Reducing Door-to-Analgesia and Door-to-50% Pain Reduction Time in the Emergency Room A Prospective Quality Improvement Study Balancing Urgency, Empathy, and Safety
Ankur Masani
Year:
2026
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...
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Cecal diverticulitis with atypical presentation in a 57-year-old man: a case report
Maryam Hafazalla
,
Thomas Coryndon
,
Heba Doudi
Year:
2026
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...
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Causes of non-urgent care visits in the emergency department in Saudi Arabia: a systematic review
Emtenan M. Bukhari
,
Mohammed A. Almohammadi
,
Mona S. Buraysali
,
Ghalyah T. Kerdawi
,
Abdullah A. Aljazaeri
,
Hussam A. Alzahrani
,
Omar M. Alsuwat
,
Wefag J. Sawadi
,
Mohammed A. Albokhari
Year:
2026
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...
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Intrathecal Hemorrhage in Severe Preeclampsia Causing Spinal Cord Compression in a Concealed Pregnancy
HMGN Senevirathna
,
PPDRP Maduchandra
Year:
2026
Background:Neurological complications of severe preeclampsia are most commonly cerebral, with seizures and posterior reversible encephalopathy syndrome (PRES) being well recognized. Spinal cord involvement is exceptionally rare, and intrathecal hemorrhage causing spinal cord compression has been only sparsely reported. When occurring in the context of a concealed pregnancy, such presentations pose a significant diagnostic challenge in the emergency department. Early recognition is critical to prevent irreversible neurological injury. This case highlights a rare dual neurological complication of severe preeclampsia and emphasizes the importance of maintaining a high index of suspicion in emergency care. Clinical Case:A 38-year-old previously healthy woman presented to the emergency department with sudden-onset bilateral lower limb weakness, urinary retention, and progressive abdominal distension. She denied being pregnant. Point-of-care ultrasound performed to evaluate abdominal distension revealed a live intrauterine fetus at approximately 34 weeks of gestation. Her blood pressure was 200/110 mmHg, and urinalysis demonstrated 3+ proteinuria, consistent with...
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Inhalational Injury Secondary to Oxalic Acid and Chlorine Exposure: A Case Series
Zeus Paolo Enriquez Rapada
,
Amado A. Flores III
Year:
2026
Background: Inhalational injury secondary oxalic acid and chlorine, individually, is uncommon and combination of the two is rare. Injuries from both agents are from accidental ingestion or inhalation and attempt to self-harm. Objectives: We present patients exposed to oxalic and chlorine gasses and seen at the emergency department, the adverse reactions related to the time of exposure, abnormalities in the diagnostic exams, and management. Case Series Presentation: A total of six patients were seen in this study. Patients exposed within 2 minutes to 10 minutes experienced difficulty of breathing, non-productive cough, sore throat, shortness of breath, throat itchiness. However, there was noted vomiting for a patient who was exposed for 15 minutes. There were no noted significant changes on complete blood count, electrolytes, 12 lead electrocardiograph and chest radiograph with one exception. There was an incidental finding of pneumonia in one of the patients. Conservative treatment was given to all...
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Emphysematous Cholecystitis - The Deadly Variant
Nursyafiqah Mohd Noor
,
Mohammad Fathullah Rossman
Year:
2026
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...
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NEWS2 Escalation of deteriorating patients in ED
Bashar Elwir
,
Mei JINGHON
,
Aqsa Munir
,
Thomas Selina
Year:
2026
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...
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Refractory Amlodipine Overdose Managed with Venoarterial ECMO
Ahmed Sarsar
,
Fathima Murthaza
,
Mohamed Abdou
Year:
2026
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...
