Background: Right-sided diverticulitis, particularly cecal diverticulitis, is a rare condition that can mimic other causes of acute abdomen and pose a diagnostic challenge.Case Presentation: A 57 year old male presented with acute tearing epigastric pain followed by lower abdominal pain. Examination revealed bilateral iliac fossa tenderness with guarding in the right iliac fossa and positive psoas and obturator signs. Laboratory testing showed elevated C reactive protein (70 mg/L) with otherwise unremarkable results. Because the initial tearing epigastric pain raised concern for serious conditions, including acute coronary syndrome, pancreatitis, and aortic pathology, cardiac enzymes, ECG, serum lipase, and contrast‑enhanced CT were obtained, which excluded these diagnoses. Abdominal ultrasound demonstrated focal bowel wall thickening in the right lumbar region. Contrast‑enhanced CT identified a cecal diverticulum with surrounding pericolic fat stranding and localized inflammatory changes without abscess or perforation, consistent with Hinchey stage Ia cecal diverticulitis. The patient was managed conservatively with intravenous ceftriaxone... Continue Reading

Introduction: The history of traumatic injury treatment is a progression from crude ancient practices to modern trauma systems, marked by significant developments in military medicine, surgery, and understanding of physiology. Key milestones include early documentation in ancient Egypt, the extensive but primitive record-keeping of the American Civil War, the introduction of antisepsis, the development of trauma centers, and advancements in casualty evacuation and the treatment of shock. There is a direct link between military and civilian trauma care that starts during the Civil War and continues until the current conflict in Ukraine. The wars of the last two decades have changed the nature of injuries seen on the battlefield, leading to further trauma management innovation. Trauma is a global burden of disease that is responsible for 5 million deaths around the world annually. Lessons learned in these hostile environments have guided many developments in trauma care in high-income countries, resulting... Continue Reading

Background Injury remains among of the leading causes of morbidity and mortality worldwide, with predominance in low-income and middle-income countries. It has been, an increasingly significant public health issue worldwide, with road traffic injuries in the rise, accounting for 16% of the global burden of disease. Despite of the observed increase in number of road traffic injuries, provision of initial care to patients sustaining such injuries is one of the big challenges. Objective The objective of this study was to describe the initial care given to road traffic injury patients, who were admitted at Muhimbili National Hospital in Tanzania from January to February, 2016. Methodology The study employed a cross-sectional study design to obtain information on the post-crash trauma experiences among road traffic injury patients admitted at trauma units of the Muhimbili National Hospital in Dar es Salaam-Tanzania from January to February, 2016. The consecutive convenient sample of 132 road... Continue Reading

Background: Discharge against medical advice (DAMA) is a common problem worldwide, associated with increased mortality rates and higher emergency department (ED) revisit rates. This study examines the characteristics, reasons and clinical outcomes of the patients leaving from the Emergency against medical advice. Materials and Methods: This is a cross-sectional study conducted at the Lebanese American University Medical Center's ED between 2019 and 2022. Data on patient demographics, reasons for DAMA, and trends over time were analyzed. Results: Over the 4 years duration, 42,672 patients visited the ED, of whom 2,767 (6.4%) left against medical advice. DAMA rates varied across the years: 3.6% in 2019, rising to 7% in 2020, peaking at 10% in 2021, and declining to 5.8% in 2022. The increase in 2020 and 2021 coincided with Lebanon’s economic collapse that hit the country end of 2019. The most frequently cited reason for DAMA was financial constraints which accounted... Continue Reading

Background: Acute dyspnea and shock are among the most common and time-sensitive presentations in emergency and critical care settings. Rapid identification of underlying cardiac etiologies is essential to guide appropriate management. Conventional diagnostic tools such as electrocardiography, chest radiography, and cardiac biomarkers often provide indirect or delayed information. Point-of-care echocardiography (POCUS) enables immediate bedside assessment of cardiac structure, function, and hemodynamics, with emerging quantitative Doppler techniques offering enhanced diagnostic precision. Case Series: We present a case series of three patients presenting with acute dyspnea due to distinct cardiac pathologies, highlighting the diagnostic and therapeutic value of focused echocardiography. The first case involved a patient with ischemic cardiomyopathy complicated by left ventricular thrombus and cardiogenic shock, where POCUS identified severe biventricular dysfunction and guided early initiation of inotropes and anticoagulation. The second case demonstrated heart failure with preserved ejection fraction (HFpEF) and pulmonary edema due to a mitral valve fibroelastoma, where... Continue Reading

