Unveiling the Diagnostic Landscape: Assessing the Rate of Positive Findings in Radiological Imaging by the Emergency Department - A Retrospective Study (December 2022 – February 2023).
Fatema Ali Abdulaal
,
Amr Gebril
,
Alaa Saleh
,
Ali Nawaz
,
Ahmed Kaabneh
,
Arun Arya
Year:
2024
Background: Diagnostic imaging is vital for accurate diagnoses and timely treatment in the Emergency Department (ED). This retrospective study aimed to assess the rate of positive findings in ED-ordered radiology scans at NMC Royal Hospital, UAE, and to identify potential areas of overutilization. Objectives: The study seeks to develop a tool for judging scan appropriateness, using the rate of positive findings as a metric to evaluate imaging appropriateness. Secondary objectives included evaluating factors influencing imaging outcomes and providing recommendations to enhance patient care, reduce costs, and optimize resource utilization in the ED. Methods: Between December 2022 and February 2023, 25,343 ED visits were recorded, with 6,633 patients underwent imaging. Samples of 100 were randomly selected for each modality, X-ray, ultra-sound, and CT scans, and 38 for MRI (due to limited data availability), totaling 338 samples. The study comprehensively analyzed patient clinical history, imaging requests, radiologist reports, and final diagnoses from...
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Clinical Spectrum of Poisoning in Pediatric Emergency in Underdeveloped Countries
Razi ur Rahman
Year:
2024
Background: Poisoning is a common presentation in pediatric emergency. Over the period, clinical spectrum changes continuously. This study helps to understand current spectrum of poisoning in pediatric population. Objective: To find out the clinical spectrum of Poisoning in pediatric population in Pediatric Emergency Department of underdeveloped country. Method: We did a cross-sectional study in eleven units of pediatric emergency of tertiary care hospitals of Pakistan during a period of six months from January 2022 to June 2022. Result: A total of 631 Patients evaluated who presented to PED in this duration. The mean age of presentation is 42.15 months with a male to female ratio of 1:1.3. In almost 80.03 % (n=505) cases the cause of poisoning in unknown, it is because proper history is not available. Out of known ingestion (n= 126), 56.34 (n=71) is due to Organophosphate ingestion, Benzodiazepine 18.25 % (n=23), Salicylate 10.31 % (n=13), Vitamin supplements...
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Impact of Asthma Management Protocol in reducing Length of Stay in Low Income Countries
Razi Ur Rahman
Year:
2024
Introduction: Asthma is recognized as one of the most common pediatric diseases. Different methods are adopted to reduce to Length of Stay of Asthmatics patients in Emergency Department. A unit-based protocol is adopted in a public sector hospital of Urban Sindh. Patients presenting in Pediatric Emergency Department (PED) were nebulized with Ventolin three times during first hour of their visit followed by Intravenous Hydrocortisone and other modalities and compliance to the protocol was assessed. Objective: To evaluate the impact of Asthma Management Protocol on Length of Stay in Public Sector Hospital Method This is the retrospective cross-sectional study over a period of Six months (from January 22 – June 22). All pediatric patients presenting with Diagnosis of Acute asthma were assessed according to Asthma Protocol and Their Length of Stay and outcome was assessed. Results: During the period of six months 594 pediatric patients came with the diagnosis of Asthma...
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Dapsone Associated Methemoglobinemia-----A Case of Blue Discoloration
Jamil Dayo
,
Erum Shakeel
,
Akbar Baig
Year:
2024
Dapsone is among the medicine that belongs to sulfone groups and being used to treat leprosy and dermatitis. It inhibits the synthesis of dihydrofolic acid by competing with para-aminobenzoic acid. This is a case of a lady in her mid70's known case of pyoderma gangrenosum recently started on dapsonepresented to ED with complaint of shortness of breath, discoloration of fingers for 4days. Patient had saturation of 88% room air. Relevant examination showed blue discoloration of the finger pulps. Arterial blood gas analysis showed oxygen saturation of 98%RA and PaO2 of 87mmHg, suggestive of positive saturation gap. She was treated with IV methylene blue on the impression of methemoglobinemia and her discoloration improved rapidly. An approach to hypoxia in ED must be considered in context of saturation gap in patients suspected of having toxicological cause. Methemoglobinemia treatment requires methylene blue administration that causes rapid resolution of symptoms.
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Thrombocytopenia and Coagulopathy in Covid-19 Manifesting as Upper Gastrointestinal Bleed and Epistaxis
Erum Shakeel
,
Noor Baig
,
Sohaib Haider
Year:
2024
COVID-19 is an acute febrile illness and the common manifestations are cough, flu and fever. COVID19 infection with severe thrombocytopenia and coagulopathy is a rare life threatening presentation. We are presenting a case of a gentleman in 20's with history of positive animal contact, who presented to emergency department (ED) with history of fever of more than a week and nasal bleed. Relevant examination showed unstable vitals, anterior nasal packing in place, left lower zone crackles and ongoing black stool. Laboratory workup revealed bicytopenia with platelet count of (6X109), low hemoglobin, deranged INR, low fibrinogen levels. The patient was managed for viral hemorrhagic fever leading to disseminated intravascular coagulation (DIC). He was managed with antipyretics, antibiotics. resuscitated with blood products, admitted to inpatient facility. His blood counts started improving favoring the possibility of thrombocytopenia secondary to viral illness, and later discharged in stable condition. COVID-19 is acute viral infection. Any...
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The role of computed tomography in severe sepsis
Fatema Ali Alshehhi
,
Falak Sayed
Year:
2024
Introduction: Sepsis is a common presentation in the emergency department (ED ). Early recognition and management is crucial for patients' prognosis, as 30-50% of patients presenting with sepsis have treatment initiated in the ED. Aims / objectives Highlight the importance of utilizing CT imaging particularly CT hypoperfusion complex in obtaining a complete and rapid diagnosis of clinically suspected septic shock, etiologies and complications. Case summary: A 66-year-old male patient brought to the ED with worsening generalized swelling mainly over the lower extremities, abdomen, and an "abdominal infection". He was hospitilized at another facility where he was treated for an unknown intra-abdominal infection. During hospitalization found to have liver problem, and valvular heart problem. ED vitals: blood pressure 97/83, pulse 91, respiratory rate 26, oxygen saturation 93% on room air. Review of systems was significant for: fatigue, chills, myalgia, shortness of breath, leg swelling, abdominal distention, abdominal pain, constipation, easy bruising,...
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Pharmacist Role in Medication Safety in a Busy Public Sector Pediatric Emergency, Pakistan
Dr Zareen Qasmi
,
Dr faiza Usman
Year:
2024
Introduction: Medication safety is very crucial part of patient safety as emergency department of any hospital is the busiest place of hospital where the possibility and likelihood of errors are much higher than any other part of the hospital. Human factor inherently limits the safety of health care process and contribute to medication errors. Recently, medication error has justly received significant attention, as it causes mortality, morbidity and additional healthcare costs, for example wrong dose prescribed and wrong dose administered for a prescribed medication.so despite the improved technology in the health care setting errors related to medication use continue to occur. The pharmacist plays a crucial role to oversee the quality of the entire drug distribution chain, from prescribing, drug choice, dispensing and preparation to the administration of drugs, and can fulfil a vital role in improving medication safety. Objective: The aim of this study is to find out frequency...
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Virtual Reality as an Acute Pain Reliever during Laceration Repair in Emergency Departments
Mahdi Rezai
,
Kourosh Javdani Esfehani
,
Mobin Naghshbandi
,
Leili Namdari
,
Davood Farsi
,
Neda Ashayeri
,
Mohsen Hariri
,
Roya Ghafoury
Year:
2024
Introduction: Virtual Reality is a promising distraction technique immersing the participant in a 3-dimentional virtual presence. The purpose of this study is to investigate the effect of virtual reality on reducing pain in adult patients during laceration repair in the emergency department. Methods: This is a randomized clinical trial conducted in the emergency departments of Rasoul Akram, Haftom-e-Tir and Firozgar hospitals, all under supervision of Iran University of Medical Sciences. A total of 160 patients with laceration in need of suturing were divided into two equal groups of 80 patients; one group receiving virtual reality glasses during the suturing whilst the other group did not. All the patients in both groups received local analgesics. The pain intensity of the patients was obtained before and after the intervention using a numerical scale (from 1 to 10). The patients' satisfaction in terms of pain reduction was measured based on the Likert scale...
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Acute on Chronic SDH as a complication of untreated spontaneous CSF leak following air travel
Asma Shahid
,
Faiza Akhlaque
Year:
2024
Introduction: Spontaneous cerebrospinal fluid (CSF) leaks are a complex disorder with a wide range of clinical and radiological features. These leaks occur without any apparent cause and are often associated with disorders of the connective tissue matrix, pre-existing dural weakness, and meningeal diverticula. Case Report: A 41-year-old male presented with new onset persistent orthostatic headaches that significantly affected his daily activities. Upon examination, his neurological functions appeared normal. Magnetic resonance imaging (MRI) of his brain and cervical spine revealed a CSF leak at the C1/2 junction. Initially, conservative management provided partial relief, but the patient's symptoms worsened after air travel. Repeat MRI showed bilateral subdural hematomas (SDH) and extension of the CSF leak into the cervical and thoracic levels. Computed Tomographic myelogram (CT myelogram) confirmed the CSF leak at the left posterolateral dural sac at the C5/T1 level. To address the CSF leak, an autologous epidural blood patch (EBP) was...
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"Establishing a novel graduate medical education wellness program and comprehensive curriculum in the United Arab Emirates"
Sahar Almansoori
,
Falak Sayed
Year:
2024
Introduction: An often overlooked aspect of medical education is the development of strategies to improve and sustain individual well-being (1, 4). Although data regarding resident physician wellbeing is still scarce in the United Arab Emirates (UAE), recent studies have shown that burnout and depression are high among physician residents (2). This paper proposes a novel wellness framework and curriculum for residency programs which would be the first of its kind in the UAE. Objectives: 1. Provide tools for programs to assess and monitor burnout and well-being in resident physicians. 2. Provide mentoring, professional development guidance, and career counselling. 3. Provide confidential mental health care and resources for resident physicians. Description: The curriculum's primary model targets Emergency Medicine residents. All domains from the American College of Emergency Physician's Wellness Wheel were incorporated (3). We proposed a three-tiered approach which includes: Mental Wellbeing, Physical Wellbeing, and Mentorship & Professional Development. This framework...
