Extracorporeal membrane oxygenation (ECMO) has a life-saving role in trauma management, with particular relevance to patients with acute respiratory failure. This narrative review describes the current evidence on the use of ECMO in the resuscitation of major trauma victims presenting with acute respiratory distress syndrome, cardiogenic shock, poisoning, burns, and traumatic brain injury, and highlights recent advances in the field. A comprehensive literature search of PubMed and EMBASE was performed for articles, using the MeSH/keywords. Over the past decade, ECMO has been increasingly applied for trauma management, encompassing both venovenous (VV) and venoarterial (VA) modes. VV-ECMO is primarily utilized in hypoxic respiratory failure following thoracic trauma and is associated with improved in-hospital mortality and higher discharge survival compared to conventional mechanical ventilation. VA-ECMO is reserved for hemodynamic collapse and extracorporeal cardiopulmonary resuscitation, a subset of VA-ECMO used specifically in cardiac arrest. Despite promising outcomes, challenges remain, including anticoagulation management, hemorrhagic complications, and the absence of trauma-specific prognostic models. Emerging applications include ECMO in traumatic brain injury, poisoning, and severe burns. Although ECMO improves outcomes in selected trauma patients, further high-quality studies are needed to define optimal selection criteria and to clarify its role across the spectrum of injuries.

Polypharmacy (the chronic concurrent use of five or more pharmaceutical agents) is independently associated with Adverse Drug Events (ADEs), functional decline, and mortality in older adults. Age-related physiological changes - including impaired renal and hepatic clearance, increased volume of drug distribution, and heightened pharmacodynamic sensitivity - substantially amplify the risk of medication-related harm in geriatric populations. The likelihood of developing an ADE increases proportionally with the number of drugs prescribed, irrespective of patient age or comorbidity burden, and parallels rates of hospitalization and functional deterioration. Neuropsychiatric medications-including benzodiazepines, antipsychotics, antidepressants, and mood stabilizers-are disproportionately implicated in falls, delirium, cognitive impairment, cerebrovascular events, and excess mortality. Measures to improve clinician awareness of rational neuropsychiatric prescribing across primary, specialist, and acute care settings are therefore a priority in geriatric medicine. Various explicit prescribing tools have been developed to identify Potentially Inappropriate Prescribing (PIP). Among these, the American Geriatrics Society Beers Criteria and the European STOPP-START algorithm are the most widely validated and adopted. This review provides a structured, evidence-based analysis of these tools, with emphasis on polypharmacy burden, PIP epidemiology, deprescribing frameworks, multidisciplinary decision-making, and the specific mechanistic and clinical risks associated with geriatric neuropsychiatric medications.

INTRODUCTION:Hemostatic agents (bleeding-stopping agents) are pharmacological or biological substances used to induce hemostasis in cases of trauma, surgical interventions, or spontaneous bleeding. These agents act at various steps of primary and secondary hemostasis, promoting clot formation, reducing blood loss, and improving patient outcomes. This narrative review examines the current status of hemostatic agents and highlights major developments and gaps in the field. METHODS:A systematic literature search was used to identify relevant articles. Consecutive trials in English between 2005 and 2025 investigating the indications and use of hemostatic agents were abstracted with a search in Google Scholar, PubMed, Scopus, Web of Science, and MEDLINE registries. Case reports, editorials, and expert opinions were excluded from the analysis. RESULTS:The use of tranexamic acid has recently been reintroduced, especially in trauma patients. It should be used in exsanguinating victims of trauma and resultant hemorrhagic shock. Prothrombin Complex Concentrates (PCC) have emerged as a favorable choice over Fresh Frozen Plasma (FFP) in bleeding due to vitamin K antagonists and other anticoagulants, and their use is increasing with studies. On the other hand, FFP is recommended when alternative treatment options are unavailable or in conjunction with first-choice agents, in narrowed indications due to possible complications. DISCUSSION:The evidence underscores that no single hemostatic agent is universally superior; optimal management requires individualized selection based on the mechanism of bleeding, underlying coagulopathy, and patient-specific factors. TXA has demonstrated consistent survival benefits in traumatic hemorrhage when administered early, yet its efficacy diminishes beyond the 3-hour window, emphasizing time-sensitivity in clinical decision-making. PCC offers practical advantages over FFP in anticoagulant reversal, including faster INR normalization, lower volume load, and no compatibility requirements, but its role in massive transfusion remains limited by the absence of factor V. FFP retains utility as an adjunct in complex coagulopathies and resource-limited settings. The integration of point-of-care viscoelastic testing (TEG/ROTEM) represents a significant advancement in guiding goal-directed hemostatic therapy and reducing unnecessary transfusions. Emerging agents and antidotes for DOAC reversal further expand the therapeutic landscape, though cost and availability remain barriers. CONCLUSION:Treatment with hemostatic agents can be lifesaving, especially after being adjusted for individual risks and benefits. Therefore, the selection of agents should be tailored on a case-by-case basis.