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THE STROKE THAT WASN’T: MILLER FISHER SYNDROME – A NEUROLOGICAL MASQUERADE UNCOVERED IN THE EMERGENCY DEPARTMENT
Gina Rami Salama Ibrahim Abdelmesih
Year:
2026
Introduction: Miller Fisher Syndrome (MFS) is a rare, immune-mediated variant of Guillain-Barré Syndrome (GBS), classically presenting with the triad of ophthalmoplegia, ataxia, and areflexia. A viral or gastrointestinal illness usually precede MFS MFS incidence is 0.09 per 100,000 annually and accounts for roughly 1–5% of GBS cases in Western populations. It predominantly affects males and typically presents in middle age. Although the initial presentation can mimic other serious neurological conditions such as brainstem stroke, MFS usually has a benign course with good recovery if treated early and appropriately. Case description : A 59-year-old previously healthy man presented to the Emergency Department (ED) with the sudden onset of tongue heaviness and difficulty speaking while at work, which began one hour prior to arrival. His symptoms were accompanied by blurry vision, unsteadiness, and dizziness. He denied any limb weakness, headache, chest pain, or vomiting. His vital signs were stable. Based on the...
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Outcomes of Patients with Septic Shock Adhering to a Standardized Protocol
Aisha Siddiqua
,
Zareen Qasmi
,
Shagufta Kanwal
Year:
2026
Background Sepsis is a life-threatening condition resulting from the body's dysregulated response to infection, leading to tissue damage, organ dysfunction, and potentially death. If not recognized and managed promptly, it may progress to septic shock and multiorgan failure. Adherence to standardized septic shock management protocols has been associated with improved patient outcomes. According to data published in 2020, there were approximately 48.9 million cases of sepsis and 11 million sepsis-related deaths worldwide, accounting for 20% of global mortality. Nearly 20 million cases occurred in children under the age of five. Furthermore, for every 1,000 hospitalized patients, around 15 are estimated to develop sepsis as a complication of healthcare delivery. Objective This study aims to evaluate the outcomes of pediatric patients with septic shock who received early protocol-driven management—including fluid resuscitation, inotropic support, and antibiotics—within the first hour of presentation to the emergency department. Methods - Design: Retrospective cross sectional study...
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Ripping abdominal pain with a tortoise heart: Descending Aortic Dissection Presentation with Backache and Sinus Bradycardia in the Emergency Department.
Nilanka Mudithakumara
,
Dushyantha Goonewardene
Year:
2026
Introduction Severe tearing-type chest pain radiating to the back is the typical presentation of Aortic Dissection, commonly manifest with tachycardia and hypertension, especially Stanford type B Aortic Dissections. We present a case of sinus bradycardia in a type B aortic dissection patient with a severe, painful aortic dissection, not involving the coronary arteries initially. This is a case of paradoxical bradycardia with severe pain. Case Report A 17-year-old, previously unscreened Sri Lankan male presented with acute onset abdominal pain radiating to the back with no hematuria, limb paralysis, fever or other urinary bowel symptoms. The clinical examination revealed no radio-radial or radio-femoral delay or blood pressure discrepancy. He had Marfanoid features and kyphoscoliosis, but the vital parameters were stable, other than severe bradycardia and sinus arrhythmia. The pain was not settling with intravenous Morphine, requiring additional analgesia. Despite being in severe pain (worst-ever 10/10), the patient was in persistent bradycardia...
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Pyrexia of unknown origin presenting as Aortic Root dissection
Nilanka Mudithakumara
,
Srijith Dahanayake
Year:
2026
Introduction Pyrexia of unknown origin (PUO) is a rare Emergency presentation, and the origin of pyrexia is rarely found in the Emergency Department(ED) because it requires extensive blood, imaging and other investigations to come to a diagnosis. Aortic root dissection is a rare presentation of PUO, that could present as an unstable cardiac tamponade. Aortitis is a rare aetiology of PUO as well. This case is a rare triple combination of PUO, present as an aortic root dissertation, with an aetiology of aortitis. Case Report A 50-year-old previously healthy Sri Lankan male with a history of on-and-off fever for one month presented to a peripheral ED with dizziness, was found to have low blood pressure of 86/52mmHg with a heart rate of around 120bpm, with audible heart sounds, no elevation of jugular venous pressure and with other stable vital parameters. He had no fever on admission. Initial stabilization and sepsis...
