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Acetaminophen (APAP) is a widely used drug in our environment with few adverse effects. Because of this, several patients affected by APAP hepatotoxicity unknown that the APAP dose-intake was excessive. This damage is mainly produced via one of APAP metabolites: N-acetyl-para-benzo-quinone imine (NAPQI), which is very toxic. The drug’s ingested doses as well as the length of time from APAP ingestion to N-acetylcysteine (NAC) therapy are the most essential determining factors in both the development and severity of APAP hepatotoxicity. However, there are other factors related, including alcohol intake, herbs and medications, age and genetic factors, nutritional status, and chronic liver disease. The ingestion of a toxic dose of APAP causes different clinical manifestations that depend fundamentally on the time elapsed since the intake. The diagnosis process depends on the intake (acute single overdose of after repeated overdoses). The Rumack-Matthew nomogram is acceptable after an acute single overdose, being the “possible hepatic toxicity” point 200 µg/mL at 4 hours and 25 µg/mL at 16 hours). This normogram is no applicable in after repeated overdoses. NAC is the antidote for APAP intoxication, and could be administered orally or intravenous. Finally, a multidisciplinary approach with the support of Psychiatry, Intensive Care Unit as well as Gastroenterology and Digestive Department will be necessary, especially in the case of attempted autolysis and severe liver failure.

The incidence of community-acquired pneumonia (CAP) ranges from 2-15 cases/1,000 inhabitants/year, being higher in those over 65 or in patients with comorbidities. In Emergency Room (ER) it represents up to 1.35% of the care. Approximately 75% of all diagnosed CAPs are treated in ER. The CAP represents the origin of the majority of septic sepsis and shock diagnosed in ER, the leading cause of death and admission to the intensive care unit (ICU) for infectious disease. A global mortality of 10-14% is attributed according to age and associated risk factors. 40-60% of CAPs will require hospital admission, including observation areas (with very variable ranges of 22-65% according to centers, time of year and patient characteristics), and between them 2-10% will be in the ICU. From all that has been said, the importance of CAP in ER is translated, and also of the “impact of emergency care on patients with CAP”, as it is the device where initial, but fundamental, decisions are made for evolution of process. The great variability among clinicians in the management of diagnostic-therapeutic aspects in the CAP is known, which is one of the reasons that explain the large differences in admission rates, of achieving the microbiological diagnosis, request for complementary studies, the choice of antimicrobial regime or the diversity of care applied. In this sense, the implementation of clinical practice guidelines with the use of prognostic severity scales and the new tools available in HUSs such as biomarkers can improve the care of patients with CAP in ER. Therefore, based on a multidisciplinary group of emergency professionals and specialists participating in the CAP care process, this clinical guide has been designed with various recommendations for decisions and key moments in the process of patient care with NAC in the Emergency Room.

Focal nodular hyperplasia (FNH) is considered the second most frequent benign liver tumor with a low prevalence, with a broad predominance in the female population. Most cases are asymptomatic and are often discovered incidentally. Diagnostic imaging through MRI, CT, and ultrasound can be achieved in up to 80% of cases. In some cases, a histopathological study may be necessary, especially in view of the diagnostic uncertainty and suspicion of malignancy. To date, the management of these lesions remains controversial, conservative management is recommended for asymptomatic or small lesions, relegating surgical treatment only in cases of symptomatic lesions or uncertain behavior.

Complete knee dislocation (CSF) is an uncommon lesion that should receive immediate attention due to the danger of secondary complications. Anterior dislocations are the most frequently observed, revealing usually concomitant complications of the stabilizing structure of the knee and is often accompanied by neurovascular lesions, including popliteal thrombosis and compartment syndrome. According to that, the literature reveals different approach in the diagnosis process to despite this complications attending to the physical exploration as well as the mechanism of the injury. According to that, closed reduction in the operation room to resolve the dislocation and confirm suspected complications are also suggested. A purpose of a case of a patient with a complete anterior dislocation of the left knee, we summarize a brief review of this pathology.