Emergency Care and Medicine

Background: Abnormalities in the canal of the Nuck are rare clinical entities with presentation in the early adulthood of females. Given their rarity, they can be misdiagnosed with a strangulated inguinal hernia. Methods: Herein, we report a young female with painful swelling of the right inguinal hernia and its surgical approach. Results: A 37-year-old female presented to the emergency department with pain in the right lower abdominal quadrant and an edematous inguinal mass. Physical examination showed a palpable inguinal mass, setting the suspicion for possible incarcerated inguinal hernia. Laboratory exams were within normal ranges. The patient was subsequently treated surgically. During the operation, a cystic well-rounded mass was identified and completely excised. The mesh and plug technique was the chosen technique for the restoration of the inguinal canal. The hospitalization length was one day, and the post-operative course was uneventful. Conclusions: Although a Nuck cyst is a rare entity, it should be taken into consideration in female adults who present with an inguinal mass. Full article

Intensive Care Unit-Acquired Weakness (ICU-AW) is a common and severe complication in critically ill patients, characterized by profound and often prolonged muscle weakness. The complexity of its diagnosis and management requires a multidimensional approach that integrates clinical, electrophysiological, and imaging tools. This review focuses on the challenges in diagnosing ICU-AW, emphasizing the limitations of traditional methods such as manual muscle testing and electrophysiological studies, and highlights the emerging role of neuromuscular ultrasound (NMUS) as a promising, non-invasive diagnostic aid. Despite its utility, no gold standard exists for NMUS, making it an evolving area of research. The pathophysiological basis of ICU-AW involves multiple mechanisms, including critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and muscle atrophy due to disuse. Understanding these underlying mechanisms is crucial for advancing diagnostic strategies and informing therapeutic interventions. Recent insights into the molecular and cellular pathways involved, such as the role of oxidative stress, mitochondrial dysfunction, and the ubiquitin-proteasome system, have opened new avenues for targeted therapies. Management of ICU-AW remains challenging as no specific treatment has been proven fully effective. Current strategies focus on early mobilization, minimizing sedation, and optimizing nutritional support. Emerging therapies targeting molecular pathways involved in muscle degradation are under investigation, highlighting the potential to translate pathophysiological understanding into therapeutic innovations. This review underscores the need for ongoing research to establish standardized diagnostic protocols and develop targeted treatments for ICU-AW. Full article

Background: Geriatric trauma patients often present with multiple comorbidities, which can complicate their treatment and impact outcomes. This study examines the effect of common pre-existing comorbidities on mortality and recovery in polytrauma patients, comparing them to polytrauma patients without these conditions. Methods: We conducted a retrospective cohort study of patients with an Injury Severity Score (ISS) ≥ 16, admitted to a Level I trauma center between 2006 and 2019. A total of 315 patients were analyzed, including 235 with at least one comorbidity (COPD, type II diabetes, or anticoagulation due to atrial fibrillation) and 80 patients without any comorbidities, who served as the control group. Results: While comorbid patients had similar ISS scores compared to controls, they experienced significantly longer hospital and ICU stays. No significant difference in overall survival was found between the groups. However, patients with comorbidities were more prone to secondary complications, such as sepsis and thrombosis. Conclusions: The presence of common comorbidities, while associated with longer recovery times and increased complication rates, did not significantly impact mortality in polytrauma patients. Full article

In recent years, the integration of informatics in emergency medicine has led to significant improvements in clinical decision-making, patient management, and overall healthcare delivery. This literature review explores the most recent trends and applications of informatics in the field of emergency medicine, including electronic health records, telemedicine, artificial intelligence, and mobile health technologies. The goal is to provide a comprehensive overview of the state-of-the-art technologies, their current implementations, and the challenges that remain to be addressed. Full article

