Medicine and Pharmacology

Abstract: Background: Standard sepsis risk stratification relies on static scores and single time-point biomarkers, failing to capture the temporal complexity of the host response. The dynamic interplay between immune dysregulation and metabolic distress remains poorly integrated into clinical phenotyping. We hypothesized that early longitudinal trajectories of these domains could reveal distinct immunometabolic phenotypes predicting intensive care unit-acquired infection (ICU-AI) and mortality. Methods: This multicenter retrospective study leveraged high-granularity data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD), enrolling adult patients with a diagnosis of sepsis identified by the International Classification of Diseases (ICD) coding. We employed unsupervised latent class growth modeling (LCGM) to identify phenotypes based on 72-hour serial measurements of core immunometabolic indices, including lymphocyte, neutrophil, and platelet counts, lactate, and the lactate dehydrogenase-to-albumin ratio (LAR). Associations with the primary outcome (ICU-AI) and secondary outcomes (28-day mortality and a composite of ICU-AI/death) were quantified using multivariable Fine-Gray competing-risk models and multivariable logistic regression. We assessed the incremental prognostic value of trajectory phenotypes beyond a baseline model comprising age and sequential organ failure assessment (SOFA) scores. Results: We identified three reproducible immunometabolic trajectory phenotypes, each exhibiting distinct temporal profiles of inflammation and organ function. Trajectory 3 (“Rapid Recovery”) demonstrated swift normalization of biomarkers and favorable outcomes. In contrast, Trajectory 2—characterized by distinct “Immunometabolic Paralysis” (persistent lymphopenia paired with sustained hyperlactatemia and elevated LAR)—conferred the poorest prognosis. Compared to the Rapid Recovery phenotype, Trajectory 2 was associated with a more than two-fold increase in ICU-AI risk and significantly higher 28-day mortality. Integrating trajectory phenotypes into baseline severity models significantly enhanced predictive accuracy and demonstrated superior net benefit in decision curve analysis (DCA). Conclusion: Early 72-hour trajectories of routine biomarkers identify a distinct “Immunometabolic Paralysis” phenotype characterized by sustained metabolic stress and immunosuppression. This dynamic classification outperforms static severity scores in predicting ICU-AI. By distinguishing patients with entrenched dysregulation from those with rapid recovery, this approach offers a scalable framework for risk stratification and predictive enrichment in future trials of immunomodulatory or metabolic therapies.

Abstract: Background and Objectives: Suspected bacterial infection is one of the leading presentations to the Emergency Department (ED) and is still associated with considerable morbidity and mortality. There is increasing evidence that biological sex may influence host immune responses, disease manifestations, therapeutic requirements, and clinical outcomes in infectious diseases. However, sex-specific differences among patients who present to the ED with suspected infection remain incompletely defined. This study, therefore, aimed to assess demographic characteristics, clinical presentation, and clinical management as well as short-term outcomes related to sex among these patients. Materials and Methods: Our single-center retrospective observational study included consecutive adults patients (n= 213) presented with suspected acute bacterial infection to the Emergency Department between June 2025 and August 2025. Results: Female patients were significantly older than male patients (72.13 ± 15.26 vs. 64.25 ± 13.66 years, p < 0.001). Cardiovascular disease and urinary tract infections were more frequently observed among women, whereas men presented significantly higher diastolic blood pressure values at admission (p = 0.004). Vasopressor therapy was more commonly required in female patients compared to males (26.0% vs. 13.3%, p = 0.019). No significant sex-related differences were identified regarding ICU admission or in-hospital mortality. Conclusions: ED patients with suspected bacterial infection demonstrate sex-related differences in age, comorbidities, infection source, and treatment requirements. Female patients were older and more frequently required vasopressor therapy. On the other hand, male patients had higher diastolic blood pressure and presented more frequently with respiratory infections. Short-term outcomes, including ICU admission and in-hospital mortality, were similar for both sexes. These findings highlight the importance of considering sex-specific characteristics in the early assessment and management of suspected infection in the Emergency Department.