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Fostering Proficiency in Essential Skills among Emergency Medicine Residents through Simulation-Based Education
Muhammad Saif Rehman
Year:
2024
Introduction: Simulation-based education has become a crucial element within emergency medicine (EM) residency programs. Medical education places great emphasis on competency-based assessments, and high-fidelity simulation has emerged as an effective methodology to support these assessments. Objective: The Accreditation Council for Graduate Medical Education (ACGME) defines a set of core competencies that healthcare professionals must acquire to ensure the delivery of safe and effective patient care. In our study, we sought to investigate the impact of simulation-based education on the enhancement of ACGME core competencies among emergency medicine residents. Method: We conducted a prospective observational study at our institute, involving all current EM residents. Each month, we conducted a high-fidelity immersive simulation session, featuring three separate scenarios for both first year (R1) and second year (R2) residents. From August 2020 to April 2023, a total of 36 simulation sessions were conducted, encompassing 108 scenarios. To assess performance in clinical and non-technical...
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The Impact of a Hybrid Training Program on Point-of-Care Ultrasound (POCUS) Knowledge Acquisition & Skills among Non-ultrasound Trained Physicians
Maryam Alnuaimi
,
Hamid Shokoohi
,
Deborah Navedo
,
Roger Dias
Year:
2024
Background: Physicians from around the world with a variety of training backgrounds practice medicine in the United Arab Emirates. Most of these physicians have not received formal ultrasound training, a critical skill to practice medicine in several specialties. Furthermore, no formal ultrasound fellowships or hospital credentialing processes exist in the UAE to prepare physicians to perform point-of-care ultrasound (POCUS). This prospective interventional pre/post study investigated the impact of a longitudinal hybrid (online and hands-on) training program on POCUS knowledge acquisition and skills of non-ultrasound-trained physicians in UAE. Methods: The POCUS training workshop was spread over four full days to accommodate capacity and physicians' shift schedule limitations (three hours of didactics and four hours of hands-on). The course focused on teaching the following ultrasound modalities: Cardiac, Focused Assessment with Sonography in Trauma (FAST), and Lung Ultrasound. Participants' knowledge was assessed via multiple choice questions pre-workshop, post-didactics, and post-hands-on while POCUS scanning...
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Reduction in Average Ambulance Response Time of Interfacility Transfer for Life-saving Cases (STEMI, STROKE, RTA) in Eastern Health Cluster of Saudi Arabia
Mobarak AlMulhim
,
Almohannad Edah
,
Sultan AlAnzi
,
Muhammad Bilal Maqsood
Year:
2024
Introduction: Interfacility transport (IFT) is a complex component of out-of-hospital Emergency Medical Services (EMS) which provides care and transport to patients who need transfer from one facility to another. The aim of IFT is that patients receive the care they need in a time-efficient and safe manner, and it helps in maintaining high practice standards and reduces financial burden. The delay in response time of interfacility transfer for life-saving cases may result in adverse health outcomes. Objective: The study aimed to identify possible causes of delay in ambulance response time for three life-saving categories (CVA, Stroke & RTA) and to reduce the average response time by applying improvement initiatives. Methods: This was a QI study. It was carried out by EMS at Eastern Health Cluster (EHC) Saudi Arabia from August 2022 till June 2023. In first phase retrospective analysis was conducted for the pre-intervention period (Jan 2022 to Aug 2022)...
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"The Perfect Week": A Novel Departmental Quality Improvement Initiative
Elsa Mohan Madott
,
Rishi Prasad
,
Anzal Mohammad Rehman
,
Ramna Abdurahman
,
Phillip Furstenburg
Year:
2024
Introduction: Patient-centered care in the Emergency Department (ED) is an often overseen but critical component of holistic healthcare. ‘The Perfect Week' was a novel initiative by the ED at Mediclinic City Hospital seeking to explore opportunities to improve patient-centered care at our facility with an emphasis on patient experience. Objective: To improve workflow performance, safety, and patient experience through implementation of multifaceted strategies, focused on improvements in workflow, placement, and resource allocation in the ED. Methods: The Emergency Department at Mediclinic City Hospital, Dubai initiated a Quality Improvement Project, entitled "The Perfect Week." Over a period of 7 days, multiple new strategies were implemented including 1) additional staff per shift, 2) placement of a physician in triage (PIT), 3) frequently used medication available in cupboard for STAT orders in triage, 4) setting up a treatment room to expedite orders placed by PIT doctor ("PIT STOP") prior to shifting to majors...
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Multi-centre Implementation of the SNAP Protocol for Paracetamol Overdose - reducing the length of stay
Roshan Joseph
,
William Manning
,
Muniswamy Hemavathi
,
Richard Austin
Year:
2024
Aim/Objective/Background: Paracetamol stands as one of the most prevalent drugs of overdose in the UK. The conventional treatment for Paracetamol toxicity involves intravenous administration of N-acetylcysteine (NAC), typically administered over 21 hours in UK hospitals. However, an alternative 12-hour infusion, known as the 'SNAP' regimen, has shown promise in reducing anaphylactoid reactions compared to the standard treatment. This study implemented the SNAP regimen in two District General Hospital Emergency Departments within the same NHS Trust as part of a quality improvement project (QIP), aiming to assess its impact on reducing adverse reactions and inpatient length of stay. Methods/Design: Trust guidelines were revised to recommend the 12-hour SNAP regimen for adult Paracetamol overdose cases, accompanied by a pre-filled prescription chart. A retrospective analysis of patient records and electronic discharge letters was conducted before and after the guideline change to identify NAC recipients and document any adverse reactions. Length of inpatient stay...
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International Federation for Emergency Medicine New and Emerging Leaders Course: A Pilot Program
Elizabeth DeVos
,
Rasha Buhumaid
Year:
2024
Background: The International Federation for Emergency Medicine (IFEM) recognizes that early career Emergency Medicine (EM) leaders need additional skills leading healthcare teams. Especially in environments where EM is a new specialty, newly graduated specialists may take positions of authority with little direct training for the responsibilities. IFEM developed a New and Emerging Leaders course to address these needs and to build an ongoing community of practice for EM leaders to gather additional support and camaraderie. In early 2023, IFEM member organizations were asked to encourage senior EM trainees and Emergency Doctors (i.e. consultants, attendings, specialists) in their first 10 years after completing EM specialty training to apply for the program. Methods The pilot course was delivered March-May 2023 consisting of one three-hour virtual meeting of the cohort each month. Each session started with a presentation from a current EM leader discussing their own leadership journey and lessons learned. Delegates participated...
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Recognise Sepsis in the Emergency Department
Bashar Jamal Elwir
,
Isaac Bell
,
Alina Paunescu
,
Venkateswara Kotamraju
Year:
2024
Objective: In the UK alone, 245,000 people are affected by sepsis with at least 48,000 people losing their lives in sepsis-related illnesses every year. Yet, for many patients, with early diagnosis it is easily treatable. The UK sepsis trust developed a sepsis screening and action tool which helps clinicians screen for and identify possible sepsis. We conducted a Quality improvement project as an audit showed compliance with the sepsis screening and action tool was 20%. Our problem statement was many patients presenting to RDH ED with suspected sepsis will not be screened for sepsis via the sepsis screening and action tool. This may lead to delays or noncompliance to the sepsis 6 pathway which effectively will lead to morbidities in this patient population. Our rationale for was improving the recognition of sepsis via the standardised sepsis screening and action tool will help raise the awareness and assure early recognition of...
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A Comparative Evaluation of ESBL Production and Carbapenem Resistance in UTIs Before and During COVID-19
Ibraheem Abdullah Altamimi
,
Abdullah Abdullah Alhumimidi
,
Ibrahim M. Alabdulkarim
,
Abdulrahman Almugren
,
Hadi Alhemsi
,
Abdulaziz Altamimi
,
Khalifa Binkhamis
,
Abdullah Altamimi
Year:
2024
Background: The COVID-19 pandemic has heightened the urgency to address antibiotic resistance, particularly ESBL and carbapenem-resistant UTIs. Our study seeks to assess the pandemic's effect on the prevalence of these resistances, comparing data from before and during COVID-19. By identifying trends in resistance patterns, we aim to enhance antibiotic stewardship and inform healthcare policies. Understanding the pandemic's impact on ESBL and carbapenem resistance is vital for guiding clinical practices and public health initiatives in tackling antibiotic resistance. Methods: This retrospective study, conducted at King Fahad Medical City in Riyadh, Saudi Arabia, analyzed positive urine cultures from January 2018 to December 2022 to assess the prevalence of antibiotic resistance among UTIs. Using WHO-recommended semiquantitative culturing methods on CLED and blood agar, bacterial isolates were identified via the BD Phoenix system and antimicrobial susceptibility was assessed following CLSI guidelines. ESBL detection employed the Double-Disc Synergy Test. Data analysis involved SPSS for statistical...
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The Public's Perception of Bystander CPR Legality in the UAE: A Cross-Sectional Study
Balkis Zaitoun
,
Bakhtawar Imtiaz
,
Maitha Alfalasi
Year:
2024
Background: Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Performance of an early, effective bystander cardiopulmonary resuscitation (BCPR) increases the likelihood of survival among OHCA victims. The frequency of BCPR performance on OHCA victims and the overall survival rate has been reported to be low in the UAE. Identifying factors that influence bystanders' response is essential to develop interventional strategies that effectively reduce rates of OHCA mortality in the UAE. This study aims to assess the public's knowledge, attitudes, and practices towards BCPR. Methods: This was a cross-sectional study conducted between April and June of 2023. Data was collected from 588 adults in the UAE using non-probability convenience and snowballing sampling methods. The research tool used was a 41-items structured questionnaire, assessing knowledge of OHCA detection, CPR execution, as well as perception towards mandatory CPR training and willingness to learn and perform CPR. Data entry...
