Pain, Bleeding, Trauma and Infections: The 4 Horsemen of the Apocalypse for the Emergency Medicine

A topical collection in Medicina (ISSN 1648-9144). This collection belongs to the section "Emergency Medicine".

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Editor


E-Mail Website
Collection Editor
Emergency Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli, 00168 Roma, Italy
Interests: short stay unit; infection, sepsis; trauma; syncope; pulmonary embolism; inflammatory bowel disease; gastroenteritis; gastrointestinal bleeding; diverticulitis
Special Issues, Collections and Topics in MDPI journals

Topical Collection Information

Dear Colleagues, 

Background and history of this topic: The emergency doctor is faced with a huge number of ailments of varying degrees of severity every day. He/she must deal with extremely mild ailments, such as external otitis, as well as time-dependent diseases, such as myocardial infarctions and major trauma. The overcrowding of the ER is a long-standing problem that is present all over the world and negatively affects the management of these disorders.

Aim and scope of the Topical Collection: to improve the management of the four most common causes of admission to the ER (trauma, infections, bleeding, and pain).

Cutting-edge research: In this Topical Collection, we welcome articles discussing acute pathologies that present with pain or bleeding or that occur due to infections or trauma. We aim to discuss ailments that require urgent attention from the diagnostic, management, and therapeutic fields.

What kind of papers we are soliciting: original research, reviews, meta-analyses, and case series.

Dr. Marcello Candelli
Collection Editor

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Keywords

  • pain
  • trauma
  • infection
  • bleeding
  • sepsis
  • shock

Published Papers (4 papers)

2023

Jump to: 2022

10 pages, 890 KiB  
Article
Pre-Test Probability Assessment and d-Dimer Based Evaluation in Patients with Previous Acute Aortic Syndrome
by Fulvio Morello, Marco Santoro, Francesca Giachino, Francesca Caciolli, Elisa Capretti, Matteo Castelli, Emanuele Pivetta, Peiman Nazerian and Enrico Lupia
Medicina 2023, 59(3), 548; https://doi.org/10.3390/medicina59030548 - 10 Mar 2023
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Abstract
Background and Objectives. Acute aortic syndromes (AASs) are emergencies burdened by high morbidity and mortality. Guideline-recommended diagnostic workup is based on pre-test probability assessment (PPA) and d-dimer testing. However, the performance of PPA and d-dimer has never been studied in [...] Read more.
Background and Objectives. Acute aortic syndromes (AASs) are emergencies burdened by high morbidity and mortality. Guideline-recommended diagnostic workup is based on pre-test probability assessment (PPA) and d-dimer testing. However, the performance of PPA and d-dimer has never been studied in individuals with previous AAS (pAAS), which represent a challenging population. Materials and Methods. We analyzed a registry of patients with pAAS evaluated in two Emergency Departments (EDs) for suspected novel AAS (nAAS). Enrolment criteria were history of pAAS and the presence of truncal pain, syncope or perfusion deficit. All patients underwent advanced imaging. Clinical data were registered prospectively and PPA was performed by applying the aortic dissection detection (ADD) and an aorta simplified (AORTAs) score. Results. A total of 128 patients were enrolled, including 77 patients with previous Stanford type A aortic dissection and 45 patients with previous Stanford type B aortic dissection. The final diagnosis was nAAS in 40 (31%) patients. Clinical variables associated with nAAS were: aortic valve disease, thoracic aortic aneurysm, severe pain, sudden pain, ripping/tearing pain and hypotension/shock. ADD score ≥ 2 had a sensitivity of 65% and a specificity of 83% for nAAS; AORTAs score ≥ 2 had a sensitivity of 48% and a specificity of 88%. d-dimer (cutoff ≥ 500 ng/mL or age-adjusted cutoff) had a sensitivity of 97% and a specificity of 13%/14.7%, for diagnosis of nAAS. Patients that were candidates for guideline-compliant PPA/d-dimer integrated rule-out were: 5 (4.9%) with ADD ≤ 1/d-dimer and 8 (7.8%) with AORTAs ≤ 1/d-dimer < age-adjusted cutoff. None of them had a nAAS. Conclusions. Patients with pAAS evaluated in the ED for red-flag symptoms showed intermediate-to-high pre-test probability of nAAS. The ADD score had lower sensitivity and specificity than in unselected patients. d-dimer, alone and integrated with PPA, was highly sensitive for nAAS, but very unspecific. PPA/d-dimer integrated strategies are unlikely to significantly reduce the number of patients with pAAS undergoing advanced imaging. Full article
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2022

