Erika Poggiali

Despite being commonly encountered in the Emergency Department (ED), syncope remains a diagnostic challenge, particularly among older adults with multimorbidity and polytherapy. The real danger is to underestimate cardiac syncope, which is associated with higher morbidity and mortality. For these reasons, we conducted a retrospective study to evaluate all patients admitted to the ED of Piacenza for syncope or presyncope between 2022 and 2024. Our goal was to investigate the occurrence of Major Adverse Events (MAEs) within 30 days after discharge home. This study aims to assess the effectiveness of our ED protocol for managing syncope, which is based on the 2018 ESC guidelines, which outline three phases that minimize the risk of missed diagnoses while avoiding excessive investigations. Despite being a retrospective monocentric study, the low incidence of MAEs observed supports the protocol’s effectiveness in identifying serious causes of syncope, thus allowing for safe and appropriate management of patients who are discharged home. In the future, the use of artificial intelligence could be useful to confirm the diagnosis, identify high-risk patients and decide the appropriate setting of care (discharge, observation, or admission).

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.

A 53-year-old man presented with severe pain in the left iliac fossa for 2 days without nausea, vomiting, diarrhea, and fever. He was affected by type 2 diabetes mellitus and denied any previous episodes of diverticulitis. Physical examination revealed abdominal tenderness and guarding. Laboratory tests, including C reactive protein, were within the normal range. Point-of-care Ultrasound (US) showed a focal, non-compressible, oval (0.6 x 1 cm), hyperechoic mass with a hypoechoic rim, located directly under the abdominal wall at the point of maximum tenderness. Enhanced Computed Tomography (CT) of the abdomen was performed (Figure 1) and confirmed the diagnostic suspicion.

An 85-year-old female patient with a medical history significant for hypertension, chronic kidney disease, renal artery stenosis, Sjogren syndrome, and hypothyroidism presented to the emergency department with sudden severe dyspnea. Physical examination revealed a blood pressure of 130/80 mmHg and a heart rate of 120 bpm. The electrocardiogram showed sinus tachycardia. Pointof- care Ultrasound (US) documented a moderate bilateral pleural effusion, normal cardiac function, and a collapsible inferior vena cava. Compression US excluded lower extremity deep vein thrombosis. An arterial blood gas showed lactic acidosis (pH 7.31, lactates 36 mg/dL – normal value < 15) and a severe respiratory failure (PaO2/FiO2 ratio of 167). Enhanced Computed Tomography (CT) of the thorax was performed.

We report the case of a 26-year-old man with a history of drug addiction who presented to our emergency department with forearm pain and signs of acute ischemia following an inadvertent intra-arterial injection of zolpidem tablets dissolved in tap water. Although relatively rare, this occurrence carries a high risk of inducing acute limb ischemia, which can lead to severe complications such as amputation or even death. The pathophysiology of limb ischemia is multifactorial, influenced by factors including the site of injection, the physicochemical properties of the drug, and the volume injected. Symptoms can range from severe pain without visible lesions to acral ischemia. In all suspected cases of intra-arterial injection, it is crucial to gather information regarding the time of injection, the type of drug used, and whether microcrystalline cellulose is present in the formulation. Current literature underscores the importance of timely diagnosis and a multidisciplinary approach in reducing the risk of amputation. In this case, the immediate combination therapy, including ketamine, iloprost, anticoagulation, and antibiotics was effective in treating the patient.

Spontaneous spleen rupture is a rare condition that occurs in less than 1% of cases without any identifiable underlying medical issues. Emergency clinicians should always include spontaneous spleen rupture in the differential diagnosis of abdominal pain, as timely diagnosis and intervention are crucial for improving patient prognosis and preventing fatal outcomes. Clinical manifestations may include pain in the epigastric region or the left upper quadrant, tachycardia, and shock. Some patients may show signs of an acute abdomen upon physical examination while maintaining stable vital signs. Point-of-care ultrasound and abdominal computed tomography play a pivotal role in the diagnosis. Standard guidelines for the treatment have not been established. While splenectomy remains the mainstay of treatment, some selected hemodynamically stable patients may be suitable candidates for splenic artery embolization. In this minireview, we will begin by discussing the case of a 53-year-old man who experienced left lower back pain for five days, initially misdiagnosed as renal colic, and we will then conclude by examining the current literature on this important topic.

A 62-year-old Italian woman presented to our emergency room with complaints of redness and a foreign body sensation in her left eye since the day before. Her vision was unaffected, and she she felt well otherwise. She had no previous history of similar episodes, ocular trauma, or foreign body incidents, and there was no record of any systemic illnesses or recent travel. She lived with her pet dog. Laboratory tests, including C-reactive protein and eosinophil count, resulted all normal. On ocular examination, her visual acuity was 20/20 in both eyes. Diffuse conjunctival congestion was noted in the left eye and a large live nematode was visualized in the temporal part of the bulb under the conjunctiva (Video 1). The cornea anterior chamber and the fundus examination were unremarkable.

Maria Salomea Skłodowska-Curie (7 November 1867 – 4 July 1934), known simply as Marie Curie, is surely the best-known scientist remembered as the first and only person and woman awarded with the Nobel Prize twice and in two different scientific fields: in physics for her research of radiation phenomena (1903) and in chemistry for the discovery of polonium and radium (1911).1 She was also the first woman in France to earn a Ph.D. and later became the first woman professor at the Sorbonne University (1906). Marie Curie is often remembered as one of the most famous women in the history of science for her groundbreaking research in radioactivity, a term she coined along with her husband, Pierre Curie. What is less well-known is her unwavering dedication to her research. Her remarkable qualities included a passion for science, high intelligence, a strong belief that her work would benefit humanity, and the perseverance to face the challenges ahead. For all these reasons, she chose not to patent her discoveries, believing that science should be accessible to all. This act of altruism reflects her deep belief in the importance of sharing knowledge and scientific progress for the common good.

The 27th of May marks the birth of the European Society for Emergency Medicine (EUSEM) thanks to a group of visionary people, known as the club of Leuven, who signed the founding act in London in 1994 to create a system model to grant to every citizen in Europe a professional, competent and above all timely response to any life, organ or limb-threatening acute condition.1 Over time, EUSEM has grown to encompass 38 national societies across Europe and now represents over 40,000 healthcare professionals working in the field of Emergency Medicine (EM). The great mission of EUSEM is to enhance research, education, practice, and standards of the specialty of EM across Europe. This includes promoting teaching, training, and research in EM, as well as facilitating the sharing of information through meetings, courses, research, and publications. EUSEM also encourages the development of standardized information systems and data banks in EM, fosters cooperation among national EM associations, and promotes international collaboration in the field of EM.1

Dear Editor, A recent publication by Drei et al.1 discusses a case involving a young male patient diagnosed with Lemierre Syndrome (LS), who was successfully treated with prolonged antibiotic therapy and anticoagulants without the need for surgery, resulting in a complete clinical recovery. The article provides a comprehensive overview of the epidemiology, aetiology, and treatment options for LS. It highlights the concerning link between a patient's young age and the potential for severe complications, which could lead to a fatal outcome if diagnosis and treatment are delayed.