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Case Report: An Atypical Cause of Pneumomediastinum
Ives Hubloue
,
Astrid Verschaeve
Year:
2024
Introduction: A pneumomediastinum is defined by the presence of free air between mediastinal structures. Here, we present a case of a patient who presented with throat pain and swelling of the neck after a tooth extraction, and was diagnosed with subcutaneous emphysema and a pneumomediastinum. Case: A 50-year-old healthy male was admitted to the emergency room with complaints of sore throat and swelling of the neck. On the same day before his admission, the patient underwent a tooth extraction of the mandibular right second molar. The heart rate was 53 beats per minute, body temperature 36,7°C, arterial blood pressure 110/70mmHg and the oxygen saturation 100% in room air. Physical examination showed a swelling in the neck, chest and bilaterally supraclavicular area with subcutaneous crepitus under the skin. The oral examination did not show any abnormalities. The patient was admitted for observation and amoxicillin/clavulanic acid was initiated. The day after, the...
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Point-of-care ultrasound clinical workflow pilot: design and adoption of a simplified automated workflow within EHR for all clinical settings
Viveta Lobo MD
,
Ashley Erin Hall MD
,
Zahra-Ghazi Askar MD
,
Luyao Shen MD
Year:
2024
Background Point-of-care ultrasound (PoCUS) offers clinical diagnostic, procedural and reassessment guidance in both the acute and non-acute care setting. However, implementation of a PoCUS program is challenging to put into practice as it requires custom design through a collaborative effort from various stakeholders in a hospital system such as clinical, IT, credentialing, Biomed, infectious control, compliance and billing that needs to work in various clinical settings. Objective Our goal was to create and implement a clinically inspired but IT-driven PoCUS workflow solution within an EHR that maximally supported a clinicians' intuitive workflow, while automatically archiving images that were easily shareable, and produced clear documentation with automatic billing capability in all types of clinical settings. Materials and Method We used an iterative design process that stressed intuitive clinical workflow, maximal use of existing systems, data reuse and automatic billing. Creation of this clinical PoCUS workflow required the use of ultrasound machines,...
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Emergency Nursing Didactics – Opinions, Resource, and Skill Exchange (E.N.D.O.R.S.E) – A collaborative academic initiative in the Emergency Department
Mohammad Anzal Rehman
,
Elrasheed Salih
,
Honey Mathew
,
Ramna Abdulrahman
,
Ahmad Chahla
,
Rishi Prasad
Year:
2024
Introduction: Emergency Physicians and Nurses often work together as the two most prominent figures at the patient bedside, involved in clinical decision making, procedures, and medication administration. However, they are not afforded many opportunities to debrief and share educational knowledge and resources surrounding decisions, implementation, and protocols. After preliminary discussions on interest and knowledge gaps, a collaboration between Emergency Physicians and nurses was established under an academic initiative entitled ‘Emergency Nursing Didactics – Opinions, Resource, and Skill Exchange (E.N.D.O.R.S.E.)' at Mediclinic City Hospital, Dubai. Aims/Objectives: We aimed to provide a platform within the Emergency Department (ED) to promote interpersonal communication and feedback between healthcare providers. The initiative sought to improve skills, confidence, and standardize workflows around essential procedures/protocols. Materials/Methods: A structured 30-minute session break-down was created and customized information handouts were prepared, with evidence-based references. Sessions were conducted once a month, with in-person teaching within the ED alongside a video...
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Emergency Department Recognition of Delirium: Quality Improvement Towards a Geriatric-Friendly ED
Mona AlGharibi
,
Mohammad Anzal Rehman
,
David Curran
,
Elsa Madott
,
Asim Islam
,
Rishi Prasad
Year:
2024
Introduction: Delirium is a common yet often undetected condition in the elderly, particularly in the Emergency Department (ED). Its subtle presentation makes timely recognition challenging. Literature shows up to 10% of older patients presenting to the Emergency Department will have Delirium, but typically only 30% of these cases are identified in the Emergency Department. Aims/Objectives: To implement quality improvement measures for early recognition of delirium in geriatric patients aged 65+ in a single center ED. Specific objectives include staff training on delirium identification, enhancing screening protocols, and implementing interventions to address delirium promptly. Materials/Methods: ED staff providers underwent systematic training to optimize integration of Delirium Triage Screening (DTS) and Confusion Assessment Method (CAM), customized to the UAE patient population, into the geriatric ED workflow. A multidisciplinary team consisting of Geriatrics, Internal Medicine, ED Staff Physicians & Nurses established Quality Improvement Projects as part of a transition to a geriatric-friendly ED....
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Preventing Hypocalcemia in Major Trauma - A QIP in a Major Trauma Centre in UK
Jitendra Manji Siyani
,
Roshan Joseph
,
Uche okpokiri
Year:
2024
Introduction: Addenbrookes is a major trauma centre in the UK dealing with trauma of all ages and mechanisms. Major trauma is often complicated by hypocalcaemia which we have recognised that is often under-recognized and under-corrected. Aims / Objectives To improve the knowledge gap among clinicians concerning hypocalcaemia as a complication of Major Trauma. Materials / Methods: Utilising the PDSA cycle, we initially retrospectively reviewed the notes of over 40 major trauma patients between August 2022 and January 2023 and carried out a clinician's survey. Following a period of formal teaching and education in October regarding hypocalcaemia as a complication of major trauma, the clinician survey was repeated. Results: In the initial survey, only 25% of clinicians recognized hypocalcaemia in major trauma - potentially leading to poorer patient outcomes. Following the implementation of the teaching programme, the incidence of clinicians recognizing hypocalcaemia rose to 75%. The prevalence of calcium prescribing by...
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Aortic Dissection that Presented to a Tertiary Hospital's ED in Dubai, UAE: A Descriptive Study
Ivyan Kambal
,
Esra AlHamadani
,
Rand Aboelkher
,
Sania Zia
,
Firas AlNajjar
Year:
2024
Background: Aortic dissection is a life-threatening condition, with a high mortality rate. It can be classified into Stanford type A or type B. This study analyzes the clinical presentation, risk factors, systolic blood pressure, and the mortality rate of patients with confirmed aortic dissection on computed tomography (CT) imaging. Mortality rate on weekends, weekdays, daytime, and nighttime was also compared. Methods: Data records of patient requiring CT aortogram in the emergency department (ED) were examined. 65 patients with confirmed acute aortic dissection on CT were included. Presenting symptoms, demographics, risk factors, and mortality rate were analyzed and compared in those with type A versus type B aortic dissection. Results: Chest pain was the most common symptom (43%). Aortic dissection is more common in males than females (83% vs 17%, respectively). A history of hypertension was present in 65% of the participants and the mean age at presentation was 50.6 years....
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Improvised Femoral Nerve Block Model Using Everyday Items: An Affordable Alternative for Medical Training
Aysha Simran Haris
,
Wasim Ahmed
,
Martin Joseph
,
Tasnim Ahmed
Year:
2024
Background : Nerve blocks have emerged as a revolutionary approach for managing pain and reducing opioid dependence among patients. Performing nerve blocks under ultrasound guidance in the emergency department (ED) is considered an effective and minimally invasive procedure that can be performed by adequately trained ED physicians. However, the cost associated with commercially available nerve block models poses a significant challenge to widespread adoption and training. To address this issue, our research team developed an improvised femoral nerve block model using readily available everyday items. Methods : The prototype femoral nerve block model was constructed using chicken breasts as a simulated anatomical structure, balloons and spaghetti as tactile representations of vessels and nerves, gel as an acoustic interface, and cling wrap for creating a sterile environment. Results : To perform ultrasound-guided nerve blocks, it is necessary to see the fascial plane division clearly while injecting the anesthetic. This clarity was...
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Knowledge, Attitude and Practice of Doctors in Odisha towards Informed Consent to Treatment: A Cross Sectional Study
Dibyasha Nayak
,
Sajid N.A. Nomani
,
Debasis Mishra
Year:
2024
Introduction: The practice of medicine is fundamentally governed by deep-seated moral principles. The long standing"paternalistic approach" has been supplanted by legal recognition and protection of patient's right to autonomy and self-determination. Informed consent serves as defence against coercion, dishonesty, abuse and exploitation. It increases patient's trust on doctor as they actively participate in medical decision-making. Aims and Objectives: To assess the Knowledge, Attitude, and Practice towards informed consent among the doctors working in Odisha(India) and the factors affecting these. Material and Methods: The study was cross-sectional survey. The study population were doctors of Odisha with minimum qualification of MBBS degree and involved in clinical practice. A structured, and pre-tested questionnaire was used to collect data. Result: 309 subjects were included in the final analysis. The majority of the study population belonged to the age group 25-30 years (39.5%) followed by 31-35 years (25.2%), and > 40 years (13.3%). Gender-wise distribution...
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Standardized Hospital Guidelines for Paracetamol Overdose - fewer prescription and drug administration Errors?
William Manning
,
Roshan Joseph
,
Muniswamy Hemavathi
,
Richard Austin
Year:
2024
Introduction: Paracetamol overdose is one of the most common drug overdoses in the UK. The standard treatment is intravenous N-acetylcysteine (NAC) which is usually administered as a 21-hour infusion in UK hospitals. A 12-hour infusion known as the "SNAP" regimen has been implemented in some centres and appears on the TOXBASE database (UK Poisons Information). The availability of two treatment options has caused confusion in our centre resulting in an increased number of prescribing and administration errors. Aims/Objectives: To produce a standardized guideline and prescription chart in two District General Hospital Emergency Departments within the same NHS Trust as part of a Quality Improvement Project (QIP) in an effort to reduce prescribing and administration errors for NAC. Methods: Trust guidelines for Paracetamol overdose were revised using the 12-hour regimen for adults only. A retrospective review of patient notes and electronic discharge summaries was performed prior to and following the implementation...