Abstract: Trauma is defined as an injury caused by external mechanical forces ranging from physical, chemical, biochemical, or physchological. The Injury Severity Score (ISS) is established on the Abbreviated Injury Scale (AIS). Advanced Trauma Life Support (ATLS) contains basic procedures for securing the airway, establishing and maintaining hemodynamic stability, and adequately assessing injuries based on diagnostic tests. The damage control strategy is a multidisciplinary approach to the polytraumatized patient, including Damage control resuscitation and Damage control surgery. In the emergency room management of a polytraumatized patient, several critical steps are taken to guarantee comprehensive care: all clothing and jewelry are removed from the patient, monitoring devices are placed, circulatory status is evaluated, blood typing and cross-matching are done, and possibly, the transfusion of blood and blood products is initiated. The Initial Hemorrhage Management Steps are: controlling the bleed source, maintaining permissive hypotension and adequate fluid resuscitation, providing coagulation support and treating/reversing trauma-induced coagulopathy. Supportive perfusion therapy provides maintenance of adequate pH, which, together with maintaining body temperature above 36℃. The shift to directed therapy based on standard coagulation tests and point-of-care methods (viscoelastic haemostatic assays), should be done as soon as possible. Substitution therapy is selected with the aim to correct the identified hemostasis disorder associated with trauma.

Abstract: Background: Procedural sedation and analgesia (PSA) is commonly used for shoulder dislocation (SD) reduction in emergency departments (EDs) but requires monitoring resources and may be associated with adverse events. Ultrasound-guided regional anesthesia (UGRA), particularly interscalene block, represents an alternative approach but is associated with a high incidence of hemidiaphragmatic paralysis due to inadvertent phrenic nerve blockade. More distal approaches such as superior trunk (ST) block may reduce this risk. This study aimed to evaluate the feasibility and adoption of ultrasound-guided ST block using low volumes of local anesthetic for shoulder reduction in a real-world ED setting. Methods: This retrospective single-center observational study included all consecutive patients with acute SD treated in a specialized orthopedic ED in Switzerland between February 2018 and February 2024. Patients underwent reduction under either PSA or UGRA. The primary aim was to assess feasibility and adoption of UGRA. Secondary exploratory analyses included temporal trends in technique use, changes in local anesthetic volume, and comparison of length of stay (LOS) between groups. Results: A total of 206 patients were included (124 UGRA, 82 PSA). The use of UGRA increased significantly over time, while PSA decreased (p < 0.001). UGRA procedures were predominantly performed by a small number of providers. Local anesthetic volume decreased over time, with most blocks performed using approximately 5 mL. No clinically apparent respiratory complications were observed following UGRA. In an exploratory analysis, LOS was shorter in the UGRA group compared to PSA (p = 0.034), although variability was considerable. Conclusions: Ultrasound-guided low-volume ST block can be successfully implemented for shoulder reduction in an ED setting and may represent a practical alternative to PSA. Its adoption in routine clinical practice requires time, training, and repeated procedural exposure. Low-volume ST approaches may help minimize clinically relevant respiratory effects, although prospective studies are needed to further evaluate diaphragmatic outcomes and optimal dosing strategies.

Abstract: Accidental foreign body ingestion is a common and often harmless event in childhood, especially among very young children, who naturally explore their surroundings by putting objects in their mouths. However, certain objects whose ingestion carries a risk of complications, sometimes potentially life-threatening. Being aware of these is particularly important, as their removal must be performed as soon as possible in a specialized center. Among these, button batteries, magnets, sharp objects, and coins require special attention. The location of the object is also important in determining the degree of urgency. Since symptoms may be absent initially or are completely nonspecific, the medical history is crucial, as prompt and correct management is particularly important. In the absence of a clear medical history, the diagnosis is often based on a high degree of suspicion. Therefore, this article aims to analyze the situations when a foreign body ingestion constitutes an emergency and to present the appropriate diagnostic and therapeutic approach in specific cases. Preventive measures are important in avoiding these life-threatening situations, and therefore, parents and caregivers must be informed and take steps to keep children from accessing dangerous objects.

