Prompt recognition of sepsis in the Emergency Department (ED) is challenging. In this study, we performed a prospective study to explore, for the first time, the diagnostic ac-curacy for sepsis of the combination of National Early Warning Score 2 (NEWS2) and Procalcitonin (PCT) in ED population admitted for infection. The endpoint was Sepsis-3-defined sepsis. NEWS2 was calculated at triage using dedicated software, while PCT was measured within 6 hours of triage registration. The diagnostic accuracy of NEWS2+PCT was compared with that of NEWS2, PCT and qSOFA using Receiver Operating Characteristics analysis. 1041 patients were enrolled. Sensitivity and specificity for sepsis diagnosis were as follows: 54%/78.8% for NEWS2≥5; 73.4%/58.3% for PCT≥0.5 ng/ml; 70.9%/67.8% for NEWS2+PCT≥5 and 25%/97.3% for qSOFA. The area under the curve of NEWS2+PCT (0.77,95% CI 0.74-0.80) was significantly high-er than that of NEWS2 (0.72,95% CI 0.69-0.75;p=0.04), PCT (0.71,95% CI 0.68-0.75;p=0.01) and qSOFA (0.70,95% CI 0.67-0.73;p<0.001). Adding PCT to NEWS2 improved diagnostic accuracy for sepsis. In crowded ED, the balance between sensitivity and specificity ensured by NEWS2+PCT≥5 can help to promptly identify patients with sepsis without overwhelming staff.
This integrative review focuses on the phenomenon of compassion fatigue in Emergency Medical Services (EMS). Specifically, it explores the available literature on the causes of compassion fatigue and its impact on personal well-being, performance, and the quality of care delivered by emergency medical services professionals. An integrative literature review was conducted following the PRISMA 2020 guidelines. Relevant studies were searched using PubMed, ScienceDirect, Google Scholar, ProQuest, and EBSCO/CINAHL electronic databases, and after further analysis 13 were selected for review. A qualitative approach involving content and thematic analyses was used to identify repeated patterns. This integrative review was carried out from January 15 to June 30, 2026. In total, there were thirteen (13) articles that met the requirements for inclusion in this paper. Five major themes were found: trauma experience, occupation-related stressors, self-criticism, accumulation of emotional burden, and work environment. All of the mentioned issues had negative consequences for personal welfare and job performance. Major outcomes were poor psychological well-being, dissatisfaction, deterioration of care standards, increased risk of experiencing burnout, and detachment. Despite the few studies focused specifically on EMS providers, the literature indicates that compassion fatigue is quite prevalent. This review not only underscores its significant contributions but also brings out issues that may arise within the institution when implementing this initiative. With such findings, there is an increased need for further research to validate the effectiveness of this initiative and address future challenges.
Pulse oximetry provides a non-invasive numerical estimate of arterial oxygen saturation. It is simple to apply and interpret by clinicians at all levels, and its use has expanded substantially across prehospital care, emergency departments, acute care units, and household monitoring. Although pulse oximetry is portable, non-invasive, and cost-effective, its limitations are clinically important because it measures oxygen saturation rather than ventilation, oxygen delivery, or tissue oxygen utilization. Over-reliance on SpO₂ values for decisions related to oxygen administration, escalation of care, and clinical deterioration may conceal subtle but serious abnormalities. This review discusses the limitations of pulse oximetry in emergency and acute care settings, including sepsis, regional hypoperfusion, dyshaemoglobinemias, COVID-19, pulmonary embolism, hyperoxia, skin pigmentation-related bias, and other relevant clinical contexts. The central message is that SpO₂ should be interpreted as one component of a broader assessment bundle and should not substitute for comprehensive clinical evaluation.
Severe acute Valproic Acid (VPA) ingestions may require intensive care, intubation, or Extracorporeal Treatments (ECTRs), but early predictors are poorly defined. In this study we aimed to identify presentation features associated with Intensive Care Unit (ICU)-level care, intubation, and ECTRs after VPA exposure. We analyzed 164 VPA cases reported to the Toxicology Investigators Consortium Core Registry from January 1, 2012, through December 31, 2025. Candidate predictors were selected a priori from severe VPA toxicity features. Associations were assessed using Fisher exact tests and Odds Ratios (ORs). Median age was 34.5 years; 144/164 exposures (87.8%) were intentional. ICU-level care occurred in 49/164 cases (29.9%), intubation in 23/164 (14.0%), and ECTRs in 5/164 (3.0%). ICU-level care was associated with respiratory depression (OR 30.0), metabolic acidosis (OR 15.9), hypotension (OR 4.63), central nervous system depression (OR 4.23), and co-ingestion (OR 3.25). Therapeutic-use cases were less likely to require ICU-level care or intubation. Respiratory depression, metabolic acidosis, hypotension, central nervous system depression, and co-ingestion identify VPA exposures at higher risk for ICU-level care.
The recent tragic death of a young man experiencing hyperactive delirium with severe agitation in Bologna (Italy), on July 19, 2026,1 should serve as a crucial reminder of the importance of effective management of this challenging emergency. While it is a tragic event, the shock of such an episode forces us to draw a core lesson for clinical practice, system design, and medical culture. Hyperactive delirium with severe agitation is indeed a true medical emergency.2 Individuals usually experience extreme agitation characterized by unexpected strength, panic, violence, disorientation, hallucinations, hyperthermia, and an accelerated autonomic nervous system. These symptoms can quickly escalate and lead to cardiopulmonary arrest, often resulting in the patient's death, frequently occurring in a pre-hospital care setting. [...]