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Implementation of a Real-Time Integrated Emergency Department Dashboard and Its Impact in a Tertiary Indian Emergency Department
Saisaranya
,
Shameem K U
Year:
2026
Background: Emergency departments (EDs) in India frequently experience overcrowding, delayed imaging, and limited visibility into time-critical pathways. Conventional dashboards primarily track census and waiting times but do not support clinical escalation or multidisciplinary coordination. This study evaluates the impact of implementing a real-time integrated dashboard in a high-volume tertiary ED. Objectives: To implement a unified dashboard linking operational, radiological, and clinical pathways and to measure its effect on efficiency and critical care timelines. Methods: This quality improvement initiative was conducted in a tertiary care ED in Kerala, India, using a two-phase design. Phase 1 employed a conventional administrative dashboard. Phase 2 introduced a clinical-operational integrated system with automated investigation tracking, color-coded delay alerts, radiology waiting clocks, multispecialty consultation tracking, and full integration of time-sensitive pathways. Pre and post-intervention metrics were compared. Results: Implementation of the integrated dashboard produced measurable improvements across radiology, operational flow, and critical care timelines. Mean CT...
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"Compassion First": An audit on Bystander Feedback and Communication Standards in a High-Volume Tertiary Care Emergency Department
Nilanka Mudithakumara
,
Senitha Asanka Liyanage
Year:
2026
Background: Effective communication is a cornerstone of patient-centered care and a critical indicator of healthcare quality. In overcrowded Emergency Departments (ED) within Lower-Middle Income Countries (LMIC), balancing rapid clinical intervention with clear communication owns unique challenges. This study evaluates healthcare staff (HCS) communication standards and their direct impact on bystander satisfaction at the Colombo South Teaching Hospital (CSTH). Methods: A prospective study was conducted in February 2025 at the CSTH Accident and Emergency (A&E) Department, which manages an average of 450 patients and 15 resuscitations daily. Feedback was gathered from 198 randomly selected patients’ families through direct observation and medical officer quality assessments. The study focused on doctor-family communication, the clarity of information provided, and the management of "bad news". Results: The assessment revealed high performance in several communication metrics: 97% of respondents reported clear communication, and 93.9% expressed overall satisfaction. Senior doctor involvement was strongly correlated with higher family...
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FRAILTY SCREENING AT ED TRIAGE: STUDY OF PREVALENCE AND PREDICTIVE VALUE IN OLDER ADULTS
Saisaranya
,
Shameem K U
Year:
2026
Background:The global population is aging rapidly, and emergency departments (EDs) increasingly serve as a primary point of care for older adults. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, is a strong predictor of morbidity, hospitalization, and mortality. Despite its clinical relevance, frailty assessment at ED triage remains underutilized, particularly in Indian settings. The Clinical Frailty Scale (CFS) is a simple, validated tool suitable for rapid triage evaluation, yet regional data on its prevalence and prognostic utility are limited. Objectives:To determine the prevalence of frailty among ED patients aged ≥65 years and evaluate the ability of CFS to predict hospital admission and 30-day mortality. Methods:We conducted a prospective observational study from October 1, 2024, to October 1, 2025, at a 30-bed tertiary-care ED at KIMSHEALTH, Trivandrum, South India, with an annual census exceeding 45,000 adult patients. Consecutive patients aged ≥65 years presenting to triage were assessed using...
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Dreaded Lazy eyelid in an innocent jammed sinus – A rare presentation of acute Sinusitis presenting with acute unilateral ptosis
Nilanka Mudithakumara
,
Viraj Jayasinghe
Year:
2026
Introduction Unilateral ptosis could be the initial presentation of a disease with dreaded complications including neurological conditions, ophthalmological and mechanical causes, tumors, etc. Acute sinusitis may present with facial pain with mild swelling and catarrhal features. Ipsilateral ptosis with sinusitis could be due to a complication of sinusitis, indicating orbital or cavernous sinus involvement. We present a case of a 13 year old Sri Lankan boy presenting with unilateral ptosis with one weekof nasal congestion, diagnosed with left frontal sinusitis complicated with right eye ptosis without other evidence of neurological orinfectious pathologies or a trauma history. Case Report A 13 -year-old boy was presented to the emergency department with leftsideddrooping eye lid and chronic ipsilateral headache and seven days history of nasal congestion. He had no fever or other features to suggest infection, trauma or toxin exposure. He was not appearing ill looking , no photophobia, no neck-stiffness. On examination,...
