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

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:10.23937/2474-3674/1510056

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 rel...

 Open Access DOI:10.23937/2474-3674/1510054

Regional Citrate Anticoagulation in Continuous Renal Replacement Therapies

Domingo Daga-Ruiz, Jonathan PĂ©rez-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 "Box": Severe Intra-Abdominal Bleeding Due to Liver Injury Post CPR

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 requirin...

 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 no...

 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 leve...

 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 ...

 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; ...

 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 lymphangioleiomyoma...

 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 abnor...

 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 coronar...

 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 excess...

 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, revea...

 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 dy...

 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. T...

 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 substra...

 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. Theoretic...

 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 ar...

 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 ...

 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 s...

 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 requi...

 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 com...

 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...

 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 bronchi...

 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 (dysgly...

 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 r...

 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 f...

 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 Unexpec...

 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 u...

 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 individua...


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