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Chest trauma is the leading cause of death in people under 40. It is estimated to cause around 140,000 deaths each year. The key aims are to reduce mortality and the impact of associated complications to expedite recovery and to restore patient’s conditions. The recognition of lesions through appropriate imaging and early treatment already in the emergency department are fundamental. The majority can be managed in a non-surgical way, but especially after traumatic cardiac arrest, a surgical approach is required. One of the most important surgical procedures is the Emergency Department Thoracotomy (EDT). The aim of this review is to provide a comprehensive synthesis about the management of thoracic trauma, the surgical procedures, accepted indications, and technical details adopted during the most important surgical procedures for different thoracic trauma injuries. Literature from 1990 to 2023 was retrieved from multiple databases and reviewed. It is also important to emphasize the medico-legal implications of this type of trauma, both from the point of view of collaboration with the judicial authority and in the prevention of any litigation.

The present research aimed to analyze the effect of HIIT with body weight on strength and functional capacity parameters in older adults. Sixty sedentary older people were randomized into the control group (n=30) and the training group (n=30), who performed the bodyweight interval training program. The training consisted of 3 weekly sessions of 30 minutes in duration, performed on alternate days, consisting of warm-up, central part, and cool-down. The main part of the training session was 20 minutes long, totalling 20 work cycles. Each work cycle comprised 30 seconds of stimulation and 30 seconds of passive recovery. To verify the functional variables of older adults, the 5-time sit-and-stand test, the 10m walk test, the Timed Up and Go (TUG), and the 1RM test were used to determine maximum muscular strength. The results showed significant differences (p

The high strain-rate and temperature properties of ultra-high molecular weight polyethylene (UHMWPE) composites are limitedly available in the public domain, primarily due to challenges in gripping the extremely strong material during testing. In this study, tensile tests were performed on UHMWPE laminates over a range of strain-rates from 4.00 × 10-4 to 2.45 × 102 s-1, and at different temperatures from -10 to 70 °C using an innovative interchangeable clamping system. The clamp was designed to overcome gripping issues while ensuring consistent boundary conditions across various testing devices. Digital Image Correlation (DIC) technique was employed to capture the displacement fields in situ. The results show that UHMWPE composites demonstrate strain-rate strengthening and temperature-induced softening effects. The strain-rate dependent models indicate a notable difference in strain-rate sensitivity, particularly with tensile strength exhibiting 87 % and 60 % higher sensitivity compared to the tensile modulus and failure strain, respectively. The Weibull statistical model indicates that the scale parameter increases by 17 % with the increase in strain-rate due to transition in failure response from ductile to brittle, which is observed through optical microscopy. In contrast, the scale parameter decreases by 58 % with the increase in temperature. Therefore, it is important to consider the effects of strain-rate and temperature on the mechanical properties for effectively utilizing this material to develop numerical models in various impact-protective applications.

Introduction: The COVID-19 pandemic had an important impact on blood bank services. The onset of the pandemic led to a decrease in the number of blood donors. A remote interview would avoid deferred donors from having to travel to the blood bank. We evaluate the feasibility of using telemedicine as an alternative to a face-to-face interview as a first blood donor screening. Methods: Our retrospective study included 404 whole blood and platelets donors, who underwent the clinical interview remotely via telemedicine. The deferred donor would not need to go to the blood bank and eligible candidates were required to donate within 7 days. On the day of donation, a mini-interview was held to ensure donor and blood safety. Results: The appointments were made from June 2020 to June 2022, including 263 candidates for whole blood (WB) and 141 for platelets (PLTs). At the end of the telemedicine interview, 285 (70.6 %) candidates were considered eligible. Telemedicine was not performed for 60 (14.8 %) candidates due to technical problems (with audio or video) or absences. The deferral rate among candidates who underwent telemedicine pre-screening was 14.6 % and, among eligible donors after telemedicine, only 7 (2.9 %) were unable to donate blood. Conclusion: Telemedicine is a viable alternative and a welcome convenience for potential donors to avoid unnecessary travel.

