In Japan, there is a shortage of emergency medicine specialists, often leading non-specialists (physicians who treat conditions outside their area of specialty) to handle cases outside their expertise, which can cause challenges and necessitate specialist support. Starting from December 2023, the St. Marianna University Hospital, which has emergency medicine specialists, began offering overnight emergency outpatient support to Kawasaki Municipal Tama Hospital using the Teladoc HEALTH Mini Cart telemedicine device (Teladoc Health, Inc., CA, USA). The case involved a 44-year-old male with a history of peritonsillar abscess and incisional drainage presented with pharyngeal pain. The treating physician at the Kawasaki Municipal Tama Hospital and a neurologist (the supported physician) examined the patient at 9 PM. An enlarged right tonsil was noted, and a peritonsillar abscess was suspected, prompting a contrast-enhanced CT scan. The results confirmed a 1 cm right peritonsillar abscess. Faced with the decision to transfer the patient to a higher medical facility, the supported physician consulted with the support physician through a Teladoc HEALTH Mini Cart. The St. Marianna University Hospital\'s emergency physician (supporting physician) used the Teladoc HEALTH Mini Cart to assess the patient\'s overall condition, blood tests, and CT images and advise on antibiotic treatment. A visit to the ear, nose, and throat expert (ENT) the following day was considered sufficient. The supported physician received feedback that the use of the Teladoc HEALTH Mini Cart reduced the burden of nighttime transfers for otolaryngological conditions, which can take several hours. This finding suggests that remote medical support can affect Japan\'s emergency medical system.

This study aimed to develop a predictive model for intensive care unit (ICU) admission by using heart rate variability (HRV) data. This retrospective case-control study used two datasets (emergency department [ED] patients admitted to the ICU, and patients in the operating room without ICU admission) from a single academic tertiary hospital. HRV metrics were measured every 5 min using R-peak-to-R-peak (R-R) intervals. We developed a generalized linear mixed model to predict ICU admission and assessed the area under the receiver operating characteristic curve (AUC). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated from the coefficients. We analyzed 610 (ICU: 122; non-ICU: 488) patients, and the factors influencing the odds of ICU admission included a history of diabetes mellitus (OR [95% CI]: 3.33 [1.71-6.48]); a higher heart rate (OR [95% CI]: 3.40 [2.97-3.90] per 10-unit increase); a higher root mean square of successive R-R interval differences (RMSSD; OR [95% CI]: 1.36 [1.22-1.51] per 10-unit increase); and a lower standard deviation of R-R intervals (SDRR; OR [95% CI], 0.68 [0.60-0.78] per 10-unit increase). The final model achieved an AUC of 0.947 (95% CI: 0.906-0.987). The developed model effectively predicted ICU admission among a mixed population from the ED and operating room.

Aortic dissection is a rare condition with a high mortality rate, the clinical manifestations of which depend on the involvement of aortic branches. We describe the case of a male patient with neurological deficits accompanied by dorsal-lumbar pain and exuberant sympathetic hyperactivity, diagnosed with ascending and descending aorta dissection, initially managed in the prehospital setting. This case reinforces the importance of maintaining high levels of suspicion for rare causes of cerebrovascular accidents.

The COVID-19 pandemic brought changes in the pattern of care use. A significant increase in the volume of emergencies was expected. However, a significant decrease was observed worldwide.
An observational, analytical and cross-sectional study of all records of emergency episodes of patients aged 18 years or older admitted to the emergency services of the University of Porto Hospital Centre (2018-2022) were analysed.
During the pandemic, a significant reduction in emergency episode admissions (up to 40% during lockdowns), an increase in pre-emergency services, and discharges from Infectious Diseases and Internal Medicine was observed. The discharges from General Practice and General Practice and Family Medicine were residual.
The lower use and type of use of emergency services during the COVID-19 pandemic had a negative impact on the disease burden. This could be prevented in future pandemics through the development of strategies to promote confidence in the use of health resources and establishing contingency plans for virtual assistance.

OBJECTIVE: Musculoskeletal (MSK) causes of chest pain are considered common in emergency care, yet management is limited, reported outcomes are poor and prevalence data in New Zealand are lacking. The present study aims to estimate the prevalence of MSK chest pain in New Zealand EDs and describe the characteristics of MSK chest pain cases.
METHODS: A retrospective chart review was conducted based on de-identified clinical notes extracted from four hospitals within the South Island of New Zealand from 3 months spanning 1 March to 31 May 2021. Individual cases were categorised to the single best-fitting cause of chest pain using systems-based categorisation, based primarily on the doctors\' documented final impression.
RESULTS: A total of 1344 cases were categorised in the present study. MSK chest pain had a prevalence of 15% (range 11-31%) of chest pain presentations across all study sites. This represented the second most common system responsible for chest pain, after the cardiovascular system. The mean age of MSK chest pain cases was 46.9 (standard deviation [SD] 19.1) years, compared to 55.5 (SD 19.7) years in all cases. Age and gender-specific data, data from rural hospitals and MSK sub-type data are presented.
CONCLUSIONS: These data provide a conservative estimate of MSK chest pain prevalence in EDs within the South Island of New Zealand. The findings highlight MSK chest pain as common in emergency care, providing a basis and justification for further research to improve management and outcomes for people with MSK chest pain.

