Background: Helicopter Emergency Medical Services (HEMSs) improve trauma outcomes by enabling rapid transport to specialized centers. In Saudi Arabia, HEMS is expanding through a partnership between The Helicopter Company and the Saudi Red Crescent Authority. However, regional outcome data remain limited. This study examines the characteristics and outcomes of trauma patients transported by HEMS to a Level I trauma center in Riyadh. Methods: This retrospective study reviewed 541 adult trauma patients transported by air ambulance to a tertiary hospital in Riyadh between January 2021 and July 2024. Data from the hospital's trauma registry and electronic medical records were analyzed for demographics, injury mechanisms, prehospital interventions, trauma team activation, and survival outcomes. Results: Most patients were young men (85.4%), with motor vehicle accidents (87%) as the leading cause of injury. Blunt trauma accounted for 98% of cases. Prehospital interventions included intubation (13.1%) and chest tube insertion (7.4%). Trauma team activation occurred... Continue Reading

Background: Drowning is a significant global public health issue, responsible for a substantial number of injury-related fatalities each year, particularly in low- to middle-income countries. This study explored the environmental and individual risk factors of drowning and proposed a multifaceted approach to prevention. Methodology: This study used a mixed-methods approach, integrating both theoretical frameworks and data analysis to evaluate the factors contributing to drowning incidents. Data were systematically extracted from peer-reviewed articles, focusing on health outcomes. The Haddon Matrix was applied to categorize pre-, during, and post-event factors across human, equipment, and physical environments, while the combined model was used to map public health strategies to these phases, providing a structured evaluation of intervention effectiveness. Results: Factors affecting drowning include a range of personal (host) risk factors, equipment-related issues, and features of the physical environment. These factors include lack of supervision, swimming skills, alcohol use, pre-existing medical conditions, cultural norms,... Continue Reading

Background: Discharge against medical advice (DAMA) impacts patient morbidity and mortality, with prevalence rates ranging from 0.76% to 4.01% of hospital admissions. This study investigated DAMA within the emergency department (ED) of a Saudi Arabian hospital, aiming to understand its prevalence and associated factors. Methods: A retrospective cohort study was conducted from January to December 2022 at a tertiary center. Demographic and clinical data on DAMA cases, including age, gender, nationality, marital status, admission details, diagnosis category, priority level, and reasons for DAMA, were extracted from the electronic hospital database. Descriptive statistics and the chi-square test were used for analysis. Results: Of the 515 identified DAMA cases, 309 were analyzed after exclusions. The majority of patients were female (52.1%), Saudi nationals (82.5%), and married (38.8%). The most frequent discharge diagnoses involved cardiology (18.1%), obstetrics and gynecology (17.8%), and neurology (14.2%). Common reasons for DAMA were refusal of the physician's plan... Continue Reading

Objective: This study aimed to evaluate job satisfaction and professional well-being among emergency staff in Madinah, Saudi Arabia. Methods: A descriptive, cross-sectional study was conducted among 295 emergency department staff (EDS) (147 nurses and 148 physicians) at King Fahad Hospital and Alula Hospital. Participants were surveyed using a demographics data form and a validated 40-item Job Satisfaction Questionnaire measuring satisfaction across six dimensions. Results: EDS reported high satisfaction with patient care and peer interactions, with 78% satisfied with patient quality and 85% with collegial support. However, dissatisfaction was significant for the workload (62%), staffing (54%), supervisory support (60%), and training (68%). Job satisfaction positively correlated with age; 72% of staff aged 40 years and above reported satisfaction as compared to 55% of younger staff (p-value < 0.01). Staff with over 10 years of experience had a satisfaction rate of 75%, while those with less than 5 years reported 50% (p-value... Continue Reading

Background: Emergency medicine (EM) is a high-stress specialty associated with burnout and sleep disturbances. Burnout is characterized by emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment, while sleep disturbances impair cognitive and physical performance. We aimed to assess the prevalence of sleep disturbances and their relationship with burnout among EM residents in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted over six months among 182 EM residents in Riyadh. Data were collected using an online survey, including demographic and professional information, the Pittsburgh Sleep Quality Index (PSQI) for sleep assessment, and the Abbreviated Maslach Burnout Inventory for burnout evaluation. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27.0. (Armonk, NY: IBM Corp.), with multiple linear regression exploring variable relationships. Results: Most participants (57.7%; n=105) reported sleep problems, with 22.5% (n=41) experiencing severe sleep disturbances (PSQI score 15–21) and 19.8% demonstrating good sleep quality (n=36; PSQI... Continue Reading

Background: Stroke is a major global health issue, ranking second in mortality and third in disability worldwide. In Saudi Arabia, it is the third leading cause of death, following ischemic heart disease and road injuries Teacher awareness of stroke signs, symptoms, and risk factors is crucial for enhancing community awareness, enabling early identification, risk modification, and prevention. The present study aimed at assessing the knowledge level on acute stroke among teachers in Public and Private Schools western region, Saudi Arabia Methods: A descriptive cross-sectional study was conducted among public and private school teachers using an online questionnaire distributed via Google Forms. The survey collected demographic and work-related data, as well as teachers' knowledge of stroke warning signs, symptoms, risk factors, treatments, response actions, and prior stroke experiences. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results: A total of 289 teachers enrolled in our study. Among them,... Continue Reading