Abstract: Background/Objectives: In male trauma patients suspected of having a pelvic fracture with urethral injury (PFUI), repeated urethral catheterization attempts can cause additional injury. Since 2021, our institution has been performing simultaneous percutaneous cystostomy using a guidewire and anterograde urethral Foley catheter insertion during pelvic angiography in patients with suspected PFUI. We aimed to analyze the characteristics and clinical course of this patient group. Methods: We retrospectively analyzed male trauma patients who were admitted to our emergency department between January 2021 and December 2025, and who underwent the aforementioned interventional procedure after standard Foley catheterization failed because of a pelvic fracture-associated urethral injury. The age, mechanism of injury, injury severity score (ISS), abbreviated injury scale, type of pelvic fracture, use of pelvic angiography, time from emergency room arrival to Foley catheterization, and administration of additional urological treatments were investigated. Results: Among 492 male patients with pelvic fractures, 11 underwent the procedure because of PFUI (age: 57.8 ± 13.9 years, ISS: 20.2 ± 9.6). Pelvic crushing was the most common injury mechanism, and pelvic angiography was performed in 81.8% of cases. The mean time from emergency room arrival to interventional Foley catheterization was 283 ± 250 min. Three patients required additional urological treatment after the acute phase, and all underwent endoscopic internal urethrotomy for urethral stricture. Conclusions: In cases in which hemodynamically unstable PFUI is suspected and initial urethral catheterization is difficult, Foley catheter insertion via interventional radiology may represent an alternative to conventional primary endoscopic realignment and suprapubic cystostomy.

Abstract: Most children presenting with a life-threatening cardiopulmonary catastrophe will have a final diagnosis of a benign, self-limited, or low-risk condition. The emergency physician must be able to recognize the pattern of normal development and not mistake it for a life-threatening condition. There are 5 pediatric presentations that commonly prompt the emergency physician to consider a cardiac or respiratory emergency. These are briefly discussed as they relate to the emergency physician and are resolved as BRUE, breath-holding spells, syncope of reflex and vasovagal origin, chest pain of benign origin, and innocent heart murmur or irregularity. Common pathophysiologic themes underlying these clinical presentations are (1) transient autonomic instability, (2) exaggerated physiologic response to pain or emotional stress, (3) benign pain of musculoskeletal or chest wall origin, and (4) cardiac flow or rhythm abnormalities with normal structural and functional cardiopulmonary findings. A framework for the evaluation of a child with an acute presentation and concern for a life-threatening condition is (1) determine if the child is currently unstable, (2) recreate the event and identify red flags for conditions such as seizure, sepsis, myocarditis, arrhythmia, critical congenital heart disease, or pulmonary embolic disease, (3) selective ordering of diagnostic tests rather than reflexive testing, and (4) disposition based on (a) whether the child's symptoms are recurrent, (b) abnormal physical examination, (c) abnormal electrocardiogram, (d) the child's history placing them at high risk for serious illness, and (e) the child failing to return to a normal baseline after observation. Each of these points will be elaborated upon and the step-by-step actions that are taken at the bedside and an explanation of what to do, how to do it, and why will be provided. Children with BRUE should have a focus placed on risk stratification as opposed to ordering a battery of diagnostic tests. Children with breath-holding spells require safe positioning of the child on their back and recognition of the 2 phenotypes of breath-holding (cyanotic and pallid) and their relationship to iron deficiency. Children with syncope of reflex or vasovagal origin can typically be distinguished from those with ominous causes based on history, particularly an orthostatic component, and ECG screening is indicated. Children with chest pain of benign origin can typically have a distinction made between musculoskeletal origin or precordial catch and exertional, inflammatory, or even ischemic origin of their chest pain. Children with an innocent heart murmur and isolated cardiac ectopy are 2 of the most common outpatient and emergency department concerns for which children and their families are referred for urgent imaging. The majority of children with these presentations will have a completely normal physical examination and can be managed as an outpatient. A pathophysiology-based, clinically concrete approach to the evaluation of children with acute presentations will lead to decreased overtesting and improved accurate disposition of children with concerns for life-threatening illness while maintaining sensitivity for detecting dangerous cardiopulmonary disease.

