Background Pain is a subjective but critical clinical symptom and should be managed with the same urgency as other vital signs in the emergency department (ED). Delayed analgesia, particularly among patients triaged to lower-acuity areas, contributes to prolonged suffering and reduced patient satisfaction. This study evaluated the impact of a structured Quality Improvement (QI) initiative aimed at improving timeliness and effectiveness of pain management in the ED.   Objective To reduce door-to-analgesia time by at least 25% from baseline and improve time to 50% reduction of initial pain score among adult ED patients with moderate to minor injuries.   Methods A prospective QI study using Plan–Do–Study–Act (PDSA) cycles was conducted over 8 weeks in a tertiary care emergency department with a 3-tier triage system. Adults aged ≥18 years presenting with pain scores ≥1/10 were included. Baseline data were collected for 50 consecutive patients over 2 weeks. Interventions included staff education... Continue Reading

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

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

Emphysematous cholecystitis (EC) is a rare but severe form of acute cholecystitis, distinguished by the presence of gas within the gallbladder wall, lumen, or surrounding tissues. It predominantly affects elderly, diabetic, and immunocompromised individuals and carries a significantly higher risk of complications and mortality compared to typical acute cholecystitis.  A case study shown a 70 years old lady with comorbid of hypertension and hyperlipidemia presented to emergency department with two days history of abdominal pain which more over the epigastric region radiated to the right side with concurrent episodes of vomiting. She was also complaining of  having loose stool for the past two days . However , no fever was documented . Upon examining her,  vital sign was stable ,however in the abdomen, there was tenderness over the right iliac fossa with positive Murphy sign.Bedside transabdominal ultrasound of the gallbladder revealed mixed hypoechogenicity over the liver segment II surrounding the... Continue Reading

Objective: This study aimed to describe occupational injury patterns and outcomes and explore associations between injury characteristics and clinical outcomes. Methods: A retrospective cross-sectional study was conducted in the Emergency Department (ED) of Rashid Hospital Trauma Center (RHTC), Dubai Health (DH), between November 2019 and December 2021. Adults aged 18–60 years who were identified during ED triage by nurses as having sustained an occupational injury, defined as a physical injury incurred as a direct result of employment, were included. Results: Among 6,730 included patients, 6,480 were male (96.3%), and the median age was 32 years (interquartile range 12; range 18–60). The most common causes of injury were direct trauma (30.1%), falls (25.6%), and sharp objects (20.5%). Isolated soft tissue injury was the predominant injury type (69.7%). Hospital admission occurred in 896 patients (13.3%), and 66 (1.0%) required intensive care unit (ICU) admission, most commonly due to head injuries. Eight deaths... 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

Background: Cesarean scar ectopic pregnancy (CSEP) is a rare but potentially life-threatening type of ectopic pregnancy in which implantation occurs within the myometrial defect of a prior cesarean scar. Early recognition is critical due to the risk of severe hemorrhage, uterine rupture, loss of fertility, and maternal death. We report a case of CSEP diagnosed by point-of-care ultrasound (POCUS), highlighting key sonographic findings. Case Presentation: A 37-year-old female presented with lower abdominal pain and amenorrhea. Investigations were positive for pregnancy. POCUS revealed a viable ectopic pregnancy embedded within the myometrium at the cesarean scar, with endogenous growth toward the uterine cavity. These findings were consistent with CSEP, which prompted an emergent obstetric consultation for definitive treatment. Conclusion: This case highlights the potential of POCUS in the emergency setting to expedite CSEP diagnosis and prompt early obstetric consultation, where early recognition may improve clinical outcomes. Therefore, it is important for emergency... Continue Reading