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OUTCOME OF PATIENTS WITH NEONATAL SURGICAL EMERGENCIES IN EMERGENCY DEPARTMENT
Aisha Siddiqua
,
Huma Waqar
Year:
2026
BACKGROUND : Neonatal surgical emergencies can have varying outcome depending upon condition , promptness of diagnosis, intervention and presence of other anomalies in neonates. Neonates born with birth defects need to addressed surgically but cultural norms hinder delayed treatment modalities in developing countries. Disease processes are often well advanced when patients received in emergency department after traditional remedies have failed at home . Immediate and appropriate surgical intervention is not available in developing countries. OBJECTIVES: The study was conducted to explore the factors influence the outcome in neonates having surgical emergencies depend upon the early recognition , timely diagnosis, stabilization , early timely referral and multidisciplinary care . By understanding these factors and providing prompt , high quality care , health care providers can improve the outcome for neonates with surgical emergencies in Emergency department and significantly reducing the morbidity and mortality in neonates....
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IMPACT OF TELEMEDICINE IN DIAGNOSIS AND MANAGEMENT OF CARDIAC ARRYTHMIAS IN CHILDREN.
Huma Waqar
,
Zareen Qasmi
,
Aisha Siddiqua
Year:
2026
OBJECTIVE: To evaluate the impact of telemedicine in diagnosis and management of cardiac arrythmias in children (0-13 years) in Pediatric emergency. INTRODUCTION: Telemedicine is defined as diagnosing and treating patients remotely using telecommunications technology. The increased burden of critically ill patients in emergency departments across the country highlights the role of telemedicine which provide remote monitoring of critical patients and assistance to emergency doctor in making accurate diagnosis and effective management of affected patients. Use of telemedicine help determine the abnormal cardiac rhythm and allows early diagnosis and management. Telemedicine is a cost effective way to bridge the gap between primary and secondary health care especially in underprivileged areas. INCLUSION CRITERIA: Patients aged 0-13 years who were diagnosed and managed for different cardiac diseases including cardiac arrhythmias after consultation with telemedicine physician. EMRs with complete data on diagnosis, treatment and outcome, from November 2023 to May 2025 were included. MATERIAL&METHODS:...
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TRENDS & CLINICAL OUTCOMES OF PEDIATRIC MEASELS CASES OVER 3 YEARS. A RETROSPECTIVE REVIEW FROM A TERTIARY CARE FACILITY IN SINDH
Wahida Latif
,
Zareen Qasmi
,
Tayyaba Ali
Year:
2026
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....
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Evaluating adherence to clinical guidelines for croup management and its impact on emergency department length of stay and patient outcomes.
Saleem Khoso
,
Aisha Siddiqua
Year:
2026
Objective: To evaluate adherence to clinical guidelines for croup management and its impact on emergency department length of stay and patient outcomes at pediatric emergencies of major tertiary care hospitals in Sindh. Background / Introduction Mostly affecting young children, croup is a common viral respiratory disease that frequently leads to ED visits. In an effort to maximize the use of healthcare resources and enhance patient outcomes, clinical guidelines and protocols have been established to standardize the management of croup. Following these recommendations has been demonstrated to lower hospital admission rates, duration of stay, and critical care admissions without raising adverse events or readmissions. Typically, these recommendations call for the use of systemic corticosteroids and racemic epinephrine for more severe cases. Determining how well these clinical standards are followed is therefore essential to comprehending how they affect patient outcomes and ED length of stay, as well as to find ways to...