INTRODUCTION:The urgent management of the patient with acute abdominal pain and other conditions comprises a rapid cardiorespiratory evaluation and resuscitation to maintain hemodynamic stability and obtain an elaborate and focused history and examination. Following the exclusion of life-threatening diagnoses, symptomatic improvement in patients with gastrointestinal conditions is vital. Vomiting causes mild to severe dehydration, leading to hypovolemia, electrolyte imbalances, and other consequences. This narrative review provides an overview of symptomatic care and antiemetic management in the acute setting. METHODS:A systematic literature search was used to identify relevant articles. Consecutive trials in English published between 2005 and 2025 investigating the indications and use of antiemetic agents were abstracted from Google Scholar, PubMed, Scopus, and Web of Science. Case reports, editorials, and expert opinions were excluded from the analysis. RESULTS:Replacement of IV fluids combined with antiemetic agents is administered to patients with conditions causing intractable vomiting, such as pancreatitis, renal colic, hollow viscus obstruction, and appendicitis, based on the patient's clinical course. Emptying and decompression of the stomach contents with the nasogastric catheters may be necessary, as aspiration can often be encountered in patients with repeated vomiting. 5-Hydroxytryptamine 3 receptor antagonists are preferred as they act on central and peripheral receptors to prevent and treat vomiting. CONCLUSION:Patients with chief complaints of nausea and vomiting should prompt scrutiny for lifethreatening diagnoses initially, and then ruling out the other differential diagnoses, which need emergent interventions to prevent further deterioration. A `symptomatic` treatment not only ensures optimal cooperation and communication with the patient but also achieves physiological homeostasis. Measures to treat dehydration, pain, nausea, and vomiting should be individualized and implemented promptly with a multidisciplinary approach. Appropriate antiemetic agents should be selected to treat nausea and vomiting per evidence-based guidelines.

INTRODUCTION/OBJECTIVE:Gabapentinoids are increasingly prescribed and utilized to treat various disorders, including neuropathic pain, post-herpetic neuralgia, and fibromyalgia. This article aims to highlight the advantages and disadvantages of gabapentinoids, specifically gabapentin and pregabalin, and address advancements and areas for improvement in the topic. METHODS:A systematic search was conducted to identify studies related to the issue in the literature. All English- language studies from 2005 to 2025 focusing on the effectiveness and safety profiles of the compounds were abstracted following searches in Google Scholar, PubMed, Scopus, Web of Science, and MEDLINE. Editorials, expert opinions, and retrospective studies were excluded from the analysis. RESULTS:These agents have been beneficial in cutting down the rates of opioid prescriptions. Many research studies showed that pregabalin prescription increased linearly over time, together with co-prescription with opioids in a substantial portion (more than one-fourth) of the total numbers. Lethal intoxications are mostly those with concurrent intake of other substances, especially opioids. DISCUSSION:Although gabapentinoids are getting wider recognition and are used more commonly worldwide in recent decades, clinicians should be aware of the inherent hazards of the agents. Decision-making algorithms and guidelines should address the pros and cons of this group in comparison to opioids and other alternatives in pain management in special groups, such as those with organ failures and important comorbidities. CONCLUSION:Prescribers of gabapentinoids need to pay attention to the use of these agents in special groups at high risk, and findings indicative of misuse and/or abuse have to be monitored properly.

