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

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