion and maintenance of central venous catheters (CVC). Catheter Related Bloodstream Infection (CRBSI) is the most frequent causes of healthcare-associated infections in intensive care units (ICUs) and is a major challenge for health care providers working in intensive care units. It gives the higher risk to the mortality rate of ICU patients and also increased length of ICU stay and additional healthcare costs for them. Most international i...

 Open Access DOI:10.23937/2474-3674/1510124

Continuous Lower Abdominal Compression a Possible Therapeutic Intervention in ARDS

Alexandru Cupaciu, MD, Vladimir Cohen, MD, Emmanuel Dudoignon, MD and François Dépret, MD, PhD

Article Type: Editorial | First Published: June 30, 2021

We report the case of sixty-years-old men who necessitated intubation and mechanical ventilation for severe COVID-19. After 3 days under mechanical ventilation, in semi recumbent position, despite being ventilated with 5.5 ml/kg/IBW and 8 cmH2O of positive end expiratory pressure (PEEP), deeply sedated and paralyzed, his plateau pressure (Pplat) was markedly elevated at 41 cmH2O. However, we noticed that placing our patient in supine position his Pplat decreased to 28 cmH2O. However, due to well...

 Open Access DOI:10.23937/2474-3674/1510123

Intra-aortic Balloon Pump Induced Dynamic Left Ventricular Outflow Tract Obstruction and Cardiogenic Shock: A Case Report

Shiun Woei WONG, MRCP and Ke Xuan Jessica Ng, MRCP

Article Type: Case Report | First Published: July 10, 2021

We present a complex case of a 50-year-old man who presented with inferior ST-elevation myocardial infarction and cardiogenic shock. Our patient presented with out-of-hospital ventricular fibrillation cardiac arrest. Cardiopulmonary resuscitation was promptly started and return of spontaneous circulation was achieved. The patient underwent urgent coronary angiography with implantation of drug-eluting stent in his right coronary artery. Intra-aortic balloon pump was inserted. However, this was co...

 Open Access DOI:10.23937/2474-3674/1510122

Underdiagnosed Delirium on Elderly Patients in the Emergency Room Principal Author

Sanchez Martinez Fatima Alondra, Ruiz Mondragon Alberto, Marín Nieto Jaime and Villaseñor Talavera Yael Sebastián

Article Type: Original Article | First Published: June 28, 2021

Delirium is a fluctuant, transitional and acute affection of cognition and attention, with multifactorial aetiologies. It is a medical emergency and requires an integral evaluation to identify the underlying causes. In elderly people, over 65 years old, the incidence of Delirium oscillates greatly between 14% to 24% at the moment of hospitalization and 6% to 56% during the time of hospitalization. The prevalence of Delirium acquired in the community oscillates from 1% to 2%. However, this preval...

 Open Access DOI:10.23937/2474-3674/1510121

Clinical Characteristics of Suspected COVID-19 in Pediatric Patients

Heather Yerdon, BS, Lauren Mutter, MD, Rick Tivis, MPH, Trevor Olsen, PhD and Anna Suessman, DO

Article Type: Original Research | First Published: May 20, 2021

This study reviews patients aged 21 and younger, who presented to the Ochsner Medical Center’s Pediatric Emergency Department during the COVID-19 pandemic. A retrospective analysis was completed comparing demographics, symptomology, and laboratory analysis between COVID positive and negative patients. This study examined pediatric patients presenting to the Pediatric Emergency Department at Ochsner Medical Center between March 11 and May 20, 2020. All children included in the study underwent C...

 Open Access DOI:10.23937/2474-3674/1510120

Acute Occlusion of the Lower Limb Artery Associated with Hyperosmolar Hyperglycemic Nonketotic Coma in a Patient with Amyotrophic Lateral Sclerosis: A Case Report

Kyoko Hayashida, MD, PhD, Shinsuke Masuda, MD, Yuichiro Yuchi, MD, Tsutomu Matsushita, MD, PhD and Kazuki Morimoto, MD

Article Type: Case Report | First Published: April 17, 2021

A 61-year-old man with amyotrophic lateral sclerosis (ALS) on tracheostomy positive pressure ventilation was brought to the emergency room due to decreased consciousness. He was diagnosed with hyperosmolar hyperglycemic nonketotic coma (HHNC) with severe systemic hypotension. He exhibited an adequate response to treatment of continuous intravenous insulin infusion and fluid replacement. On the third day, he developed acute limb ischemia due to extensive occlusion from the left common iliac arter...

 Open Access DOI:10.23937/2474-3674/1510119

Evaluation of Obstetric Patient Transfers by Helicopter in Turkey

Asiye Uzun, MD, Eren Usul, MD, Gülşah Çıkrıkçı Işık, MD, Semih Korkut, MD

Article Type: Original Research | First Published: April 09, 2021

Air ambulance services, which began in 2008 in our country, have become increasingly widespread. Today, there are command centers in 17 cities, and helicopter ambulances are preferably provided during the day, while air craft ambulances are used at night. The aim of the present study was to examine the characteristics of obstetric patient transfers by helicopter ambulance throughout Turkey in 2020. This study was started after receiving permission from the Turkish Ministry of Health, and all obs...

 Open Access DOI:10.23937/2474-3674/1510117

Thyrotoxic Periodic Paralysis- An Uncommon Disease in the Western World: A Case Report

Sara Samad, DO, Joshua M Samuel, BSc and Frida Popilevsky, MD

Article Type: Case Report | First Published: March 31, 2021

Thyrotoxic Periodic Paralysis (TPP) is a rare diagnosis in the western world; however, its incidence has been rising in recent years due to globalization. This condition has the potential to be deadly if not detected and treated in a time appropriate manner. This case discusses our management of a patient who came into our hospital with complaints of total body numbness and weakness for several hours. He was subsequently diagnosed with TPP and was treated with Methimazole and aggressive potassiu...

