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Background: Simulation-based basic airway management training may enhance the learner's competence and offer practitioners the opportunity to practice infrequently applied skills in cases with difficult airway management. Here, we aimed to examine the effectiveness of implementing the American College of Surgeons/ Association for Surgical Education (ACS/ASE) simulation-based Basic Airway Management module in the current medical school curriculum in PNU. Methods: This is a quasi-experimental study in which 44 students were enrolled in the training course; the instructors comprised six practicing physicians and technicians from the anesthesia and emergency departments. The students were divided among six groups for a 20-minutes hands-on training. Cognitive assessment and performance rating scale were conducted after the introduction of the module. An independent t-test was applied to analyze the pre- and post-test training scores for the cognitive assessment and performance rating scale. Statistical significance was set at p < 0.05. Results: There was a significant improvement... Continue Reading

Introduction: Overcrowding in the emergency department (ED) seems to be a major barrier toward providing appropriate medical service and is associated with increasing in-hospital mortality. This study aimed to investigate unscheduled return visits to the ED within 72 hours, to identify the most common chief complaints/ diagnoses, and to estimate the mortality rate within 1 month of that visit. Methods: A cross-sectional retrospective study was conducted among patients above the age of 15 of both genders; Saudis and non-Saudis were included. The work was carried out at King Abdulaziz Medical City, Riyadh, from January to December 2017. The data were extracted from the BESTcare system, and there were 11,177 (6.1%) out of 182,602 visits to the ED which were unscheduled return visits. A computerized simple random sampling technique was used, and we enrolled a total of 375 revisits. The main variables were age, gender, chief complaints of the first and... Continue Reading

Background: The emergency department (ED) waiting room duration has been a challenge in many EDs. This study has implemented a focus plan-do-study-act (PDSA) cycle study on ED waiting room patients in a private hospital in Kuwait. Each PDSA cycle included one of the following interventions: hospitality measures, number of triage nurses, number of ED physicians, and number of receptionists to see their impact on the ED waiting times. Methods: The waiting times were collected per patient coming into the ED and their assigned Canadian Triage Acuity Scale (CTAS) level over a 12-month period, as well as the number of patients left without being seen (LWBS). Each intervention was introduced into the ED and a 2-month period following each was given to see the effect on the waiting time. Results: As divided per CTAS level, there were 38,157 patients included in the analysis. The results showed that for every increase in... Continue Reading

Background: Patients' avoidance of medical care and visiting emergency departments (EDs) during the viral coronavirus disease-2019 (COVID-19) pandemic has been reported in many countries; however, similar studies are almost absent in Saudi Arabia. We aimed to (1) study the tendency to avoid or delay medical care during the COVID-19 pandemic, (2) identify factors that affect patients' decision to visit an ED when required, and (3) examine the medical consequences and possible complications in terms of a patient's health due to avoiding medical care during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted using a descriptive and analytical survey to explore the prevalence of patient avoidance of medical care. The survey was distributed through social media websites to the population of Saudi Arabia. Results: Of the 1,275 participants in this study, 51% were male and the majority (77.8%) were aged between 21 and 49 years. Forty-four percent (n =... Continue Reading

Background: The Canadian Triage and Acuity Scale (CTAS) is a scale that identifies the urgency of the case and helps to determine the time needed to be assessed by the physician in the emergency department (ED). However, further research is needed to identify factors that need to be taken into consideration in future CTAS to avoid misclassification of non-urgent patients at high risk who need admission and can be triaged away from the ED. The aim of the study was to evaluate the admission of non-urgent patients to decrease the burden on the ED by triaging them away from primary health care (PHC). Methods: A descriptive-analytical retrospective cohort study was performed including all patients who presented to the ED of King Abdullah Medical Center, Makkah, during a period starting on 9 May 2019 and were classified as CTAS levels 4 and 5. Data of those patients regarding CTAS levels, sex,... Continue Reading

