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Topic Review
Addressing Challenges in EMS Department Operations
Emergency medical services (EMS) are essential in providing timely medical attention and transportation to people in need during times of crisis. Effective EMS operations are crucial for delivering prompt and effective healthcare. However, the landscape of EMS operations is constantly evolving, posing a number of challenges that require rigorous research and innovative solutions.
  • 951
  • 02 Jan 2024
Topic Review
Hemoptysis in Cancer Patients
Hemoptysis in cancer patients is a potentially serious symptom that requires detailed evaluation by oncologists and emergency department physicians. Timely diagnosis and appropriate management are crucial to address both the immediate concern of bleeding and the broader implications for the patient's cancer care. As hemoptysis in cancer patients indicates the presence of complications or progression of the disease, investigating the underlying cause using appropriate diagnostic procedures such as imaging studies (CT scans, bronchoscopy) and laboratory tests is vital, as it can significantly impact treatment choices and potentially alter the patient's overall prognosis. Risk stratification for cancer patients presenting with hemoptysis will support a personalized treatment approach that ensures that each patient receives tailored and effective care and identifies patients who are at a higher risk of deterioration, warranting more aggressive diagnostic and treatment plans and close, continuous monitoring for these patients.
  • 944
  • 12 Oct 2023
Topic Review
Basic Signs and Complete Lung Ultrasound Examination
Lung ultrasound (LUS) has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures. The integration of bedside ultrasonography in the daily clinical activity of intensivists could reduce the risk of radiation exposure, need of patient transport, and hospital costs and may redirect patient’s management. A qualitative LUS approach is based on interpreting artifacts (A- and B-lines) and real images to distinguish between normal and pathological context. If a qualitative approach gives important information on the morphological assessment of the lung for the diagnosis, a quantitative approach allows us to extend the utility of the examination to lung monitoring.
  • 893
  • 30 May 2023
Topic Review
Cold Atmospheric Plasma in Critically Ill Patients
Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing.
  • 890
  • 08 May 2023
Topic Review
Initial Management of Cardiogenic Shock
Cardiogenic shock (CS) is a complex syndrome manifesting with distinct phenotypes depending on the severity of the primary cardiac insult and the underlying status. As long as therapeutic interventions fail to divert its unopposed rapid evolution, poor outcomes will continue challenging health care systems. CS represents a life-threatening condition equated to a dismal prognosis. Since the introduction of the fundamental mechanisms of shock in 1972, CS has been universally defined as a state of severe end-organ hypoperfusion and tissue hypoxia resulting primarily from cardiac pump failure.
  • 879
  • 13 Apr 2023
Topic Review
Percutaneous Biliary Drainage
Ultrasound guidance in biliary interventions has become the standard tool to facilitate percutaneous biliary drainage as well as percutaneous gall bladder drainage. Monitoring of the needle tip whilst penetrating the tissue in real time using ultrasound allows precise manoeuvres and exact targeting without radiation exposure.
  • 873
  • 28 Feb 2024
Topic Review
Management of Adolescents Admitted with Severe Anorexia Nervosa
Anorexia Nervosa (AN) affects up to 0.5% of adolescents. It is considered the third most common chronic disease in adolescence and also the psychiatric illness with the highest mortality rate, ranging from 2–8%. Part of this high mortality is explained by the multi-systemic stress caused by prolonged fasting, especially on the cardio-vascular system. Although there is a general agreement regarding admission criteria, the initial management of admitted patients with severe malnutrition due to AN is still highly variable with no international consensus on the optimal nutritional rehabilitation for this specific population.
  • 871
  • 02 Apr 2022
Topic Review
Nanoparticles in Cancer Therapies and Clinical Diagnosis
Timely diagnosis and appropriate antitumoral treatments remain of utmost importance, since cancer remains a leading cause of death worldwide. Within this context, nanotechnology offers specific benefits in terms of cancer therapy by reducing its adverse effects and guiding drugs to selectively target cancer cells.
  • 823
  • 23 Nov 2023
Topic Review
Differential Diagnosis of Acute Pelvic Pain
In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities, the correct assessment of these patients may be challenging. The most frequent gynaecological causes of acute pelvic pain in non-pregnant women are pelvic inflammatory disease, ruptured ovarian cysts, ovarian torsion, and degeneration or torsion of uterine leiomyomas. On the other hand, spontaneous abortion, ectopic pregnancy, and placental disorders are the most frequent gynaecological entities to cause acute pelvic pain in pregnant patients.
  • 819
  • 26 Oct 2023
Topic Review
Bedside Testing in Acute Vestibular Syndrome
Patients with stroke and vestibular neuritis can both present with an acute vestibular syndrome (AVS). Patients with AVS have acute-onset, continuous vertigo, dizziness, or unsteadiness lasting days to weeks, usually associated with vomiting, nystagmus, severe postural instability, and head movement intolerance.
  • 812
  • 06 Sep 2023
Topic Review
The Diagnosis of Community-Acquired Pneumonia
Community-acquired pneumonia (CAP) is among the most common causes of death and one of the leading healthcare concerns worldwide. It can evolve into sepsis and septic shock, which have a high mortality rate, especially in critical patients and comorbidities. The diagnosis of CAP generally necessitates an infiltration on Chest X-rays (CXR) in a patient with fever, dyspnea, cough, and sputum.