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Knowledge attitude and practice of Infection Control in Emergency Department in Tertiary care hospitals of eastern India
Dr. Deepak Kumar
,
Dr. Sajid N.A. Nomani
Year:
2024
Background: Lack of knowledge about infection control practices have led to tragic consequences and probable legal hazards. With the advent of pandemic like COVID-19, practice of infection control measures have become essential. Staffs working in Emergency Medicine department are the first point of contact with the patients and precautionary measures are of utmost importance. The more skilled they are in infection control, the lesser are their chances to spread diseases unintentionally. Objectives: To evaluate the knowledge, attitude and practice of infection control practice using a semi-structured questionnaire in Emergency Medical Department of tertiary care hospitals in Bhubaneswar and also to enhance the hospital control programmes and make a positive impact in the health care sector. Materials and Methods: This cross-sectional study was conducted in the Emergency Medical Department of four tertiary care hospitals in Bhubaneswar from May 2022 to April 2023 among the staff working in the Emergency Department. A...
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Severe Digoxin Toxicity in a Child Managed with Cholestyramine. A Case Report
Suman Noorani
,
Nadeem ullah Khan
,
Shahan Waheed
,
Hadia Iftikhar
Year:
2024
Digoxin toxicity is a common problem in clinical practice because its therapeutic window is relatively narrow (from 0.5 to 2 ng/ml). The toxic effects occur at concentrations > 2.8 ng/ml and are mainly related to disturbances of cardiac function and of circulatory system as well as GI and CNS disturbances. We report a case of digoxin toxicity in a 2.5years old male child who accidently ingested 15 tablets of digoxin x 0.25mg. During his stay in pediatric ICU, typical symptoms of toxicity were observed. Digoxin-specific antibody (Fab) fragments have become the mainstay of treatment in severe digoxin toxicity. However, due to its high cost and limited availability, alternative measures are used to manage severe intoxications in countries like Pakistan, where Fab fragments are not available. Here we successfully treated severe digoxin intoxication with Cholestyramine.
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Fatal case of EBV induced hemophagocytic lymphohistiocytosis (HLH), presenting with acute abdomen
Gina Rami Salama Ibrahim Abdelmesih
Year:
2024
Introduction : Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome with excessive immune activation. Primary or secondary HLH, have a high mortality rate approaching 50%, despite multiple management regiments. In adults, infections, especially EBV, and hematological malignancies are the most common causes. HLH recognition is often delayed, due to unfamiliarity of physicians of this diagnosis. Scores are available to aid physicians recognize HLH, but can be applied if the diagnosis is suspected. Case description: 40 years old male, from Sierra Leon, presented to the emergency with acute abdomen. Patient had high grade fever, generalized abdominal pain and vomiting. Initial investigations showed massive hepatosplenomegaly, monocytosis, thrombocytopenia, deranged LFT. Patient admitted as a case of acute cholecystitis. Patient was started on broad spectrum antibiotics but failed to improve and continued to rapidly deteriorate requiring intubation and inotropic support in ICU. Patient was managed as a case of septic shock and underwent open...
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Emergency Medical Services in Sindh, Pakistan: Flood 2022
Shahid Ahmed Laghari
Year:
2024
Sindh is the worst affected province by the floods-2022 in the country, having affected more than 12.4 million people in the province. Pakistan Red Crescent Society (PRCS) is auxiliary to Govt of Pakistan with the motive of health system strengthening. PRCS played a remarkable during emergency situations such as during the flood disaster 2022 in Pakistan, to understand the patient's need for services PRCS along dedicated volunteers, respond in the worst flood-affected districts of Sindh including Larkana, Sehwan-Janshoro, Jacobabad, Thatta and Dadu. We used a mixed method approach for this research study, qualitative and quantitative evidence-based data was collected during emergency response interventions in the Sindh during the flood response. Qualitative data was achieved from text, videos, images and focus group interviews. Additionally, quantitative data was also received from mobile health teams and Psycho-Social Supporters. We developed a successful Emergency Medical Services response model that can be replicable at national...
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Antibiotics for Suspected Urinary Tract Infections in the Emergency Department, How Are We Doing?
Nisreen Maghraby
,
Dunya Alfaraj
,
Abdulmonem AlSaleh
,
Shahad Alsheikh
,
Saleh Al Qahtani
,
Khaled Alzahrani
,
Zainab Alzakari
,
Farah Mohamed
,
Noor Alsheikh
Year:
2024
Background: Urinary tract infection (UTI) is a major public health issue that affects millions of people each year, and a common reason for hospital admission and Emergency Department (ED) visits. ED is a common yet crucial setting for antibiotic prescription. Unfortunately, antibiotic therapies that are unnecessarily prescribed continue to contribute to the global issue of bacterial resistance. Our study aims to determine the prevalence and reasons for inappropriate antibiotic use for UTI in the ED, to highlight the most commonly prescribed antibiotic, and to define the most sensitive antibiotic and most common pathogen based on urine cultures. Methods: A retrospective cohort review conducted at King Fahad University Hospital in Al Khobar, eastern province of Saudi Arabia. Data was collected during the duration of 2017 – 2022 from electrical medical records for all patients who had a urinalysis and urine culture in the ED and were managed as outpatients. Antibiotic prescription...
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MRI v/s Non contrast CT brain in evaluation of stroke
ROHAN SHAH
Year:
2024
Introduction: Stroke is a common and leading cause of death and disability in the world. The guidelines for use of recombinant tissue plasminogen activator (rtPA) include stroke onset within 3 to 4.5 hours, preceded by a computed tomographic (CT) scan to exclude the presence of haemorrhage. Aims/Objectives: The importance of MRI/CT perfusion of brain in radiographic evaluation of stroke. Materials / Methods: A 27-year-old male patient was brought to the ED following an episode of new onset of seizure 20 minutes before coming to ED. History of headache, dizziness was there since last 3 hours. Patient was in post ictal phase. So, differentials at this point were metabolic causes of seizure/space occupying lesion/stroke with new onset of seizure. One episode of GTCS was witnessed in the ED. Urgent MRA brain and neck was suggestive of acute non haemorrhagic right MCA infarcts with thrombus in right carotid bulb and in the...
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Comparison of Different Ketofol Procedural Sedation and Analgesic Doses during Orthopedic Procedures in Patients Referred to the Emergency Department
Saeed Abbasi
,
Kourosh Javdani Esfehani
,
Majid Ghodsipoor
,
Davood Farsi
,
Mahdi Rezai
,
Peyman Hafezimoghadam
,
Mani Mofidi
,
Nazanin Alaei Faradonbeh
Year:
2024
Background: Orthopedic procedures are one of the most common medical procedures in the Emergency Department (ED) and are also among the most painful procedures performed on the conscious patient. This study aimed to compare different doses of ketofol in procedural sedation and analgesia in patients referred to the EDs. Methods: In this double-blinded clinical trial, 296 patients aged 18 years or over presented with the need for orthopedic procedures in the three academic EDs in 2020 were studied. After completing the written consent, the patients were randomly assigned to four treatment groups. Demographic information, underlying diseases, patients' physical condition, type of orthopedic injuries requiring intervention, and patients' vital signs were recorded in a checklist for each patient. Results: In this study, the mean age, gender, level of education, addiction, patients' physical condition, type of procedures performed, apnea, hypoventilation, bradycardia, hypotension, and agitation in all four treatment groups were not statistically...
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The Effectiveness of Point of Care Ultrasound (POCUS) in Emergency Department
Sumudu Ruhunage
,
Mubashir Hamid
Year:
2024
POCUS has become an invaluable tool in Emergency departments over the last few years. It enables the Emergency Physician to arrive at a most likely diagnosis and start treating the patients within a matter of few minutes which leads to significant improvement in length of hospital stay and reducing morbidity and mortality from complications that can arise from delayed treatment.
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40-Year-Old Female Presents with Intestinal Malrotation and Hemorrhagic Ovarian Cyst: A case report and review of the literature
Sabrina Berdouk
,
Obaida Farouk
Year:
2024
Background: Intestinal malrotation is a congenital anomaly that refers to the failure of the normal fetal rotation of intestines around the superior mesenteric artery and their fixation in the peritoneal cavity, which happens between weeks 5-12 of embryological development. Most of the cases are discovered during the first year of life where the baby presents with abdominal cramps and bilious vomiting due to small bowel obstruction or volvulus. Globally, adult cases are rare and make about 0.2% of all cases discovered all over the world, while there is no data published in UAE on adult cases till date. 15% of adults with confirmed intestinal malrotation can stay asymptomatic throughout life, while the rest may present either chronically with frequent abdominal pains together with irregular bowl habits, or acutely with bowel obstruction, intestinal ischemia or volvulus. These symptoms are caused by Ladd's bands: peritoneal bands that run from the cecum to...
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Bilateral Arm Weakness, Think Extracranial! A Case Report of Spinal Cord Infraction
Alaa Chikh Hussein
,
Ruqya Alzaabi
Year:
2024
Out of all ischemic neurological injuries that we encounter on an almost daily basis in emergency departments, only 1-2% are spinal cord infarctions. As a leading cause of disability and one of the leading causes of death, stroke has always been a top concern emergency. In this report we present a case of a 52-year-old Asian female with a history of hypertension and cervical spondylosis, presenting with sudden bilateral arm weakness and numbness. She also complained of chronic neck pain but a recent numbness. Neurologic examination showed upper extremity power of 3/5 on the right and 4/5 on the left. In addition to a restricted active range of motion bilaterally. There was also tenderness of cervical spines C5 and C6, hyporeflexia in the upper extremities, and reduced tone bilaterally. Pulses were intact with good capillary refill time but were asymmetrical. For this reason, our vascular team did a bedside doppler...