Introduction: Non-compressible torso hemorrhage (NCTH) is a major cause of preventable mortality in trauma, particularly when immediate surgical intervention is not available. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a promising technique to control severe hemorrhaging and stabilize patients until definitive surgical care can be performed. Case Presentation: We report the case of a 45-year-old woman who sustained multiple traumatic injuries—including thoracic, pelvic, and aortic damage—after a fall from approximately 5 m in an apparent suicide attempt. She arrived at a secondary-level trauma center in profound hemorrhagic shock, unresponsive to standard resuscitation. Interventions: As the patient’s condition deteriorated to cardiac arrest, an emergent REBOA procedure was performed by emergency physicians. This intervention rapidly restored hemodynamic stability, enabling damage control resuscitation and safe transfer to a Level 1 Trauma Center for definitive surgical management, including thoracic endovascular aortic repair and splenectomy. Outcomes: After prolonged intensive care, the patient recovered sufficiently to be discharged for rehabilitation. This case illustrates the life-saving potential of early REBOA deployment in a non-surgical, resource-limited setting to bridge patients to definitive care. Conclusions: This case supports integrating REBOA into emergency trauma protocols, particularly in centers without immediate surgical capabilities. Further research is warranted to refine REBOA deployment strategies, balloon positioning, patient selection, and the role of imaging guidance. Full article

Background: Emphysematous pyelonephritis (EPN) is an infectious disease of the renal system caused by gas-producing microorganisms harboring the kidneys. Patients with diabetes mellitus (DM), an endocrine disease with hyperglycemia, are particularly susceptible to the EPN as their immune system is compromised in fighting against infections. Case Description: We present a case of a 50-year-old female with a history of chronic diabetes and persistent hypertension. She presented with symptoms of pyrexia and flank pain. Following findings from ultrasound, she was advised to undergo computed tomographic (CT) scans that reveal air-filled hypodense areas at the upper and mid pole of the right kidney and in the renal pelvis of the right ureter, which confirms the class I EPN in the patient. Urine culture identifies Escherica coli as the causative agent for EPN. The patient was managed with third-generation antibiotics over two weeks, leading to full recovery without surgical intervention. Discussion: The availability of CT imaging makes early diagnosis and reduces mortality associated with EPN. Conservative medical management should be the initial treatment strategy for EPN. However, severe cases require immediate therapeutic action. In our case, the patient was treated with antibiotic therapy and recovered. Conclusions: CT scan seems to be the optimal diagnosis in patients with acute emphysematous pyelonephritis. Patients with EPN class I respond well to medical treatment with excellent outcomes. Full article

Introduction: The literature has suggested two variants of appendicitis: a simple variant that may even resolve spontaneously and a more aggressive variant that may proceed to complication. We review two cohorts compatible with “mild” appendicitis: children with acute appendicitis that presented with normal inflammatory markers (NIMs), and confirmed on pathological examination, and children with sonographically confirmed appendicitis that resolved without medical or surgical intervention. Methods: We identified all children diagnosed with appendicitis from June 2016 to June 2024. To confirm the accuracy of the initial sonographic diagnosis of appendicitis in children with spontaneous resolution, two study radiologists, blinded to clinical data, reviewed the images for signs of appendiceal inflammation. We compared cases of NIM with cases presenting with elevated inflammatory markers, and cases of spontaneous resolution with cases of uncomplicated appendicitis treated medically. Results: A total of 999 children were diagnosed with appendicitis, with 845 confirmed on pathology. Of these 845, 17 had NIMs and were less likely to present with vomiting than children with elevated inflammatory markers (24% versus 61%, p = 0.002). Fourteen had spontaneous resolution and twenty-five were treated medically. White blood cell count (14.1 versus 10.2, p = 0.005) and appendiceal diameter (8.6 mm versus 7.6 mm, p = 0.078) were higher for children with conservative treatment. Children receiving medical treatment received intravenous analgesia more frequently (88% versus 50%, p = 0.009). More resources were used for medical treatment—these children had longer hospitalizations (3.5 versus 1.6 days, p = 0.001) and more frequently received repeat bloodwork (68% versus 36%, p = 0.051). Conclusions: Appendicitis that resolves spontaneously, and appendicitis that presents with normal inflammatory markers, may represent rare, low-risk forms of appendicitis that may not be associated with progression to complication. While pediatric appendicitis should not be ruled out in the presence of a normal laboratory evaluation, cases that present without gastrointestinal symptoms, without severe pain, and with an appendiceal diameter and inflammatory markers below a certain threshold may warrant continued observation and serial ultrasound to evaluate for progression prior to initiating therapy. Full article