Background: Tracheal intubation (TI) is an intervention in the Emergency Department (ED) to stabilise children and to protect the airway. The aim of the study was to investigate the prevalence of TI, the number of attempts to achieve successful intubation, the indications and the adverse outcomes related to TI in the paediatric population. Methods: A quantitative cross-sectional study, using a chart review of the hospital's electronic database, was conducted with paediatric patients who required intubation, from May 2015 to the current date. Results: A total of 159 paediatric patients' records were analysed. The proportion of a successful first intubation attempt was 87.4% (n = 139), two attempts 6.9% (n = 11), and three or more attempts 5.7% (n = 9). The most frequent indication for TI in the sample was trauma (35.3%, n = 55). In terms of TI-related complications, 22% (n = 35) experienced at least one complication. Of... Continue Reading

Background: Activating the emergency medical services (EMS) system in case of medical emergencies must be quick and precise. This study was designed to measure public awareness of Riyadh's EMS phone number. Methods: This is a cross-sectional study. It identifies major public hubs in Riyadh, Saudi Arabia, as the target locations. It was conducted from September 1st 2019 to December 31st 2019. A semi-structured survey was developed and distributed in person using convenience sampling to measure public awareness of EMS phone number. Ethical approval was obtained to include both adult and youth populations. Results: A total of 4,806 participants agreed to complete the survey, 2,690 (56%) were male and 2,116 (44%) were female. The majority of participants ,(3,986, 82.9%) were adults above the age of 18, while 820 (17.1%) were minors under the age of 18. In terms of education, 3,320 (69%) participants had completed college-level or higher. Saudi citizens totaled... Continue Reading

Background: Information and promoting awareness of emergency medicine (EM) as a vital and independent branch of medicine has been a core component of the national undergraduate medical curriculum for a number of years. This project aims to assess how successful this integration has been by evaluating clinical-level students on their knowledge, exposure, and overall opinion of the subject. Methods: A survey was conducted by means of a cross-sectional online questionnaire that was made available to clinical year students in all medical colleges in Saudi Arabia. Demographic data, descriptive statistics, and correlation analyses were then carried out to discern if any patterns or commonalities could be found. Result: A total of 356 medical students participated in the study. Regarding EM perception and interest, a significant variance in responses was highlighted between the 4th, 5th, and 6th-year students. Regarding exposure, 68.8% did not have the EM as an independent course module, and... Continue Reading

Background: Heart-type fatty acid-binding protein (H-FABP) is a new biochemical marker which is recently being used in the early diagnosis of acute coronary syndrome (ACS) in the early phase at 0-3 hours of chest pain onset. The aim of this study was to diagnose ACS patients early in the ER using H-FABP in the early stage during 0-3 hours of chest pain. Methods: This is a cross-sectional descriptive study that included 41 ACS patients who presented to the emergency department of the Suez Canal University Hospital, who fulfilled the inclusion and exclusion criteria. Results: Out of the 41 patients of ACS, 26 were male and 15 were female with a mean age of 56.8 ± 12.9 years. It was found that H-FABP was elevated in 68.3% of the patients at 0-3 hours of chest pain which increased to 80.5% at 3-6 hours of chest pain onset with 76.2% sensitivity at... Continue Reading

Background:The percentage of affected children in mass casualty incidents (MCIs) in Saudi Arabia is high (39.1%). Thereby, this study aimed to assess the level of preparedness, preparedness plans, and the knowledge of pre-hospital workers related to pediatric patients in MCI. Also, to identify training methods needed in order to highlight the critical points of improvement regarding emergency medical services (EMS) personnel awareness. Methods: This was a descriptive cross-sectional study carried out among pre-hospital care providers of the Saudi Red Crescent authority stations and Ministry of Health EMS departments in Riyadh City. The questionnaires were distributed to 239 pre-hospital workers, who were selected by convenient sampling. Results: A total of 200 pre-hospital workers completed the questionnaire, with a response rate of 84%, where 97.5% were males. Only 36% participants had pediatric trauma training in the past year and 64% participants had never triaged pediatric trauma patients. Conclusion: There was lack of... Continue Reading