 Open Access DOI:10.23937/2474-3674/1510116

Correlation between the Glasgow Coma Scale Score and Tomographic Findings with in-Hospital Mortality in Patients Admitted in the Emergency Service of the General Hospital of Zone 50 of the IMSS of San Luis Potosi, with a Diagnosis of Traumatic Brain Injury

Alejandra Plasencia Ramos, Alberto Ruiz Mondragón, Iraida Martínez Moreno, Miguel Angel Zarate Espinosa and Monica Aleli Plasencia Ramos

Article Type: Original Article | First Published: March 10, 2021

A Traumatic brain injury (TBI) is caused by sudden exchange of mechanical energy that causes cranial injury. It is a condition with high morbidity and mortality. A substantial number of survivors suffer disabling injuries. Management is aimed at avoiding secondary brain injury, thus improving the prognosis and reducing mortality. In the General Zone Hospital 50 of the Mexican Social Security Institute in San Luis Potosí, TBI is a frequent cause of visit in the emergency service; it represents 1...

 Open Access DOI:10.23937/2474-3674/1510115

Incidence of Acute Kidney Injury and Associated Factors in Previously Healthy Young Adults Entering the Emergency Observation Service of the General Hospital of Zone Number 50 of the IMSS

Carlos Armando Dueñas Arreola, Alberto Ruiz Mondragón, Fátima Alondra Sánchez Martínez and Jorge Alfredo García Hernández

Article Type: Original Article | First Published: March 05, 2021

Acute Kidney Injury (AKI) is a Health problem that occurs with considerable frequency in our environment, often affecting people in an age range in which they are economically active or start the formation of a family. There are no records of the incidence of this condition in our environment, as well as no record of the impact on people of working age. To establish the incidence of AKI, determine the Incidence of the Economically active population that develops AKI, as well as to identify the m...

 Open Access DOI:10.23937/2474-3674/1510114

A Rare Combination of Bilateral Obstructing Ureteral Stones, Acute Kidney Injury and Metformin-Associated Lactic Acidosis: A Case Report

RPJ Boxma, MG Vervloet and JJ Haitsma

Article Type: Case Report | First Published: February 05, 2021

Metformin associated lactic acidosis is a severe and potentially fatal condition. We here report a severe metformin-associated lactic acidosis in acute kidney injury caused by bilateral obstructing ureteral stones as an extremely rare combination of pathologies. Early treatment with bicarbonate infusion and subsequent acute haemodialysis was provided. As a result, respiratory failure and mechanical ventilation was prevented and the patient was discharged several days after the event. The patient...

 Open Access DOI:10.23937/2474-3674/1510113

Management of Multiple Rib Fractures-Results from a Major Trauma Centre with Review of the Existing Literature

D Chowdhury, P Okoh and H Dambappa

Article Type: Review Article | First Published: December 21, 2020

The main respiratory complications that arise from fractured ribs are multifactorial. It is well known that inadequate pain management in these patients lead to complications arising from poor ventilatory function. With an already compromised underlying pulmonary system this compounds on the effect on an already failing system leading to significant pulmonary complications. Rib fractures in the form of flail segments pose a particular problem in this regard. When one considers an elderly patient...

 Open Access DOI:10.23937/2474-3674/1510112

Extracorporeal Membrane Oxygenation (ECMO) Transpires to be a Promising Surrogate Therapy for Severe Refractory near Fatal Asthma: A Case Report

Ali Al Bshabshe, MD, FRCP, Omprakash Palanivel, Mohammed Amer Bahis, Nasser Mohammed Alwadai, RRT and Ali Mushabebassiri

Article Type: Case Report | First Published: December 03, 2020

The standard first-line therapy for severe asthma exacerbation is bronchodilators and corticosteroids. Any patients not responding to this standard therapy often needs invasive ventilation, which can promote numerous related complications and mortality. Recent studies conclude that ECMO can be adopted as an alternative approach as it significantly enhances the survival rate in severe respiratory failure compared to standard invasive ventilation. In contrast, ECMO effectiveness in near-fatal asth...

 Open Access DOI:10.23937/2474-3674/1510111

A Surprising Cause of Shock

Bernhard Baumeister MD and Reto Nueesch MD

Article Type: Case Report | First Published: November 28, 2020

A mayor challenge in emergency medicine is identifying life threatening conditions and simultaneously starting an adequate therapy. Therefore physicians often have to quickly commit themselves to the most likely diagnosis to avoid any delay of treatment. Nevertheless clinicians have to stay alert, repeatedly reassess differential diagnoses and change the initial treatment when needed. A 59-year-old man was admitted to our emergency department by ambulance in state of shock. He presented with red...

 Open Access DOI:10.23937/2474-3674/1510110

Delayed Intubation during Cardiac Arrest in Covid-19 Patients

Arash Harzand, MD, MBA, A Maziar Zafari, MD, PhD

Article Type: Commentary | First Published: July 16, 2020

Recent guidance from the American Heart Association (AHA) on resuscitation strategies in coronavirus disease disease of 2019 (Covid-19) includes several notable departures from before, including to proceed directly to endotracheal intubation over non-invasive ventilation (NIV) and to actively pause chest compressions during intubation attempts to minimize the likelihood of unsuccessful attempts. Although such recommendations have a dual focus on protecting frontline rescuers from aerosolizing pr...