This study evaluates the implementation of the Global Initiative for Asthma (GINA) guidelines in asthma management within an emergency department (ED) setting. A pre- and post-intervention design was employed to assess key asthma management metrics. Results demonstrated significant improvements in peak expiratory flow (PEF) measurement, discharge practices, follow-up adherence, and reductions in hospital admissions. The findings underscore the potential benefits of evidence-based guidelines in optimizing asthma care (Global Initiative for Asthma, 2021). Continue Reading

INTRODUCTION Unscheduled return visits (RVs) to Pediatric Emergency Departments within 72 hours of discharge remain a critical quality metric in Pediatric Emergency care.Numerous studies have highlighted a trend among caregivers to return to ED rather than consult primary care providers when a child’s symptoms persist or worsen, contributing to ED overcrowding, clinician fatigue, and diagnostic delays. Children returning within a short interval are typically assigned higher triage categories due to concerns about disease progression or missed diagnoses,necessitating specialist evaluation or inpatient admission. These return visits are also associated with increased clinical risks, including a higher chance of complications or mortality.   OBJECTIVE This study aims to investigate the clinical characteristics,revisit patterns,and outcomes of pediatric patients who return to the emergency department within 72 hours of discharge   METHODOLOGYA retrospective chart review was conducted across five emergency departments operated by the ChildLife Foundation over a six-month period, from December1,2024, to May31, 2025.Data... Continue Reading

Introduction: The emergency department is a high-pressure environment where rapid assessment and intervention can mean the difference between life and death. Vital signs, including blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation, serve as primary indicators of a patient’s physiological status. ABG analysis, on the other hand, provides crucial insights into respiratory function, acid-base balance, and metabolic status. This study tried to analyze deaths over a year in an emergency department in a tertiary care centre and identify hemodynamic and blood gas parameters that could predict early death in ER. Aims and objectives;  Analyze mortality patterns and their association with vital signs and arterial blood gas (ABG) parameters on arrival to the ER. Methodology:  This was a retrospective study conducted in the emergency department (ED) of AIIMS Patna over a one-year period ( Jan 1 , 2024 to 2025 ). Patients were categorized into two groups based on... Continue Reading

Background: This systematic review synthesizes evidence on the prevalence, causes, and associated factors of non-urgent emergency department (ED) visits in Saudi Arabia, which contribute to overcrowding, increased costs, and delays in urgent care.Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched from inception to the search date. We included observational studies from Saudi Arabia reporting prevalence, reasons, or factors associated with non-urgent ED visits. Three reviewers screened titles/abstracts and assessed full texts. Two reviewers extracted data using a standardized form and assessed study quality using Joanna Briggs Institute critical appraisal tools. Because of heterogeneity across definitions and outcomes, we synthesized findings narratively.Results:Eleven studies published between 2002 and 2024 were included (total sample size 30,684). Non-urgent ED visit prevalence ranged from 20.7% to 82.4% (mean 49.75%). Most studies defined non-urgent visits using the... Continue Reading

Introduction: Anisocoria is a significant clinical sign that may indicate serious neurological conditions such as third cranial nerve palsy, intracranial hemorrhage, or uncal herniation. However, it can also be caused by benign disorders like Adie-Holmes syndrome. Adie pupil is characterized by a tonically dilated pupil with poor or absent light reaction and preserved, though often slow, near response. It is caused by postganglionic parasympathetic denervation at the level of the ciliary ganglion. The condition typically affects young women and is unilateral in 80% of cases. When accompanied by diminished or absent deep tendon reflexes, the condition is referred to as Adie-Holmes syndrome. We report a case of a man diagnosed with Adie pupil after comprehensive emergency evaluation. Case:A 39-year-old man presented to the emergency department with the complaint of blurred vision and a dilated right pupil noticed on awakening.  He denied any history of trauma, headache, diplopia, nausea, or systemic... Continue Reading