  • 791
  • 27 Jun 2023
Topic Review
Sepsis and Septic Shock in Adult Patients
Sepsis/septic shock is a life-threatening and time-dependent condition that requires timely management to reduce mortality. The management of sepsis/septic shock is challenging and involves different pathophysiological aspects, encompassing empirical antimicrobial treatment (which is promptly administered after microbial tests), fluid (crystalloids) replacement (to be established according to fluid tolerance and fluid responsiveness), and vasoactive agents (e.g., norepinephrine (NE)), which are employed to maintain mean arterial pressure above 65 mmHg and reduce the risk of fluid overload.  In cases of refractory shock, vasopressin (rather than epinephrine) should be combined with NE to reach an acceptable level of pressure control. If mechanical ventilation is indicated, the tidal volume should be reduced from 10 to 6 mL/kg. Heparin is administered to prevent venous thromboembolism, and glycemic control is recommended. The efficacy of other treatments (e.g., proton-pump inhibitors, sodium bicarbonate, etc.) is largely debated, and such treatments might be used on a case-to-case basis.
  • 766
  • 06 May 2023
Topic Review
Echocardiographic Assessment of PTTM patients in the ED
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease that obstructs pulmonary vessels, leading to pulmonary hypertension (PH) and right-sided heart failure causing rapid progressive dyspnea in patients with cancer. 
  • 762
  • 28 Jan 2022
Topic Review
Disorders Requiring Transfusion
Blood transfusion is a lifesaving procedure in critical care settings across all species and is often required in equine intensive care and emergency situations. There are numerous reasons why horses may require a transfusion, and when administered thoughtfully, at the appropriate time and in the correct way, blood or blood component transfusion can be one of the most readily accessible lifesaving procedures that a veterinarian can perform. 
  • 746
  • 07 Sep 2022
Topic Review
Point of Care Ultrasound of the Optic Nerve
Point of care ultrasound (POCUS) of the optic nerve is easy to learn and has great diagnostic potential. Within emergency medicine, research has primarily focused on its use for the assessment of increased intracranial pressure, but many other applications exist, though the literature is heterogeneous and largely observational. In many of these applications, sonographic optic nerve sheath diameter (ONSD) has moderately high sensitivity and specificity, but the supporting studies are heterogeneous.
  • 734
  • 09 Mar 2023
Topic Review
US Findings of Pelvic Pain in Reproductive Age
Pelvic pain in reproductive age often represents a diagnostic challenge due to the variety of potential causes characterized by overlapping clinical symptoms, including gynecological and other disorders (e.g., entero-colic or urological). It is also necessary to determine if there is a possibility of pregnancy to rule out any related complications, such as ectopic pregnancy. Although ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are strongly integrated, the choice of which is the ideal diagnostic tool should be guided both by clinical suspicion (gynecological vs. non-gynecological cause) and by the risk ratio–benefit (ionizing radiation and instrumental costs), too.
  • 731
  • 22 Apr 2022
Topic Review
Pain Management at the End of Life
Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis.
  • 704
  • 14 Jul 2023
Topic Review
Cerebral Sinus Vein Thrombosis and Gender
Cerebral sinus venous thrombosis (CSVT) is a relatively rare acute disorder of cerebral circulation, but it can potentially be associated with serious sequelae and a poor prognosis. The neurological manifestations associated with it are often not adequately taken into consideration given the extreme variability and nuances of its clinical presentation and given the need for radiological methods suitable for this type of diagnosis. CSVT is usually more common in women, but so far there are little data available in the literature on sex-specific characteristics regarding this pathology. CSVT is the result of multiple conditions and is therefore to be considered a multifactorial disease where at least one risk factor is present in over 80% of cases.
  • 628
  • 25 Jun 2023
Topic Review
Traumatic Cardiac Arrest
A paradigm shift in traumatic cardiac arrest (TCA) perception switched the traditional belief of futility of TCA resuscitation to a more optimistic perspective, at least in selected cases. The goal of TCA resuscitation is to rapidly and aggressively treat the common potentially reversible causes of TCA. Advances in diagnostics and therapy in TCA are ongoing; however, they are not always translating into improved outcomes. Further research is needed to improve outcome in this often young and previously healthy patient population.
  • 573
  • 26 Jan 2024
Topic Review
Pain Management Analgesia
Effective pain management in hospitalized patients involves a multimodal approach tailored to the severity and type of pain (mild, moderate, or severe) and the patient's clinical condition. The goal is to provide adequate pain relief while minimizing side effects and preventing complications like opioid dependence or gastrointestinal and renal issues from NSAIDs. Mild Pain: Managed with non-opioid analgesics such as acetaminophen or NSAIDs. Topical agents like lidocaine patches or capsaicin cream may be used for localized pain. Moderate Pain: Combines non-opioid analgesics with low-potency opioids (e.g., tramadol). Adjuncts like topical therapies or neuropathic pain medications (e.g., gabapentin) may also be employed. Severe Pain: Requires short-acting opioids (e.g., morphine, hydromorphone) often administered via scheduled dosing or patient-controlled analgesia. Long-acting opioids are reserved for chronic conditions like cancer-related pain. Special considerations include adjusting treatment for patients with chronic pain, hepatic or renal dysfunction, or risk factors for adverse drug reactions. Preventive measures, such as bowel regimens for opioid-induced constipation, and regular reassessment of pain control are critical components of care. The approach prioritizes not just the relief of pain but also the functional improvement and safety of patients. Consultation with pain management or palliative care teams is advised for complex or refractory cases.
  • 429
  • 25 Nov 2024
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