Background: This study compared outcomes of pregnant females with and without COVID-19 and their fetuses/newborns. Methods: This is a retrospective study from 2020 to 2023 utilizing the United States Collaborative Network of the TriNetX Database. We compared the outcomes of pregnant females with COVID-19 and pregnant females without COVID-19. Maternal outcomes evaluated were death, intubation, intensive care unit (ICU) admission, and premature rupture of membranes (PROM) within 9 months of the diagnosis of pregnancy. Fetal outcomes included preterm birth and intrauterine death (IUD). A subgroup analysis of outcomes was performed based on the mother’s vaccine status. Results: The risks of maternal death (RR = 1.97), maternal intubation (RR = 3.33), and maternal (ICU) admission (RR = 1.76) were significantly higher in pregnant females with COVID-19. For the neonate, there was a higher risk of preterm birth (RR = 1.12). When the confounders were eliminated with propensity matching, there was still an increase in maternal intubation (RR = 3.24) and maternal ICU admission (RR = 1.60). For the neonate/fetus, there was a decreased risk of PROM (RR = 0.83) and IUD (RR = 0.74) for the fetuses of the mothers with COVID-19. For the subgroup analysis, the mother was at an increased risk of ICU admission (RR = 0.04) when unvaccinated. Conclusions: There is an increased risk of poor outcomes for pregnant women infected with COVID-19; however, fetal outcomes are generally favorable. When unvaccinated, there was an increased risk of ICU admission for the mother. Full article

Background: We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia that were present on presentation, which were successfully managed with venovenous extracorporeal membrane oxygenation (VV-ECMO). Case Presentation: A 40-year-old patient with a past medical history of asthma was admitted to a local hospital due to dyspnea, cough, and wheezing, where the patient was diagnosed with HIV infection, ARDS, and combined pneumocystis and cytomegalovirus pneumonia. Their pulmonary function quickly declined, necessitating mechanical ventilation (MV). After all conventional therapies failed, the patient was transferred to a tertiary medical center for VV-ECMO therapy. The patient was successfully treated with antiretroviral therapy (ART), antibiotics, antivirals, steroids, and 48 days of VV-ECMO support, with complete resolution of their respiratory symptoms. The patient was discharged on hospital day 82. Conclusions: HIV-positive patients with ARDS that is complicated by opportunistic pulmonary infections can be successfully managed with ART, appropriate anti-infective therapies, and VV-ECMO. Full article

Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences of it and efforts to derive meaning from it. Methods: From an initial random sample of 182 survivors of the Oklahoma City bombing, narrative descriptions of this experience were collected 7 years after the bomb blast from 116 of the original sample, for the purpose of examining persistent as well as newly evolving content through qualitative analysis. The narrative content was analyzed for the evolution of thematic content in narrative data also collected at 6 months post-disaster and 1 year later. Results: The thematic content of the bombing experience was structured in a chronological fashion from the bomb blast (sensory, cognitive, and emotional), its immediate aftermath (e.g., escaping danger), and later experiences, (e.g., leaving the bomb site and receiving hospital treatment). During the time between interviews, the focus and general content of the narratives changed minimally, despite considerable compression of detail. Conclusions: The consistency of the material in these narratives over 7 years may reflect the persistence and salience of disaster memories, with the potential for its continuation for the rest of their lives. Full article

Objective: To review imaging findings of isolated tibiofibular interosseous membrane (IOM) injury and propose an injury mechanism. Case Report: A retrospective review was conducted on five patients who presented with lower leg pain following a traumatic athletic injury. MRI examinations revealed isolated tibiofibular IOM injury without associated fractures or distal syndesmotic disruption. The observed injury patterns, along with the blunt, non-rotational trauma reported in each case, suggest that the mechanism behind this unique presentation may involve sudden traction or direct impact to the lower leg. Conclusion: Isolated tibiofibular IOM injury should be considered in patients with lower leg pain after blunt trauma. MRI of the entire tibia and fibula can be instrumental in characterizing and confirming the injury and should be considered when clinical and injury mechanism indicators are present. Full article

