In the Arabian Gulf States (AGS), emergency medicine (EM) is well recognized and established as a specialty and has achieved many advancements in different areas, and in particular the emergency medical services. Board certified EM physicians from both international and national programs are leading the specialty development and progress, with national residency training programs in EM filling the shortage of physicians in the field. Although at a national level the EM organizations, conferences, and journals are available to support the specialty, research in EM is still lagging behind and needs major progression. There is still a big potential for improving the specialty, and many challenges and barriers to overcome. The article is a brief journey on the EM specialty in the AGS, and it reflects the status of EM in this rapidly growing part of the world. Continue Reading

Background: Hajj is an annual religious ritual that takes place for a specific period in Makkah city. Every year, the Kingdom of Saudi Arabia hosts more than two million pilgrims from more than 160 countries around the world for Hajj. It is crucial to minimize illnesses among pilgrims. This study aimed to assess the impact of preventive measures on acute illnesses among pilgrims. Methods: A retrospective cross-sectional study was conducted during the Hajj season from August to September 2019. A random sample was extracted from electronic evaluation forms filled by professional health care workers at two airports in Saudi Arabia including pilgrims before their departure and after the end of hajj season. Results: The study included 2,479 pilgrims. The most frequently associated comorbidity was Diabetes Mellitus in 49.54%. Upper respiratory tract infection was found in 39.17% and was the most common illness reported. Comorbidities had a crude odds ratio (OR)... Continue Reading

Background: Shared decision-making is an essential part of patient care. Patients need more information to support their decision-making about treatment options. An Arabic language decision aid (DA) for metastatic colorectal cancer patients (mCRC) was developed, considering systemic therapy (chemotherapy with or without targeted therapy) as a choice of treatment to assess its role in patients' decision-making. Methods: A multicenter randomized controlled trial was conducted in four out patients in oncology clinics in Saudi Arabia to measure patient certainty when selecting their treatment options and the satisfaction and willingness of oncology physicians using the Arabic DA among mCRC patients. Results: Ninety-two patients with mCRC considering first-line systemic therapy were randomly allocated to the intervention arm (DA with usual care) or control arm (usual care alone). The outcome measured the patients' certainty regarding their decision: Decisional Conflict Scale (DCS). 51 (55%) were randomized to the DA arm. Both arms scored low in... Continue Reading

Background: Emergency physicians (EPs) are exposed to various stressors that lead to burnout. No studies to date have examined these factors in the emergency departments (EDs) of the Kingdom of Bahrain. Objective: The study aims to identify the prevalence rates, associated variables, and predictors for burnout and stress among EPs in Bahrain's EDs. Methods: A cross-sectional study involving 134 EPs working in the ED of 3 major tertiary hospitals completed an electronic survey, which included the Copenhagen Burnout Inventory and Stress Overload Scale-Short Form. Results: The survey had a response rate of 86.7% (n = 116). EPs reported a prevalence rate of 81.0% for personal burnout, 69.8% for work-related burnout, and 40.5% for patient-related burnout. Approximately 23.9% EPs were at high risk for illness. Our measures illustrated that higher personal, work-related, and patient-related burnout was associated with higher personal vulnerability, event load, and stress overload. Other contributing factors for burnout... Continue Reading

Background: Currently, the demand for emergency medicine physicians is much higher than the available workforce. To overcome this issue, some institutions have increased their working hours. No previous study in Saudi Arabia addresses this issue and its impacts on physicians. Aim of the study: this study evaluates physicians health, social life, and decision making in 12 hours shifts compared against regular 8 hours. Methods: This cross-sectional study was conducted in various cities and hospitals in the Kingdom of Saudi Arabia using a questionnaire that surveyed 173 emergency physicians working in different hospitals across Saudi Arabia. Results: There were many similarities and differences between the participants who worked 12-hour shifts and those who worked 8-hour shifts. The most significant differences were that those who worked 12-hour shifts were more likely to be male than female and more likely to be married than unmarried. In addition, the 12-hour working physicians had more... Continue Reading

Background: Medical identification (ID) feature on smartphones provides healthcare providers (HCPs) with crucial information about the patient in emergencies. Utilizing medical IDs depends on public awareness. Objective: To estimate the level of awareness about medical ID features on smartphones among the public in Jeddah, Saudi Arabia, in 2020. The estimated awareness will be compared to similar studies in Saudi Arabia. Methods: This was a qualitative cross-sectional study. A standardized electronic questionnaire was distributed to the public of Jeddah. Responses of the participants were collected via a Google Form. The data were analyzed in Statistical Package for the Social Sciences V27 to answer the questions of interest. Results: In total, 388 participants met the inclusion criteria. Of the respondents, 36.3% were aware of medical ID features on smartphones, with more awareness among females and significant associations of awareness with age and education level (p = 0.004, p = 0.026). Additionally, the... Continue Reading

Background: In the emergency department (ED), pain is the most common complaint, especially among trauma patients. However, two-thirds of trauma patients are discharged from EDs with moderate to severe pain. Therefore, pain management is an important part of care in trauma patients. Objective: To assess the effectiveness of pain management among trauma patients in the ED. Method: This is a retrospective cohort study conducted on adult trauma patients who attended the ED in King Abdulaziz medical city (KAMC) in Jeddah from June 2016 to July 2018. The study evaluated if the pain was evaluated during the patient encounters, and the pain score was registered. Furthermore, we assessed if pain medications were administered, their type and dosage, and the pain score evaluation before and after administration. Pain score was scored using the numeric pain scale. Data were collected from the health information system (Best care®) and analyzed using SPSS version 24.... Continue Reading

