Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH. We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms ‘intracerebral haemorrhage’, ‘tranexamic acid’ and ‘antifibrinolytic’. Authors of ongoing clinical trials were contacted for further details. We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid. Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established. Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

Emergency medicine (EM) has evolved significantly over the past 50 years, transitioning from a focus on acute injuries and illnesses to include primary and specialty care, disaster response, and social issues. To date, nearly 60 countries have officially recognized EM as a medical specialty. However, growing patient demands, healthcare staff shortages, and an aging population have strained emergency departments, worsening working conditions for EM professionals and compromising patient care. To address these challenges, formal recognition of EM as a specialty is crucial. As a specialty, EM offers significant benefits. It improves patient outcomes by ensuring structured, standardized training that equips specialists with the skills to manage acute conditions such as trauma, stroke, and myocardial infarction. Countries with recognized EM specialties have reported reduced morbidity and mortality and enhanced healthcare resilience during crises like pandemics and mass casualty events. Additionally, professional recognition aids in recruitment, retention, and reducing burnout among EM practitioners by establishing clear career pathways. Furthermore, it ensures specific paraclinical training in areas such as patient flow, and it strengthens healthcare systems. However, despite these benefits, challenges remain. Resource diversion from primary care, increased healthcare costs, and the initial investment required for training programs are potential drawbacks to EM specialty recognition. Achieving EM recognition will require a strategic collaborative approach, focusing on education, professional support, and collaboration across healthcare sectors.

The aim of this retrospective study was to identify the role of ultrasonography as a decision-making and screening tool in emergency patients with pathological changes. Material and method: The study was carried out for 28 months in the Emergency Department of the County Emergency University Hospital, Cluj-Napoca. An ultrasound examination was performed as part of the clinical algorithm within the first hour of treating non-critical patients after they had been triaged. The diagnostic decision based on the results of the ultrasound examination was compared with the final diagnosis on discharge from the Emergency Department. Results: In study were included 1565 patients with a mean age of 50.61±19.21 years. Ultrasound changes were detected in a statistically significant number of patients from all the examined subgroups (p≤0.002). The concordance between clinical and ultrasound findings was of 54.06%. Of all the examined patients, 20.63% were referred to surgery department based on the results of the ultrasound examination. Surgery was the final therapeutic decision in 5.06% of all the patients with normal ultrasound findings. Conclusions: Ultrasonography as an integrated tool in the clinical examination algorithm allowed the identification of non-critical patients who required emergency surgery (20.63%). The integration of point-of-care ultrasound into the clinical examination allows the management of emergency patients through the ranking of decisions: hospital admission for surgery and medical treatment, other diagnostic investigations, referral to outpatient care and family physician.

This systematic review explores the application of Raman spectroscopy (RS) in traumatic brain injury (TBI) research, emphasizing the need for innovative and efficient diagnostic tools. The development of such techniques aims to alleviate healthcare costs while providing timely assessment of injury severity. A systematic literature search for the use of RS in TBI was conducted in PubMed, Scopus, and Web of Science from inception to July 28, 2025, following PRISMA guidelines. We included only original English-language studies (animals and humans) in free full-text format. Risk of bias was assessed using specific tools for both animal and human models. Findings were classified according to the cohorts, and spectroscopic technique alongside their particularities. The initial search found 261 articles, with 26 studies meeting the inclusion criteria. Among them: 15 were animal studies and 11 translational/human-relevant studies. Among animal studies, 3 focused on in-situ monitoring and TBI classification, 2 on blast-induced models, 5 on blood biomarker analysis, 2 on retinal-based point-of-care diagnostics, and 3 on Raman microscopy. The translational research studies aimed to identify and validate TBI biomarkers for developing future diagnostic strategies in human patients. RS distinguished injured from control tissue through spectral changes reflecting protein and lipid alterations and differentiated lesion areas by revealing astrogliosis-related reorganization. Instantaneous in-situ RS devices achieved >92% accuracy in severity classification and detected biomarker-related molecular changes. Point-of-care RS platforms using lateral flow strips enabled rapid detection of specific TBI biomarkers (GFAP, NAA, NSE, S100B, UCH-L1), showing performance comparable to ELISA while offering faster, simpler, and cost-efficient testing.

Background/Objectives: This study provides the first national-level assessment of burnout among family physicians (FPs) and emergency physicians (EPs) in Romania. Burnout syndrome is a growing concern in medical settings, particularly among primary care physicians. The aim of this study was to compare the levels of frustration and emotional exhaustion (EE) among the Romanian EPs and FPs. Methods: A cross-sectional observational online study was conducted using validated psychometric questionnaires. Statistical analyses included correlation, regression, and between-group comparisons. Results: A total of 307 participants were included (222 FP and 85 EP). EPs reported significantly higher levels of frustration (Mean ± SD = 1.94 ± 1.22) and EE (2.52 ± 0.86) than FPs (2.01 ± 1.24 and 2.51 ± 0.84, respectively; p < 0.001). Regression analysis identified ‘feeling at the end of one’s strength’ (M = 1.26, p < 0.001) and ‘evening exhaustion’ (M = 1.20, p = 0.0112) as significant predictors of EE. Conclusions: The findings highlight the need for differentiated intervention strategies adapted to the specific work conditions of each medical specialty. Organizational support and mental health promotion are recommended to reduce burnout, alongside encouraging professionals to practice individual strategies to ensure well-being.

Background/Objectives: Chronic obstructive pulmonary disease (COPD) remains a major global health problem, affecting over 300 million people worldwide. Its high morbidity and mortality rates impose substantial psychosocial and financial burdens on patients and healthcare systems. In the emergency setting, managing acute exacerbations of COPD (AECOPD) poses a major clinical challenge, as these patients often present with multi-organ dysfunction secondary to hypoxia and hypercapnia. Identifying reliable prognostic biomarkers could improve early risk stratification, guide therapeutic decisions, and enhance patient outcomes. Methods: This multicenter, prospective, observational study aims to evaluate the prognostic significance of several novel biomarkers—resistin, club cell secretory protein 16 (CC16), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), S100β protein—alongside conventional markers such as N-terminal-pro–B-type-Natriuretic-Peptide (NT-proBNP), D-dimer, high-sensitivity troponin I (hs-cTnI), C-reactive protein (CRP), and procalcitonin in patients with AECOPD admitted to the Emergency Department (ED). Blood samples will be collected at admission. The novel biomarkers (resistin, CC16, IL-6, TNF-α, S100β) will be measured using standardized ELISA kits, while conventional biomarkers (NT-proBNP, troponin I, CRP, procalcitonin) will be analyzed using routine automated clinical laboratory methods. Correlations between biomarker levels, clinical and imaging data, severity scores (GCS, SOFA, CFS, Ottawa COPD Risk Scale, DECAF, BAP-65), and short-term outcomes (hospital discharge status and 28-day survival) will be assessed. The study has received approval from the Ethics Committee of the “Iuliu-Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, and all participating hospitals. Written informed consent will be obtained from all participants or their legal representatives. Results: This study protocol does not report results, as data collection and analysis are ongoing. Conclusions /Expected Impact: By identifying novel biomarkers with prognostic and pathophysiological relevance, this research aims to inform the development of early risk stratification tools and support future evidence-based approaches to the management of critically ill COPD patients in the ED.