Introdução: A contaminação bacteriana (CB) de hemocomponentes é um evento adverso da transfusão de hemocomponentes, potencialmente grave e grande causadora de sepse e mortes relacionadas a transfusão. A AABB (Association for the Advancement of Blood & Biotherapies) define que os Serviços de Hemoterapia (SH) devem ter métodos para detectar bactérias em todos os componentes plaquetários (CP) destinados a transfusão. No Brasil, a Portaria de Consolidação n°5 fixa a obrigatoriedade em 1% da produção. Nos SH comumente é utilizada a hemocultura, valendo-se de 8 a 10 ml de amostra, dificultando e depreciando os CP, que já possuem baixos volumes. Faz-se necessário uma alternativa para detecção de CB nas bolsas de CP, mantendo-se a sensibilidade e utilizando-se menor volume de amostra possível, a um custo permissivo. Objetivo: Definir um protocolo para hemocultura dos CP, utilizando baixo volume de amostra, avaliando-se a sensibilidade do teste aplicado e o custo da operação. Materiais e métodos: Os doadores de sangue foram triados no Serviço de Hemoterapia e Terapia Celular do Hospital Israelita Albert Einstein entre abril e junho de 2024. As hemoculturas automatizadas foram processadas no equipamento BD BACTECTM, que utiliza uma metodologia de fluorescência para rápida detecção de bactérias em amostras. Os frascos utilizados foram os PlateletsAerobic/F Culture Vials e PlateletsAnaerobic/f Culture Vials, recém registrados para uso no Brasil e específicos para utilização em amostras de CP deleucotizadas provenientes de SH. Para validação foram utilizadas 12 cepas bacterianas. O volume mínimo requerido pelo fabricante para inoculação foi de 4 ml por frasco. Para os controles negativos foram utilizados CP e salina. Resultados: Todas as amostras positivas demonstraram resultado conforme esperado. O tempo médio para positivar os frascos inoculados foi: S.aureus (t = 13:28h), E.clocae (t = 10:54h), E.coli (t = 10:37h), S.agalactiae (t = 9:35h), S.epidermidis (t = 19:46h), S.mascescens (t = 11:13h), K.oxytoca (t = 11:15h), C.albicans (t = 23:05h), P.aeruginosa (t = 15:01h), C.perfringens (11:04h), B.cereus (t = 11:43h), C.acnes (t = 11:03h). Os frascos sem inóculo apresentaram resultados negativos. Discussão: O tempo médio de detecção dos patógenos se mostrou adequado (< 24h), comprovando sensibilidade para todas as cepas testadas. Em se tratando de um hemocomponente cujo volume total é significativamente baixo (40 a 70 ml), a possibilidade de uma inoculação de apenas 4 mls contra 8 mls dos frascos tradicionais se mostra bastante significativa e benéfica para o produto final. O custo do insumo é parecido com os frascos já utilizados pelo Serviço, o que possibilitaria sua implementação. Conclusão: A sensibilidade semelhante, associada a um baixo consumo de amostragem, oferta de um hemocomponente mais volumoso, e um custo financeiro similar tornam a realização das hemoculturas automatizadas com frascos aeróbios e anaeróbios de plaquetas uma boa solução para SH que realizam triagens microbiológicas para seus produtos plaquetários.

