Sepsis has been regarded as one of the cardinal causes of death across the globe. Its significance and time-critical nature accounted for 20% of worldwide deaths, according to a 2024 WHO study. As for the Hong Kong condition, Ling et al. have documented a 21% surge in incidence and 1-in-4 deaths from 2009 – 2018 in the Intensive Care Unit of Hong Kong, leading to a major health burden to society. Emergency Department (ED) Nurses as the ‘gatekeeper’ for various life-threatening diseases, while it appears not to be the case in the ‘Hour-1-Sepsis Bundle', judging by its low compliance rate. Nevertheless, various studies focused on Sepsis management instead of reviewing knowledge, attitude, and self-reported competencies of ED Nurses towards Sepsis screening, or implementing educational programs prompting early identification of Sepsis in the ED  This is a single-center interventional study conducted in the ED of Kwong Wah Hospital. 70 eligible ED... Continue Reading

Methemoglobinemia is a rare but life-threatening hematologic condition where hemoglobin is oxidized from the ferrous (Fe2+) to the ferric (Fe3+) state, impairing oxygen delivery to tissues. While congenital forms exist, acquired methemoglobinemia often triggered by medications or chemical exposures is more common. Prevalence in pediatric populations is estimated at approximately 0.0015%. ​ Case Presentation: A 6-year-old male presented to the Apollo Hospitals Navi Mumbai Emergency Department with fever, abdominal pain, vomiting, epistaxis, and acute breathlessness. Physical examination revealed central and peripheral cyanosis with an SpO2 of 88% on room air, which only improved to 92% despite high-flow oxygen (10L). Notably, the patient had a history of exposure to a watch repair solution and prior consumption of "outside food." ​ Diagnostic Workup: Venous Blood Gas (VBG) analysis confirmed methemoglobinemia with a level (FMetHb) of 31.0% and respiratory alkalosis. Laboratory results showed mild thrombocytopenia (Platelets: 89,000) and a normal hemoglobin (15.5 g/dL).... Continue Reading

Abstract: Background: shock is a complex condition where similar vital signs at the bedside can actually reflect very different underlying physiology. While protocol-driven management helps stabilize early, it can sometimes mismatch treatment to the patient’s actual physiology, especially in undifferentiated shock. This can lead to avoidable harm, such as fluid overload or using the wrong vasoactive medications.   Objective: To introduce a practical, physiology-based framework that uses bedside ultrasound to help tailor early assessment and treatment for patients in shock.   Methods/Framework: After reviewing the subject, we introduce the Physiology–Profile–Plan (3Ps) framework, a quick, repeatable clinical process that complements ABC resuscitation. The first step, Physiology, is to identify the main cause of shock, such as pump failure, vasodilation (pipe failure), volume loss, obstruction, or a combination of these. Profile creates a real-time picture of the patient’s hemodynamics by combining clinical exams with various types of monitoring, with a focus on... Continue Reading

  TITLE A Novel Trajectory-Based, Anticipatory Model for the Management of Emergency, Intensive Care, and Chronic Conditions, Exemplified by Hypertension   AUTHOR Abdulatif Aljaili Mohammed   ABSTRACT Background:Conventional hypertension management relies on fixed diagnostic thresholds, most commonly 140/90 mmHg. This threshold-based approach is inherently reactive and often permits silent vascular injury to progress for years before intervention is initiated. Such delays may contribute to irreversible cardiovascular, cerebrovascular, and renal complications that ultimately present as emergencies, increasing emergency department (ED) visits and intensive care unit (ICU) admissions. Objective:To introduce the Progressive Serial Incremental Change (PSIC) Model, a novel trajectory-based framework that reconceptualizes hypertension as a dynamic process rather than a static threshold, enabling earlier identification of pathological blood pressure evolution and anticipatory intervention. Methods / Conceptual Framework:Serial blood pressure measurements can demonstrate gradual, progressive increases over time—such as readings evolving from 110 mmHg to 114 mmHg, 117 mmHg, and 119 mmHg... Continue Reading

Sepsis has been regarded as one of the cardinal causes of death across the globe. Its significance and time-critical nature accounted for 20% of worldwide deaths, according to a 2024 WHO study. As for the Hong Kong condition, Ling et al. have documented a 21% surge in incidence and 1-in-4 deaths from 2009 – 2018 in the Intensive Care Unit of Hong Kong, leading to a major health burden to society. Emergency Department (ED) nurses are the ‘gatekeepers’ for various life-threatening diseases, while it appears not to be the case in the ‘Hour-1-Sepsis Bundle', judging by its low compliance rate. Nevertheless, various studies focused on Sepsis management instead of reviewing knowledge, attitude, and self-reported competencies of ED Nurses towards Sepsis screening, or implementing educational programs prompting early identification of Sepsis in the ED  This is a single-center interventional study conducted in the ED of Kwong Wah Hospital. 70 eligible ED... Continue Reading