INTRODUCTION:The primary goal in treating acute pain is to provide effective analgesia while minimizing the risk of progression to chronic pain. Opioids have long been the mainstay for treating moderate to severe pain. However, their use is increasingly questioned due to challenges such as addiction, tolerance, and adverse effects, including respiratory depression. A multimodal approach (balanced analgesia, multimodal analgesia- MMA), which includes non-opioid analgesic agents (NOAAs), adjuvant medications, and opioids, is recommended. This review was designed to cover the current characteristics and use of typical NOAAs, specifically nefopam and flupirtine, in contemporary practice. METHODS:A review search was conducted to abstract articles for analysis. All studies published in English from 1990 to 2025, mainly investigating NOAAs, specifically nefopam and flupirtine, were included. We used Google Scholar, PubMed, Scopus, Web of Science, EBSCO, and MEDLINE databases to extract articles. The findings of these articles were analyzed narratively to highlight mechanisms of action, indications, safety, and specific features. RESULTS:NOAAs may represent a viable alternative in contemporary analgesic treatments. Unlike opioids, centrally acting NOAAs do not carry the same risk of dependence and abuse, making them suitable alternatives for patients with acute and/or chronic pain. Recent studies provide valuable insights into these agents' evolving role in pain management. Typical NOAAs, such as nefopam and flupirtine, are associated with mild side effects, including nausea, dizziness, and anticholinergic symptoms, which may affect their acceptability in certain patient populations. Furthermore, their contraindications render them potentially dangerous for individuals with convulsive disorders or those taking specific medications, necessitating careful patient selection and clinical judgment. CONCLUSION:Although these agents are beneficial in reducing opioid consumption, their use should be tailored to each patient, with careful follow-up. Patients receiving NOAAs should be monitored for adverse effects, particularly during treatment initiation. Monitoring is also essential for elderly patients and those with cardiovascular or neurological conditions to ensure safe administration. In conclusion, the clinical use of NOAAs requires careful consideration of potential adverse effects, contraindications, and drug interactions. Further well-designed studies are needed to better define these agents' characteristics, limitations, and comparisons with alternative pain management approaches.

Treatment of acute pain primarily aims to provide effective analgesia with negligible untoward effects while preventing the development of chronic pain. Opioid-sparing analgesic techniques can reduce the risk of numerous adverse effects, including postoperative nausea and vomiting, dependency, histamine release, hypotension, and respiratory depression. As rich literature data indicate the hazards of opioids, the medical community has long been searching for opioid-sparing analgesic techniques that may alleviate these untoward outcomes. Centrally acting non-opioid analgesics (CANOAs) were launched as alternative agents to opioids. CANOAs modulate pain perception at the central level without interacting with opioid receptors, making them particularly valuable in multimodal analgesia strategies. CANOAs generally have a rapid onset and sustained duration of action. Their unique mechanisms of action enable them to alleviate both nociceptive and neuropathic pain components. Clinicians should consider the specific characteristics, indications, and drawbacks of each agent in different clinical situations. Most professional organizations have issued algorithms and guidelines to guide clinicians on the uses, limitations, and drawbacks of these agents. Although CANOAs may be used as effective agents in pain treatment in various clinical settings, more population-based, controlled studies will further enlighten their role in the evolving management of pain.

Smoking is among the most commonly cited preventable causes of cardiopulmonary death. Interventions aimed at helping patients quit smoking in healthcare institutions yielded limited success. Various factors, including legal regulations, economic constraints, lack of time, motivation, and incentives can hamper these efforts. Emergency departments (EDs) are the most critical referral settings for individuals with acute health problems resulting from the direct and indirect effects of smoking. Smoking cessation (SC) interventions conducted in acute disease settings may be effective for individuals with low dependency and a strong intention to quit. A structured SC intervention delivered when individuals seek care for an acute and serious health issue may have a greater impact than other approaches. Therefore, structured SC interventions may effectively increase SC rates in adult patients with acute respiratory infections in the EDs. ED visits due to a health crisis, such as acute respiratory problems, may represent a good opportunity to tackle in most patients as an excuse to launch a fresh beginning, including SC. However, more comprehensive research and support programs are needed for individuals with high addiction levels.