Jump to: 2023

5 pages, 1488 KiB  
Technical Note
K-Rod: An Innovative Method of Personalized Rib Splinting for Expeditious Management of Flail Chest in Acute Care Settings
by Chia-Jung Lin, Yung-Sung Yeh, Yen-Ko Lin and Chao-Wen Chen
Medicina 2023, 59(1), 76; https://doi.org/10.3390/medicina59010076 - 29 Dec 2022
Cited by 1 | Viewed by 2884
Abstract
Flail chest is a severe type of multiple rib fracture that can cause ventilation problems and respiratory complications. Historically, flail chest has been mainly managed through pain control and ventilatory support as needed. Operative fixation has recently become popular for the condition, and [...] Read more.
Flail chest is a severe type of multiple rib fracture that can cause ventilation problems and respiratory complications. Historically, flail chest has been mainly managed through pain control and ventilatory support as needed. Operative fixation has recently become popular for the condition, and some studies have revealed its potentially positive effects on the outcomes of patients with flail chest. However, for those for whom surgery is unsuitable, few treatment options, other than simply providing analgesia, are available. Herein, we introduce our innovative method of applying personalized rib splinting for quick management of flail chest, which is easy, tailor-made, and has significant effects on pain reduction. Full article
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13 pages, 2019 KiB  
Article
Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture
by Jan Gewiess, Markus Martin Luedi, Beat Schnüriger, Theodoros Hercules Tosounidis, Marius Johann Baptist Keel and Johannes Dominik Bastian
Medicina 2022, 58(9), 1291; https://doi.org/10.3390/medicina58091291 - 16 Sep 2022
Cited by 3 | Viewed by 2166
Abstract
Background and Objectives: C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study was to document effective [...] Read more.
Background and Objectives: C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study was to document effective hemodynamic stabilization after C-clamp application by means of vital parameters (primary outcome parameter), and the subsequent effect on metabolic indices and volume management (secondary outcome parameters). Materials and Methods: C-clamp application was performed between 2014 and 2021 for n = 13 patients (50 ± 18 years) with unstable pelvic fractures and hemodynamic instability. Vital parameters, metabolic indices, volume management, and the correlation of factors and potential changes were analyzed. Results: After C-clamp application, increases were measured in systolic blood pressure (+15 mmHg; p = 0.0284) and mean arterial pressure (+12 mmHg; p = 0.0157), and a reduction of volume requirements (p = 0.0266) and bolus vasoactive medication needs (p = 0.0081) were observed. The earlier C-clamp application was performed, the greater the effect (p < 0.05; r > 0.6). Heart rate, shock index, and end-tidal CO2 were not significantly altered. The extent of base deficit, hemoglobin, and lactate did not correlate with changes in vital parameters. Conclusions: In the majority of hemodynamically unstable trauma patients not responding to initial fluid resuscitation and severe pelvic fracture, early C-clamp application had an additive effect on hemodynamic stabilization and reduction in volume substitution. Based on these findings, there is still a rationale for considering early C-clamp stabilization in this group of severely injured patients. Full article
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10 pages, 621 KiB  
Article
Is the Use of Segways or E-Scooters in Urban Areas a Potential Health Risk? A Comparison of Trauma Consequences
by Kai Hoffeld, Olivia Mair, Markus Wurm, Philipp Zehnder, Dominik Pförringer, Peter Biberthaler, Chlodwig Kirchhoff and Michael Zyskowski
Medicina 2022, 58(8), 1033; https://doi.org/10.3390/medicina58081033 - 02 Aug 2022
Cited by 3 | Viewed by 2433
Abstract
Background and objectives: Electromobility has become increasingly popular. In 2001, Segway personal transporters (Segway) were established for tourists, and e-scooters have been in use since their approval in 2019. The aim of this study was to analyze and compare the types of injuries [...] Read more.
Background and objectives: Electromobility has become increasingly popular. In 2001, Segway personal transporters (Segway) were established for tourists, and e-scooters have been in use since their approval in 2019. The aim of this study was to analyze and compare the types of injuries directly related to the use of Segways and e-scooters, respectively, in a German city and to phrase potential safety advice. Materials and Methods: All patients presenting to our emergency department after Segway incidents were retrospectively analyzed and compared with the prospectively collected cohort of patients following e-scooter incidents. Presented injuries were analyzed by body region and injury severity score (ISS). Epidemiological data were collected. Results: Overall, 171 patients were enrolled. The Segway group included 56 patients (mean age 48 years), and the e-scooter group consisted of 115 patients (mean age 33.9 years). Head injuries (HI) occurred in 34% in the Segway group compared to 52% in the e-scooter group. The ISS was approximately equal for both groups (mean ISS Segway group: 6.9/e-scooter group: 5.6). Conclusions: Since the e-scooter group presented a high number of HI along with a higher likelihood and greater severity of HI, mandatory use of helmets is suggested. Full article
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Reversal anticoagulation in geriatric trauma: a narrative review

Author: Dr. Marcello Candelli

 

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