Background: Metformin-associated lactic acidosis (MALA) is a well-recognized adverse effect of metformin, which can rapidly progress to severe clinical features including altered mental status, respiratory failure, circulatory failure, and multiple organ dysfunction syndrome. While MALA is known, fatal cases resulting from intentional metformin overdose for suicide are comparatively rare, posing unique management challenges. Case Presentation: A 56-year-old male with a history of hypertension and diabetes mellitus was found unconscious in a bathtub with multiple wrist lacerations. A suicide note and empty blister packs of prescription medication were discovered nearby, including a total of 162 hypoglycemic tablets containing 10,500 mg of metformin. He was initially transported to a local hospital, where he received fluid resuscitation and bicarbonate therapy for severe lactic acidosis (pH 7.186, lactate 16.0 mmol). However, the acidosis remained uncorrected, and transfer to our facility was arranged due to the lack of continuous hemodiafiltration (CHDF) capabilities at the referring... Continue Reading

Introduction: Calcium channel blocker (CCB) overdose typically presents with early hypotension and bradycardia. This case highlights an unusual delayed complication in a 21-year-old female with iron deficiency anemia, depression, and connective tissue disease who intentionally ingested 100 mg of amlodipine.   Case Presentation: The patient presented 2 hours post-ingestion with dizziness, hypotension (98/57 mmHg), tachycardia (HR 103 bpm), and mild fever (37.7°C). Initial management included IV calcium gluconate and hydration. Unexpectedly, 20 hours later, she developed acute hypoxemia and dyspnea. Imaging revealed bilateral pulmonary infiltrates, pleural effusions, atelectasis, and B-lines on ultrasound, with preserved ejection fraction. NT-proBNP escalated sharply (46 → 1701 → 2002 pg/mL). She was managed with diuretics, steroids, and high-flow nasal cannula (HFNC) oxygen, with suspected non-cardiogenic pulmonary edema.   Key Learning Points: Atypical Delayed Complication: CCB overdose may precipitate late-onset non-cardiogenic pulmonary edema despite initial hemodynamic stabilization. Role of Biomarkers & Imaging: Rising NT-proBNP with preserved... Continue Reading

Abstract: Background: shock is a complex condition where similar vital signs at the bedside can actually reflect very different underlying physiology. While protocol-driven management helps stabilize early, it can sometimes mismatch treatment to the patient’s actual physiology, especially in undifferentiated shock. This can lead to avoidable harm, such as fluid overload or using the wrong vasoactive medications.   Objective: To introduce a practical, physiology-based framework that uses bedside ultrasound to help tailor early assessment and treatment for patients in shock.   Methods/Framework: After reviewing the subject, we introduce the Physiology–Profile–Plan (3Ps) framework, a quick, repeatable clinical process that complements ABC resuscitation. The first step, Physiology, is to identify the main cause of shock, such as pump failure, vasodilation (pipe failure), volume loss, obstruction, or a combination of these. Profile creates a real-time picture of the patient’s hemodynamics by combining clinical exams with various types of monitoring, with a focus on point-of-care ultrasound (POCUS). Important ultrasound checks include evaluating... Continue Reading

Background: Timely access to care is a key pillar of health system quality. Reducing delays before admission to definitive care improves outcomes for patients with time-sensitive conditions, including trauma. Despite growing interest in reducing time to definitive care in many low- and middle-income countries (LMICs) and the disproportionately high burden of injuries in these countries, empirical evidence from these settings remains limited. In this study, we present the associated factors of delays experienced by injured patients admitted to hospitals, as part of the Equi-Injury study, which aims to understand access to quality injury care in LMICs. Methods: We recruited moderately to severely injured patients who were admitted for at least twelve hours to nineteen healthcare facilities across Ghana, Pakistan, Rwanda, and South Africa. Data were collected on demographics, socioeconomics, injury characteristics, the patient journey from injury to definitive care (including transport taken and number of prior facilities visited), and time... Continue Reading