 Open Access DOI:10.23937/2474-3674/1510095

Clostridium Sporogenes Causing Bacteremia Originated from the Skin and Soft Tissue Infection in an Immunocompetent Patient - Case Report and Literature Review

Harith A Alataby, MD, Vaishali Krishnamoorthy, MD, Laura Ndzelen, MD, Foma Munoh Kenne, MD, Kate Valenti, MLT, Jessie Savermuttu, MD and Jay Nfonoyim, MD

Article Type: Case Report | First Published: July 09, 2020

Clostridium sporogenes is a major cause of food spoilage. In this report, we present a case of bacteremia in an immunocompetent patient, caused by C. sporogenes and most likely originated from the skin and soft tissue infections. 75-year-old man with PMHx of Parkinson’s disease presented to ED after he was found lying on the floor inside his house, covered in urine and feces for unknown duration of time. He was extremely lethargic and dehydrated. He had BP90/60 mmHg, PR100, RR 22, temperature ...

 Open Access DOI:10.23937/2474-3674/1510109

A National Survey in Belgium on Post-ICU Follow-up Program

Danielle Prevedello, MD, MBA, Fabio Silvio Taccone, MD, PhD and Jean-Charles Preiser, MD, PhD

Article Type: Original Article | First Published: June 17, 2020

As the mortality in critical care patients reduces, post-intensive care syndrome grows as a public health concern, specially following outbreaks. Consequently, to address that problem, post-ICU follow-up programs emerged as a possibility to understand the long-term outcomes better and support ICU survivors. This study aims to state the prevalence of those programs in Belgium and comprehend how Belgians manage the care of ICU survivors....

 Open Access DOI:10.23937/2474-3674/1510108

Covid-19 Pandemic and Health Professionals: Practical Approaches

Rebecca Renata Lapenda do Monte, Francisco de Assis Fernandes Tavares, Bruno Barreira Cardoso, Alyne Barreto Mesquita de Goes, Thais Cristina Loyola da Silva, Brenda de Oliveira Silva, Yara Saiane Marim Araujo, Amália Cinhtia Meneses Rego and Irami Araújo-Filho

Article Type: Research Article | First Published: May 28, 2020

COVID-19 disease is a pandemic, with severe clinical manifestations, high lethality and which has reached at least 128 countries. In this sense, the bioprotection of health professionals is a fundamental principle in preserving the lives of those who work in the direct care of patients who are victims of SARS-CoV-2. Each day the number of confirmed cases exceeds the most optimistic estimates, which cause severe damage and overload in the infrastructure of health systems. The present study addres...

 Open Access DOI:10.23937/2474-3674/1510107

Investigation of Cases of Violence against Women: Examples of the Eastern Turkey

Turgut Dolanbay, Serhat Tunc, Levent Sahin and Murat Aras

Article Type: Research Article | First Published: May 27, 2020

In our country, women are mostly exposed to domestic violence. It is known that almost one in four women is exposed to physical violence. The low level of women’s education in the east of Turkey, the lack of economic freedom, and the low income level are among the main reasons for violence against women. It was aimed to raise awareness of the issue by drawing attention to the issue of violence against women, which frequently takes place in the national and international media and contribute to...

 Open Access DOI:10.23937/2474-3674/1510104

Depression and Anxiety Levels of Parents of Children Evaluated with Head Trauma in Emergency Department


Article Type: Original Article | First Published: May 04, 2020

The fear of having a serious pathology with the symptoms of head trauma and the promt for exclusion of pathologies by imaging methods increase the admissions to the emergency services. Nowadays, the increasing frequency of admissions may be due to parents' level of awareness about head trauma, easy access to health services or anxiety and depression levels of parents. Two hundred children with mild head trauma under 5 years of age were included in the study. After the initial evaluation, a descr...

 Open Access DOI:10.23937/2474-3674/1510106

Flying Blind: Early Outcomes Following Implementation of Formal Critical Care Services in a Low-Resource Setting

Elizabeth M Stoeckl, BS, Kristin L Long, MD, MPH and Emnet Tesfaye, MD

Article Type: Commentary | First Published: May 14, 2020

Global health endeavors in low- and middle-income countries (LMIC) have traditionally emphasized humanitarian relief and primary care. Increasingly, specialty services, such as critical care medicine, are recognized as key components of sustainable, effective health care systems, even in settings with constrained resources. We illustrate the successful implementation of critical care services at Hawassa University teaching hospital in Ethiopia. Although not without challenges, the introduction o...

 Open Access DOI:10.23937/2474-3674/1510105

Simulation Education to Advance Emergency Medicine and Pediatric Critical Care in Nepal

Roshana Shrestha MD, Lisa Alianiello CNP, Shaza Aouthmany MD, Fenil Kholwadwala MD, Nicholas Deluga MD, Kevin Nguyen MD, Kris Brickman MD and Anmol Shrestha MD

Article Type: Research Article | First Published: May 06, 2020

Internationally emergency medicine is a relatively young specialty that is increasingly recognized for its potential for growth. In low middle-income countries (LMICs) like Nepal resources are quite limited and the development of new specialties such as emergency medicine can be slow to evolve. Specific areas of emergency care, including pediatric critical care have significant challenges due to clinical and educational limitations in countries like Nepal. Countries with robust healthcare system...