Background: A disaster is a severe functional disruption of a community, and occurring over a short or long period of time that causes widespread human, material, economic, or environmental loss which exceeds the ability of the affected community or society to cope using its own resources. In this study, we aimed to assess the awareness and confidence of Saudi emergency medical services (EMS) students regarding disaster response skills, and to identify the preferred method of induction and training for coping with a disaster situation. Methods: A descriptive cross-sectional survey, modified from the Arabic Disaster Preparedness Evaluation Tool, was distributed in all colleges for EMS in Saudi Arabia, including government and private colleges, targeted at alumni of the EMS class of 2017/18. Results: A total of 329 surveys were collected. EMS students were shown to be prepared to face a disaster situation (M = 3.44; M = 3.84). Practical simulations and... Continue Reading

End-of-life care (EOLC) care is a unique specialty consisting of comprehensive multidisciplinary healthcare delivery to patients with a wide range of terminal illnesses. However, this form of care raises many ethical questions, and some religions disregard several actions of EOLC. While a complete understanding of all faiths is challenging for a busy healthcare professional, a good grasp of the major religions is essential. In this review paper, we focus on the ethical dilemmas of EOLC in Saudi Arabia from an Islamic perspective, emphasizing the ethics of the right of care. This review helps to demonstrate that the literature on EOLC is global and yet inconclusive in some areas. In Saudi Arabia, there are now more than 15 comprehensive cancer centers with palliative care units. Palliative care is becoming increasingly relevant in the Kingdom as the number of patients diagnosed with severe life-threatening illnesses rises. Despite this, healthcare practitioners' awareness of... Continue Reading

Background: Thyroid storm is a life-threatening health condition associated with hyperthyroidism. Apathetic hyperthyroidism is an atypical presentation of the thyrotoxicosis spectrum; this atypical presentation of apathetic thyroid storm makes the diagnosis of thyroid storm more challenging. Case Presentation: A previously healthy 23-year-old female presented to the emergency department with a 3-hour history of inability to talk or move limbs. Initial clinical examination showed that patient was conscious, alert, and febrile, with no external rashes or neck stiffness but was unable to move all limbs. Increased reflexes in all four limbs with no clonus and no rigidity was found. There was no sign of stroke in computed tomography scan, and other neurological assessments were normal. Cardiac examination showed persistent sinus tachycardia reaching 160 heartbeats per minute, despite antipyretic and fluid treatment. This finding raised the suspicion of hyperthyroidism and thyrotoxicosis. Thyroid function test revealed thyroid stimulating hormone level of 0.005 μlU/ml,... Continue Reading

Background: Ocular compartment syndrome (OCS) is a severe ophthalmological emergency that should be diagnosed and treated immediately to prevent permanent loss of vision. It is usually caused by a retro-orbital bleed that increases intraorbital pressure and threatens the patient's vision. This paper aims to present a rare case of OCS and the procedure of lateral canthotomy and acantholysis. Case Presentation: We present a 13-year-old boy who presented with facial injuries caused by a motorbike accident. The patient had vomited multiple times and was fully conscious. The patient had profound signs of increased intra-orbital pressure, which was found to be 70 mmHg. A significant right peri-orbital edema and ecchymosis of the right eye were present. The diagnosis of OCS was made, and lateral canthotomy with acantholysis procedure was performed. After the procedure, the pressure dropped, and vision was saved. Upon opening the eye, a flat retina, pale macula, and disc with... Continue Reading

Background: The use of electronic cigarettes (e-cigarettes) is increasing worldwide. Allergic reactions have been reported from the metal used, and a few cases have been reported of angioedema of the lip, but none were related to the e-cigarette liquid. Case Presentation: We report a case of allergic reaction with angioedema from e-cigarette liquid, most likely histamine-mediated angioedema, in a healthy 24-year-old Saudi man, who did not have a history of any allergy or atopy. The subject presented complaining of left lower lip swelling 1 hour after smoking an e-cigarette and spilling liquid into the mouth. The case reported no shortness of breath, skin rash, or tongue swelling. On examination, vital signs were normal. The patient had left lower lip swelling and gingival erythema. The patient reported having experienced a similar episode in the past with a different type of e-cigarette liquid on the right lower lip, but it was less... Continue Reading

Background: Massive pulmonary embolism (PE) is a deadly disease that can be managed by thrombolytic therapy to save patients' lives. A case of postpartum woman Who presented to the emergency department (ED) with cardiac arrest due to massive PE. Case presentation: We report a case of 34-year-old woman who presented to the ED with cardiac arrest due to massive PE 2 weeks post-uncomplicated spontaneous vaginal delivery. She was managed by a comprehensive multidisciplinary team approach, cardio-cerebral resuscitation (CCR), and systemic thrombolysis. The thrombolysis resulted in massive vaginal bleeding, which led to a prolonged cardiac arrest. This was recognized timely and managed adequately. The patient survived and was discharged home with a good neurological and cardiovascular outcome. Conclusion: Vaginal bleeding may occur post thrombolysis in post-partum life-threatening PE, which can be resolved by a multidisciplinary team-based approach coupled with CCR. Continue Reading