Background: With growing emergency department visits, there has been a growth in national health expenditure. This situation is exacerbated by physicians ordering ineffective investigations and procedures. This study aimed to assess the emergency physician's awareness of the cost of diagnostic tests and interventions, and how awareness of costs may impact their medical decision. Methods: This cross-sectional study was conducted among emergency physicians in Saudi Arabia. The data were collected via a self-administered questionnaire disseminated through emails to all physicians. Results: A total of 233 physicians participated, the majority of whom were males (73%) and aged 24-34 years old (70.8%). Of the included physicians, 41.2% were junior residents, and three-quarters (75.5%) of the respondents had never worked in private hospitals. Two-thirds of respondents agreed/strongly agreed that knowing financial cost would affect their clinical practice. Physicians tended to overestimate the cost of drugs while underestimating the cost of diagnostics and laboratory tests.... Continue Reading

Background: As an emerging infectious disease, COVID-19 has led to overwhelming pressure on healthcare facilities and has caused significant morbidity and mortality worldwide. The WHO declared it a pandemic in early 2020, and due to a lack of knowledge at the initial phase, there were numerous misconceptions. During the pandemic, evidence-based practices improved patient care. Here we surveyed a representative sample of Saudi emergency medicine physicians in-training to assess their knowledge, attitudes, and practices about COVID-19. Methods: An online survey with 18 questions was generated using survey monkey and provided to the target audience via the messaging service WhatsApp. Results: Most of the participants' ages ranged between 26 and 31 years old, and males were slightly higher in number. Most of the participants demonstrated awareness of the cardinal symptoms of COVID-19 and risk factors for the severity of the infection. Half of the participants believed they could differentiate between COVID-19... Continue Reading

Background: Breaking bad news encompasses conveying information that significantly impacts an individual's view of their present and future. In emergency departments (EDs), medical professionals often face the challenge of delivering distressing news. This study explored patient and family preferences for receiving bad news in the ED, considering sociodemographic factors such as education and gender. Methods: This cross-sectional study involved 304 patients from the ED of King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. The participants were divided into four groups based on their gender and educational level. A p-value of Continue Reading

Background: Millions of Muslims gather annually in Makkah, Saudi Arabia, for pilgrimage (the Hajj). Some medical conditions need specialized care involving transfer outside the hospital. However, providing health care to emergency cases in such unparalleled mass gatherings is challenging. This study aimed to describe the medical conditions of patients transferred by the medical convoy team in well-equipped ambulances to Arafah in Makkah during the Hajj season in 2019. Methods: Patients' data were extracted via a standardized electronic evaluation form. The treating physicians made the primary diagnoses in the admitting secondary or tertiary healthcare facilities. Results: Of the 274 transferred patients, 36.1% were older adults (>60 years), 55.8% were men, 59.9% were Asian, and 36.4% were African. The primary diagnoses were cardiovascular diseases (26.7%), fractures (16.1%), respiratory diseases (15.3%), gastrointestinal diseases (12.8%), skin infections (10.3%), metabolic diseases (4.7%), neurological or psychiatric diseases (4.7%), and urogenital diseases (3.6%). Older adults comprised 50.0%... Continue Reading

Background: Emergency ultrasound has become an essential component of patient care and a mandatory skill for emergency medicine (EM) residents. Since 2001, major EM organizations have released guidelines mandating the integration of bedside ultrasonography into EM practice. This study aims to evaluate the ultra sound knowledge of emergency residents and their progress by conducting a survey before and after their emergency ultrasound (EUS) rotation. Method: This longitudinal prospective study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, to investigate the improvement in knowledge, interpretation accuracy, and clinical decision-making based on ultrasound findings. The study included first-year residents who joined the residency program in 2023. The research team collected data by administering a pre-test and post-test. Results: We analyzed data from 12 residents. Half of them had received ultrasound training, and half of them used ultrasound on a daily basis. Regarding the perceived barriers to ultrasound training, the... Continue Reading

Background: The Emergency medicine (EM) residency program in Saudi Arabia spans 4 years, equipping trainees with the necessary knowledge, skills, and attitudes to excel as emergency physicians. This study aims to elucidate the factors influencing EM residents' choice of training centers in Saudi Arabia. Methods: We conducted a cross-sectional study using an online questionnaire to gather data from EM residents across Saudi Arabia. We employed a convenience, non-random sampling technique. The questionnaire was divided into two sections, gathering sociodemographic data and factors influencing the choice of training center. Results: The study included 223 EM residents. Of these, 134 (60.1%) were male, and the majority (43.9%) were in their first year, with most respondents hailing from Jeddah (59.2%). The "friendliness of the residents/ staff" was deemed most critical, with a mean score of 4.51, while "prestige" was the least important, scoring 2.55. "Closeness of location," "number of consultants," "availability of different... Continue Reading

