Writing a Textbook on Emergency Medicine -My Experience Continue Reading

Background: Small bowel obstruction (SBO) is a common cause of acute abdominal pain. Many diagnostic modalities are used to diagnose or rule out SBO. Objective: This study aimed to compare the diagnostic accuracy of SBO for point-of-care ultrasound (POCUS) to that of abdominal X-ray (AXR) using computerized tomography (CT) and/or patients' follow-up as the gold standard. Methods: This was a prospective, cohort study of a convenience sample of adult patients, who presented to the emergency department (ED) with signs and symptoms suggestive of SBO. Emergency medicine residents performed POCUS looking for sonographic signs of SBO. Abdominal X-ray and CT results were based on the radiologist's final report. Results: A total of 77 patients were enrolled in the study. The mean age was 56 years, and the mean BMI was 28 kg/m2. Point-of-care ultrasound had a sensitivity of 90%, specificity of 61%, +likelihood ratio (LR) of 2.3, and -LR of 0.159,... Continue Reading

Background: Traumatic head injury represents a substantial cause of trauma in pediatric emergency rooms (ER). This study aimed to calculate the prevalence of abnormal computed tomography (CT) scan reports (CT) in the pediatric ER at King Abdullah Specialized Children's Hospital (KASCH) in Riyadh. In addition, it examined different variables that are more likely associated with a normal CT scan. Methods: This single-center retrospective chart review study was conducted using nonprobability convenience sampling; data were collected from the electronic health records of ER pediatric patients. Patients aged 0 to 14 years, who had a trauma and a brain CT scan ordered in KASCH ER, from May 2017 to May 2019 were included. Results: In total, 502 CT scans were done due to a traumatic head-related event. About a third (34.5%, n = 173) had an abnormal CT scan, with the majority of the group (69.4%, n = 120) being male. The... Continue Reading

Background: Active listening of caregivers to the patients and involving them in decisions about their condition can significantly enhance the treatment outcome and patient experience. Objectives: To investigate patients' experience regarding the quality of communication with their doctors in the emergency department (ED). Method: This was a cross-sectional, observational, survey-based study. Data were collected from adult patients attending the King Faisal Specialist Hospital ED before their final disposition (admission or discharge) using a self-administered 14-item questionnaire. Results: A total of 558 patients took part in this study. More than 90% of the participants state that the doctors listened to them carefully were generally respectful, answered all of their questions and concerns, and the doctors had a reassuring attitude and way of talking. While the patients were encouraged to express what bothered them, they could understand what the doctor explained about their condition. Around 80% reported that the doctor explained to... Continue Reading

Background: The emergency department (ED) is the hospital division that is most vulnerable to poor communication and teamwork-based medical errors that affect patient safety. One approach to prevent medical errors is by training and assessing healthcare workers using simulation-based (SB) teamwork and communication training. This study aimed to explore the extent to which SB training could improve teamwork and communication and reduce preventable medical errors in the ED. Method: The study was conducted at the Ministry of National Guard Health Affairs, a tertiary care center with a 39-bed ED, in Saudi Arabia. A total of 123 ED healthcare staff participated in the study. This study adopted a single-subject experimental design with the intervention of simulation training in ED cases. The methodology focused on three domains: 1) patient safety in the ED, 2) inter-professional and multidisciplinary simulation team training, and 3) team dynamic enhancement use. Staff perceptions regarding teamwork and communication... Continue Reading

Background: Success rates of cardiopulmonary resuscitation (CPR) in in-hospital cardiac arrest (INCA) and out-of-hospital cardiac arrest OOHCA is reported to be 15% and 3%, respectively. However, people in the general population have high and unrealistic expectations of the success of CPR outcomes. Many studies have attributed these false expectations to be due to misinformation disseminated by the mainstream television media. To this end, we have set to investigate this by performing a survey among the general public of the Kingdom of Saudi Arabia (KSA) and the general public in the United States (US). Methods: Two cross-sectional surveys were carried out in the general populations of KSA and USA. The US data was collected via an electronic questionnaire delivered on the survey platform SurveyMonkey® and the data was analyzed for the public's expectations and the source from which the information was obtained. Statistical analysis was later done to check the impact... Continue Reading