 Open Access DOI:10.23937/2474-3674/1510102

Possibility Enhanced Recovery Program in Emergency Surgical Treatment of Patients with Colorectal Obstructive Cancer

Sizonenko NA, Surov DA, Soloviev IA, Demko AE, Babkov OV, Martynova GV, Sviatnenko AV, Osipov AV, Yastrebov IP and Bezmozgin BG

Article Type: Original Article | First Published: April 15, 2020

During the treatment of the patients of the ERAS group in preoperative period, the following measures were taken: Patient information, his psychological preparation, prevention of postoperative pain, nausea and vomiting, thromboembolic and infectious complications. Intraoperative measures included local anesthesia of the skin in the line of laparotomy access, colon and small (under indications) intestines decompression, small intestine lavage, embryology oriented surgery and D3 lymphadenectomy, ...

 Open Access DOI:10.23937/2474-3674/1510101

The Reliability of Oxygen Saturation Compared with Arterial Blood Gas Analysis in the Assessment of Respiratory Failure in Acute Asthma

Mustafa Mahmood Eid

Article Type: Original Research | First Published: March 19, 2020

Asthma is one of the leading causes of respiratory failure. It is important to predict which patients might suffer from respiratory failure. The aim of this study is to investigate the possibility of using pulse oximetry as alternative to arterial blood gas analysis for measuring oxygen saturation (SaO2) to predict hypoxic respiratory failure. A prospective study was conducted in the Emergency Department (ED) of [name deleted to maintain the integrity of the review process] over one year. A conv...

 Open Access DOI:10.23937/2474-3674/1510100

Acute Pneumonia: The Beginning of a Revision of Views or Just a Statement of Known Facts?

Igor Klepikov, MD

Article Type: Commentary | First Published: March 14, 2020

The author conducted research on the topic under discussion in the USSR at the State Institute for advanced training of doctors (Novokuznetsk). To date, the USSR and the mentioned Institute no longer exist. However, research and clinical trials of new approaches to the treatment of children with acute pneumonia and the results of this work can provide answers to a number of questions facing us today, which allows us to consider the research of thirty years ago relevant and worthy of mention....

 Open Access DOI:10.23937/2474-3674/1510099

Preliminary Discussion of the Distribution Characteristics of Venomous Snake Species in One City and Four Counties in Guangxi and the Diagnosis and Treatment Strategies of Snakebite based on the Classified Evidence Method

Yi Luo, Zhengzhao li, Jianfeng Zhang, Qibin Li, Chongyu Zhai, Peinan Yu and Peng Guo

Article Type: Research Article | First Published: March 11, 2020

From the perspective of clinical diagnosis and treatment of snakebite and combined with existing zoological data, we aimed to characterize the distribution of snake species in one city and four counties in Guangxi and make regional snakebite diagnostic charts. Geolocation data of the research region and snake distribution were collected from the municipal and county governments and referring to authoritative zoological monographs, respectively. We characterized the distribution of venomous snake...

 Open Access DOI:10.23937/2474-3674/1510098

Safety and Effectiveness of Neuromuscular Blockers in the Treatment of Acute Respiratory Distress Syndrome: Systematic Review and Meta-Analysis

Alfredo Aisa-Alvarez MsC, MD, Cesar A Rojas-Gomez, MD and Gilberto Camarena-Alejo MHA, MD

Article Type: Research Article | First Published: March 07, 2020

Two review authors independently screened the abstracts and titles for relevance. Screening for inclusion, data extraction, and risk of bias assessment were performed by one author and checked by the second. We assessed trials for the overall quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) instrument. We calculated the risk ratios (RR) and 95% confidence intervals (95% CI) for dichotomous outcomes, while for continuous results we obtaine...

 Open Access DOI:10.23937/2474-3674/1510097

Organophosphate Poisoning and Suicide in Nepal: A Reflection on the limitations of Behavioral Health Resources

Tyler Johnston, MS, Kris Brickman, MD, Roshana Shrestha, MD, Anmol Shrestha, MD and Shaza Aouthmany, MD

Article Type: Case Report | First Published: February 15, 2020

Organophosphate poisoning is the most common cause of suicide attempt in Nepal. Mortality rates of organophosphate poisoning are 41 times higher than they are in the United States, even with appropriate treatment. In low middle income countries organophosphate poisoning is much more prevalent than any other forms of suicide due to the easy availability in these agricultural countries. The most common cause of organophosphate poisoning for intentional suicide is from depression. Social reforms wi...

 Open Access DOI:10.23937/2474-3674/1510096

Evaluation of Accidents and Injuries in International Rally Organizations Held in Turkey


Article Type: Original Research | First Published: February 13, 2020

International rally events, such as the World Rally Championship (WRC) and the Bosphorus Rally and the World Rally Cross Championship (WRX), have been held in Turkey from 2014 onwards. WRX race is an asphalt runway race in which two different categories of vehicles (Super car and RX-Lite) are racing and the rally racers aim to get the first place by passing one another. Super cars have approximately 650 hp engine, RX-Lite cars have approximately 380hp engine. Having been known since 1967, rallyc...

 Open Access DOI:10.23937/2474-3674/1510094

Importance of Genetic Polymorphisms (Rs662 and Rs854560) of the Paraoxonase-1 Gene as Risk Factor for Acute Ischemic Stroke in Turkish Population

Nevin Karakus, Nursah Basol, Serbulent Yigit, Pinar Cogas, Tuba Ceviz, Ali Kablan and Osman Demir

Article Type: Research Article | First Published: December 11, 2019

Allele frequencies of PON1 gene Q192R and L55M polymorphisms didn’t demonstrate any significant differences between patients and controls (p > 0.05). However, genotype frequencies were significantly different between patients and controls in terms of Q192R polymorphism (p = 0.030). Statistically significant correlations were observed between systolic and diastolic blood pressures of patients and L55M polymorphism (p = 0.017 and p = 0.039, respectively). Heterozygosity for the both Q192R and L5...