Objective: This study aimed to assess the knowledge, attitude, and practice of Saudi teachers regarding their role in managing anaphylaxis in the Makkah region. Methods: A descriptive cross-sectional study surveyed 677 teachers from public and private schools in Makkah between 2023 and 2024, utilizing convenience sampling. Results: The surveyed teachers, aged 23 to 60 years with a mean age of 44.1 ± 11.9 years, comprised 50.7% males. Most held bachelor's degrees (81.7%), with 9.5% had diploma and 8.9% post-graduate degrees. Regarding teaching phases, 36.3% focused on primary, 33.4% on intermediate, and 30.3% on secondary school levels. The majority (59.7%) had over 15 years of teaching experience, while 22.3% had 11-15 years, and 18% had 1-10 years. Findings indicated limited overall knowledge (15.1%) among teachers, with only 17.3% being familiar with epinephrine as a treatment. However, 93.1% believed educational lectures on anaphylaxis were necessary for school staff. Notably, 28.8% of teachers... Continue Reading

Background: The career choice of specialization in the medical profession is very complex. This study aimed to observe the most popular choice of medical field specialization, factors influencing the student's choices, and future job features that would impact the choice of medical field specialization. Methods: A cross-sectional study was conducted through a self-administered online survey, distributed by email, through the Office of Clinical Affairs, to the final year (sixth year) medical students and interns in seven different medical schools in the Western Region of Saudi Arabia. Results: A total of 294 participants completed the survey, of which 56.5% were sixth-year medical students. The gender distribution of the sample was almost 2:1 female to male ratio. The most common choice of field specialization was surgical subspecialty followed by emergency medicine at 16.0%, and 15.6%, respectively. The items that had the most impact on the medical students' choice of medical field specialty... Continue Reading

Objective: This study aimed to determine factors predicting hospital admissions at King Abdulaziz Medical City in the emergency department (ED), Rdiyadh, Saudi Arabia. Methods: A retrospective study was conducted at the ED of King Abdulaziz Medical City among adult patients aged ≥14 years triaged in ED and arriving by either paramedic transport or self-referral and presented to ED from 01/01/2021 to 01/01/2022. The data were collected from the patient's medical records and a pre-designed checklist was prepared to collect data. Results: The majority of patients (88.7%) arrived at the ED walk-ins, as for patient acuity, a substantial segment of the population (86.9%) fell into category 3. Exactly half of the patients reported no known comorbidities. The prior visit to the ED within the past 72 hours was documented in 12.3% of the cases. As for the patients' outcomes post-triage, a large proportion (78.4%) were discharged after their ED visit. The... Continue Reading

Introduction: Endotracheal intubation is a high-risk procedure that can be lifesaving for critically ill or injured patients. Assisted devices, such as the bougie and stylet, are commonly used to improve success rates and reduce complications. The bougie facilitates the passage of the endotracheal tube through the vocal cords while the stylet is inserted into the endotracheal tube prior to intubation. However, there is variation in clinical practice regarding the preference for using these devices in difficult airway management. Methods: This systematic review and meta-analysis included randomized controlled trials (RCTs) that compared the efficacy of bougie versus stylet in tracheal intubation. Medline, Embase, Cochrane Central of Controlled Trials, and Clinical trials.gov were searched for studies discussing the same topic. The primary outcome was the first-attempt intubation success rate between the bougie and stylet. Our secondary outcomes were to compare the duration of intubation and the complication rates between bougie and stylet.... Continue Reading

The prognosis for patients with thoracic trauma depends largely on the management presented in the emergency department (ED), along with other major factors. This PRISMA scoping review explored ED management for patients with thoracic trauma. A systematic review study was conducted and initially, 157 articles were identified through database research. After screening, following the inclusion and exclusion criteria, and checking for other eligibility conditions, the studies were reduced to 11 articles. Each included study was assessed for quality independently by two reviewers using a modified form of the quality assessment of diagnostic accuracy studies (QUADAS-2). The survival rate following emergency thoracotomy is approximately 9%-12%, whereas, for blunt trauma, the survival rate is 1%-2%. 85% of patients may be treated by emergency physicians after employing minor procedures. The frequency of hospitalization reduced to 24% from 49% along with a decline in the duration of hospitalization. The diagnostic accuracy for ultrasonography (US)... Continue Reading

Background: This case report highlights the successful revascularization therapy and favorable functional outcome in a rare and challenging case involving basilar artery occlusion and left subclavian artery partial obstruction. Case Presentation: We report a patient presented with a high National Institutes of Health Stroke Scale score and altered mental state following collapse. Timely intervention, with multidisciplinary team approach including mechanical thrombectomy and intravenous thrombolysis, led to a remarkable neurological recovery. The discussion emphasizes the significance of prompt revascularization in cases of posterior circulation stroke and underscores the need for further research on multiple arterial obstructions. Conclusion: This case illustrates the potential for positive prognostic indicators even in complex scenarios, ultimately improving patient outcomes in such critical conditions. Continue Reading