Background: Despite all the development in healthcare access and services, out-of-hospital cardiac arrest (OHCA) remains a challenge and still has a poor prognosis. Thus, this study aimed to retrospectively apply the American Heart Association (AHA),Advanced Life Support (ALS), and Termination of Resuscitation (TOR) 2010 criteria to all OHCA patients who arrived at the emergency department (ED) in Abu Dhabi and determine their survival outcome. Methods: A retrospective chart review was done among OHCA patients received by a tertiary care hospital's ED in Abu Dhabi over a period of 1 year in 2018. Results: A total of 87 patients were included; 21 (24.1%) patients met the AHA ALS TOR criteria and none of them survived To hospital discharge, with specificity and positive predictive value (PPV) of 100%. Only three patients (3.4%) who survived to be discharged from the hospital did not meet the AHA ALS TOR criteria. Conclusion: AHA ALS TOR... Continue Reading

Background: Aortic dissection (AD) is a catastrophic condition that represents a challenging diagnosis for emergency physicians. Its presentation can vary widely and may present with non-specific symptoms. A delay in the diagnosis of AD is associa ted with a high rate of morbidity and mortality. Case Presentation: A 77-year-old man presented to the emergency department with a history of acute epigastric abdominal pain and bilateral lower limb weakness. A suspected AD was confirmed by urgent computed tomography angiography in less than 1 hour; which showed extensive dissection of his aorta from ascending part up to the abdominal aorta; "DeBakey1." The emergency complex aortic repair was then performed by the cardiothoracic surgical team that had resulted in a successful fortunate recovery. Conclusion: DeBakey type1 AD is a serious cardiovascular surgical emergency, with a dismal prognosis if missed in the emergency room. Our prompt diagnosis and expedited approach in handling this case... Continue Reading

Background: About 65% of poisoning cases are related to children and of these, more than half of the patients are 5-year-old or less. While non-accidental poisoning is rare. We report two cases of intentional salbutamol poisoning in two young siblings presenting separately multiple times over a period of two years with similar presentations of tachycardia, hyperglycemia and hypokalemia. Case Presentation: Two siblings, one 3-year-old boy and the other one, 1 year old girl, presented at emergency department. Both presented with tachycardia and vomiting, while the boy also had hypeglycemia and hypokalemia, and girl also had subjective fever and poor oral intake. Other vital signs, physical examination, HbA1c, genome sequence, and upper gastrointestinal tract examination were all normal. Child protective team was called due to suspension of Salbutamol toxicity and lab work confirmed it. The mother was interviewed who became resentful and refused to undergo any psychological assessment and left the... Continue Reading

Background: Spontaneous pneumomediastinum (PM) is a rare benign disease entity in children with several predisposing factors. This study reports a case of spontaneous PM related to the use of electronic cigarettes (e-cigarettes) in a 17-year-old adolescent. Case Presentation: A 17-year-old male, user of e-cigarettes, with no underlying pulmonary disease presented to the emergency department with acute chest pain, without any preceding events including trauma. His physical examination was unremarkable apart from positive Hamman's crunch. A plain chest X-ray showed PM and left-sided apical pneumothorax. Chest computed tomography confirmed the presence of PM, accompanied by pneumopericardium and bilateral apical pneumothoraces. The patient reported the use of e-cigarettes, and he was admitted and conservatively managed in the hospital and discharged after three uneventful days. In this case, smoking e-cigarettes was the only predisposing factor found to be associated with the development of spontaneous PM. Conclusion: Emergency physicians should consider the diagnosis of... Continue Reading