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An Audit of Patient Characteristics, Contributing Factors, and Outcomes of Patients Leaving against Medical Advice at Sheikh Khalifa Medical City Abu Dhabi
Shamma Salem Alhajeri
,
Ibrahim Atfah
,
Ali Bin Yahya
,
Salama Matar Al Neyadi
,
Fatema Salem Al Ameri
,
Nasser Ahmed
,
Ismail Al Ramahi
,
Kenneth Charles Dittrich
,
Hasan Qayyum
Year:
2024
Background: Leave against Medical Advice (LAMA) is defined as ‘a decision to leave the hospital before the treating physician recommends discharge'. The prevalence of LAMA has been reported as 0.07% to 20% in emergency departments (ED) worldwide. Leave against Medical advice has also been reported to have higher rates of re-admission, longer subsequent hospitalization, and more importantly worse patient outcomes. In addition to this, they are also associated with poor healthcare resource utilization. We conducted a single center audit to establish the quality of documentation, identify patient demographics, contributing factors, and outcomes of patients leaving against medical advice from our ED. We benchmarked our data against locally available SEHA clinical policy guidelines. Objectives: The primary aim of this audit was to evaluate the demographic and socio-economic characteristics of patients who opt for LAMA, identify contributing factors in patients who opt for LAMA, and benchmark our current practice against a SEHA...
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ACA occlusion presenting with purely sensory deficit : case study
Gina Rami Salama Ibrahim Abdelmesih
Year:
2024
Introduction: Neurological symptoms, such as facial asymmetry, speech abnormalities and weakness, are common presentation to the Emergency Department, with acute stroke being the most important differential that must be diagnosed in timely manner for appropriate management. Such symptoms are typical presentations of anterior circulation strokes. Posterior circulations strokes can be more complicated to diagnose, clinically and radiographically, as more vague symptoms such dizziness, vomiting or visual disturbance usually prevail. Less common atypical symptoms can be missed and failed to be identified as stroke. Anterior circulation strokes are more common, with MCA being the culprit in most cases. ACA occlusions with resultant ischemic stroke is less prevalent. When present, the main symptom is weakness in the lower limb with mildly deranged upper limb weakness. Case description: 42 years old Indian man, known case of uncontrolled type 2 DM and Hypertension, presented to the ER, with 14 hours of worsening right lower...
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Pulses Never Lie: Detecting Painless Aortic Dissection in a Stroke-Like Presentation
Heba Ahmed
,
Sheikha Al Zaabi
,
Danish Salim
,
Nasser Ahmed
Year:
2024
Introduction Aortic Dissection remains a formidable medical emergency, presenting a unique and challenging diagnostic puzzle due to its diverse range of manifestations. This critical condition, characterized by a tear in the aortic wall, demands urgent attention as it can lead to life-threatening complications. Typically, patients with aortic dissection experience excruciating pain, aiding in its recognition and timely management. However, there exists a less common and more insidious variant – painless aortic dissection, which poses a diagnostic dilemma due to its atypical presentation. Case presentation We report a case of painless aortic dissection in a 48 years old previously healthy man. He presented with an acute onset of left sided paralysis for 6 hours. Physical exam revealed a cool, pale and pulseless left lower extremity with a power of 0/5 and absent sensations. The right lower extremity was warm with palpable pulses and a power of 5/5. Pulse status was confirmed...
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A Misleading Pain: Unravelling Pulmonary Embolism Masquerading as Flank Pain
Heba Ahmed
,
Salama Al Neyadi
,
Maryam Alnuaimi
Year:
2024
Introduction Pulmonary embolism (PE) is one of the commonly encountered diagnoses in the emergency department and poses a significant threat to patients' lives. However, there remains a diagnostic challenge due to the wide range of presentations, some of which can be atypical and thus misleading. In fact, pulmonary embolism has recently been named in the literature as the great masquerader. In this article we discuss a case of pulmonary embolism that presented with abdominal pain. Case Presentation We report a case of a 25-year-old female with a past medical history of hypertension and end stage renal disease on regular hemodialysis, who presented to the emergency with sudden onset, severe left sided flank pain radiating to the chest for 2 days. She noted that the pain was constantly present and worsened with breathing. She also reported black stools and one episode of spitting blood. She denied the presence of other symptoms....
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Collaborative Advanced Trauma Care (CATC): Evaluation of a trauma education program developed in Pakistan in an Ethiopian context
Anna Yaffee
,
Adeel Khatri
,
Sama Mukhtar
,
Emily Russell
,
Saima Ali
Year:
2024
Introduction: Trauma globally represents an overwhelming burden of morbidity and mortality. Effective management with trauma teams has proven to reduce time to resuscitation and definitive care. Tikur Anbessa Specialized Hospital (TASH) is a tertiary care hospital in Ethiopia, where we implemented Collaborative Advanced Trauma Care (CATC), a collaborative, multidisciplinary trauma team training program for emergency medicine (EM) physicians, surgeons, and nurses, developed in Pakistan. Methods: CATC at TASH included virtual lectures, in person skills and simulation practice. Participants assessment included trauma knowledge post-test, and standardized leadership and teamwork assessment. Participants completed a knowledge, attitudes and practices (KAP) survey and post-course evaluation. Results were evaluated with descriptive statistics and common themes. Results: 140 participants were trained in CATC (83 physicians, 57 nurses). Nurses increased scores on average by 17%. Physician scores were not significantly changed. Leadership and teamwork assessment scores improved by 22% over a 24-hour period. On KAP survey, participants...
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Pharmacy Preparedness in Disaster Management in Pediatric Emergency Department (PED)
Dr Faiza Usman
Year:
2024
Introduction: A pharmacist plays a crucial role in disaster management in (PED) especially during natural disasters. Pharmacist role in disaster management is not just limited to dispensing medication, ensuring the continuity of drug therapy, identifying drug interactions, managing drug shortages, and preventing prescription errors. Pharmacists are uniquely positioned during disasters to provide healthcare continuity and medication management to affected communities. Floods are one of the natural disasters occurring worldwide which have a massive range of health impacts. In addition to immediate dangers such as drowning, floods can increase the transmission of some waterborne diseases i.e. cholera, malaria, gastroenteritis which can be easily treated with oral rehydration salts, antimalarial, antibiotics and IV drips if needed. Objective: This study was aimed at providing an overview of pharmacists' roles in disasters and formulating a definition of roles and tasks regarding the medication safety and to calculate the burden of diseases mainly water borne...
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Urgent Surgery for A Month-Long Headache: a Case Report
Erkan Gunay
Year:
2024
Traumatic brain injury (TBI) is defined as impaired brain function due to external force. In the adult population threated at the Emergency Department (ED) prevalence is twice as high in males then females. It is classified as mild moderate and severe based on Glasgow Coma Scale (GCS). Subdural Hematomas (SDH) are generally associated with high-energy traumas, especially road accidents and mostly seen amongst the population aged
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Not Every Anosmia is COVID, a Case of Nasal Mass
Erkan Gunay
Year:
2024
Anosmia is a frequent symptom for COVID infection. It was experienced by almost 53% of those affected, sometimes persisting longer periods. Nasal blockage is common symptom for emergency patients and frequently associated with allergic rhinitis. 25-year-old male presented with persistent bilateral nasal blockage, blood-stained nasal discharge, anosmia and headache. During the beginning of the pandemic, he was diagnosed with COVID and complaining of anosmia and nasal blockage. He was treated with antihistaminic medicine for allergic rhinitis, but his symptoms persisted. He had breathing, bleeding and smelling problems in the last 2 years and started complaining of left sided proptosis for 3-4 weeks. He was referred from ophthalmology. He denied other prior disease or medication. On examination he has nasal voice, left side exophthalmos, without diplopia or vision problem. The right tympanic membrane was intact, left side dull with effusion. Other system evaluations were unremarkable. Nasal endoscopy revealed fungating mass with...
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Prevalence of Career Indecision and Factors Influencing it among Medical Students and Interns in Oman
Ali Abdullah Al Ajmi
,
Fatma Salim Al Kharusi
,
Aisha Al Khamisi
Year:
2024
Aim and objectives: Career indecision (CI) is a broad term refers to the uncertainty and difficulty of decision- making of the future career among junior professionals. This study aims primarily to estimate the prevalence of CI among senior medical students and medical interns in Oman. Secondly, it assesses the association of socio-demographics factors influencing it. Finally, it examines the association between participation in career development activities and CI among them during the academic year of 2022-2023. Methods: A cross-sectional study was conducted using anonymous self-administered questionnaire in English language. We used a 21-item Career Factors Inventory (CFI) to determine CI score. CI scores were further classified to low-level CI (score 27-71) and high-level CI (score 72-105). Results: Total number of participants was 161. The minimum sample size calculated was 153 participants for 95% confidence interval. Unpaired t test and ANOVA test were used to determine association. The results showed the...
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A race against time: A case report of fulminant myocarditis leading to cardiogenic shock
Martin Joseph
,
Tasnim Ahmed
Year:
2024
Background: Fulminant myocarditis (FM) is the most severe form of acute myocarditis (AM), an inflammatory heart condition often triggered by viral infections or autoimmune disorders. It manifests as an uncommon syndrome encompassing various clinical presentations, including severe acute heart failure (HF), cardiogenic shock (CS), ventricular arrhythmias, or cardiac arrest. FM carries significant morbidity and mortality. This case report highlights the importance of early identification of FM, initiating end-organ support, and ensuring timely transfer to specialized facilities with mechanical circulatory support capabilities to improve patient outcomes and reduce complications. Case presentation: A previously healthy 40-year-old male presented to the Emergency Department (ED) with chest pain and worsening dyspnea over the past week. In the ED, he displayed diaphoresis, tachycardia, hypotension, and severe respiratory distress. An initial ECG showed sinus tachycardia with ST elevation and Q-waves in anterior leads. Point-of-care echocardiography (ECHO) revealed global hypokinesia and severe left ventricular (LV) dysfunction, with...
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Sodium nitrite ingestion in a suicide attempt: First reported case in the Middle East
Lamees Ahmed
,
Fatimetou Ba
,
Farah Ammar Lamee Al-khaleefa
,
Abrar Al-saadoon
,
Mhd Samer Al Merie
Year:
2024
Sodium nitrite (NaNO2) is a water-soluble, white-yellow-colored crystalline powder with various practical applications including use as a food preservative, antimicrobial, and coloring agent. The use of sodium nitrite has recently emerged as an increasingly popular method of suicide. The first reported case of intentional sodium nitrite ingestion occurred in 1979. Two cases were reported in Tokyo, Japan, one in 1996 and another in 2000. Between 2000 and recent years, there has been a distinct lack of cases with only 1 case in New Zealand in 2010 reported. However, since 2019 the number of reported suicides using sodium nitrite has significantly increased compared to previous years. Sodium nitrite ingestion can be fatal, depending on the dose ingested. It causes ferrous iron to be oxidized to ferric iron (Fe3+), thus losing its ability to bind oxygen and resulting in a greater affinity for oxygen in the remaining Fe2+ heme groups that are present...