Objectives: This systematic review seeks to offer an overview of the current level of knowledge about the clinical efficacy of prehospital tourniquets (TQ). Methods: A comprehensive search of relevant databases was conducted to identify studies that met the inclusion criteria. PubMed, Science Direct, and Scopus were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process. Results: Our results included eight studies with a total of 1,434 patients with 1,058 (73.8%). The eight studies were retrospective in nature. TQ application time ranged from 15 minutes to 190 minutes. There were significantly fewer delayed amputations, fewer fatal hemorrhages, fewer acute renal damage cases, more transfusions in those who underwent the prehospital TQ, the average systolic blood pressure of patients in the TQ group was higher, less fresh frozen plasma, less total packed red blood cells, fewer fasciotomy, and less vascular injury in patients with penetrating traumas. Complications included... Continue Reading

Seizures are a critical medical emergency requiring prompt intervention to improve patient outcomes and prevent complications. Intranasal (IN) midazolam has emerged as a promising treatment due to its ease of administration and rapid onset. However, there is a lack of comprehensive systematic reviews assessing its effectiveness, particularly in prehospital settings compared to other treatments. This study aimed to systematically evaluate and compare the efficacy of intranasal midazolam in acute seizure management and patient outcomes in prehospital care and emergency departments. A comprehensive search was conducted, using the PICOS framework, including clinical trials and observational studies published between August 2014 and August 2024. Data were extracted using Covidence and organized into summary tables for analysis. Three out of 489 studies included 5,062 patients, all under 18 years, and 4,957 in prehospital settings. One study was a clinical trial and two were cohort studies. The main indicator of medication success was seizure... Continue Reading

Mechanical ventilators (MVs) played a critical role during the coronavirus disease 2019 (COVID-19) pandemic, providing respiratory support for critically ill patients and reducing mortality. However, the global scale of the pandemic led to significant ventilator shortages, necessitating various strategies to manage MV supply and optimize resource allocation. Real-time tracking systems in health command and control centers emerged as essential tools for monitoring and distributing ventilators efficiently. This study employed a mixed-method approach, incorporating the experience of the National Health Command Center (NHCC) in Saudi Arabia and a narrative review of strategies used to address MV shortages during the COVID-19 pandemic. Several solutions were implemented to meet the increased demand for ventilators, including optimizing high-flow nasal cannulas and using modified single ventilators. Ethical considerations in ventilator allocation highlight the need for a coordinated, multi-sectoral approach to prevent discrimination and maintain public trust. In Saudi Arabia, the NHCC faced substantial logistical challenges... Continue Reading

Background: Unilateral lower limb swelling presents a broad differential diagnosis, often attributed to deep vein thrombosis (DVT), lymphedema, or cellulitis. However, arteriovenous malformation (AVM) remains a rare but critical consideration. Case Presentation: An 89-year-old Middle Eastern man with a known case of AVM of the left thigh presented with worsening swelling and patchy skin discoloration in the affected limb. The patient also had a history of DVT and was bed-bound due to an old stroke for several years. Initial Doppler studies ruled out recurrent DVT. Further imaging with computed tomography angiography identified an arteriovenous fistula between the common femoral artery and vein, likely secondary to post-thrombotic recanalization. In addition to embolization and stenting, vascular surgery introduced an external pneumatic compression device to reduce venous congestion and manage limb swelling. This approach was adopted to provide symptomatic relief while minimizing the risks associated with invasive interventions. Conclusion: This case highlighted the... Continue Reading

Background: Appendicitis is a common, but perplexing medical mystery. It occurs unexpectedly and requires rapid medical intervention. Pediatric fishbone-induced appendicitis is a rare but serious condition that is often misdiagnosed because of its nonspecific symptoms. Fish bones are often observed in the gastrointestinal tract during the treatment of such patients. However, in rare cases, the fishbone enters the appendix and causes appendicitis. Case Report: We report the case of a 5-year-old boy who experienced appendicitis. The patient was admitted to the hospital with severe abdominal pain accompanied by fever, nausea, and vomiting. The pain was identified as fishbone-induced appendicitis. The patient underwent a successful laparoscopic appendectomy without signs of perforation. Conclusion: Identifying fishbone-induced appendicitis in pediatric patients can be challenging, as most parents fail to recall if their child consumed fish. This case underscores the need for detailed clinical assessment to uncover uncommon causes of appendicitis. Thorough examinations should be... Continue Reading

Background: Salicylate toxicity can manifest with delayed symptoms that complicate prompt diagnosis and intervention. Although delayed peak concentrations after ingestion have been documented, reports of patients remaining asymptomatic for more than 20 hours are uncommon. Case presentation: We present the case of a 2-year-old female who ingested a highly toxic dose of 463 mg/kg of enteric-coated aspirin and remained asymptomatic for the initial 20 hours. Subsequently, she developed severe symptoms of increased respiratory effort and altered mental status with laboratory confirming combined respiratory alkalosis and anion-gap metabolic acidosis. Patient was initially managed through sodium bicarbonate alkalization and was later managed through hemodynamic dialysis due to persistence of symptoms. Conclusion: This case report underscoring the importance of vigilant monitoring and prompt intervention in patients with salicylate ingestion and possibility of delayed symptoms following asymptomatic period. Continue Reading