 Open Access DOI:10.23937/2474-3674/1510093

Electrocardiographic Brugada Pattern Unmasked by Febrile Illness

Antonio Villa, Alfredo Corticelli, Luisa Chiappa and Antonella Savinelli

Article Type: Case Report | First Published: December 04, 2019

Brugada syndrome is associated with a high risk of sudden cardiac death and some authors suggested the possibility that a febrile state may unmask the Brugada syndrome. We present a case of fever-induced type I electrocardiographic Brugada pattern. This is well known among the cardiologists, but it is necessary to introduce this clinical entity to other specialists, especially among internists and physicians of the emergency. Brugada syndrome, first described in 1992 as a new clinical entity by ...

 Open Access DOI:10.23937/2474-3674/1510092

Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-Year-Old Pregnant Woman

Breyanna Reachi, PharmD, Jenna Negrelli, PharmD, Abby Hickman, PharmD, MBA, BCCCP, Sarah Beesley, MD and Jeffrey Osborn, MD

Article Type: Case Report | First Published: September 19, 2019

A 15-week pregnant 32-year-old female was admitted to an outside hospital for alcohol withdrawal and developed multiple episodes of ventricular tachycardia (VT) and TdP resulting in her prompt transfer to our hospital for escalation of care. On arrival she was awake, alert, and hemodynamically stable but quickly began experiencing recurrent episodes of TdP that developed into pulseless VT despite defibrillation, magnesium and calcium administration, and chest compressions. We initiated lidocaine...

 Open Access DOI:10.23937/2474-3674/1510091

Comparison of Normal Skin and Thermal and Chemical Burn Wounds using Vibrational Optical Coherence Tomography

Frederick H Silver, Nikita Kelkar and Ruchit Shah

Article Type: Research Article | First Published: September 16, 2019

The search for methods to evaluate the extent and severity of skin lesions, such as burns and other skin disorders, has been a subject of extentive research. While suction testing, elastography and other tests can be done noninvasively on intact skin, these tests cannot be done on burns and open wounds due to the possible injury that may occur. In addition, they fail to yield comparable results obtained using destructive tests such as uniaxial tensile testing. We have developed a technique to co...

 Open Access DOI:10.23937/2474-3674/1510090

The Bone Phone: Improving Time to Pain Medication Administration in Long Bone Patients

Brian Wagers, MD, Santhi Reddi, MD, Kara Kowalzyck, MD and Jessica Kanis, MD

Article Type: Research Article | First Published: September 05, 2019

Orthopedic complaints are one of the most frequent reasons for presentations to the pediatric emergency department (PED). National metrics have defined that each child should have a pain assessment and/or pain medication administered within one hour of arrival to an emergency department. Patient surges, transfers from referring hospitals, and acuity can affect the ability of a PED to meet this metric. We queried our electronic medical record (EMR) for all patients presenting to our level 1 traum...

 Open Access DOI:10.23937/2474-3674/1510089

Enhancement of NK Cell-Mediated Lysis of Osteosarcoma Cells by Up-Regulating the NKG2D Ligands using Spironolactone and Avemar

Sellamuthu Subbanna Gounder, Thamil Selvee Ramasamy, Sharaniza Ab Rahim and Baskar Subramani

Article Type: Original Article | First Published: September 04, 2019

Natural Killer (NK) cell has the capability to immunosensitize and cell-mediated lysis of many types of cancer cells, however, most of the cancer cells are evading the NK cell-mediated lysis by down-regulating the NK cell specific ligands. In the present study, we have evaluated the comparative and synergic effect of spironolactone (SPIR) and (AVE) in enhancing the susceptibility of osteosarcoma cells (MG-63) to NK cell-mediated lysis in vitro. NK cells used in this study was characterised by th...

 Open Access DOI:10.23937/2474-3674/1510088

The 'SAFE PT' Handover: Impact on Safe Patient Handover between Shifts in the Emergency Department

Ahmed Mikky, MD, Mohamed Al Busafi, MD and Issa Al Salmi, MD, PHD

Article Type: Research Article | First Published: September 04, 2019

50 participants each were approached prior and post implementation of SAFE PT to fill descriptive questionnaires. The new SAFE PT tool was found to be clear and user friendly. It enhanced the handover process to a smooth one and was found to be systematic and highlighted the high acuity patients as well as red flags of each patient handed over. The bedside handover coupled with the prefilled written SAFE PT made it a safe process with increased patient satisfaction emphasized by the significant ...

 Open Access DOI:10.23937/2474-3674/1510087

Extracorporeal Cardiopulmonary Resuscitation in a 36-Year-Old Man with Viral Myocarditis Who Survived Prolonged Cardiac Arrest and Bedside Decompressive Laparotomy Neurologically Intact

Elizabeth K Powell, MD, Gretchen A Lemmink, MD, Joshua T Trester, MD and Louis B Louis IV, MD

Article Type: Case Study | First Published: August 26, 2019

We report a case of prolonged cardiac arrest in a patient with viral myocarditis who was subsequently cannulated for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) while in cardiac arrest. The patient developed bowel ischemia and abdominal compartment syndrome on ECMO and required a bedside decompressive laparotomy and hemicolectomy. This case demonstrates that prolonged downtime with high quality CPR and potential ischemic complications of VA-ECMO should not preclude ongoing resusc...