BACKGROUND:   There is a growing burden or pesticide poisoning in the Philippines due to easy availability and inadequate regulatory oversight. The varying toxicities of different pesticides can complicate management, especially due to the limited understanding of the synergistic effects or increased toxicity that may result from combinations of these chemicals.   CASE REPORT   This case presents a 63-year-old male who ingested 3 bottles of pesticides with the active ingredients of Chlorpyrifos, Cypermethrin, Butachlor, Pretilachlor and Xylene. The patient was referred by EMS following a poisoning incident, with medical directives to ventilate using a BVM, provide immediate transport, and bring the pesticide bottles for identification. At the ED, the patient is unresponsive, hypotensive 80/60 mmHg, tachycardic at 116 beats per minute (bpm), tachypneic 31 breaths per minute, and desaturation of 89%. He had pinpoint pupils and milky-white, petroleum-like oral secretions. On further history, he had been drinking alcohol with... Continue Reading

Venom induced coagulopathy is a well-recognized and common complication of viper snakes. Few cases are reported from the Middle East region, where the Echis species is a particularly problematic genus of the Viperidae family, with untreated envenomations carrying an estimated 20% mortality rate. Presence of destructive enzymes in the snake venom enables them to produce their local tissue damage effects, which manifest as localized edema that can in rare cases progress into limb threatening compartment syndrome. Here we present the case of a 34 years old man who experienced a saw-scaled viper snake bite to his right index finger. In the matter of a few hours, the patient developed rapidly progressive pain and swelling that extended to his forearm despite receiving Saudi polyvalent anti-venom at a rural facility. Shortly after the patient attended a tertiary center where not only his swelling was increasing to involve the arm, but his coagulation profile... Continue Reading

Background: Contrast Media (CM) imaging is a critical component of acute stroke management. Nevertheless, the risk of Post-Contrast Acute Kidney Injury (PC-AKI) in patients who undergo computed tomography angiography (CTA) or computed tomography perfusion (CTP) is a topic of controversy.Aim: This study aimed to estimate the incidence and assess the predictors of PC-AKI after neurological imaging in adult patients with acute stroke.Methods: This retrospective cohort study was conducted at the National Guard - Health Affairs, Riyadh, Saudi Arabia. Medical records of adult patients diagnosed with acute stroke who underwent CTA/CTP were reviewed. PC-AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥1.5-1.9 times the baseline level 48 hours after CM administration.Results: The study included 741 consecutive patients. PC-AKI incidence was 1.8% (95% CI: 0.98%, 3.1%). Univariate logistic regression analysis showed that increased risk of PC-AKI was significantly associated with chronic kidney disease (p < 0.001), elevated baseline... Continue Reading

Background:Injuries are a leading global health concern, accounting for 4.4 million deaths annually and contributing significantly to disability and healthcare demands. Up to 40% of injured individuals experience long-term disability, and injuries contribute to approximately 10% of the global burden of disease. Outcomes vary significantly across countries and settings, with a disproportionately high share of adverse outcomes happening in low- and middle-income countries (LMICs). Despite this, data on injury outcomes in LMICs remain limited. This study presents post-injury mortality and morbidity from the Equi-Injury project, which aimed to explore facilitators and barriers to equitable access to quality care after injury in LMICs. Methods:We recruited patients with moderate to severe injuries from 19 hospitals across Ghana, Pakistan, Rwanda, and South Africa. Data were collected on demographics, socioeconomics, injury characteristics, the patient journey from injury to definitive care (including transport taken and number of prior facilities visited), and outcomes of death or... Continue Reading

Objective: This study aimed to assess migraine prevalence and shift work-related factors among emergency residents in Riyadh, Saudi Arabia.Methods: A cross-sectional study enrolled 376 emergency residents. A validated questionnaire and Migraine Disability Assessment Test (MIDAS) were used to collect the data from the emergency residents.Results: Out of 376 emergency medicine residents surveyed across Riyadh hospitals, 34.3% were diagnosed with migraines, and 44.1% reported a family history. Frequent headache episodes (3-6/month) were experienced by 43.4% of participants, with 34.0% reporting headaches lasting from 5 to 10 minutes. Throbbing or pulsating headaches (56.4%) and one-sided headache locations (50.5%) were the predominant clinical features. Photophobia, phonophobia, nausea, and vomiting were reported by 43.4%, 47.3%, 46.0%, and 38.0%,respectively. Common triggers included sleep disturbances (53.5%), strong smells (33.8%), and lights (33.8%). The median MIDAS score was 7 (IQR: 8), with only 17.3% experiencing severe migraine-related disability. Disability was significantly higher among females, those ≥35 years... Continue Reading