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Lessons learned from a fatal case of Tuberculosis Meningitis: A case report
Farya Rehman
,
Afnan Abdul Lathif
,
Martin Joseph
,
Abdulla Alhmoudi
Year:
2024
Background In 2023, 10 million cases of Tuberculosis were reported by the WHO. Tuberculous meningitis (TBM) may be the sole manifestation of Tuberculosis (TB) and does not require prior pulmonary or extrapulmonary disease[1]. Approximately one-half of all TBM infections lead to severe neurological disability with a mortality rate of 30% with death in 6 months and 50% overall[2-4]. Despite being inarguably the most devastating clinical presentation of TB, frequent diagnostic delays are common due to low clinical suspicion or misdiagnosis as current diagnostic tests still have a limited yield[5]. The best way to reduce mortality and morbidity associated with TBM is by maintaining a high index of suspicion, timely diagnosis and initiation of treatment. This case report aims to highlight the clinical presentation, imaging findings, and diagnostic pitfalls in the diagnosis of TBM. Case Presentation A 36-year-old Indian man with no significant medical, social, or travel history initially sought treatment...
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Impact of Peer Feedback on the Quality of Academic Sessions in an Emergency Medicine Training Program: A Quality Improvement Project.
Emranur Rahman
,
Sareh Karimi
,
Mansoor Husain
Year:
2024
Introduction Feedback is at the heart of medical education; different teaching encounters call for different types of feedback. (1). Feedback serves as a powerful tool in the realm of education, playing a vital role in shaping students' learning experiences and fostering their academic growth. Recognizing the importance of feedback and implementing effective feedback mechanisms can lead to enhanced learning outcomes, improved performance and increased motivation among learners(3). It can be incorporated to enhance teaching and learning techniques since it has an immediate impact on the process of acquiring knowledge and has a direct impact on both teaching and learning(4). Methods: We designed a project to improve the quality of our academic day by integrating feedback forms into all our academic activities. In November 2022 we sent out a survey to all residents to evaluate the quality of the sessions in the academic day. Based on the responses received we incorporated...
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‘The Contrast May Burn a Little' - Case Report of Severe, Anaphylactic Shock Following MRI IV Contrast
Elrasheed Salih
,
Mohammed Anzal Rehman
,
Rishi Prasad
Year:
2024
We present a case of a 46-year-old male who developed acute onset shortness of breath, hypotension, and hypoxia soon after receiving IV contrast for a routine MRI scan. A portable Chest X-ray revealed diffuse, bilateral infiltrates, similar to features of pulmonary edema or Acute Respiratory Distress Syndrome (ARDS). During his in-hospital stay, the patient was treated with High-flow nasal cannula oxygen, phenylephrine to support hemodynamic status as needed, a short course of hydrocortisone, and nebulizers to assist shortness of breath. Gadolinium-based contrast agents are a useful adjunct in CT and MRI imaging. Adverse reactions to these contrast agents are rare (
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Blood Donation Practices and Awareness of Blood Types Among Adults in the United Arab Emirates: A Cross-Sectional Community-Based Study
Dima Saleh
,
Ghaith AlWawi
,
Rand Tayyem
,
Alaa Al Hajji
,
Reem Alketbi
,
Majd Albeetar
Year:
2024
Background: Blood donation is crucial to ensure the availability of life saving therapies in clinical settings. To date, no studies have assessed the knowledge of blood donors regarding blood types, and blood donation practices within the United Arab Emirates (UAE) population. Aim: The present study's primary objective is to assess knowledge regarding blood types and blood donation practices among adult blood donors in the UAE. The aim is to evaluate the effectiveness of existing initiatives and propose strategies for donor recruitment and retention. Methods: This cross-sectional community-based study involved 259 participants selected through convenience sampling. Interviews were conducted at blood donation sites, and blood type data for each participant was collected from the blood bank following their donation. Statistical analysis was conducted using SPSS Statistics version 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.), and p-values of
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Unique presentation of Congenital ureteropelvic junction obstruction in adult
Faiza Akhlaque
,
Asma Shahid
,
Akil Ghfarbhai Parmar
,
Zeeshan Khan
Year:
2024
Summary: A 34-year-old female, without comorbidities, presented to the emergency department with sudden right flank pain. Initial workup showed elevated WBC (14.5) and normal creatinine (0.81), but later developed fever spikes and rising CRP (59.50). Gentamicin treatment was initiated. Transferred for a Diuretic Renogram, confirming suboptimal function of the right kidney with obstruction at the renal pelvis/PUJ. Split functions indicated 32% for the right kidney and 68% for the left. Radiological workup included ultrasound, CT KUB with contrast, and CT Urography, revealing right renal acute hydronephrosis without evidence of stones. Management involved symptomatic treatment, but with persistent symptoms, Gentamicin prophylaxis was initiated. The patient was transferred for Renogram, detecting suboptimal right kidney function. A planned stent insertion followed by Robotic-assisted and laparoscopic pyeloplasty was scheduled. Discussion: Uretero Pelvic Junction Obstruction (UPJO) is a partial blockage where the ureter enters the kidney. Congenital UPJO can result from intrinsic narrowing, high ureter...
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A Case of Simultaneous Sinus Venous Thrombosis and Bilateral Pulmonary Embolism with OCP Use
Noura Al Dosari
Year:
2024
Case Summary A 45 year old female presented to the ED with right arm weakness, aphasia, and syncope. She is known to have hypertension with medication noncompliance and abnormal uterine bleeding with a recent OCP use. She was diagnosed with sinus venous thrombosis and pulmonary embolism. Physical examination is remarkable for spontaneous eye opening but no response to commands along with global aphasia and a complete drift of the left lower extremity. Her GCS was 11/15. Otherwise, the rest of her physical examination was unremarkable. Stroke code was announced, and the case was discussed with the neurologist. The patient was managed with a heparin bolus, heparin infusion, and Keppra. Blood pressure was maintained via nicardipine to keep the systolic BP under 140. Blood work done and patient went for imaging. Patient was not eligible to tPA since she arrived past the 4.5-hour window. The patient ultimately underwent a craniectomy. Cerebral...
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Acute Upper Limb Ischemia Secondary to Primary Left Subclavian Thromboembolism: A Case Report
Phalguni Sai Preethi Asapu
,
Neema Francis
,
Thiagarajan Jaiganesh
Year:
2024
Acute primary subclavian thromboembolism by itself is an infrequent occurrence. There is a prevalence of less than 1% in the world population. It remains crucial to have a high suspension of such cases as they are usually asymptomatic. Early treatment is imperative to avoid complications. Treatment modalities vary depending on the cause of the disease. We report a 46-year-old previously healthy female in the Emergency Department who presented with excruciating pain and bluish discoloration of the fourth and fifth digits of the left upper limb. A Computed tomography angiogram showed partial thromboembolism of the left subclavian artery.
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An Accidental Exposure To Chlorine Causing Chemical Pneumonitis
Nazneen Syeda
,
L O Idris
Year:
2024
Chlorine is a reactive gas used by humanity for over two centuries. Exposure to chlorine has occurred in a number of situations, including as a chemical warfare agent, in industrial and domestic exposures, and as a result of accidents and spills.Respiratory complications that develop after acute exposure to chlorine gas include rhinitis, pneumonitis, pulmonary edema, and acute respiratory distress syndrome (ARDS) .Up to 1% of exposed individuals die. We present one such unique incident of a young 18 year old boy who developed chemical pneumonitis within a span of 24 hours after a bottle of clorox (sodium hypochlorite) fell over his face while he was asleep.The patient was kept for observation in the hospital due to profuse coughing and chest discomfort . After admission his saturation dropped and he required oxygen support.Through this case we highlight the importance of treatment of chlorine exposure which is essentially symptomatic, with the efficacy...
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The Effectiveness of Point of Care Ultrasound in Emergency Department
Dr Sumudu Ruhunage
,
Dr Mubashir Hamid
Year:
2024
Point of Care Ultrasound (POCUS) has rapidly evolved into an essential diagnostic tool within Emergency Departments (EDs) in recent years. This review highlights the pivotal role of POCUS in facilitating prompt diagnosis and timely initiation of treatment by Emergency Physicians, leading to notable improvements in patient outcomes. By enabling rapid assessment and aiding in the formulation of a most likely diagnosis within minutes, POCUS contributes significantly to reducing the length of hospital stays and mitigating the morbidity and mortality associated with complications arising from delayed treatment. This abstract underscores the indispensable nature of POCUS in enhancing the efficiency and effectiveness of emergency healthcare delivery, ultimately improving patient care and outcomes.
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Giant Left Atrial Aneurysm In A Three Year Old
Maitha Yousif Almazrouei
,
Antoine AbdelMassih
,
Nishant Shah
Year:
2024
Background: The PA to the LA fistula is a rare cause of central cyanosis. Embryologically, incomplete degeneration of septum between the arterial and venous plexus of the pulmonary vascular bed or defective capillary loop leads to formation of thin-walled sacs resulting in formation of pulmonary arteriovenous fistula. The more restrictive the fistula is, the more subtle is the extent of cyanosis and the less evident is the clinical presentation. Case Description We describe the case of three years-old patient, who presented with unresolving pneumonia, that necessitated CT imaging. CT imaging revealed a mass in the posterior mediastinum that was communicating with the left atrium. Originally it was thought that this is an aneurysmal dilation of one of the pulmonary veins, that could have resulted from mitral regurge. Echocardiography showed an aneurysmal dilation of the left atrium, with an abnormal retrograde flow across the roof of the left atrium, pulmonary hypertension...