 Open Access DOI:10.23937/2474-3674/1510086

Psychosocial Considerations for Pediatric Care in Emergency Departments

Julie Lerwick, PhD, LPC, NCC, RPT

Article Type: Case Study | First Published: August 26, 2019

When pediatric patients are admitted into emergency departments a different course of psychological care is required. Often, when admitted, children are scared and in pain. Fear and pain at any age introduces unexpected behavioral responses, and this is not an exception for children. This makes children quite vulnerable in emergency departments, regardless if caregivers are trained to work with pediatric patients. Within the urgency of delivering emergent medical care, as well as maintaining str...

 Open Access DOI:10.23937/2474-3674/1510085

Hyponatremia in Children with Systemic Inflammatory Response Syndrome Presenting to the Emergency Department

Osama El-Assal, MD, PhD, Sarah A Marzec, MD, Michael L Forbes, MD, Michael Bigham, MD, Ryan Reichert, MD, Jeffrey D Solomon, MD and Miraides F Brown, MS

Article Type: Retrospective Study | First Published: July 25, 2019

Hyponatremia is observed in children with meningitis, encephalitis, pneumonia, urinary tract infections, and Kawasaki disease. The presence of hyponatremia is associated with increased morbidity and mortality in adults. The clinical significance of hyponatremia in febrile pediatric patients is unknown. The objective of this study was to evaluate the prevalence and prognostic value of hyponatremia in children presenting to the emergency department (ED) with systemic inflammatory response syndrome...

 Open Access DOI:10.23937/2474-3674/1510084

Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection

Mohammed A Said, MBChB, MPH, Wangari-Waweru Siika, MBChB, Vitalis Mung'ayi, MBChB and Reena Shah, MBChB, MRCP, MSc

Article Type: Original Article | First Published: July 13, 2019

Sepsis is global health priority and the leading cause of death in critical care. The SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis. It uses SOFA and qSOFA scores in place of the SIRS criteria for better ability to predict mortality in patients with suspected infections. The performance of these scores in critical care units outside high-income countries remains largely unknown....

 Open Access DOI:10.23937/2474-3674/1510083

Characterization of Pediatric Procedural Competency in Emergency Physicians

Daniel Slubowski, MD , Brian Wagers, MD and Jessica Kanis, MD

Article Type: Research Article | First Published: July 11, 2019

Medical and traumatic resuscitation are among the core competencies of emergency medicine. When compared to adult patients, the frequency of high acuity pediatric patients requiring procedures is low. Currently in emergency medicine practice, especially in academic settings, maintaining proficiency in high acuity and low frequency pediatric procedures may be a problem for physicians after completing training....

 Open Access DOI:10.23937/2474-3674/1510082

The 'SAFE PT' Handover: A Qualitative Study for Developing an Improvised Tool Facilitating Safe Patient Handover

Ahmed Mikky, MD, Mohamed Al Busafi, MD and Issa Al Salmi, MD, PHD

Article Type: Qualitative Study | First Published: July 03, 2019

The aim of this study is to identify and establish an effective and a standardized tool that is easily reproducible for the safe handover of patients at end of shift at the emergency department (ED) for continuity of care, smooth transition and minimising errors. This tool is designed to assist emergency physician and nurses in building a safe patient culture one that is reliable and upholds the standards of quality and improvement guided by international goals....

 Open Access DOI:10.23937/2474-3674/1510081

Iatrogenic Related to the Knowledge Deficit of Patient Safety in the Care: A Descriptive Analysis

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

The Outcome of Undisplaced Femoral Neck Fracture in Elderly

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

Pneumococcal Sepsis as a Cause of Massive Splenic Infarction in Patient with Unknown Celiac Disease

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

A Prospective Study on Severe Hypotension in Critically Ill Patients Sedated with Propofol

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

A Case Control Study of Risk Factors for Depression in Intensive Care Unit Patients

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

Postoperative Delirium in a Patient Following Laparoscopic Cholecystectomy and Spinal Anesthesia

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

Glaucopsia in Emergency Department

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 associate any chronic eye diseases. We present a case ...

 Open Access DOI:10.23937/2474-3674/1510074

Enhancement of NK Cell Cytotoxicity against MDA-MB-231 Cell by Presence of OK432

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 diseases throughout world. However, the treatments attem...

 Open Access DOI:10.23937/2474-3674/1510073

The Importance of Detecting Regulatory T Cells in Neonatal Sepsis

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 significance of Tregs. Sepsis is a common critical ill...

 Open Access DOI:10.23937/2474-3674/1510072

Assessment of the Degree of Stress during Pediatric Ground Transport

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 cancer cells, tissues and tumors diagnosis. After iden...

 Open Access DOI:10.23937/2474-3674/1510070

Femoral Fractures in Children Treated in a Regional Trauma Center in Nigeria

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 the femur in children seen in a regional trauma cent...

 Open Access DOI:10.23937/2474-3674/1510069

Preparing Residents for Emergent Vascular Access: The Comparative Effectiveness of Central Venous and Intraosseous Catheter Simulation-Based Training

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

What Statistics do Emergency Physicians Need to Know

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

Use of Programmed Multilevel Ventilation as a Superior Method for Lung Recruitment in Heart Surgery

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

Altruism: Brief Review of Current Opinions and Implications on Community Emergency Medicine

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

Predictors of Adverse Outcome Early After ICU Discharge

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

Extreme Hypernatraemia and Sepsis in a Patient with Huntington's Dementia: A Conundrum in Fluid Management

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

An Exploratory Study of Overnight Education in the Medical Intensive Care Unit

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

Efficacy of Cervical Immobilization in Multiple Trauma Patients

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

Non-Small Cell Lung Cancer Presenting as a Facial Soft Tissue Metastasis in a Non-Smoker

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 incidentally. We present a case of a 66-year-old ma...