Pain in older adults is highly prevalent and persistently undertreated, and its management becomes substantially more hazardous when renal, hepatic, or respiratory failure co-exists. Age-related pharmacokinetic changes — reduced hepatic blood flow and cytochrome P450 activity, declining glomerular filtration, and altered body composition — are compounded by pharmacodynamic changes, including heightened central nervous system sensitivity and reduced homeostatic reserve. This narrative review synthesises contemporary evidence and current prescribing frameworks into an organ-failure-stratified approach to analgesic selection. Paracetamol and topical agents remain the safest first-line options across all three organ failure states. Non-steroidal anti-inflammatory drugs should be avoided when the estimated glomerular filtration rate falls below 30 mL/min and are contraindicated in cirrhosis. Opioids remain indispensable for moderate-to-severe pain but require dose reduction, interval extension, and close monitoring: fentanyl and buprenorphine are preferred in renal failure, whereas morphine, codeine, and meperidine should be avoided; all opioid doses must be reduced in hepatic failure; and in respiratory failure or chronic obstructive pulmonary disease opioids should be given at the lowest effective dose and never combined with other central nervous system depressants. Adjuvant analgesics carry agent-specific organ restrictions. Frailty, cognitive impairment, and polypharmacy further modify risk. ‘Start low, go slow’ must be calibrated individually to the type and severity of organ dysfunction present.

Ingestion of button batteries (BB) represents a substantial health hazard, causing more common and severe complications than most other ingested objects. While the primary mechanism of injury is alkaline caustic injury (mediated by hydroxide ions produced through electrolysis at the site of the button battery), additional pathophysiological processes include pressure-induced necrosis, accumulation of hydroxide compounds at the battery's negative pole, direct caustic tissue injury, and potential heavy metal toxicity. Full-thickness burns, esophageal perforation, tracheoesophageal and aortoesophageal fistulas are encountered shortly after exposure. Vocal cord paralysis due to BB ingestion appears to be an early sign to predict the severity of the condition. Besides expedient removal, mitigation strategies are the key to the management. Pre-BB removal using honey or sucralfate and post-removal sterile acetic acid irrigation in the operation room can alleviate complication rates. This review is intended to cover and summarize all aspects of these incidents to provide information to clinicians and healthcare personnel.

Aim: This study evaluated the effectiveness of a structured smoking cessation intervention and its relationship with nicotine dependence in smokers presenting to the emergency department (ED) with acute respiratory infections (ARI). Materials and Methods: A single-center, prospective, randomized controlled trial was conducted. Participants (adults with ARI) were randomized to a control group (standard medical care) and an intervention group (standard care + structured smoking cessation counseling). Nicotine dependence was measured by the Fagerstrom Test of Nicotine Dependence (FTND). Smoking cessation rates were analyzed after one week and one month. Results: The mean age of the 288 participants was 45 years (+/- 19.09 SD), and 72.6% (n = 209) were male. The smoking cessation rate was 45.7% (n = 21) in the intervention group and 7.3% in the control group (at one-month follow-up, p < 0.001). While high FTND scores negatively affected smoking cessation rates (p < 0.001), cessation rates were significantly higher in individuals with low FTND scores in comparison to those with high scores. 21.2% (n = 61)of the participants stated that they decided to quit smoking on the same day. Discussion: Structured smoking cessation interventions may prove effective in increasing smoking cessation rates in these adult patients with ARI in the emergency setting. However, more comprehensive support programs are needed for individuals with high addiction levels.