Our study identified strains of the A/H5N1 virus in analyzed samples of subsistence poultry, wild birds, and mammals, belonging to clade 2.3.4.4b, genotype B3.2, with very high genetic similarity to strains from Chile, Uruguay, and Argentina. This suggests a migratory route for wild birds across the Pacific, explaining the phylogenetic relatedness. The Brazilian samples displayed similarity to strains that had already been previously detected in South America. Phylogeographic analysis suggests transmission of US viruses from Europe and Asia, co-circulating with other lineages in the American continent. As mutations can influence virulence and host specificity, genomic surveillance is essential to detect those changes, especially in critical regions, such as hot spots in the HA, NA, and PB2 sequences. Mutations in the PB2 gene (D701N and Q591K) associated with adaptation and transmission in mammals were detected suggesting a potential zoonotic risk. Nonetheless, resistance to neuraminidase inhibitors (NAIs) was not identified, however, continued surveillance is crucial to detect potential resistance. Our study also mapped the spread of the virus in the Southern hemisphere, identifying possible entry routes and highlighting the importance of surveillance to prevent outbreaks and protect both human and animal populations.

Introdução: A trombose relacionada ao cateter (TRC) é responsável pela maioria dos eventos trombóticos no neonato. Objetivo: Investigar a frequência da TRC, a associação com os dias de uso do cateter até o diagnóstico e o número de cateteres utilizados em uma Unidade de Terapia Intensiva Neonatal unicêntrico. Métodos: Estudo caso-controle que incluiu 14 casos e 42 controles. A coleta de dados ocorreu entre janeiro de 2017 e dezembro de 2020 em uma UTIN pública. Foram calculadas razões de chances brutas (COR). O estudo respeitou os padrões éticos das diretrizes nacionais. Resultados: Duzentos e noventa e quatro neonatos utilizaram cateter venoso central, dos quais 14 (4,7%) foram diagnosticados com TRC. O cateter em uso no momento do diagnóstico foi o cateter central inserido centralmente em 8 (57,1%). Antes do diagnóstico, o tempo acumulado de uso do cateter foi de 34,5 dias e a mediana do número de cateteres utilizados foi de três. Um maior número de dias de uso do cateter >30 (COR 19,11; IC 95% 2,28-160,10; p=0,007) e número de cateteres utilizados >3 (COR 7,66; IC 95% 1,51-38,70; p=0,01). Conclusão: Os casos de TRC foram associados à gravidade clínica; número de cateteres e dias cumulativos de uso do cateter. Sugerimos que o rastreamento de trombose seja realizado em neonatos que necessitem de longo tempo de uso do cateter e mais de três cateteres. Reduzir a duração e o número de cateteres venosos usados ajudará a reduzir a TRC.

Chest pain is one of the most prevalent causes of Emergency Department (ED) admission and could be a presenting symptom of Acute Coronary Syndrome (ACS). The aim of this review was to provide an overview of the research about troponin and its limitations and new biomarkers used in patients with cardiovascular diseases, with a special focus on soluble Suppression of Tumorigenicity 2 (sST2) and Soluble Urokinase Plasminogen Activator Receptor (suPAR). In January 2024, a PubMed and Reviews in Cardiovascular Medicine (RCM) search was carried out to identify all relevant papers in the past five years. 80 articles were included in the final review. ssT2 and suPAR are involved in both acute and chronic cardiovascular disease and can predict the risk of adverse events. sST2 and suPAR are promising biomarkers that, in combination with troponin, could help in the management of patients with chest pain in the ED. Further studies are needed to validate their role in management of ACS in this specific setting.

BackgroundAt the start of the coronavirus disease 2019 (COVID-19) pandemic, widespread blood shortages were anticipated. We sought to determine how hospital blood supply and blood utilization were affected by the first wave of COVID-19.Study design and methodsWeekly red blood cell (RBC) and platelet (PLT) inventory, transfusion, and outdate data were collected from 13 institutions in the United States, Brazil, Canada, and Denmark from March 1st to December 31st of 2020 and 2019. Data from the sites were aligned based on each site's local first peak of COVID-19 cases, and data from 2020 (pandemic year) were compared with data from the corresponding period in 2019 (pre-pandemic baseline).ResultsRBC inventories were 3% lower in 2020 than in 2019 (680 vs. 704, p