Background: Snakebite envenomation remains a life-threatening emergency in rural and resource-limited settings, where delayed presentation, limited access to antivenom, and fragmented referral systems contribute to morbidity and mortality. In the Philippines, cobra envenomation commonly results in neurotoxic manifestations requiring urgent intervention.Methods: We present a case series of four patients with neurotoxic snakebite envenomation treated with purified cobra antivenom (PCAV) at the emergency department of a tertiary referral hospital in Northern Luzon in 2024. Data were retrospectively reviewed, including demographics, clinical presentation, timing of referral, antivenom administration, supportive management, and outcomes.Results: Among 193 emergency department consultations for snakebite, 28 patients required admission, and four received antivenom. Patients included one pediatric case, two adult males, and one elderly patient with multiple comorbidities. All patients presented with neurotoxic features such as ptosis, dysarthria, dysphagia, or altered sensorium. Two patients required endotracheal intubation and mechanical ventilation, including one who suffered cardiac arrest during interfacility... Continue Reading

This case report presents the effective management of a rare and life-threatening spontaneous hemothorax resulting from the rupture of an intercostal artery aneurysm in a patient with undiagnosed neurofibromatosis type 1 (NF-1). The patient exhibited acute chest pain and hemodynamic instability, requiring a multidisciplinary strategy that included permissive hypotension and interventional radiology (IR). Coil embolization successfully managed the hemorrhage, resulting in hemodynamic stabilization and positive patient outcomes. This case highlights the significance of promptly identifying spontaneous hemothorax in NF-1, the necessity of targeted resuscitation strategies, and the effectiveness of minimally invasive endovascular techniques in addressing vascular complications. This case study highlights the complexities involved in addressing an atypical presentation of an undiagnosed case of NF-1, which was further complicated by a sudden spontaneous hemothorax resulting from the abrupt rupture of an intercostal artery aneurysm. This underscores the essential importance of promptly identifying life-threatening bleeding and the necessity for a resuscitation... Continue Reading

Background Emergency Departments (EDs) are increasingly affected by crowding, prolonged patient stays, and delayed transfer of care, increasing the risk of missed or delayed recognition of clinical deterioration. At Royal Derby Hospital ED, delays and inconsistencies in escalation following abnormal National Early Warning Score 2 (NEWS2) observations were identified as a patient safety concern. A sentinel event involving a patient with viral myocarditis, where delayed escalation and response contributed to a fatal outcome, triggered this quality improvement project (QIP). Although trust escalation guidance existed, adherence was inconsistent and did not reflect ED workflow. Aim To improve compliance with timely escalation and response for deteriorating adult patients in the ED from 56% to 80% within 6 months, by standardising escalation pathways and embedding reliable NEWS2-aligned escalation processes. Methods A multidisciplinary QI team was established including ED consultants, registrars, nursing staff, healthcare assistants (HCAs), junior doctors, and digital transformation colleagues. The project... Continue Reading

IntroductionCalcium channel blocker (CCB) overdose is a leading cause of cardiovascular drug-related mortality, typically presenting with refractory hypotension, bradycardia, and metabolic acidosis . While initial therapy—including calcium, high-dose insulin euglycemia therapy (HIET), and vasopressors—remains the mainstay of management, extracorporeal membrane oxygenation (ECMO) serves as a salvage intervention in cases of refractory cardiogenic shock. A systematic review reported an 84.6% survival rate with ECMO in CCB overdose, reinforcing AHA recommendations to VA-ECMO in refractory shock unresponsive to maximal medical therapy . We report a case of amlodipine-induced vasoplegic shock successfully managed with VA-ECMO. Case Presentation:A 37-year-old woman with hypertension and hypothyroidism presented 15 hours after ingesting 220 mg of amlodipine and 6 g of paracetamol in a suicide attempt. She was hypotensive and acidotic despite early fluid resuscitation, High-dose insulin euglycemic therapy, vasopressors, glucagon, and intralipid. She then deteriorated to refractory vasoplegic shock with pulmonary edema requiring mechanical ventilation. A worsening... Continue Reading

Introduction: Measles is a contagious airborne disease which is vaccine preventable, although included in the extended programme of immunization with administration of two doses at 9 and 15 months of age. It remains a menace for children or causing short- and long-term complications and even death in infected patients. According to WHO an 11-fold rise in 2025 was reported as compared to the same period in 2024. Objective: The objective of this study is to analyse the cases of measles presenting in the paediatric emergency department of Dr Ruth K M Pfau Civil Hospital Karachi. Method: It is a retrospective analysis of three years data from May 22- Apr 25 of measles patient who visited the ED and a clinical diagnosis of measles is made. The study includes all patients from 1 month to 13 years of age triaged as P1, P2 and P3 according to the WHO ETAT system.... Continue Reading