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Severe Hydrocarbon Pneumonitis, A Fatal Complication of Petroleum Aspiration: A Case Report
Neema Francis
,
Phalguni Sai Preethi Asapu
,
Mansoor Husain
,
Thiagarajan Jaiganesh
Year:
2024
This case report outlines a patient who ingested and aspirated petroleum, leading to acute respiratory distress syndrome (ARDS), chemical pneumonitis, and subsequent complications. Despite rigorous interventions, the patient's condition worsened, resulting in his death. This report highlights the challenges in managing such cases and underscores the importance of early recognition, aggressive treatment, and multidisciplinary care. Introduction: Severe hydrocarbon pneumonitis from petroleum ingestion is rare, with an incidence of less than 2%. Children are particularly vulnerable due to accidental ingestion of household items containing hydrocarbons. Occupational exposure and fuel siphoning, especially in developing countries, are other common risk factors. Hydrocarbon pneumonitis occurs when hydrocarbons are inhaled or ingested, disrupting lung surfactant function, leading to decreased pulmonary compliance, bronchial edema, and lung tissue damage. Case Presentation: This report presents a 28-year-old male who developed hydrocarbon pneumonitis after accidentally ingesting and aspirating petroleum while siphoning fuel. The patient experienced violent coughing and a...
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Frequency of Peripheral IV Catheter in Neonates with Prolong Stay in Emergency of Low-Income Country
Dr Ayesha Javed
Year:
2024
Background: Peripheral intra venous catheter-the usual route for administrating iv antibiotics, nutrition, and other medications. It is secured by splints and adhesive dressings to the skin. However, prolong stay in the ED, and other factors result in frequent IV cannulation which increases the risk of infection and is always a painful procedure. Multiple dressings used to secure the cannula may also result in skin injury and further increase risk for infection. Objective: The present study aims to establish a relationship between length of stay of neonates and the number of peripheral IV catheter lines placed. Material and Method: This is a retrospective chart review of neonates admitted through the emergency room of a public sector hospital supported by Child life foundation, their length of stay, and the number of IV catheters used during their stay with the help of EMR data from doctors, staff, and pharmacists for each patient. Results:...
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DKA Prediction in Children Using Artificial Intelligence: Improved Emergency Care
Arifa Parveen
,
Mohsina Riffat
,
Sarang Shaikh
Year:
2024
Diabetics Keto Acidosis (DKA) is a serious health problem that requires timely intervention to prevent harmful consequences. This study analyzes various types of patient data, including clinical parameters and historical records such as family history, genetics, age, gender, etc., to identify early indications for developing DKA in children. The proposed AI-based system can support healthcare professionals in the emergency department by providing accurate and timely predictions/decisions. The dataset consisted of various clinical, and laboratory parameters such as "blood sugar level, hco3, pH values, urinary ketones, acidosis, sodium, and potassium values". Furthermore, along with the above parameters the dataset also contained some additional parameters such as "gender, age, and family history". The total size of the dataset was 5000 rows with 978 rows as "children diagnosed with DKA" and 4021 rows as "normal children". For the model selection stage, we selected 08 different machine learning models such as logistic regression, k...
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Effect Of Estimated Waiting-Time Provision On Patients' Satisfaction With Emergency Department: A Randomized Controlled Trial
Khalid Nabeel Almulhim
,
Lina Abdulaziz AlMudayris
,
Zeyad Khalid Alshehri
,
Ahmed Khalid Alnawah
,
Danah Abdulaziz Aljeri
,
Abdulaziz Shary Hadadi
Year:
2024
Background: Patient satisfaction is a quality measure that may provide important details about the medical care given by providers. A higher patient compliance rates and fewer malpractice claims are associated with patient satisfaction. Evaluating patient experience and satisfaction of emergency beneficiaries have been conducted through various hospitals across the Gulf region, and yet no comparable study has been done in King Fahad Hospital. Therefore, our study aimed to examine the effect of estimated time provision on patient satisfaction with emergency care in KFHH. Method: A randomized controlled trial was conducted from 1st to 30th of November 2023 at King Fahad Hospital Emergency department in Al-Hofuf. It included those triaged as 3 and above and those 18 and above. Patients were divided into two groups, an intervention group was provided the time, and 2 questionnaires were used at both triage entrance and after being seen by the physician. Result: A total...
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Predictors of Per-Intubation Cardiac Arrest in Pediatrics Patients Presenting to the Emergency Department
Noman Ali
,
Erum Shakeel
,
Haniya Ather
,
Nirdosh Kumar
Year:
2024
Introduction: Airway management is one of the vital resuscitative procedures undertaken in many critically ill pediatric patients presenting for emergency care. Around (2–33/10,000) of all pediatric patients presenting to the emergency department (ED) require airway protection for various conditions, such as respiratory failure, airway protection, and cardiac arrest 1-3. In children, airway management demands great caution because of their age-related differences in anatomical and physiological characteristics and limited physiological reserves. Rapid sequence intubation (RSI) has become the standard technique to facilitate pediatric emergency airway management. The objective of the study is to determine the risk factors associated with peri-intubation cardiac arrest in pediatric patients presenting to the emergency department. Methods: This retrospective matched case-control study was carried out at the Emergency Department of the Aga Khan University Hospital from January 01, 2017, to December 31, 2022, will be included. Cases were identified as pediatric patients (age
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Acquired Cerebral Achromatopsia Secondary to Occipital Stroke
Noura Khalid Alhosani
,
Noura Khalid Alhosani
,
Fatima Alkhyeli
,
Fatima Alkhyeli
,
Falak Sayed
,
Falak Sayed
Year:
2024
Background: Acquired cerebral achromatopsia, a form of color vision impairment, is infrequently reported and often results from injuries to the occipital cortex. Case Presentation: We detail a case of a middle-aged women with vascular risk factors who visited the emergency department with blurred vision and disturbances in color perception, characterized as an inability to differentiate colors. A notable finding in her neurological examination was homonymous hemianopia. Hyperacute magnetic resonance imaging revealed a subacute infarction in the right occipital lobe. As she was outside the treatment window for alteplase and invasive interventions, she received aspirin and clopidogrel as treatment. Discussion: Patients with posterior circulation strokes often present with non-specific symptoms, which can lead to delayed diagnoses and treatment. Acquired cerebral achromatopsia, the inability to perceive color after acute brain injury, is a rare phenomenon associated with PCA stroke that has not been well studied yet. It usually involves the ventral occipitotemporal...
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A Descriptive study of child abuse cases in the paediatric emergency department (tertiary care hospital in Karachi)
Hareem Ayub
Year:
2024
Background: Child abuse is an alarming issue that leads to lifelong health consequences, both physically and psychologically. The past few years, an increased number of abuse cases (sexual and physical) were reported in paediatric emergency departments (PED). Knowing the commonly presented abuse and other vital factors (age and gender), prompt effective measures can be developed by the system for child safety. Objective: To determine the number of child abuse cases along with the age and gender commonly presenting in the PED. Methods: Retrospective review of abuse cases that required in-patient care in PED of ChildLife foundation Karachi, during the period of January'2021-June'2022. Results: Total of 39 child abuse cases were reported. 25 were sexual-abuse, out of which 16 were male (64%) and 9 (36%) were female. From age 1month-5years, 37.50% (n=3) were female and 62.50% (n=5) were males. From age 6-10years, 70% (n=7) were male and 30% were female. Lastly,...
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Knowledge attitude and practices regarding difficult airway management among adults in the emergency departments of Pakistan
Hadia Iftikhar
,
Sarah Afzal
,
Naheed Habibullah
Year:
2024
Objective: This study aimed to evaluate the difficult airway management related knowledge, attitudes and practices amongst physicians and nurses working in the emergency departments of Pakistan. Method: A web-based questionnaire was distributed nationwide amongst physicians and nurses working in emergency departments nationwide. Results: There were 81 respondents for this in-term analysis. Most (70.4%) have practised emergency medicine for less than five years. 85.2% said their hospital had an EM training program. The majority (75.3%) preferred the RSI approach to managing airways in the emergency room. The average number of endotracheal intubations handled in a month and the average number of unexpectedly difficult intubations encountered in 100 cases were respectively 16.06±15.27 and 12.66±16.36. The exact steps of the ASA difficult airway algorithm were known to 60.5% of the responders. In terms of managing difficult airways, 39.5% of respondents felt competent. Conclusion: There is a lack of institutional and nationwide guidelines regarding...
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Chronic Limb Threatening Ischemia masquerading as Vitamin D deficiency; A case report
Sarah Afzal Kothari
,
Hadia Iftikhar
,
Iqra Anis
Year:
2024
Introduction: Limb Ischemia is an uncommon but high risk emergency. It mostly presents as a painful limb in patients with peripheral arterial disease with risk factors such as hypertension, diabetes, smoking and chronic kidney disease. Timely diagnosis and intervention are crucial for reversal of ischemia. It can cause significant morbidity and mortality if left untreated due to the devastating complications. Case Presentation: We report a 42 year old healthy male who presented to the emergency department with acute pain in his left leg for 2 days. He had a history of intermittent bilateral lower limb pain and paresthesia for 2 years. Apart from well controlled Diabetes, he had no other significant medical history and reported no trauma or addictions. The patient was being managed as vitamin D deficiency by physicians at different levels of the health care system over the course of 2 years for muscular spasms and nutrient deficiency...
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Factors improving intravenous fluid flow rate for rapid resuscitation, based on the Hagen-Poiseuille law
Mahdis Seddiq
,
Firas Jaafar Kareem Alnajjar
Year:
2024
Primary approach to the resuscitation of critical patients, in the emergency setting, requires a swift establishment of 2 large-bore peripheral intravenous catheters (PIVC) access accompanied by rapid fluid administration. This preferred use of a PIVC over a central venous catheter (CVC) stem from its ability to achieve faster fluid delivery, due its larger radius and shorter length. This is explained by the Hagen-Poiseuille Law whereby doubling the radius can increase flow 16-fold, and halving the length can double the flow. The law was applied in this experiment for the I.V tubing system itself. The results demonstrated that the 4mm I.D tube achieved the highest flow rates under both gravity and compression with a p-value of 0.009. Despite the Hagen-Poiseuille Law favoring shorter lengths, the 30 cm length resulted in the slowest flow rates. As emphasis is held on the importance of circulation in rapid resuscitation, ideal fluid delivery instruments specifically...