Coffee is one of the most widely consumed beverages in the world, which has important repercussions on the health of the individual, mainly because of certain compounds it contains. Coffee consumption exerts significant influences on the entire body, including the gastrointestinal tract, where a central role is played by the gut microbiota. Dysbiosis in the gut microbiota is implicated in the occurrence of numerous diseases, and knowledge of the microbiota has proven to be of fundamental importance for the development of new therapeutic strategies. In this narrative review, we thoroughly investigated the link between coffee consumption and its effects on the gut microbiota and the ensuing consequences on human health. We have selected the most significant articles published on this very interesting link, with the aim of elucidating the latest evidence about the relationship between coffee consumption, its repercussions on the composition of the gut microbiota, and human health. Based on the various studies carried out in both humans and animal models, it has emerged that coffee consumption is associated with changes in the gut microbiota, although further research is needed to understand more about this link and the repercussions for the whole organism.

Dual fuel combustion has gained attention as a cost-effective solution for reducing the pollutant emissions of internal combustion engines. The typical approach is combining a conventional high-reactivity fossil fuel (diesel fuel) with a sustainable low-reactivity fuel, such as bio-methane, ethanol, or green hydrogen. The last one is particularly interesting, as in theory it produces only water and NOx when it burns. However, integrating hydrogen into stock diesel engines is far from trivial due to a number of theoretical and practical challenges, mainly related to the control of combustion at different loads and speeds. The use of 3D-CFD simulation, supported by experimental data, appears to be the most effective way to address these issues. This study investigates the hydrogen-diesel dual fuel concept implemented with minimum modifications in a light-duty diesel engine (2.8 L, 4-cylinder, direct injection with common rail), considering two operating points representing typical partial and full load conditions for a light commercial vehicle or an industrial engine. The numerical analysis explores the effects of progressively replacing diesel fuel with hydrogen, up to 80% of the total energy input. The goal is to assess how this substitution affects engine performance and combustion characteristics. The results show that a moderate hydrogen substitution improves brake thermal efficiency, while higher substitution rates present quite a severe challenge. To address these issues, the diesel fuel injection strategy is optimized under dual fuel operation. The research findings are promising, but they also indicate that further investigations are needed at high hydrogen substitution rates in order to exploit the potential of the concept.

Nowadays, engine experimental research represents a very expensive field within the automotive industry, but it remains fundamental for engine and vehicle development. The present work aims to investigate a novel approach for engine control system calibration, by adopting machine learning techniques to model physical parameters of the engine starting from experimental data measured at the test bench. The main goal is to create a methodology which accelerates the calibration process without losing accuracy. A model that estimates air mass flow is created by adopting either a tree ensemble model or an artificial neural network trained on a small dataset, which was previously acquired at the test bench using a random calibration of the volumetric efficiency map. The model’s performance is first validated on a larger, random dataset. Then, the volumetric efficiency calculated from the air mass flow model estimation is used to calibrate the transfer function of the Engine Control Unit. Finally, the sensitivity of the model error correlated with the number of data points acquired is used in order to determine the best practice for a Design Of Experiment, which minimizes data acquisition. The methodology proposed can lead to reduced time and costs of the whole calibration process of the engine, without losing accuracy. The analysis was conducted on the entire vehicle, which is crucial for drivability, especially in motorcycles since they are highly sensitive to air-to-fuel ratio adjustments. This work demonstrates that machine learning models can be adopted for the fine-tuning of the calibration process, which is normally performed manually.

