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Introduction: Emergency departments (EDs) have been identified as the highest risk area within a hospital to be exposed to workplace violence (WPV). This study aimed to estimate the prevalence of WPV against healthcare providers in EDs in Saudi Arabia, to explore the experiences and attitudes of ED staff toward WPV, and to identify the possible risk factors for WPV. Methods: A cross-sectional survey study was conducted with physicians and nurses working in 37 EDs in three provinces in Saudi Arabia, using a convenient sampling method. Over a 1-year period, 787 ED staff members were contacted and a 60% response rate was achieved. Results: The 1-year prevalence of at least one violent act against ED staff was 45%. Verbal threats were the most common type of WPV (42%). The study found that the prevalence of WPV against physicians (47%) was higher than against nurses (41%). However, when comparing the physician and... Continue Reading

Background: Trauma is the third leading cause of death worldwide and the most common cause of death among people aged 1-44 years. In Saudi Arabia, traumatic injuries cause one death and four injuries every hour, but survival rates have improved owing to improvements in pre-hospital care processes. Methodology: This retrospective study conducted in King Abdulaziz Medical City (KAMC), Emergency Medicine Department, included data taken from KAMC trauma registry, QuadraMed®, and patients' files. Injury Severity Score (ISS) was used to assess the severity of trauma. We included individuals of both sexes with ISS of ≥9 and aged ≥15 years with different types and mechanisms of injury. Results: Overall, 335 patients (123 transported by helicopter and 212 transported by ground ambulance) were included. The mean ISS for helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) patients was 20.80 and 19.74, respectively. All HEMS patients had blunt trauma. For GEMS... Continue Reading

Background: Intravenous (IV) fluids are a commonly prescribed treatment in the emergency department (ED). Often the prescription of a treatment to be administered in the ED prolongs the patients' length of stay (LOS). We hypothesize that IV fluids are overprescribed in the ED, mainly in patients classified as Emergency Severity Index (ESI) triaged level 3 (T3) and level 4 (T4). Methods: We conducted a quality audit to assess the appropriateness of IV fluid use in adult (age > 16 years) hemodynamically (HD) stable ESI triaged T3 and T4 patients at a tertiary hospital ED during two 6-month periods. Appropriate use of IV fluids was defined from the published literature and our own clinical experience. The primary outcome looked at was the number of patients appropriately prescribed IV fluids before and after implementing a list of indications for IV fluid use in HD stable patients. Results: Analysis showed 62.8% of T3... Continue Reading

Background: Shortness of breath is a very common presentation at the pediatric emergency department, but making a diagnosis based on it is very challenging for physicians because of the numerous differential diagnoses, including respiratory and cardiac causes. Case Presentation: Herein, we describe the case of a 2-month-old patient who presented to our emergency department in October 2017 with shortness of breath for 3 weeks duration. She was diagnosed as having lower respiratory tract infection; a cardiac murmur was incidentally found, which turned out to be a very rare congenital cardiac disease: left ventricular non-compaction cardiomyopathy (LVNC). She was treated with anti-failure medications but unfortunately died before cardiac transplant. Conclusion: As demonstrated by this case, non-compaction cardiomyopathy can be easily missed and misdiagnosed because of its rarity and diverse symptoms on presentation. Since corresponding treatment modalities are lacking, the prevention of associated complications is the primary goal of LVNC management. Continue Reading

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We believe the readers of SJEM will take great interest in our recent work on the burgeoning field of Dignitary Medicine (DM). Historically, there are significant lessons learned from medical catastrophes that affected or killed leaders from all over the world, all of which highlighted the importance of the physicians-leaders' relation (When Illness Strike the Leaders-by Jerald Post). We always assume that leaders as VIP get the best health care, while in fact their health outcome are compromised by many factors, including the inner circle interference and their families influences, but also the lack of physician special training. DM involves caring for government leaders, their family, and other high-profile individuals, generally referred to as dignitaries. Dignitaries require 24/7 access to complex care, mitigation against unique threats, such as assassination, coordination of medical care with security services and an inner circle of advisors, and greater medical record privacy than the average... Continue Reading

Paramedics in the Pre-Hospital care setting are a crucial part of the "When seconds matter" team of Bahrain's First Emergency Medical Conference, 2019. The teamwork concept is emphasized within newly developed Paramedic Internship Programs in Saudi Arabia where preceptors reiterate "The Golden-Hour" phrase. Dr. Cowley coined this phrase and recognized the importance of "The Golden Hour" from his personal experiences in post-World War II and his career in the 1960s. His practices allowed him to recognize that the earlier the trauma patient reached definitive care, the greater the chances were of survival. Paramedics are a crucial part of the team by having a quick response time to the scene, treat the patient's lifethreatening injuries first, and transport the patient to the most appropriate hospital. The Paramedic's on-scene time is as vital as their patient assessment and critical thinking skills, to make an appropriate in-field diagnosis. "Not All Pre-hospital Time is... Continue Reading

Normal pressure hydrocephalus is a rare pathological condition of the brain where the cerebrospinal fluid accumulates in the ventricles thus enlarged, but with normal opening pressure on lumbar puncture. This results in three classical symptoms, namely, progressive mental impairment, gait disturbance, and urinary or bowel incontinence. It most commonly occurs in adults over the age of 60 years. It could be extremely misdiagnosed by many clinicians since the symptoms resemble other neurodegenerative disorders. Here, we are reporting a case of idiopathic Normal Pressure Hydrocephalus who was brought to the Emergency Department after falling down on the floor complaining of an imbalanced gait, with the typical triad of the aforementioned symptoms. He is a known case of diabetes mellitus. His walking problem was thought to be a complication of his diabetic foot and he had physical therapy for that, but it kept worsening with time. His gait was shuffling and brady-kinetic,... Continue Reading