Background: In the crucible of disasters, civic engagement emerges as a dynamic force that channels individual strength and collective willpower toward the common good. Although it has been recognized as a necessary precondition for community resilience, studies on the motivators for citizens’ activities during disasters are relatively limited. This study underscores the interplay of personal resilience, risk perception, and coping strategies in the context of emergency-oriented civic engagement. It provides a robust framework for comprehending the cognitive and emotional processes that drive individuals’ responses to threats and risks to improve knowledge about public behavior, psychological conditions, and mental health during man-made disasters. Method: an online survey was conducted with a sample of 1514 citizens in Israel. A model incorporating both moderation and mediation effects was proposed. Results: The results reveal a consistent positive relationship between personal resilience and emergency-oriented civic engagement and point to the importance of both the intervening role of risk perception and the moderating role of coping strategies. Conclusions: discuss the importance of resilience-building programs and the promotion of positive coping strategies which can empower individuals to navigate the complexities of risk perception and engage actively in civic activities during disasters. Full article

Current research is mostly focused on the impact of fertilizers on human health when they are ingested through food; the main form of this is chronic damage. Intoxication through oral ingestion of fertilizer is an extremely rare situation. We report a case of a 38-year-old man that attempted to commit suicide by ingesting only 20 mL of a water-soluble fertilizer. Acute kidney injury occurred early, which showed that the toxicity could not be ignored. It was necessary to seek medical attention as soon as possible. In addition, the patient experienced gastrointestinal dysfunction and a severe inflammatory response; inflammatory markers increased rapidly. Physicians implemented antimicrobial stewardship to reduce antimicrobial drug resistance and the risk of hospital infection, and the patient’s inflammatory response was well controlled. Although the damage was severe, the patient quickly recovered to normal after appropriate treatment. The prognosis is very good. This successful case provides guidance for clinical treatment. Full article

Background: Open knee joint injury is a deep traumatic laceration violating the joint capsule. This study aimed to assess outcomes and associated factors of open knee joint injuries in trauma patients at Tibebe-Ghion Specialized Hospital, Bahirdar, Ethiopia, 2021. Methods: An institution-based retrospective cross-sectional study was conducted by reviewing the medical records of 43 patients treated for open knee joint injuries from January 2019 to July 2021, with an 86% response rate. Data were entered and exported using Epidata Manager Version 4.4 and analyzed using SPSS version 25. Results: Fourteen (32.5%) of the study subjects developed either infections or limping during follow-up due to open knee injuries, with the majority of injuries (58.1%) being caused by car accidents. The presence of associated injuries, wound size, time to wound closure, debridement as a management option, sex, and diagnostic methods showed a significant association with complication outcomes. Among the diagnosed infections, 90% were cases of septic arthritis. During the study period, eight patients (18.6%) developed limping during follow-up. The complication rate among open knee injury patients in the study area was significantly high, with one-third of patients experiencing complications. Targeted public awareness campaigns like car accidents should be conducted to educate the population about orthopedic emergencies and strategies to reduce complication risks, aiming for more favorable outcomes. Full article

Prehospital care, and especially emergency medical services (EMSs), are facing an increasing demand, while experiencing financial pressure. Strategies aimed at improving prehospital care management emphasize the efficient utilization of resources, but often overlook the long-term implications for the prehospital healthcare system, encompassing emergency medical services, emergency departments, and healthcare authorities. This paper draws on almost ten years of improvement in EMS’ key performance indicators such as response time or overtime in Switzerland, using Discrete Event Simulation. Three representative simulation studies are used to reflect on the optimization potential of alternative bases and rosters, methodological limitations, and the uptake of the derived recommendations. The results demonstrate that EMSs’ efficiency gains in resource utilization increasingly come into conflict with emergency departments’ and healthcare authorities’ policies, indicating a need to enrich Discrete Event Simulation with a systemic perspective. A new methodology that conceptualizes long-term prehospital care planning as an interdisciplinary and iterative process utilizing a novel combination of System Dynamics and Discrete Event Simulation is proposed. Full article