Abstract: Objectives: To evaluate the impact of Point-of-Care Ultrasound (POCUS) performed by family physicians on the management of abdominal pain in the emergency department, assessing its effect on length of stay, performance of complementary diagnostic tests, diagnostic concordance, and patient satisfaction. Methods: Quasi-experimental pilot study with a control group conducted in a hospital emergency department. A total of 222 adult patients with abdominal pain were included and allocated according to the attending professional (with or without ultrasound training). Clinical, care-related, and patient-satisfaction variables (SERVPERF questionnaire) were analyzed. Non-parametric statistical tests were used, and multiple linear regression analyses were performed. Results: The POCUS group showed a shorter length of stay (3.46 vs. 4.41 hours; p=0.022) and a lower number of plain radiographies (16.8% vs. 69.9%; p<0.001) and CT scans (p=0.034). Diagnostic concordance was significantly higher in the experimental group (99.2% vs. 75.7%; p<0.001). Overall satisfaction with received care was also higher in the intervention group (p<0.001), with significant differences observed across all evaluated dimensions. The multivariate model explained 26.6% of the variability, with patient satisfaction emerging as a positive predictor. Conclusions: POCUS improves the quality of care in emergency departments by reducing length of stay and the use of complementary diagnostic tests while increasing diagnostic accuracy and patient satisfaction. Its implementation can be considered an effective and potentially cost-effective strategy; however, further studies with greater methodological robustness are required to validate the development of standardized composite indexes.

Abstract: Background: Modern warfare has introduced novel mechanisms of injury, particularly drone-induced blast trauma, resulting in complex craniomaxillofacial injuries. These injuries differ substantially from traditional ballistic trauma and require adapted surgical strategies. This study aimed to evaluate the clinical characteristics, management approaches, and long-term outcomes of midfacial blast injuries. Methods: A retrospective analytical study was conducted on 41 patients with drone-induced midfacial blast injuries treated at a tertiary referral center in Armenia following the 2020 Nagorno-Karabakh war. All patients underwent surgical management after initial stabilization and were followed for 5 years. Clinical outcomes, complications, and reconstructive needs were assessed. Results: All patients presented with comminuted midfacial fractures, frequently associated with polytrauma (87.8%). Burns were observed in 82.9% of cases. Surgical management included radical debridement and early definitive osteosynthesis using titanium fixation systems. No cases of postoperative osteomyelitis, bone sequestration, or implant failure were observed during the 5-year follow-up. Patients with extensive soft tissue defects, particularly nasal and lip amputations required multiple reconstructive procedures. Long-term follow-up revealed progressive soft tissue thinning over titanium meshes, especially in the zygomatico-orbital region, necessitating secondary interventions such as lipofilling. Conclusions: Drone-induced midfacial blast injuries represent a distinct and severe form of trauma. Early definitive reconstruction following adequate debridement was associated with favorable outcomes. However, soft tissue reconstruction remains challenging and often requires staged procedures. Long-term follow-up is essential to manage delayed complications and optimize aesthetic outcomes.

Abstract: The use of technology-enhanced training for prehospital mass-casualty incident (MCI) preparedness has grown quickly, but there has been no comprehensive overview of how these technologies operate throughout the training process or how competencies are evaluated. This scoping review, conducted as part of the MCIPHER (Mass-Casualty Incident Prehospital Emergency Response) project, followed the Arksey and O'Malley framework and PRISMA-ScR guidelines. We searched seven databases and additional sources, screened 2,105 records, and included 28 studies published from 2015 to 2025. Virtual reality was the most common method (43%), followed by hybrid approaches (29%) and screen-based simulations (21%). We identified five key analytical constructs. Three were derived from the data: the Technology Function Spectrum revealed that half of the studies used dual-purpose platforms for both training and performance assessment; the Data Capture Architecture linked embedded data collection to advanced learning outcomes (L2+); and the Pedagogical Transparency Gap showed that 75% of studies did not specify a training design framework. Two other constructs — the Immersion-Evaluation Paradox and the Scalability-Rigor Tension — suggest areas for future research. Using a modified Kirkpatrick framework with an L2+ (Applied Learning) sub-level, 56% of completed studies demonstrated applied learning through embedded performance assessments. Overall, these findings suggest that investments in MCI preparedness should focus more on measurement capabilities than immersion, incorporate assessment into training platforms, and work to reduce geographic and resource disparities.