Background: Cantharidin, a toxic substance produced by Meloidae (Coleoptera family) beetles, poses serious health risks upon ingestion, including renal impairment, hematemesis, altered consciousness, electrolyte imbalances, and hematuria. Case Report: This study presents two pediatric cases of cantharidin poisoning resulting from the biting of Meloid beetles. Case 1 involved a 2-year-old exhibiting hematuria and vomiting, while case 2, a 9-month old, presented with agitation, lethargy, and hematuria. Both cases required intensive care and supportive management. Conclusion: These cases highlight the clinical manifestations of cantharidin intoxication in children following exposure to Meloid beetles. Early recognition of symptoms, prompt medical intervention, and close monitoring are crucial in managing cantharidin poisoning, for which no specific antidote currently exists. Continue Reading

Background: Carbon monoxide (CO) is a colorless and odorless gas from combustion sources causing accidental or intentional poisoning. Patients present with nonspecific symptoms such as headache and dizziness, but severe cases can lead to altered mental status. Myocardial injury is a life-threatening outcome of CO poisoning, requiring timely evaluation and management. Case Presentation: A 33-year-old pregnant female with no prior co-morbidities presented to the emergency department with dizziness, vomiting, and syncope. She had been exposed to CO from a petrol generator, resulting in a carboxyhemoglobin level of 9.6%. The patient exhibited global hypokinesia and reduced ejection fraction. After receiving oxygen therapy, she showed improvement and was discharged in stable condition. Conclusion: This case underscores the importance of early recognition and management of myocardial injury in CO poisoning, particularly in pregnant patients. Prompt oxygen therapy and appropriate follow-up are crucial to mitigate long-term cardiovascular and fetal complications. Continue Reading

Background: Patients with chronic obstructive pulmonary disease (COPD) are at risk for tension bullae, potentially leading to tension pneumothorax. Distinguishing tension bullae from tension pneumothorax in acutely dyspneic COPD patients is essential but challenging. A case was presented where chest tube placement in a tension bulla provided initial benefit but resulted in a bronchopleural fistula. Case Presentation: A middle-aged male with COPD presented to the Emergency Department with severe dyspnea. History, bedside ultrasound, and chest radiograph suggested tension bulla or tension pneumothorax. Computed tomography was done which confirmed tension bulla. Despite bullectomy being the preferred treatment, clinical deterioration necessitated urgent chest tube placement, leading to rapid improvement. However, 2 days later, a bronchopleural fistula developed, requiring thoracotomy. Conclusion: Emergency physicians must be aware of tension bullae as a rare cause of acute dyspnea in COPD. This case underscores the need for specific management protocols, potentially including smaller diameter catheters for... Continue Reading

Background: Naphthalene poisoning from mothball exposure is a prevalent cause of toxicity in children worldwide. Naphthalene poisoning can lead to hemolytic anemia, methemoglobinemia, and hepatic and renal damage. Studies regarding naphthalene ingestion not associated with complications do not exist. Case Report: We report a novel case of unwitnessed naphthalene mothball ingestion in a 5-year-old child who did not exhibit any complications, such as hemolysis or methemoglobinemia, and was discharged safely with no sequelae. Conclusion: Awareness of the dangers of naphthalene poisoning is important to prevent poisoning and death. Continue Reading

Background: Since economics is a social science studying individuals' behavior, it is plausible to employ its relevant concepts to study human behavior in the immediate response of lay citizens towards emergency incidents. In this context, economics has identified three types of policy lags in fiscal decisions that are of great interest to our study: recognition lag, decision lag, and implementation lag. Objectives: This study aims to apply the three policy lags in economics to the concept of ‘chain of survival' (CoS), in the hope of enticing rethinking its first link, and to seek solutions for CoS's optimal activation. Methods: This cross-sectional study explores immediate responses to prehospital emergencies through a global online survey in four languages. It assesses how lay citizens recognize medical emergencies and activate the EMS system. Data is analyzed with SPSS v26 while summarizing qualitative variables via frequencies and percentages. Results: A total of 239 respondents were... Continue Reading

Background: Acute Coronary Syndrome (ACS) and Acute Heart Failure (AHF) are severe medical conditions that are closely associated with higher rates of readmissions and mortality in hospitals. These conditions pose an exponential challenge to the health care system and increase patient burden. Objectives: This study aims to identify the effect of Telephonic follow-up on readmission and mortality rates in Rashid Hospital due to ACS and AHF. Methods: In 2022, we conducted a prospective study. We divided 805 patients admitted with ACS and AHF in Rashid Hospital into two groups and compared the readmission and mortality rates of patients who were followed up with those who were not. The data collection tool included a demographic questionnaire, which was then analyzed by statistical tests and SPSS software. Results: There are patients in the follow-up call group versus patients in the no follow-up call group. The patients with follow-up calls had a higher... Continue Reading