Point-of-care ultrasound (POCUS) has emerged as a transformative diagnostic tool in cardiac arrest management, particularly for non-trauma cases, offering clinicians real-time, dynamic imaging to guide resuscitation efforts. As with any relatively new area of study, previous research on POCUS is limited, and there is a lot of heterogeneity in studies’ methods, outcomes, and practice contexts. This systematic review and meta-analysis aimed to evaluate the effectiveness of POCUS in both identifying the cause of non-traumatic cardiac arrest and improving patient outcomes during treatment. A comprehensive search of multiple databases from January 2010 toDecember 2023 identified studies meeting rigorous inclusion criteria, focusing on adult patients and assessing outcomes such as return of spontaneous circulation, survival rates, and diagnostic accuracy. To support the high quality of the analysis, the quality assessment of diagnostic accuracy studies-2 tool and the Cochrane risk of bias tool were employed. Pooled analysis was undertaken using RevMan with relative... Continue Reading

Background: Hunan hand syndrome (HHS) is a painful, self-limited capsaicin-induced contact dermatitis that occurs after exposure to Capsicum species. Capsaicin activates transient receptor potential vanilloid-1 receptors on nociceptive fibers, producing intense burning pain that can mimic the sensation of burns or allergic reactions. Although benign, HHS can prompt emergency department (ED) visits and unnecessary investigations if not recognized promptly.Case Presentation: A 44-year-old woman presented to the ED with severe burning pain in both palms after chopping a large quantity of red bell peppers without gloves. Vital signs were unremarkable (blood pressure 129/83 mm Hg, heart rate 73 beats per minute, temperature 36.8°C, respiratory rate 18 breaths per minute). Examination showed bilateral palmar erythema, mild swelling, and marked hyperesthesia without blistering. Initial treatment with diphenhydramine and a hydrogel burn shield containing tea tree oil provided minimal relief. Lidocaine gel was applied for 30 minutes, followed by 0.25% β-sitosterol, sesame oil, and... Continue Reading

Sympathomimetic drugs such as methamphetamine, amphetamine, and cocaine are widely used as stimulants that act on the central nervous system by increasing catecholaminergic activity. Rising global use of these substances has been associated with increased psychiatric morbidity, including suicidal ideation and behavior. However, the magnitude and consistency of this association remain unclear. This review aimed to evaluate and quantify the association between sympathomimetic drug use and suicidal ideation or suicide attempts. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, MEDLINE, EMBASE, and the International Journal of Emergency Medicine were searched for studies published between 2000 and 2024. Random-effects models were applied, and study quality was assessed using the Newcastle–Ottawa Scale and ROBINS-I tool. Twenty-six studies involving over 10,000 participants were included. Sympathomimetic drug use was associated with a significantly increased risk of suicidality (pooled OR = 2.85; 95% CI: 2.10-3.87). Injection use and psychiatric comorbidity were... 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: Although pain is one of the most frequent reasons for pediatric emergency department (ED) visits, it continues to be underappreciated, underassessed, and undertreated. Despite the availability of validated pain scales and evidence-based pharmacological and non-pharmacological strategies, many children leave the ED without adequate relief. The consequences of poorly managed pain extend beyond immediate encounters with psychological and physiological sequelae that may persist into adulthood.Methods: A structured narrative review was conducted using PubMed, MEDLINE, and the Cochrane Library from January 2013 to July 2025. The search terms included “pediatric pain,” “analgesia,” “ED,” “multimodal analgesia,” “non-pharmacologic,” “opioid safety,” and “family-centered care.” The inclusion criteria included randomized controlled trials, systematic reviews, meta-analyses, and high-quality observational studies focusing on acute pediatric pain in the ED. Studies confined to chronic or perioperative pain without ED relevance were excluded.Results: This review presents recent advances in pediatric pain management and introduces the practical mnemonic Systematic, Multimodal,... Continue Reading

Background: Timely activation of emergency medical services (EMS) is a critical determinant of outcomes in acute coronary syndrome (ACS), yet utilization rates vary widely across regions. This study examines ambulance use among ACS patients presenting to a major emergency department in Kuwait, with the aim of identifying patterns, influencing factors, and patient-reported reasons for choosing ambulance transport over self-transport.Methods: A prospective cross-sectional survey was conducted from February to May 2025 at Farwaniya Hospital. Adult patients diagnosed with ACS and admitted within 24 hours were enrolled. Sociodemographic, clinical, and transport-related data were collected via structured questionnaires and electronic medical records. Descriptive and inferential analyses were performed to assess associations between transport mode and key variables.Results:  Of 413 enrolled patients, only 134 (34.4%) arrived by ambulance, whereas 279 (67.6%) used self-transport. Age, gender, nationality, marital status, comorbidities, education, and final diagnosis showed no significant association with transport mode. Ambulance use was higher... Continue Reading