Abstract: Background: The COVID-19 pandemic profoundly disrupted healthcare utilization patterns at both primary care (PC) and hospital emergency department (ED) levels. This study aimed to assess the impact of the pandemic on referral patterns from PC to a hospital ED and on the resource consumption associated with those referrals. Methods: describe briefly the main methods or treatments applied. Methods: A descriptive, retrospective, longitudinal comparative study was conducted at a first level hospital of Madrid (Spain). All consecutive PC-to-ED referrals received during two observation windows were included: a pre-pandemic period (1 June-31 December 2019; n=946) and a post-pandemic period (1 January-30 June 2022; n=1,797). Sociodemographic characteristics, referral form quality, diagnostic specialty, and in-ED resource utilization variables were collected and compared using χ², Student’s t-test, and Mann–Whitney U tests as appropriate. Results: A total of 2,743 referrals were analyzed. The monthly referral rate increased by approximately 122% between periods (135/month vs 300/month). No significant differences were found in patient age (mean 53.1±18.3 vs 54.9±19.0 years; p=0.015) or sex. Referral form completion improved significantly for clinical history (94.5% vs 98.2%; p<0.001). Orthopedics referrals nearly tripled (5.8% vs 18.4%), while respiratory/COVID-19-related referrals represented 22.0% of the 2022 caseload. ED length of stay between 3 and 6 hours increased from 13.0% to 42.8% (p<0.001), while the need for urgent blood tests fell from 68.9% to 56.0% (p<0.001), hospital admission from 68.4% to 10.9% (p<0.001), and referral to another center from 12.3% to 0.9% (p<0.001). Conclusions: indicate the main conclusions or interpretations. The abstract should be an objective representation of the article, it must not contain results which are not presented and substantiated in the main text and should not exaggerate the main conclusions. After the initial COVID-19 waves, PC-to-ED referrals increased substantially while requiring fewer complementary investigations and generating fewer hospital admissions, suggesting improved coordination and clinical resolution capacity between PC and the ED. These findings have important implications for post-pandemic healthcare planning.

Abstract: Background and Objectives: Slovenia, as many other European nations, have introduced voluntary first responders to enhance survival rates in out-of-hospital cardiac arrests. In currently published research exists no conclusive data on the optimal retraining interval, categorizing recommendations as expert opinion with limited reliability. Materials and Methods: Experimental prospective research was conducted on newly certified (N = 342) and senior (N = 140) licensed first responders (LFRs) in Slovenia, in accordance with national guidelines. LFRs were reassessed for retention of skills and knowledge one year after previous certification. Additionally, each cohort was classified into groups according to the number of interventions they engaged in over the past year, and their retention of skills and knowledge was assessed. Results: In the initial year of service, no statistically significant decline in skills (median 53 [52-54] vs. 53 [50-54]; p = 0.059) and knowledge (median 10 [9-10] vs. 9 [9-10]; p = 0.458) was observed among new LFRs. In contrast, senior LFRs exhibited a marked reduction in skills (median 51 [49-54] vs. 54 [52-55]; p < 0.001) until recertification, although their knowledge (median 9 [8.5-10] vs. 10 [9-10]; p = 0.091) remained stable. The frequency of interventions did not affect the new LFRs; however, there was a significant decrease in skill (median 49 [47-51] vs. 54 [52-55]; p < 0.001) retention among senior LFRs who did not participate in any interventions during the previous certification period. Notably, senior LFRs who engaged in at least one intervention did not demonstrate any decline in skills (median 52 [50-54] vs. 54 [52-55]; p = 0.117). No reduction in knowledge was detected. Conclusions: Initial training for Slovenian LFRs has been found to be adequate. However, senior LFRs experience a decline in skills if they do not participate in interventions during the certification period. A different strategy for recertifying senior LFRs should be adopted, considering the number of interventions they have been involved in during this time.