Arterial blood gas, with subsequent radial arterial puncture as a simple access point, comprises a ubiquitous medical procedure in the diagnostic workup of patients admitted to the emergency department with dyspnea. Despite being a relatively safe and technically straightforward procedure, due to its considerable use, it is of vital importance to be able to promptly recognize its potential complications. We present the case of a 96-year-old female patient admitted to the emergency department with dyspnea and cough who underwent left radial arterial puncture for arterial blood gas. A total of three puncture attempts were performed until arterial blood was collected. Roughly two weeks upon observation, the patient was readmitted to the emergency department after the insidious appearance of a painful swelling in the left wrist, with progressive worsening since hospital discharge. On physical examination, a painful erythematous pulsatile swelling in the left wrist\'s volar aspect was observed, and further point-of-care ultrasound evaluation documented a cysticlike collection, communicating with the radial artery\'s lumen, and suggesting the probable diagnosis of iatrogenic radial pseudoaneurysm. The patient was hospitalized and underwent surgical resection of radial pseudoaneurysm, with subsequent arterial repair. Although severe complications from arterial blood gas have a low incidence rate, prompt diagnosis and management are required. Therefore, point-of-care ultrasound, as an additional diagnostic tool, may play a role in minimizing the risk of procedural complications.

It is aimed to evaluate the knowledge of Pre-Hospital Emergency Health Services (PHEMS) staff about the treat and release criteria in hypoglycemia cases and their attitudes in the decision-making processes related to hospitalization.
The sample of this descriptive cross-sectional study consisted of 714 paramedics working in PHEMS in Turkey. A survey developed in Microsoft Forms, which includes various features such as age, gender, years of professional experience, developed in line with the literature, and questions covering treat and release in hypoglycemia cases and absolute hospital transport criteria, was used in the collection of data. Participants who agreed to participate in the study answered the online survey.
Of the 714 participants, 402 (56.30%) were female and 312 (43.70%) were male. 598 (83.75%) of the participants, who had a dilemma regarding the transfer of hypoglycemia cases that became stable after treatment to the hospital, decide to transfer the patient to the emergency room. 706 (98.88%) reported that the presence of another emergency that needs intervention in addition to hypoglycemia was decisive in the decision to transfer to the absolute hospital, and 586 (82.07%) reported that the patient\'s who did not return to his normal mental state after emergency medical intervention was decisive in the treatment and release decision.
PHEMS employees have high knowledge and awareness related to treat and release criteria in hypoglycemia cases with which they have high experience. PHEMS employee, who has a dilemma related to making a treat and release decision, decides to transfer to the hospital with a high rate. PHEMS systems should define the treat and release protocols for hypoglycemia cases more clearly in order to use emergency services and health resources effectively.

BACKGROUND: This case report presents the case of a man with no known coagulopathy or preceding trauma, who spontaneously developed a spinal epidural hematoma (SEH). This is an uncommon condition which can have variable presentations including hemiparesis mimicking stroke, resulting in the potential for misdiagnosis and inappropriate treatment.
METHODS: A 28-year-old Chinese male with no past medical history presented with sudden onset neck pain associated with bilateral upper limbs and right lower limb subjective numbness but intact motor function. He was discharged after adequate pain relief but re-attended the emergency department with right hemiparesis. A magnetic resonance imaging of his spine revealed an acute cervical spinal epidural hematoma at C5 and C6. While admitted, he had spontaneous improvement of his neurological function and was eventually managed conservatively.
CONCLUSIONS: SEH, although uncommon, can be a mimic of stroke and it is important to avoid misdiagnosis as it is a time critical diagnosis, and administration of thrombolysis or antiplatelets can lead to unfavourable outcomes. Having a high clinical suspicion can help to guide us in the choice of imaging and interpretation of subtle signs to reach the correct diagnosis in a timely manner. Further research is required to better understand the factors that would favour a conservative approach as opposed to surgical treatment.

Extreme heat and hot weather has a negative impact on human health and society. Global warming has resulted in an increase in the frequency and duration of heatwaves. Heat-related illnesses are a significant negative consequence of high temperatures and can be life-threatening medical emergencies. The severity of the symptoms can depend on the pre-existing medical conditions and vary from mild headaches to severe cases that can lead to coma and death. The risk of heat-related illness may be higher for people experiencing homelessness due to a lack of access to cool places and water, and the complex interactions between mental illness, medications and substance use disorder. This paper presents two cases of people experiencing homelessness who were admitted to the emergency department of a hospital in Sydney, Australia during a heatwave in November 2020. Both cases were adult males with known risk factors for heat-related illness including hypertension and schizophrenia (Case One) and hepatitis C, cirrhosis, and alcohol use disorder (Case Two). These cases show that severe weather can not only be detrimental to homeless people\'s health but can also cause a significant economic toll, evident by the $70,184 AUD expenditure on the care for these two cases. This case report highlights the requirement to determine the risk of heat-related illness to people experiencing homelessness and need to protect this vulnerable population from weather-related illness and death.

The differential diagnosis of abdominal pain ranges from benign to life-threatening conditions. This case report describes the importance of the differential diagnosis and a faster and more accurate diagnosis. A 75-year-old male presented to the emergency room (ER) with diffuse abdominal pain, associated nausea, vomiting, diarrhea, and a fever of 38.5ºC since the previous day. Medical history included hypertension, dyslipidemia, and obesity. Clinical examination showed hypotension and a distended abdomen with diffuse tenderness in all quadrants. Blood tests revealed a hemoglobin of 11.3 g/dL, and an arterial blood gas test revealed metabolic acidosis and lactate of 8 mmol/L. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed a large aneurysm in the infrarenal aorta with an extension of about 17x8x8 cm and an exuberant mural thrombus. The patient underwent endovascular treatment of the aneurysm; however, he died during surgery.