 Open Access DOI:10.23937/2474-3674/1510059

Widened Mediastinum on Chest X-Ray as an Indicator of Mediastinal Injuries: A Relic of the Past?

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 within the Emergency Department itself....

 Open Access DOI:10.23937/2474-3674/1510058

Stem Cell Therapy for Ischemic Stroke: From Bench to Bedside

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

Incidence of Venous Thromboembolism in Asian Trauma Patients - An Asian Trauma Centre Review

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

A Young Woman with Dyspnea Following Delivery- Cardiomyopathy, Pulmonary Embolism or Both?

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

Role of Obstetric High Dependency and Intensive Care Unit in Improving Pregnancy Outcome and Reducing Maternal Mortality-A Study in Rural Central India

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 related to indications for HDU/ICU admission, interve...

 Open Access DOI:10.23937/2474-3674/1510054

Regional Citrate Anticoagulation in Continuous Renal Replacement Therapies

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

Intravenous Subdissociative-Dose Ketamine versus Morphine for Acute Traumatic Pain in Geriatric Patients in the Emergency Department: A Case Series

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

Thinking Outside the

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 requiring aggressive fluid resuscitation and vasopressors....

 Open Access DOI:10.23937/2474-3674/1510051

Utility of an Emergency Department Chest Pain Protocol in Ruling Out Acute Coronary Syndrome

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

Acidosis and ketonuria in an 8-Year-Old Male

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

The Role of Probiotics in Critically Ill Adult Patients with Pneumonia

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

Things to Keep in Mind in High Flow Therapy: As Usual the Devil is in the Detail

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 not documented in the literature to date. In a Task ...

 Open Access DOI:10.23937/2474-3674/1510047

Caring Critically Ill Patients in the General Wards in Tanzania: Experience of Nurses and Physicians

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

Early Protocolized Bedside Ultrasound in Shock: Renal Function Improvements and Other Lessons Learned

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 level....

 Open Access DOI:10.23937/2474-3674/1510045

To Determine Blood Lactate Levels in Patients with Sepsis Admitted to a Respiratory Intensive Care Unit and to Correlate with their Hospital Outcomes

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 as the Age and Chronic Health Evaluation (APACHE) ...

 Open Access DOI:10.23937/2474-3674/1510044

Severe Venlafaxine Intoxication with Refractory Pulseless Electrical Activity Cardiac Arrest Successfully Treated with Intravenous Lipid Emulsion

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

Penile Fracture: Report of Eight Cases and Review of Literatures Reported in China

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; ultrasonography can be very helpful in equivocal c...

 Open Access DOI:10.23937/2474-3674/1510042

Modeling Quality Improvement Strategies to Reduce Treatment Delays for Severe Sepsis at a Tertiary Care Hospital in India

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

Sphingomonas Paucimobilis Bacteremia in a Hemodialysis Patient and Literature Review

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

Effects of the Miyakejima Volcano Eruption on Public Health

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

Clinical Characteristics and Predictors of Recurrence and Surgical Management of Pneumothorax

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 lymphangioleiomyomatosis....

 Open Access DOI:10.23937/2474-3674/1510038

Found the Needle in the Haystack! The Case of a Fishbone Causing Vasovagal Syncopes and Abdominal Pain: A Case Report

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

Clinical Profile and Outcomes of Elderly Patients in an Asian Intensive Care Unit: A Retrospective Observational Study

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

Ventricular Tachycardias in Structurally Normal Hearts - A Case Report and Review of the Literature

Juergen Schiefermueller

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 abnormalities e.g. previous myocardial infarction, it i...

 Open Access DOI:10.23937/2474-3674/1510035

Acute Inferior Wall ST Segment Elevation Myocardial Infarction diagnosed During Bi-Ventricular Pacing

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 coronary artery (RCA)....

 Open Access DOI:10.23937/2474-3674/1510034

Noise Pollution in the Pediatric Intensive Care Unit and its Effect on Sedation

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 excessive noise exposure; some of this is related to the...

 Open Access DOI:10.23937/2474-3674/1510033

Acute Dyspnoea with Co-Incidental Finding of Carbon Monoxide Poisoning - A Case Report with Review of Current Literature

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

Effective Neurally Adjusted Ventilatory Assist (NAVA) Ventilation in a Child with a Large Bronchopleural Fistula

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

Bilateral Diaphragmatic Paresis after Cardiac Surgery: The Key is the Clinical Point-of-Care Ultrasound

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, revealing the POCUS a recovery on the left side but per...

 Open Access DOI:10.23937/2474-3674/1510030

Rapidly Progressive Fatal Gas Gangrene due to Clostridium Septicum in a Patient with Colon Cancer Revealed by Autopsy

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

Successful Treatment of Cerebral Sinus Thrombosis with Edoxaban Alone

Yasushi Shibata

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

Agenesis of the Bilateral Internal Carotid Arteriesled to the Development of Vertigo

Yasushi Shibata

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

Environmental Factors Urging the Development of Atopic Diseases in 75 Children

Arnaldo Cantani

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

Targeted Temperature Management Following Cardiac Arrest: In-Hospital Trends in Utilization

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

A Rare Case of Boerhaave Syndrome Presenting with Right Tension Pneumothorax and Review of the Literature

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

Mid-Regional Proadrenomedullin as a Prognosis Biomarker of Mortality in Patients Treated with Non-Invasive Ventilation in the Emergency Room

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

Emerging Concepts in Acute Heart Failure: From the Pathophysiology to the Clinical Case Based Approach

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

Cerebral Air Embolism in Commercial Flights: A Potentially Fatal Complication of Intrathoracic Lesions

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 dyspnea were common....