A significant challenge in utilizing hydrogen in conventional internal combustion engines is achieving a balance between NOx emissions and brake power output. A lean premixed charge (Lambda ≈ 2.5) allows for efficient and stable combustion with minimal NOx emissions. However, this comes at the cost of reduced power density due to the higher air requirements of the thermodynamic process. While supercharging can mitigate this drawback, it introduces increased complexity, cost, and size. An intriguing alternative is the 2-stroke cycle, particularly in an opposed piston (OP) configuration. This study presents the virtual development of a single-cylinder 2-stroke OP engine with a total displacement of 0.95 L, designed to deliver 25 kW at 3000 rpm. Thanks to its compact size, high thermal efficiency, robustness, modularity, and low manufacturing cost, this engine is intended for use either as an industrial power unit or in combination with electric motors in hybrid vehicles. The overarching goal of this project is to demonstrate that internal combustion engines can offer a practical and cost-effective alternative to hydrogen fuel cells without significant penalties in terms of efficiency and pollutant emissions. The design of this novel engine started from scratch, and both 1D and 3D CFD simulations were employed, with particular focus on optimizing the cylinder’s geometry and developing an efficient low-pressure injection system. The numerical methodology was based on state-of-the-art commercial codes, in line with established engineering practices. The numerical results indicated that the optimized engine configuration slightly surpasses the target performance, achieving 29 kW at 3000 rpm, while maintaining near-zero NOx emissions (

Cardiogenic pulmonary edema (CPE) is characterized by the development of acute respiratory failure associated with the accumulation of fluid in the lung’s alveolar spaces due to an elevated cardiac filling pressure. All cardiac diseases, characterized by an increasing pressure in the left side of the heart, can cause CPE. High capillary pressure for an extended period can also cause barrier disruption, which implies increased permeability and fluid transfer into the alveoli, leading to edema and atelectasis. The breakdown of the alveolar-epithelial barrier is a consequence of multiple factors that include dysregulated inflammation, intense leukocyte infiltration, activation of procoagulant processes, cell death, and mechanical stretch. Reactive oxygen and nitrogen species (RONS) can modify or damage ion channels, such as epithelial sodium channels, which alters fluid balance. Some studies claim that these patients may have higher levels of surfactant protein B in the bloodstream. The correct approach to patients with CPE should include a detailed medical history and a physical examination to evaluate signs and symptoms of CPE as well as potential causes. Second-level diagnostic tests, such as pulmonary ultrasound, natriuretic peptide level, chest radiograph, and echocardiogram, should occur in the meantime. The identification of the specific CPE phenotype is essential to set the most appropriate therapy for these patients. Non-invasive ventilation (NIV) should be considered early in the treatment of this disease. Diuretics and vasodilators are used for pulmonary congestion. Hypoperfusion requires treatment with inotropes and occasionally vasopressors. Patients with persistent symptoms and diuretic resistance might benefit from additional approaches (i.e., beta-agonists and pentoxifylline). This paper reviews the pathophysiology, clinical presentation, and management of CPE.

Background: COVID-19 caused by SARS-CoV-2 virus is characterized by respiratory compromise and immune system involvement, even leading to serious disorders, such as cytokine storm. Methods: We then conducted a literature review on the topic of sepsis and covid-19, and in parallel conducted an experimental study on the histological finding of patients who died from SARS-Covid 19 infection and a control group. Results: Sepsis associated with covid-19 infection has some similarities and differences from that from other causes. Conclusion: In this paper the complex interplay between the 2 disorders was discussed, focusing on the similarities and on the effect that one could have on the other. A preliminary experimental section that demonstrates the multisystemic involvement in subjects who die from SARS-CoV-2 is also proposed.

Ethanol production in Brazil started in the early 1930s due to laws created by the Brazilian government. However, ethanol production only increased significantly with the National Program of Ethanol implementation in 1975. This program was another action taken by the Brazilian government aiming to provide conditions for the development of the ethanol industry in the country. With the program, it was possible to achieve significant progress; however, it finished in the mid-1980s. Currently, ethanol is produced on a large scale by more than 300 sugarcane mills all over the country. In 2016, the Brazilian government provided another incentive for ethanol production by creating the RenovaBio Program, which aimed to reduce greenhouse gas emissions. Besides the environmental aspect, Brazil’s ethanol industry needs to develop to supply future biofuel demand. According to the forecast provided in this paper, and considering technical, economic, and environmental aspects regarding the Brazilian ethanol industry, the current and only feedstock used is likely to be insufficient. Thus, the ethanol produced from corn would be an attractive secondary feedstock to complement sugarcane ethanol as the primary feedstock.

Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient’s admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981–April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.

The authors present two cases of mouth floor hemorrhage consequences of implant placement within the atrophic anterior mandible. In one patient, the implant placement was associated with the guided bone regeneration (GBR) technique. This serious complication has been widely described in the literature, especially in the anterior mandible area. In cases of bone resorption, the edentulous ridge becomes closer to the artery, and the risk of vessel injury increases. In both patients, the hematoma rapidly spread in the loose tissues of the mouth floor, displacing the tongue posteriorly and cranially, with airway compromise. The patients were hospitalized with nasotracheal intubation to secure the airway. In both patients, the bleeding stopped spontaneously, and after a few days, the oral floor swallowing was reduced, allowing the endotracheal tube to be removed. In about 2 weeks, the hematoma completely resorbed without surgery. According to the literature, the main cause of floor of the mouth hemorrhage is the mandibular lingual cortical plate perforation during bone drilling with subsequent sublingual–submental artery injury. In fact, in the first patient presented, this surgical error was clearly noticeable on the CT scan. Differently, in the second case reported, no radiological signs of inner cortical perforation were observed, and together with a mouth floor hematoma, a blood collection was also evident on the lower lip, suggesting a different cause of bleeding. Most likely during the periosteal release incision, mandatory in GBR technique, the ascending mental artery was injured, and hematoma spread in the mouth floor through the similar incision done on the lingual flap. Firstly, the mouth floor hemorrhage caused by an injury of a vestibular soft tissue artery during GBR surgery was reported. Strategies and recommendations to avoid this life-threatening event are provided, based on the literature review and the authors’ experience.

In 2021, the H5N1 virus lineage 2.3.4.4b spread to the Americas, causing high mortality in wild and domestic avian populations. South American countries along the Pacific migratory route have reported wild bird deaths due to A/H5Nx virus since October 2022. However, limited genomic data resulted in no cases reported in Brazil until May 2023.Brazil reported its first case of highly pathogenic avian influenza virus (HPAI A/H5N1) in May 2023. The virus was detected in Cabot's tern specimen in Marataízes, Espírito Santo. Cases were also found in backyard poultry and other wild birds, but no human or commercial poultry cases occurred. HPAI poses risks to the poultry industry, food security, and public health.Researchers used next-gen sequencing and phylogenetic analysis to study the Brazilian sample. It confirmed its affiliation with the 2.3.4.4b clade and proximity to sequences from Chile and Peru.This sheds light on the spread and evolution of HPAI A/H5N1 in the Americas, emphasizing continuous monitoring to mitigate risks for both avian and human populations. Understanding the virus's genetics and transmission allows implementing effective control measures to protect public health and the poultry industry.

Introduction: Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations.Methods: This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21–May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic.Results: We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), “access block” (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean “access block” time (718 vs 1,223 min; P < 0.001), and “access block” total time (650,379 vs 1,359,172 min; P < 0.001).Conclusion: Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic.

Lung ultrasound has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures; among point-of-care ultrasound techniques, the lung ultrasound saw the greatest spread in the last decade. The COVID-19 pandemic has given a boost to the use of ultrasound since it allows to obtain a wide range of clinical information with a bedside, not harmful, repeatable examination that is reliable. This led to the remarkable growth of publications on lung ultrasounds. The first part of this narrative review aims to discuss basic aspects of lung ultrasounds, from the machine setting, probe choice, and standard examination to signs and semiotics for qualitative and quantitative lung ultrasound interpretation. The second part focuses on how to use lung ultrasound to answer specific clinical questions in critical care units and in emergency departments.