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Moving With No Beating Heart: CPR-Induced Consciousness in Three Middle-Aged Women—A Case Series
Nilanka Mudithakumara
,
Jagath Wijayarathna
Year:
2026
Background: Cardiopulmonary resuscitation-induced consciousness (CPRIC), also known as CPR-induced awareness, is a rare but increasingly recognized phenomenon where patients exhibit signs of consciousness—such as purposeful movements or following commands—during active chest compressions despite the absence of a spontaneous heartbeat. Estimated to occur in 0.3% to 0.9% of cardiac arrests, it is thought to be a surrogate for high-quality CPR that provides sufficient cerebral perfusion to maintain brain function. However, the lack of standardized clinical guidelines for managing conscious patients during resuscitation creates significant challenges for healthcare providers. Case Series: This series describes three middle-aged Sri Lankan women (aged 52, 55, and 62) who presented to the Emergency Department in ventricular tachycardia (VT) cardiac arrest secondary to acute myocardial infarction. In all three cases, the patients gained consciousness specifically during high-quality, uninterrupted chest compressions. * Case 1: A 52-year-old patient attempted to grasp the resuscitator's gown during CPR. * Case 2:...
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"Researching the research interest" An audit of research involvement in Emergency Medicine Trainees of Sri Lanka.
Nilanka Mudithakumara
,
Bandara Ekanayake
Year:
2026
Introduction: Research involvement among Emergency Medicine (EM) trainees is a critical yet under-studied area, particularly within Low- and Middle-Income Countries (LMIC). In Sri Lanka, where Emergency Medicine is currently in its establishing phase, trainees face unique challenges. This study investigates the research involvement, knowledge, and perceived barriers among EM trainees to provide actionable recommendations for enhancing the local EM research culture in LMICs. Objectives: The study aims to evaluate research knowledge, interest, and output among Sri Lankan EM trainees. It identifies systemic barriers and resource gaps while providing actionable recommendations to bridge the "interest-application" divide and establish a sustainable research culture within this developing specialty in a LMIC. Methods: A descriptive cross-sectional study was conducted using an anonymous, voluntary, self-administered questionnaire with 63 EM trainees across four current batches in Sri Lanka. Data were collected using MS Excel and focused on previous research involvement, publication and presentation history, attendance at...
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Impact of an Emergency-Department Acute-Pancreatitis Admission Protocol on CT Use: A Retrospective Pre–Post Study
Mostafa Alhabboubi
,
Laurie Robichaud
,
Seth Davis
,
Paul Brisebois
,
Jerome Williams
,
Shannon Fraser
,
Alex Guttman
,
Xiaoqing Xue
,
Marc Afilalo
,
Eli Segal
Year:
2026
Background:Early abdominal CT is often performed for acute pancreatitis (AP) in the emergency department (ED), despite guidelines recommending delayed imaging unless diagnosis is uncertain or deterioration occurs after 48–72 h. Excess imaging may prolong ED length of stay (LOS) without improving outcomes. We evaluated whether implementing an ED admission protocol for AP reduced CT use and ED LOS. Methods:We conducted a retrospective pre–post study at a university-affiliated ED. Adults with AP were included from two periods: pre-protocol (Feb 2019–Feb 2021) and post-protocol (Apr 2021–Jan 2023). Primary outcomes were proportion receiving CT before admission and ED LOS. Secondary outcomes included CT ordering service, ultrasound use, complications, and mortality. Results:A total of 458 visits were analyzed (210 pre-, 248 post-protocol). Overall CT use was unchanged (88.5 % vs 85.5 %, p = 0.40). CTs ordered by ED clinicians decreased (97.8 % to 91.9 %; p = 0.037), while those by surgery increased...
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Occupational injuries presenting to the emergency department of a tertiary hospital in Dubai: a retrospective analysis
Ivyan Kambal
,
Hebah Sabri
,
Khalid Ali
,
Nour Sabobeh
,
Rand Aboelkher
,
Alaa Shoqeir
,
Ali Al-Najjar
,
Aya Alsabbah
,
Malak Abdulelah
,
Ruqaya Alsalihi
,
Sura Al-Rawi
,
Firas Al-Najjar
Year:
2026
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...