Aim: This study aims to identify patient groups diagnosed with syncope in the emergency department (ED) based on initial evaluation, distinguish those whose etiology remains unclear necessitating hospitalization, and assess factors influencing serious clinical outcomes (SCOs) within 30 days post-ED admission for suspected syncope. Material and Methods: This prospective, single-center observational study included patients presenting to the ED with suspected syncope over a six-month period. Subjects were categorized into three groups: those diagnosed and discharged following initial testing in the ED, those requiring hospitalization, and those undiagnosed in the ED but discharged for outpatient follow-up within 24 hours. The study's primary endpoint was the incidence of SCO, with secondary analysis focusing on determinants of SCO. Results: The study encompassed 257 patients, among whom 22 (8.6%) experienced serious clinical outcomes (SCOs). The incidence of SCO was significantly higher at 22.2% among Group 2 patients, who required hospitalization, compared to those discharged directly from the emergency department (ED) (p=0.013). Notably, 62.9% of the hospitalized patients (Group 2) were diagnosed with cardiac syncope, while 11.1% had an undetermined cause of syncope despite ED evaluation. Abnormalities in electrocardiogram (ECG) were observed in 59.1% (n=13) of the patients who experienced SCOs (p<0.001). Discussion: The data indicates a statistically significant increase in SCOs among patients admitted to the hospital compared to those discharged from the ED. Moreover, the presence of a normal ECG appears to correlate with a lower likelihood of experiencing SCOs, underscoring the value of ECG as a predictive tool in the assessment of syncope.

Objective: The objective of this study was to ascertain the effectiveness of the immature granulocyte (IG) count and percentage in diagnosing and discriminating between non-complicated acute appendicitis (NCAA) and complicated acute appendicitis (CAA). Materials and Methods: This study was conducted using data from 244 adult patients who underwent appendectomy. A retrospective assessment of demographic details, preoperative white blood cell (WBC) count, number and percentage of neutrophils, neutrophil-to-lymphocyte ratio (NLR), lymphocyte (LYM) count (IGC), IG count and IG percentage (IG%), operation findings, and pathology results was conducted. Patients diagnosed with acute appendicitis (AA) were categorised as NCAA and CAA according to pathology reports and surgical outcomes. Results: The WBC, NLR, IGC and IG% did not differ significantly (p>0.05) between the CAA and NCAA groups. Conclusion: The findings of this study indicate that AA is statistically more prevalent in the early 30s.The number and percentage of neutrophil counts, NLR, IG in the diagnoses of AA, in conjunction with the elevated number of WBC, prove negligible in differentiating between CAA and NCAA. In the emergency room, examining the hemogram parameters merely reveals that the prediction of complications is rendered meaningless. The study revealed no statistically significant relationship between the groups. Consequently, hemogram parameters (LYM, WBC, NLR, IGC, and IG%) were deemed unreliable for distinguishing between CAA and NCAA.

Life-threatening arrhythmias, shock and airway compromise represent the most crucial situations to treat in the daily routine of acute medicine. Rapid access to automated external defibrillators (AEDs) and other necessary equipment increases survival rates significantly. The unmanned aerial vehicles (UAV) appear to revolutionize prehospital medicine enabling advanced health care delivery to those in austere environments and difficult regions for both defibrillators and blood products (BP). Although there are still many factors to consider, drone networks show potential to greatly reduce lifesaving equipment travel times for those with cardiac arrest (CA). More research should be performed to fill the gaps in routine practice of operating drones in different clinical scenarios, and geographical variations. As far as delivery of BP via drones, key benefits are minimized risk to human life, cost, speed of delivery and ability to cover areas beyond those of conventional planes. Challenges can be airspace management of BP, decisions on appropriate level of care to deliver during transit and user acceptability. Appropriate integration of drones to ambulances and emergency medical services facilitates efforts to improve healthcare, particularly in difficult and underserved regions. In brief, indications of drone use should be individualized to deliver vital equipment and care to the victim in emergency need, while the effectivity of UAVs must be evaluated case by case basis. This article aims to review the current status of above-mentioned technology and pluses and minuses of UAVs used worldwide, along with future projections.