Background: Bronchiolitis is the most common reason for hospitalization and frequent cause of viral infection. This study aimed to determine the risk factors for severe bronchiolitis in children admitted through the emergency department at Sultan Qaboos University Hospital in Oman. Methods: A retrospective chart review was conducted among children Continue Reading

Background: The emergency department (ED) is a crowded area with complex workflow. Broad spectrum antibiotics given within the first hour of recognizing sepsis have proven to lower the mortality rate. Initiating optimal dose of Vancomycin to attain targeted serum level is an important role of emergency physicians and pharmacists. Objective: To evaluate the efficacy and safety of Vancomycin loading dose (VLD) (25-35 mg/kg) in reaching the targeted Vancomycin serum trough level compared to regular dose (15-20 mg/kg) in ED. Study design and settings: A multicenter, retrospective, cohort study. Methods: The study was carried out in four hospitals in Saudi Arabia; patients who received VLD were matched in a 1:1 fashion based on age category and diagnosis suspected in the ED. Inclusion criteria were age ≥14 years, diagnosed with serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA), and microbiology culture confirmed MRSA. Exclusion criteria were missing weight, SCr, or Vancomycin trough... Continue Reading

Background: In response to the coronavirus disease 19 (COVID-19) pandemic, a new set of rapid measures for containment was necessary to deal with the medical emergency, and emergency services are a vital part of this response. However, if poorly handled, it can facilitate transmission to patients and healthcare workers. Yet, the practice-based exercises required to evaluate the preparedness of healthcare facilities in face of the current pandemic are lacking. We aim to assess the applicability of emergency procedures for respiratory pathogens for tertiary medical center in Saudi Arabia. Methods: Suitability and rapidity of the response were measured by conducting the "Homeland Security Exercise and Evaluation Program" simulation in which six medical evaluators observe the admission procedures of four mock victims of COVID-19 to the Emergency Department in King Abdulaziz University Hospital, Jeddah. Results: A total of 27 healthcare workers participated in the exercise during March 2020. The simulation drills gave... Continue Reading

Background: Even though ultrasound is an excellent tool in medical diagnostics and evaluation, its lack of full automation can be a substantial downside. In this study, we evaluated the result of bedside ultrasound right upper quadrant (RUQ) pain by physicians in the emergency ward of King Saud University Medical City when compared to the review of the diagnosis by hospital radiologists. Methods: By means of a questionnaire, data were collected from King Saud hospital patients who presented with RUQ pain suggesting biliary disease in the emergency department. The questionnaire was made available on-site and a notification was passed to all on-duty physicians per shift to fill it out after the initial investigation of RUQ pain and to place the printout in a collection box. Results: Half of the initial diagnoses were cholelithiasis (53.6%), followed by cholecystitis (30.4%), and lastly cholangitis (3.4%), making the majority of suggested diagnoses related to the... Continue Reading

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Background: Only 1% of all aortoiliac aneurysms could be presented with isolated internal iliac artery aneurysms with an incidence of 0.1% in the general population. Patients are mostly asymptomatic, yet they can present with clinical presentations related to aneurysm size and adjacent anatomical structures. Case Presentation: We report the case of a 76-year-old male patient with ruptured isolated internal iliac artery aneurysm presenting as ecchymosis and severe thigh pain with redness and discoloration. The patient was known hypertensive, diabetic type 2, and had end-stage renal disease but was not on regular hemodialysis. The patient's vital signs and systemic and abdominal examination were unremarkable, further laboratory tests were also normal. There was no sign of surrounding cellulitis and all the peripheral pulses were intact and normal. Because of unclear diagnosis and repeated visits to the emergency department, the patient was admitted for further investigation to rule out malignancy. CT abdomen was... Continue Reading

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