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Case of Cardiac Toxicity from Ingestion of Pong-Pong Seeds (Cerebra odolliam)
Shobhit Swarup
Year:
2026
Cerebera odollam, commonly known as the pong‑pong or suicide tree, contains potent cardiac glycosides capable of inducing life‑threatening arrhythmias and hyperkalemia. Intentional ingestion is well‑documented in parts of South and Southeast Asia. Despite the biochemical similarity of its toxins to digoxin, evidence guiding optimal medical management remains limited. This case report highlights a severe presentation of C. odollam toxicity and describes the critical role of early recognition, management of hyperkalemia, and timely administration of anti‑digoxin immune Fab. A 56‑year‑old woman presented to the Emergency Department with vomiting, dizziness, and lethargy following intentional ingestion of pong‑pong seeds obtained from a local park. Initial vital signs were stable, and point‑of‑care ultrasound revealed normal cardiac activity. Laboratory findings demonstrated acute kidney injury (creatinine 110 µmol/L), severe hyperkalemia (6.8 mmol/L), elevated lactate (3.5 mmol/L), and a measurable digoxin level of 0.7 ng/L. Electrocardiography showed abnormalities consistent with hyperkalemia and cardiac glycoside toxicity. Hyperkalemia protocol was initiated with intravenous...
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Optimizing Dog Bite Management through Telemedicine in Resource Limited Primary Health Care centers: Insights from Sindh and Balochistan
DR AIMAN ISLAM
Year:
2026
Dog bites are a significant global public health concern, causing an estimated 55,000 deaths annually, with approximately 31,000 reported from Asia, primarily affecting children under 15. In low- and middle-income countries, like Pakistan, rabies often termed “the disease of the impoverished” remains endemic due to delayed medical care and poor access to post exposure prophylaxis (PEP) . Telemedicine has emerged as a promising tool to bridge healthcare gaps in underserved settings. By facilitating accurate case categorization, standardized treatment decisions, it supports Pakistan alignment with the One Health approach recommended by WHO to achieve rabies elimination by 2030. The study explores it roles in improving protocol adherence and clinical outcomes dog bite cases at primary health centers. Objectives: To evaluate the burden of pediatric dog bite cases and access role of telemedicine in optimizing management through protocol adherence and treatment modification in resource limited primary health care centers across Sindh and...
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Assessment of emergency physicians’ perspectives on shared decision-making in a tertiary hospital in Jeddah, Saudi Arabia
Ali Alshehri
,
Mohammed Alsukhayri
,
Randa Almalki
,
Ali Alaidroos
,
Mohamed Eldigire Ahmed
Year:
2026
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...
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Enteric-coated aspirin use in acute chest pain in Saudi Arabia: a cross-sectional study of practice patterns and systemlevel implications
Fandi Z Alanazi
,
Sarah M Albassam
,
Khalid A. Ateyyah
,
Mohammed Y. Iqbal
Year:
2026
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...
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Assessment and evaluation of pain management in oncology patients presented to the emergency department
Ahmad Mahmoud Wazzan
,
Moudi Alasmari
,
Yaser Rambo
,
Abdullah Murshid
,
Nawaf Alharthy
,
Abdulrahman Qurunfulah
,
Abdulellah Alqudsi
Year:
2026
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...
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Emphysematous gastritis in a patient with metastatic cholangiocarcinoma: a case report
Ibrahim Alzubaidi
,
Rawan M Alqurashi
,
Emtenan M Bukhari
,
Husun K Kecheck
Year:
2026
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...
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The use of artificial intelligence in diagnosing emergency cases: a crosssectional study of physicians’ perspectives on the effectiveness of AI systems in improving diagnostic accuracy and reducing time to diagnosis
Sara S Al-Zahrani
,
Abdulrahman Mohammed Alkhuzaee
,
Mamdouh Saeedan Alqurashi
,
Jana Osama Ghazi
,
Majed Ahmad Dowayd
,
Sulafah Reda Namangani
,
Rahaf Khalid Bashamakh
,
Nawaf Hussain Aljafari
,
Mohammed Abu Aish
Year:
2026
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...
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Point-of-care ultrasound (POCUS) for diagnosing cesarean scar ectopic pregnancy in the emergency department
Fatimah Hakami
,
Hassan M. Alshaqaq
,
Abdullah Ali Alqarni
,
Hussain M. Alhashem
,
Ahad Al Saud
Year:
2026
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...
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