Abstract: Background: Microcirculatory dysfunction is a key feature of septic shock and contributes to organ failure despite the apparent normalization of systemic hemodynamic parameters. Extracorporeal blood purification (EBP) therapies aim to modulate the dysregulated inflammatory response through removal of endotoxins and cytokines; however, their impact on tissue-level perfusion remains unclear. Direct bedside assessment of microcirculation may provide mechanistic insight into the effects of EBP beyond macrohemodynamic stabilization. Methods: This structured narrative review summarizes current evidence on direct microcirculatory assessment during EBP therapy in sepsis. A literature search of PubMed, Web of Science, and Scopus was performed using combinations of the terms “microcirculation” and “blood purification” or “hemoadsorption.” Studies published between 2015 and 2026 evaluating direct sublingual microcirculation using sidestream dark field (SDF) or incident dark field (IDF) videomicroscopy during EBP were included. Both experimental and clinical studies were considered. Results: Eight studies met the inclusion criteria. Selective endotoxin adsorption with polymyxin B hemoperfusion (PMX-HP) demonstrated improvements in perfused vessel density and small vessel density in both animal and clinical settings. Non-selective cytokine adsorption devices (CytoSorb and HA380) were associated with increases in microvascular flow index (MFI), perfused vessel density (PVD), and proportion of perfused vessels (PPV), although most data derive from small observational studies. Across studies, improvements in microcirculatory parameters were observed during or following hemoadsorption therapy; however, heterogeneity in design, timing, and concomitant treatments limits definitive interpretation. Conclusions: Current evidence suggests that EBP may positively influence microvascular perfusion in septic shock when assessed using direct videomicroscopy. Nevertheless, data remain limited and predominantly observational. Larger randomized controlled trials incorporating predefined microcirculatory endpoints are required to determine whether mediator removal translates into sustained restoration of tissue perfusion and improved clinical outcomes.

Abstract: Lazarus phenomenon (LP), also named auto-resuscitation, may happen after the end of ineffective cardiopulmonary resuscitation (CPR), or after death is confirmed in a person who did not undergo CPR, and heart activity returns spontaneously. The aim of the study was to focus on elder individuals (aged >60) experiencing the Lazarus phenomenon and to analyse distractors that cause the LP. Methods. PubMed, Scopus, and Web of Science electronic databases were searched to find cases of LP from the year 1982 until 31 December 2025. Of the 81 total cases found, 48 pa-tients were elder than 60 years and were included in the study. For the analysis they were divided into two subgroups dependent on age: No 1 (79-60), No 2 (≥80). Results. The causes of cardiac arrest were divided almost equally between cardiac and non-cardiac causes (47.6% and 52.3% respectively). Cardiac arrest occurred equally in the IH and OH, each accounting for 50%. The ECG rhythm during cardiopulmonary resuscitation prior to the onset of LP was as follows: A – 58.7%, PEA – 37% and VF – 4.3% respectively. In 16 out of 37 cases where such data were reported, a return to consciousness was confirmed, representing 43.2%. During statistical analysis of these data no relationship was found. Conclusions. In older people, even those of very advanced age, Lazarus phenomenon may occur following resuscitation or even if resuscitation is not attempted. Based on the analysis of the available data from a literature on LP case reports we have not identified any specific cause for LP in older individuals. The causes of LP probable lie outside the analysed data. Accurate reporting is required, including data such as: CPR time points with details of medication administered during CPR, airway management, quality of ventilation, and laboratory tests (blood gas analysis, electrolyte levels, complete blood count) in order to analyse the suggested causes of LP.

Abstract: One of the most debated scientific topics in recent years is the role of noninvasive respiratory support techniques in the treatment of de novo acute hypoxemic respiratory failure. Until pre-COVID-19, the most accredited guidelines did not make recommendations for or against the use of these techniques in this clinical condition, and the increased risk of adverse events for patients who failed the noninvasive approach was widely reported in the literature. In recent years, in addition to the pandemic experience, we have seen the widespread use of high-flow nasal cannulas (HFNC) in the emergency department, as well as the production of numerous studies comparing them to the more established techniques of noninvasive ventilation and continuous positive airway pressure (NIV, CPAP), as well as to conventional oxygen therapy (COT). The most recent guidelines recommend the use of HFNC as a first-line technique in the treatment of de novo acute hypoxemic respiratory failure to avoid the need for tracheal intubation. However, the strength of these recommendations remains weak, the quality of the underlying evidence is poor, and their usefulness in deciding which technique to apply to an individual patient is questionable. The progressive establishment of the pathophysiological concept of Patient's Self-Inflicted Lung Injury (P-SILI), a potential risk of additional lung damage in spontaneously breathing patients, has highlighted the importance of assessing each patient's risk of developing this complication, individualizing treatment to the patient's specific needs, and monitoring the patient during treatment. This brief narrative review will illustrate the most recent literature on these topics.

