Management of polytraumatized patient in Emilia Romagna. Data analysis of nontrauma center Hub Emergency Department

Introduction Trauma still has a great impact in term of morbidity and mortality all over the world. In Emilia Romagna, a region of the north of Italy, the Integrated System of Assistance to Trauma (SIAT) was created to ensure the best management of prehospital and early in-hospital trauma patient. Materials and Methods We reporte and discuss the results of an experimental study done in Emergency Department of Ferrara; datas refer to management of prehospital and early in-hospital trauma patient in the biennium 2015-2016. Results Datas show an increase in cases handled in the hub center instead of in the spoke ones; anyway there was an increasing in centralizing patients in the regional Hub Trauma center. Trauma Team was correctly activated, with an increasing trend. In addition, raising percentage of admission in ICU was associated with the raising percentage of patients treated in emergency medicine ward. Conclusions This article allows us to reflect and discuss about prehospital and in hospital polytraumatized patient path. Thanks to this newborn protocol of centralisation, traumatic patients were uniformly managed in the Western Emilia Romagna SIAT; trauma had a multidisciplinary approach and more appropriate admission. This resulted in optimizing the whole process from the income to the outcome of the patient. Moreover, the hospital of the study showed to be ready to cover the amount of trauma, except for those patients who needed to an hyperspecialistic approach

A case of dyspnea: respiratory failure due to pulmonary arteriovenous malformation

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary arteries and veins. The clinical features suggestive of PAVMs are stigmata of right-to-left shunting (dyspnea, hypoxemia, cyanosis, cerebral embolism, brain abscess), unexplained hemoptysis, or hemothorax. We present a case of a young man who presented to the Emergency Department complaining of dyspnea, polycythemia, and persistent hypoxemia. Angio-computed tomographic scan of the chest detected multiple PAVMs. PAVMs are uncommon in the general population, but they represent an important consideration in the differential diagnosis of common pulmonary problems, including hypoxemia, pulmonary nodules, and hemoptysis

Door-to-needle time in acute ischemic stroke: analysing intra-hospital delays, predictive factors, improving strategies. The experience of Baggiovara hospital (MO, Italy)

Stroke is a syndrome characterized by a sudden and quick development of neurological deficits due to vascular cause. The loss of function could be global, with permanent symptoms, until death, or transient (TIA) if blood supply is rapidly restore. International Task Force defined this acute pathology “a preventable and treatable catastrophe”: it is the third cause of death in developing countries, accounting for 2-4% of the public health budget. Management strategies include: Primary prevention: public information in order to increaseawareness Acute phase management, from the activation of the emergency service tothe rehabilitation and early secondaryprevention Health care for survivors withdisability The starting point of this study is the concept that “time is brain”, enhancing the role of the interval between the onset of symptoms and the final treatment (the “door to needle time”, DNT). This led us to carry a retrospective critical analysis, evaluate the DNT before and after the introduction of an internal protocol, aiming at the standards suggested in literature

The AMS Star Tracker thermal qualification overview

Four different thermal-vacuum tests were performed on AMICA Star Tracker (AST) in the period March-July 2006 in the space simulator of the SERMS laboratory in TerniItaly. Each of these tests was designed to verify different AST camera design features. The Thermal Balance test was conceived to validate the thermo-elastic model of the instrument and the active and passive thermal control subsystems. The Thermal Vacuum Cycling test was conceived to validate the AST electronics operative and survival temperature limits under vacuum conditions. The worst hot and cold operative and survival limits of the lens and filters in the AST optical system were assessed by means of the "Sun in the lens" and Lens Cold tests

Management of major bleeding in patients treated with direct oral anticoagulants: From experience to standardized protocols

Evaluation of clinical-laboratory-therapeutic management and related clinical outcomes (thrombotic-hemorrhagic complications) of patients undergoing treatment with direct oral anticoagulants (DOACs) during major bleeding. This is a two-year observational retrospective study. 27 cases of major bleeding in patients undergoing a therapy with DOACs presented to the Emergency Department of Arcispedale Santa Maria Nuova (Reggio Emilia Hospital). 16 cases (59%) underwent reversal of anticoagulation treatment: 19% using specific reversal therapy (idarucizumab) and 81% using non-specific agents [4-factor prothrombin complex concentrate (4F-PCC)]. Routine laboratory data were available for all the cases, but only for some patients it was possible to obtain the plasma dosage of the oral anticoagulant. Laboratory data confirm rapid correction of activated partial thromboplastin time within one hour from the reversal of anticoagulation with idarucizumab. The absence of correlation between standard blood tests and plasma drug dosage in patients treated with factor Xa Inhibitors was confirmed too. The management of major bleeding during treatment with DOACs using reversal therapy (idarucizumab) and non-specific reversal agent (4F-PCC) showed minimal thrombotic (0.3%) and hemorrhagic (0.3%) complications at 90 days; no events occurred after 6 months

L’utilizzo del Lat Gel nell’anestesia locale delle ferite pediatriche in Pronto Soccorso

Sedation and analgesia are common strategies to manage acute procedural pain and anxiety in Emergency Department, but no standardized protocol in children is approved. Application of topical LATgel (Lidocaine 4%, Adrenaline 0,05%, Tetracaine 0,5%) on wounds before painful procedures seems to be as effective as intradermal infiltrations in reducing procedural pain. A review of 34 paediatric cases from Pavullo Hospital (MO, Italy) presenting with laceration requiring suture was conducted. Pain assessment was performed in triage and, after 30mins of LATgel application, from parents, children and doctors during the suture. LATgel administration improves children’s compliance, minimizing pain and related fear during procedures. Our findings are consistent with international literature

A new device for ultrasound-guided peripheral venous access

Background: In patients with difficult peripheral venous access, alternative techniques require expertise and are invasive, expensive, and prone to serious adverse events. This brought us to designing a new venous catheter (JLB\uae Deltamed, Inc.) for the cannulation of medium and large bore veins; it is echogenic, and available in different lengths (60 / 70 / 80 mm) and Gauges (14 / 16 / 17 / 18). Methods: We led a multi-center observational convenience sampling study to evaluate safety and effectiveness of JLB. Data was collected from June 2015 to February 2018. Inclusion criteria were age \u2a7e 18, difficulty in obtaining superficial venous access in the veins of the arm, need for rapid infusion, or patient\u2019s preference. Results: We enrolled 1000 patients, mean age 66.8 years. In total, 951 (95.1%) had the device placed in internal jugular vein, 28 in basilic or cephalic vein, 15 in femoral vein, 5 in axillary vein (infra-clavicular tract), and 1 in the external jugular vein. The procedure was performed by attending physicians or emergency medicine residents under US guidance. Mean procedure time (from disinfection to securing) was approximately 240 s. Mean attempts number was 1.21. Early complications (<24 h) occurred in four patients, consisting in two soft tissue hematoma, one phlebitis, and one atrial tachyarrhythmia. No major complications (such as pneumothorax) were reported. Mean indwelling time was 168 h (7 days); early occlusion/dislocation occurred in four cases. Conclusion: According to preliminary data, the application of JLB appears to be safe, cost-effective, and rapid to place bedside