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The use of ultrasound by emergency medicine teams after earthquakes: a scoping review
Evert Verhoeven
,
Sofie Pauwels
,
Michel Debacker
,
Ives Hubloue
,
Thomas Ecker
Year:
2024
Introduction: Earthquakes can have a significant impact on imaging modalities available in the surrounding hospitals. Ultrasound can offer several advantages in earthquake response scenarios but is underrepresented in the bibliometric analysis on imaging modalities after earthquake. This scoping review aims to analyse the gap in literature by examining the possible roles of ultrasound during different timeframes after an earhtquake. Methods: A scoping review was carried out using the PRISMA method searching Pubmed, Scopus and Web of Science. Grey literature was searched and snowballing was performed on the reference list. Results were extracted into 3 time cathegories for use during the first 72 hours after, during the first 6 weeks after, and follow up of patients during the years after the earthquake. Results: A total of 13034 studies were put into COVIDENCE TM, 69 references were found in Grey literature, 24 articles were witheld for extraction. Limitations: Articles were excluded based...
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Bilateral Hearing Loss after Carbon Monoxide Poisoning
Daniel Tirado
,
Ahmed Alsakha
,
William Santiago
,
Dallin Lindahl
,
Monica Morgan
,
Jeanna Marraffa
Year:
2024
Background: Carbon monoxide (CO) is an odorless, colorless, flammable gas that is formed by the incomplete combustion of fuels and binds to hemoglobin with 200 to 250 times greater affinity compared to oxygen. As a result, blood oxygen-carrying capacity is reduced when CO is bound to hemoglobin. Reversible and irreversible unilateral or bilateral hearing loss due to CO poisoning has rarely been reported. We present a case of an 18-year-old previously healthy male with bilateral hearing loss after severe CO poisoning. Case Report: An 18-year-old male with no past medical history presented to the emergency department (ED) after being found unconscious with emesis in his vehicle. He failed to respond to Naloxone. In the ED, he was obtunded with vital signs significant only for tachycardia of 115 bpm. Initial workup revealed leukocytosis (WBC 16.0 10*3/uL), hyperglycemia (glucose 195 mg/dl ) and high sensitivity troponin elevation (131 ng/L). Electrocardiogram revealed sinus...
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Identification of Indicators for the Evaluation of Health Disaster Management Interventions during the Relief Phase: Scoping Review of the Peer-Reviewed Literature
Sofie Pauwels
,
Michel Debacker
,
Ives Hubloue
Year:
2024
Introduction: Disasters have existed for many ages and although they are known to threaten health, there is still lack of evidence regarding the effectiveness of health disaster response interventions. Indicators are primordial for the evaluation of such interventions. The main objective of this study was to map the output, outcome and impact indicators used to evaluate health interventions in disasters and to identify gaps in the existing peer-reviewed literature. Methods: A scoping review of the peer-reviewed literature was performed. Scopus, Web of Science and Pubmed were the 3 databases in which the search was launched. All references published in the peer-reviewed literature in English, Dutch or French since 1990 were eligible for inclusion if they met all the inclusion criteria. Characteristics of the studies, the interventions and indicators identified were charted. Interventions were categorized using an extraction template. Results: A total of 8329 articles were identified. After removal of duplicates,...
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Does trauma system regionalization improve outcomes in patients with major traumatic injuries?
Zia Danesh Jummani
Year:
2024
Introduction: Trauma system regionalization is a fundamental approach to trauma care leading to preventable deaths and decreased morbidity amongst major trauma care patients. A trauma system consists of all critical components of the patient pathway which include injury prevention, pre-hospital care, patient transfer, initial management, definitive management, and rehabilitation. Trauma care systems are operating in the USA, Germany, Australia, and the UK. UAE initiated trauma registry and system development in 2010. Comparative analysis of trauma system would enhance strategy implementation by public health decision makers in enhancing trauma patient care outcome measures. Aims / Objectives Systematic review of the evidence for the impact of trauma system regionalization on clinically important trauma outcome measures including mortality. Materials / Methods Trauma registry data from TARN in the UK would be analyzed in addition to the literature search for the effect on trauma outcome measures pre-trauma and post-trauma system regionalization. The Al Ain...
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Investigating characteristics of patients and healthcare Visits Prior to Out-of-Hospital Cardiac Arrest in Two Tertiary Hospitals in Oman
Tasnim Al Habsi
,
Mohammed Al Badri
,
Amal Al Mandhari
,
Khalid Al Harthi
,
Thekra Al Obaidnai
,
Maimoona Al Hinai
,
Abdulmajeed Al Shukaili
,
Mohammed Al Hassani
,
Naima Al Hinai
Year:
2024
Introduction The high incidence of out of hospital cardiac arrest (OHCA) as well as its low survival rates are contributing to the burden on public health. Emerging evidence have recognized prodromal symptoms and patterns of healthcare use suggesting the possibility of predicting these cardiac events despite the general belief that they are merely sudden. Our study aimed to identify the characteristics of patients who present in OHCA and the utilization pattern of healthcare facilities by these patients in the period preceding the cardiac arrest. Methods This is a retrospective study which included adult OHCA patients who presented at two emergency departments (ED) in Muscat, Oman between 2016 and 2020. The ED visits that occurred within the six months preceding the arrest were investigated. Descriptive statistics and frequency tables were used to report the baseline characteristics of all patients. Associations were tested using chi-square test. Results The final cohort consisted of...
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MANAGEMENT OF A PATIENT PRESENTED WITH AMITRIPTILINE POISONING- A RARE CASE REPORT
Dr Harsha Makwana
,
Dr Sumit Bhut
,
Dr Parth Kapadiya
Year:
2024
Tricyclic Antidepressant overdose for suicidal poisoning purpose is not frequent but still possible in patient and his near relative due to its availability at home. On susception laboratory testing is required for many poisons but availability is limited and any delay in diagnosis and starting management may worsen the patient's condition. Amongst all TCAs, Amitriptyline is classic having sedative and anticholinergic properties. Its self-poisoning is not that much common in general population. Here we are reporting a case of Amitriptyline poisoning in a healthy women aged 30 years brought by relatives with drowsiness and giddiness to our Emergency Medicine Department, LG Hospital, Narendra Modi Medical College, Ahmedabad. Her relatives had given history of self-ingestion of 30 Tab of Amitriptyline Hydrochloride. Each Tablet contained 25 mg of drug molecule. On examination in ED, patient was in drowsy but arousable state. Patient had tachycardia (130/min), high blood pressure (140/90 mm of Hg)...
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Approach To Poisoned Patients with High Anion Gap Metabolic Acidosis in The Emergency Department – A Case Series
Reem Khalid Ali
,
Ebtesam Safi
,
Tibah Ahmad Al Abbasi
,
Salma Abdullah Khamis Rajaby
Year:
2024
Toxicology cases are frequent presentations in the emergency department (ED) and often their presentation can vary from a straightforward manner to a complex manner. In this case series we will discuss three cases that presented to the emergency department with a known, suspected, and unknown toxicological substance ingestion with the common denominator being high anion gap metabolic acidosis (HAGMA). High Anion Gap Metabolic acidosis is a subcategory of metabolic acidosis. Categorizing metabolic acidosis as high anion gap aids in identifying the underlying disease process and subsequently initiating appropriate treatment. There have been many broadly inclusive mnemonics used to list the common causes of High anion gap acidosis such as CAT MUDPILES which correspond to Carbon monoxide, Cyanide, Congenital heart disease, Aminoglycosides, Theophylline, Toluene, Methanol, Uremia, Diabetic ketoacidosis, Alcoholic ketoacidosis, Starvation, Acetaminophen, Phenformin, Paraldehyde, Iron, Isoniazid, Inborn errors of metabolism, Lactic acidosis, Ethanol, Ethylene glycol and Salicylates respectively. It is not...
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Case Report on May-Thurner Syndrome Presented in Emergency Department with Pulmonary Embolism and Deep Venous Thrombosis Post Oral Contraceptive Pill Consumption
Faiza Akhlaque
,
Asma Shahid
Year:
2024
Case Summary: A 42-year-old woman with a history of multi-nodular goitre, prolactinoma, endometriosis, and polycystic ovarian disease developed left leg swelling after starting oral contraceptive pills (OCPs) on August 19th. She flew to Singapore and presented with severe leg pain, diagnosed with deep venous thrombosis (DVT). OCPs were stopped, and she was discharged on Rivaroxaban. Returning to the UAE, she presented the same day with shortness of breath and chest pain. Physical exam showed left leg swelling and pitting edema. Lab tests indicated elevated D-dimer (2.52), suggesting ongoing potential thrombotic activity. Thrombophilia screening was negative. Imaging confirmed DVT involving the left iliac, femoral, popliteal veins, and posterior tibial vein. CT Angiography found a pulmonary embolism (PE).CT Abdomen/Pelvis revealed compression of the left iliac vein by the right iliac artery, causing acute thrombosis—suggestive of May-Thurner syndrome. Treatment was guided by these findings, addressing her complex condition promptly. Management: Patient was initially...
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Measurement of temperature excursions in different medication storage compartments during a mass casualty incident
Saskia Van Kemseke
,
Sofie Pauwels
,
Wilfried Cools
,
Ives Hubloue
Year:
2024
Introduction: When a Mass Casualty Incident (MCI) or a disaster strikes, medication used on the scene is likely to be exposed to temperature excursions and variations. During MCIs/disasters pharmaceuticals are often not stored as recommended by the manufacturer. This could result in to a decreased stability of pharmaceuticals used on the scene and may result in treatment failure, especially when hazardous temperature excursions occur >30°C and >40°C. Aims/objectives: The main objective was to measure the magnitude of temperature excursions in medication storage compartments, how long they last and how often they occur during MCIs in Belgium. Materials/Methods: This observational study was conducted in Brussels (Belgium). The measurement period started in December 2020 and ended in August 2021. The measurements were done in 3 different simulation settings where medication is potentially stored at the time of an MCI, namely in an Advanced Medical Post (AMP), in the outdoor setting ("in the...
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