Large Language Models (LLMs) are becoming increasingly adopted in various industries worldwide. In particular, there is emerging research assessing the reliability of LLMs, such as ChatGPT, in performing triaging decisions in emergent settings. A unique aspect of emergency triaging is the process of trauma triaging. This process requires judicious consideration of mechanism of injury, severity of injury, patient stability, logistics of location and type of transport in order to ensure trauma patients have access to appropriate and timely trauma care. Current issues of overtriage and undertriage highlight the potential for the use of LLMs as a complementary tool to assist in more accurate triaging of the trauma patient. Despite this, there remains a gap in the literature surrounding the utility of LLMs in the trauma triaging process. This narrative review explores the current evidence for the potential for implementation of LLMs in trauma triaging. Overall, the literature highlights multifaceted applications of LLMs, especially in emergency trauma settings, albeit with clear limitations and ethical considerations, such as artificial hallucinations, biased outputs and data privacy issues. There remains room for more rigorous research into refining the consistency and capabilities of LLMs, ensuring their effective integration in real-world trauma triaging to improve patient outcomes and resource utilisation. Full article

Background: The recent earthquakes that occurred in Southern Turkey on the 6th of February 2023, were the most devastating earthquakes that have occurred in Turkey in the modern era. Teams of rescuers from 19 EU states quickly responded and carried out rescue missions across the affected area. This article is a report of a case series of rescues performed by the Romanian response team RO-USAR 1, with its aim being to assess the need of an internation consensus regarding immediate first-care in patients that are victims of natural or human-made catastrophes. Operations: A total of five victims were extracted alive from under the debris by our team and transported to the nearest available hospital by ambulance. A total of eight deceased victims were also extracted to facilitate access to the aforementioned alive victims. Conclusions: Quickly recognizing life-threatening situations and rapidly instating rapid fluid resuscitation is an essential step in reducing mortality in patients affected by major natural or human-made disasters. The need for an international consensus for the prehospital care of these patients is needed now more than ever in order to further ameliorate morbidity and mortality that largely occurs due to crush syndrome and its derived complications. Full article

The global health crisis caused by the COVID-19 pandemic severely restricted in-person international events and clinical exposure opportunities for medical students. As a result, fostering global collaborations and providing hands-on experiences for future healthcare professionals has become increasingly challenging. The Khon Kaen University International Challenge of Emergency Medicine (KKU ICEM) is the world’s first international emergency medicine (EM)-focused competition for medical students. Since 2016, it has been held eight times and attracted participation from approximately 500 students across 18 countries spanning Asia, Europe, North America, and Africa. The KKU ICEM not only equips medical students with essential EM knowledge but also cultivates international friendships and cross-cultural competence. Initiatives like the KKU ICEM can play a crucial role in preparing the next generation of healthcare professionals for the challenges ahead. Full article

Inter-hospital transfers remain a significant part of emergency care service missions, even though efforts have been made to change this. We examined the use of prehospital emergency care units in inter-hospital patient transfers in one wellbeing services county in Finland. We evaluated the potential strain they place on regional prehospital emergency care readiness, and examined how these transfers arise between different regions, populations, and healthcare centers. This was a register-based pilot study using prehospital emergency care inter-hospital transfer mission statistics within the wellbeing services county of Pirkanmaa, Finland during 2020 and 2021. The data were extracted from the emergency care service’s field management program. A descriptive analysis of the data was performed, in which interdependencies between several variables were examined. During the two years, there were 5812 prehospital emergency care inter-hospital transfer missions dispatched to prehospital emergency care units. The number of prehospital emergency care inter-hospital transfer missions was especially notable in rural regions, where there were also fewer units available. Based on the results, the criteria for prehospital emergency care use in inter-hospital transfers require clarification, since there is an observable strain caused by these transfers on regional emergency care readiness. The results of this pilot study encourage further studies on the use of prehospital emergency care units in inter-hospital patient transfers. Full article