Objective: The purpose of this study was to determine what emergency physicians think about SDM in their practice. Methods: A cross-sectional study was performed in the department of emergency medicine of a tertiary hospital in Jeddah, Saudi Arabia from December 2025 to February 2026. The validated Shared Decision Making Questionnaire – Physician Version (SDM-Q-Doc) was used to gather data. Descriptive statistics were made and multiple linear regression analysis was conducted to determine factors associated with SDM scores.Results: A total of 82 physicians participated, yielding a response rate of 97.6%. The mean overall SDM-Q-Doc score was 45.91 ± 7.26 (85.0% of the maximum score), indicating a high level of physician-perceived SDM practice rather than directly observed clinical practice. Higher scores were observed for items related to information provision, while lower scores were noted for collaborative decision-making components. The SDM-Q-Doc demonstrated excellent internal consistency (Cronbach’s α = 0.926). In multivariable analysis, physicians aged... Continue Reading

Objective: This study aimed to assess aspirin formulation use for acute chest pain in emergency departments and primary care centers in Saudi Arabia, with a focus on Ministry of Health facilities. Methods: A cross-sectional, anonymous, convenience-based electronic survey was conducted among the healthcare professionals involved in the care of patients with acute chest pain in the Ministry of Health emergency departments and primary care centers. The survey assessed aspirin formulation, dose, and method of administration, as well as knowledge regarding enteric-coated aspirin absorption, availability of non-enteric aspirin, and willingness to change practice. Results: A total of 58 participants, most of whom worked in emergency departments (79.3%) and were emergency physicians (74.1%), were included. Enteric-coated aspirin was reported as the most commonly used formulation for acute chest pain (57%), most often administered by swallowing the tablet whole (58.6%), and 69.0% of participants were aware that enteric-coated aspirin has delayed absorption. Only... Continue Reading

Objective: This study aimed to evaluate the pain management practices for oncology patients in the emergency department (ED), focusing on pain assessment, analgesic use, and treatment effectiveness.Methods: This retrospective cohort study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia, from January 2020 to December 2023. A total of 341 oncology patients who presented to the ED with pain were included. As pain scores for most patients were missing, observed values were retained, and a transparent, conservative approach was used to estimate missing scores to enable inferential analyses. The primary outcome was effective pain relief (≥2-point reduction, 0–10 scale).Results: The mean age was 54 years, and 47% of participants were male. Pre-treatment pain scores were documented in 18% of patients; reassessment after analgesia was recorded in 28%. The mean pain score decreased from 7.4 pre-treatment to 1.6 post-treatment (p < 0.001). Opioid use was associated with greater odds... Continue Reading

Background: Emphysematous gastritis is a rare, life-threatening infection of the stomach wall caused by gas-forming bacteria. Fewer than 200 cases have been reported. The mortality rate has declined from 60% to 33% owing to earlier diagnosis and improved care. This report presents a case of emphysematous gastritis, highlighting the challenges with diagnosis and management.Case presentation: A 70-year-old woman with unresectable cholangiocarcinoma and hepatic metastases presented with fever, abdominal pain, and coffee-ground vomiting. Imaging revealed gas within the gastric wall consistent with emphysematous gastritis. She was managed conservatively with intravenous antibiotics, fluids, and proton-pump inhibitors. Despite treatment, her condition worsened and she was transitioned to palliative care. She died on hospital day 21.Conclusion: This case describes the difficulties in managing emphysematous gastritis in a patient with a complex medical history and advanced malignancy and the unfavorable outcome despite timely and appropriate treatment. It highlights the need for early recognition of emphysematous... Continue Reading

Background: Artificial intelligence (AI) has the potential to improve diagnosis accuracy and speed in emergency rooms; yet, its acceptance and use by emergency physicians in Saudi Arabia remain limited.Methods: A descriptive cross-sectional survey was issued to emergency physicians in Saudi Arabia. The questionnaire looked at demographics, AI exposure, perceived benefits and problems, and overall views toward AI. The data were evaluated with descriptive statistics, chi-square tests, ANOVA, and logistic regression.Results: A total of 352 physicians participated, the majority of whom were young residents. Only 11.6% said they used AI on a regular basis. The majority of physicians (65.3%) had a negative attitude, whereas 6.8% were optimistic. Consultants had more favorable perceptions than residents. Attitudes differed considerably by region, age, gender, country, and professional level (p < 0.05). Key perceived benefits included increased diagnostic accuracy and speedier decision-making, while major hurdles included a lack of training, system inaccuracy, and difficulties interpreting... Continue Reading