 Open Access DOI:10.23937/2474-3674/1510021

An Unstable Coronary Situation: A Case of Two Aborted Myocardial Infarctions in Three Days

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

Efficacy of Early Laparoscopic Surgery in Acute Abdomen Secondary to Perforated Jejunal Diverticulitis

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

Pre-Hospital Ultrasound: Current Indications and Future Perspectives

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

Aetiology and Presentation of Intestinal Obstruction among Patients Presenting to a Tertiary Hospital in Uganda

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. This study aimed to determine the current presentat...

 Open Access DOI:10.23937/2474-3674/1510017

Arginine in the Critically Ill: Can we Finally Push Past the Controversy?

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 substrate for nitric oxide production. In this review we ...

 Open Access DOI:10.23937/2474-3674/1510016

How to Deal With Febrile Neutropenia in Chemotherapy - Treated Cancer Patients? A Comprehensive Approach to Prevention and Therapy

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

Addressing Moral Distress in Critical Care Nurses: A Pilot Study

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. Theoretical framework: Nathaniel's Theory of Moral Reckonin...

 Open Access DOI:10.23937/2474-3674/1510014

Use of Transthoracic Impedance Data to Evaluate Intra-arrest Chest Compression Quality

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 arrests (OHCA) treated with the LUCAS mechanical co...

 Open Access DOI:10.23937/2474-3674/1510013

Use of Steroid for Extubation Failure due to Stridor in Surgical Intensive Care Patients

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 frequently fails extubation....

 Open Access DOI:10.23937/2474-3674/1510012

Almost Total Airway Obstruction Due to Unidentified Massive Hemoptysis under Extracorporeal Membrane Oxygenation

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 second day of illness. Sustained hemoptysis develop...

 Open Access DOI:10.23937/2474-3674/1510011

Inter-hospital Critical Care Transport: Implementation of a Novel Policy and Review of the Literature

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 require the coordination of extensive cardio-pulmonary ...

 Open Access DOI:10.23937/2474-3674/1510010

Inadvertent Late Migration of Jugular Catheter and Bilateral Pleural Effusion and Pneumomediastinum

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 complications....

 Open Access DOI:10.23937/2474-3674/1510009

High Flow Conditioned Oxygen Therapy for Prevention of Reintubation in Critically Ill Patients: A Preliminary Cohort Study

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 to prevent laryngeal edema and patients with hype...

 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 bronchial aspirate, following the introduction of treatme...

 Open Access DOI:10.23937/2474-3674/1510007

Glycemic Disturbances on Admission as a Predictor of Inpatient Mortality

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 (dysglycemia) were those considered to be < 70 or > 200 m...

 Open Access DOI:10.23937/2474-3674/1510006

Ventricular Arrhythmias in Acute Coronary Syndrome Patients: Therapy of Electrical Storm

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 renal denervation are available. AAD therapy is lim...

 Open Access DOI:10.23937/2474-3674/1510005

To Give or Not To Give - Is that the Question?: The Changing Face of Emergency Oxygen Therapy

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 for administration and prescription of oxygen, depe...

 Open Access DOI:10.23937/2474-3674/1510004

Cerebral Fat Embolism Syndrome: Diagnostic State of the Art: with and without Intra-medullary Fixation, with and without Long Bone Fractures

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 Unexpected presentation (CFES without any long bone fract...

 Open Access DOI:10.23937/2474-3674/1510003

Albuminuria in Critically lll Patients: A Prospective Cohort Study

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

Use of Dexmedetomidine in the Management of Alcohol Withdrawal Syndrome in Critically Ill Patients

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 unit (ICU) length of stay (LOS), more frequent infe...

 Open Access DOI:10.23937/2474-3674/1510001

Protocols for Uncontrolled Donation after Circulatory Death: International & Comprehensive Analysis

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 individuals as many as seven days after death. Actually, th...


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ClinMed Journals Index Copernicus Values

Clinical Medical Image Library: 93.51

International Journal of Critical Care and Emergency Medicine: 92.83

International Journal of Sports and Exercise Medicine: 91.84

International Journal of Womens Health and Wellness: 91.79

Journal of Musculoskeletal Disorders and Treatment: 91.73

Journal of Geriatric Medicine and Gerontology: 91.55

Journal of Infectious Diseases and Epidemiology: 91.55

Clinical Medical Reviews and Case Reports: 91.40

International Archives of Nursing and Health Care: 90.87

International Journal of Ophthalmology and Clinical Research: 90.80

International Archives of Urology and Complications: 90.73

Journal of Clinical Nephrology and Renal Care: 90.33

Journal of Family Medicine and Disease Prevention: 89.99

Journal of Clinical Gastroenterology and Treatment: 89.54

Journal of Dermatology Research and Therapy: 89.34

International Journal of Clinical Cardiology: 89.24

International Journal of Radiology and Imaging Technology: 88.88

Obstetrics and Gynaecology Cases - Reviews: 88.42

International Journal of Blood Research and Disorders: 88.22

International Journal of Diabetes and Clinical Research: 87.97

New Issues


International Journal of Clinical Cardiology

ISSN: 2378-2951 | ICV: 89.24



Obstetrics and Gynaecology Cases - Reviews

ISSN: 2377-9004 | ICV: 88.42



Journal of Hypertension and Management

ISSN: 2474-3690 | ICV: 87.69



International Journal of Diabetes and Clinical Research

ISSN: 2377-3634 | ICV: 87.97



Journal of Infectious Diseases and Epidemiology

ISSN: 2474-3658 | ICV: 91.55