Abstract:

Background: Cardiac arrest is the third leading cause of natural death in Europe and thus presents a growing burden on both our society and healthcare system. There has been very little research done on cardiac arrests of non-cardiac origin despite their increasing incidence, as they represent a heterogenous group of patients in which the type and outcome of treatment vary depending on the underlying cause of the cardiac arrest. Aim: The aim of our study is to research how the Slovenian healthcare system has worked and currently works in the field of cardiac arrests of non-cardiac origin. Methods: Our study was descriptive and retrospective. We compared 2 time periods, 2010/2011 and 2022/2023. Our sample included all patients admitted to Centre for Intensive Internal Medicine (CIIM) during these periods after either out-of-hospital or in-hospital cardiac arrest of non-cardiac origin. Results: The incidence of all cardiac arrests of non-cardiac origin was higher in 2022/2023 (Hi-squared test, p=0.021), while the incidence of those that occured in-hospital was lower in 2022/2023 (Hi-squared test, p=0.007). The number of male patients was higher in the second period (Hi-squared test, p=0.013). The age of the patients did not differ significantly between the two periods (Student's t-test, p>0.05). ICU stay was longer in the second period (Mann Whitney U test, p=0.027). The number of tests performed was higher and treatment was more aggressive in the second period than in the first period. Patient survival was higher in the second period in the in-hospital cardiac arrest of non-cardiac origin group (Student's t-test, p=0.048). Conclusion: The incidence of cardiac arrest of non-cardiac origin in Slovenia has been increasing through the years. Better hospital treatment results in better overall survival and a lower incidence of in-hospital cardiac arrests. More patients with out-of-hospital cardiac arrests are nowadays being resuscitated by lay bystanders in the field, so patients' survival to hospital admission is higher. The proportion of male patients is increasing, age is not changing significantly. Despite better diagnosis processes, new treatments and improved knowledge, the survival and neurological outcome of patients have not improved significantly.

Abstract: Wild-boar–related trauma is uncommon but may result in severe injuries that pose di-agnostic and therapeutic challenges, particularly in wilderness or resource-limited en-vironments. Most literature consists of isolated case reports, regional series and foren-sic descriptions; clinical guidance is therefore fragmented. This guideline synthesizes two complementary evidence sources: a structured observational cohort documenting 101 injuries sustained by boar hunters during organized hunts in Germany, and a comprehensive systematic review of all globally published wild-boar– and feral-pig–related human injuries. The observational cohort provided internally consistent epi-demiologic information on who was injured, under what circumstances, how quickly assistance was obtained, and how injuries were treated and ultimately healed. The systematic review added detailed insight into injury morphology and severity across diverse settings, including reports of deep wound tracts, extensive soft-tissue disrup-tion, significant contamination and the risk of hemorrhage, neurovascular compromise or thoracoabdominal penetration. Integrating these sources enabled a field-oriented approach to assessment and management, emphasizing early hemorrhage control, broad-spectrum antibiotic therapy, appropriate use of imaging, thorough surgical ex-ploration when indicated and region-specific tetanus or rabies prophylaxis. Together, these findings support clinicians working in remote or austere environments who may encounter these rare but potentially serious injuries.

Abstract: Background/Objectives: Erythroderma is a rare but potentially life-threatening dermatological emergency characterised by generalised erythema and scaling involving more than 80% of the total body surface area. Erythroderma is associated with significant morbidity and mortality due to systemic complications and diverse underlying aetiologies. Methods: In this narrative review PubMed and Google Scholar were searched up to February 2026. Studies were screened for relevance to emergency physicians, with emphasis on epidemiology, diagnostic approach and acute management. Non-English publications and conference abstracts were excluded. Fifty-seven sources were included in the final synthesis. Results: Erythroderma most commonly results from exacerbation of pre-existing inflammatory dermatoses, drug reactions, infections, or cutaneous T-cell lymphoma. Clinical presentation includes diffuse erythema and scaling affecting ≥80–90% of body surface area, often accompanied by pruritus, systemic symptoms, and signs of organ dysfunction. Systemic complications arise from cutaneous barrier failure and include fluid imbalance, thermoregulatory dysfunction, cardiovascular strain, protein loss, and secondary infection. Initial emergency department management prioritises supportive care, fluid and nutritional optimisation, restoration of skin barrier function, and assessment for organ dysfunction. While definitive aetiological diagnosis is not always immediately required, certain conditions—particularly severe drug reactions and infectious causes such as Staphylococcal Scalded Skin Syndrome—necessitate urgent targeted intervention. Conclusions: Erythroderma represents a syndromic emergency requiring systematic evaluation and early supportive management. Prompt recognition of high-risk aetiologies and timely dermatology referral are essential to optimise outcomes and reduce morbidity and mortality.

Abstract: Introduction: To investigate if specific emergency physician(EP) admission diagnoses and/or neurological signs/symptoms on admission to the Emergency Department(ED) were associated to normal/not-informative emergency-electroencephalogram(emEEG). Methods: Data from consecutive patients admitted to the ED of our tertiary hospital during two-years period (1 Jan 2023-31 Dic 2024) were retrospectively analyzed. We evaluated the correlation between nor-mal/not-specific emEEG and EP admission diagnoses and neurological signs/symptoms on admission. Epileptic EEGs and EEGs showing triphasic morphology sharp-waves were considered as specific patterns. Results: A total of 2,008 patients underwent emEEG during the study-period. EmEEG was considered not-informative in 100% of global amnesia diagnosis, 100% of mild head trauma, 100% of migraine with aura, 98.3% of transient ischaemic attack(TIA), 95.6% of transient loss of consciousness(TLC) when seizure was not the primary suspected diagnosis and 92.7% of falls of unknown dynamics. Epileptic patterns were detected in 4% of patients presenting with TLC and in 2.4% of those with falls of unknown dynamics, with approximately half of these patients having a pre-existing diagnosis of epilepsy. Triphasic waves were detected in 4.9% pa-tients with falls of unknown dynamic, in 1.7% with TIA and in 0.4% with TLC. All these patients showed fe-ver/sepsis or metabolic/electrolyte disorders. Overall, across all clinical scenarios, emEEG was considered not-informative in 385(19.1%) patients who underwent emEEG. Conclusions: emEEG is almost not-informative in the diagnostic pathway of global amnesia, mild head trauma and migraine with aura, while in patients with TIA, TLC, or falls of unknown dynamics, EP can consider to safely avoid emEEG in the absence of previous epilepsy, fever/sepsis, metabolic/electrolyte disturbances or drug abuse.

Abstract: Sepsis is usually described as a dysregulated host response to infection associated with severe organ dysfunction and failure. In 2023 the author proposed that many aspects of sepsis suggested a physiological response and defence to infection that only became “dysregulated” if the infection was overwhelming or there was a deficiency of thiamine and/or intracellular glucose to provide ongoing fuel for the immune response and/or mitochondrial production of adenosine triphosphate (ATP).It was also proposed that during sepsis, the immune system received priority access to available glucose, prompting insulin resistance that minimised glucose utilisation by less essential tissues. Concurrently, mitochondrial ATP production via oxidative phosphorylation (OXPHOS) was deprioritised, with the immune system relying on anaerobic glycolysis for ATP generation. This suppression of OXPHOS was only a temporary measure; mitochondrial ATP production must be resumed for complete recovery. Persistent suppression culminated in critical ATP deficits and cell death.The 2023 paper also reviewed glucose, thiamine and insulin metabolism during sepsis and concluded that administering high-dose insulin alongside mild hyperglycaemia and intravenous thiamine—a pyruvate dehydrogenase kinase (PDK) inhibitor—might help restore physiological mitochondrial ATP production when administered during a crucial window in the sepsis process, potentially improving survival outcomes.The thrust of that hypothesis may have been validated by a recent experiment on sepsis in mice that found superior survival, albeit short-term, following treatment with combined glucose and thiamine compared to antibiotics.