Acute Emergency Research Articles

Mechanical Thrombectomy via Transbrachial Approach in the Emergency Management of Acute Ischemic Stroke Patients with Aortic Pathologies: Our Experience and Literature Review.

Mechanical thrombectomy (MT) via the transbrachial approach (TBA) is a very rare option used in cases of patients with aortic pathologies and acute ischemic stroke (AIS) due to the insufficient evidence in the literature, the difficulty from a technical point of view and the result of this technique influenced by the complications that frequently accompany it. Only a few cases of patients with aortic pathologies and acute ischemic stroke where MT via TBA were reported in the literature, and its application in the emergency management of AIS has still not been dealt with in detail. Out of a need to clarify and clearly emphasize the effectiveness of this approach in emergency MT via TBA in patients with AIS and aortic pathologies, this literature review and case report has the following objectives: the first one is the presentation of an emergency MT via transbrachial approach performed in a 44-year-old patient with AIS and diagnosed aortic coarctation during transfemural approach (TFA), with successful reperfusion in our department and the second one is to review the cases reports of patients with different aortic pathologies and AIS reperfusion therapy performed by MT via TBA from the literature. A total of nine cases (one personal case and eight published cases) were revised in terms of aortic pathologies type, reperfusion therapy type, and the complication of both mechanical thrombectomy and local transbrachial approach. Mechanical thrombectomy through the transbrachial approach was the first choice in more than half of these cases (55.55%, n = 5 cases) in the treatment of acute ischemic stroke in the presence of previously diagnosed aortic pathologies. In one-third of all cases (33.33%, n = 3, our case and 2 case reports from the literature), the transbrachial approach was chosen after attempting to advance the guiding catheter through the transfemoral approach and intraprocedural diagnosis of aortic pathology. In only one case, after an ultrasound evaluation of the radial artery that showed a monophasic flow, MT was performed via TBA. Local transbrachial complication was reported in one case, and in two other cases, it was not stated if there were such complications. Hemorrhagic transformation of AIS was reported in two cases that underwent MT-only cerebral reperfusion via TBA, one with acute aortic dissection type A and our case of previously undiagnosed aortic coarctation. In the cases in whom short and long-term follow-up was reported, the outcome of treatment, which was not exclusively endovascular (77.77% cases with only MT and 33.33% with association of first thrombolysis and after MT), was good (six from nine patients). In two case reports, the outcomes were not stated, and one patient died after a long hospitalization in the intensive care unit from respiratory complications (our patient). Being a clinical emergency, acute ischemic stroke requires urgent medical intervention. In patients with aortic pathologies, where acute ischemic stroke emergency care is a challenge, mechanical thrombectomy via the transbrachial approach is a safe alternative method for cerebral reperfusion.

Sudden Ocular Complication after Snake Bite

Introduction : A snakebite constitutes a common acute medical emergency and has several systemic and even ocular consequences. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.
 Case Illustration : A 17 years old man came to emergency department with painful swelling on his left hand and sudden blurred vision right after his left hand were bitten by venomous snake in the rice field. Diplopia and ptosis were developed several hours after admission. On eye examination, visual acuity was 0,05 on right eye and 0,8 on left eye, abnormal pupillary reflects on both eyes were present, pupil dilatation, limited eye movement and ptosis were present, Intraocular pressure were 23,7 mmHg on right eye and 24,5 mmHg on left eye. Antivenom was administered immediately. He received cycloplegic, timolol eyedrop, and prednisolone eyedrop for ocular treatment
 Discussion : Ocular complications are rare and uncommon but they may lead to sight-threatening conditions. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Mild neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.
 Conclusion : This study presented a rare case of systemic ocular complication as a result of a snake bite. Ophthalmoplegia induced ocular discomfort for an extended period is a rare symptom of snake-bites. Combined treatment of steroid with antivenom may improve the recovery from sudden ocular manifestation in snake bite.

(404) National Trends of Penile Fracture Encounters 2016-2019

Abstract Introduction Penile Fracture (PF) is an acute urological emergency resulting from the rupture of the tunica albuginea and one or both of the corpus cavernosa. Immediate surgical intervention is crucial in avoiding long-term complications, however the epidemiology and treatment patterns remain understudied, especially with the introduction of the 10th Revision of the International Classification of Diseases (ICD-10). Objective To evaluate national trends of PF encounters as well as predictive factors of inpatient admission from the emergency department (ED). Methods All patients admitted to the ED for PF between 2016-2019 were extracted from the NEDS using the ICD-10 Diagnosis Code S39.840 and its modifiers. Multivariable logistic regression was performed to identify predictors of this inpatient admission. Results Between 2016-2019, there were an estimated 7,091 weighted encounters related to PF in the US with an overall 13% increase in cases (Figure 1). About 20.8% (1,477) of these encounters led to inpatient admission. The average age of a patient presenting with PF was 41 years old. The majority of encounters took place in the South (44.12%) at non-trauma center rural hospitals (63.99%) and involved private insurance holders (44.42%). For those admitted to inpatient service, the average length of stay was 1.44 days, with a maximum of 26 days. The average total charge for patients discharged from the ED was $11,224 USD and those admitted were faced with charges averaging $33,474 USD. Predictors of inpatient admission included an Elixhauser Comorbidity Score > 1, encounters in the Northeast, Midwest, and Western states, and being covered by Medicaid (p < .05). Conclusions Penile fractures have seen a small increase in incidence from 2016-2019. Although inpatient admissions are less common, they carry significantly higher costs. Further studies of treatments and regional analysis may be warranted to decrease the amount of inpatient admissions. Disclosure No.

Onboarding in intensive care and emergency medicine in Germany

The treatment of acute life-threatening conditions in intensive care and emergency medicine requires in-depth training and education, with initial training playing akey role. What is the structure and quality of the initial training of physicians and nurses in intensive care units and emergency departments in Germany? With the help of survey software, an online questionnaire comprising 40questions in German on the aforementioned topic was designed. It was distributed via the website of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN) and via pertinent social media channels. In total, 103 nurses and 125 physicians participated in the survey. The average work experience of the participating nurses and physicians was 8.5 ± 5.1 and 3.0 ± 3.1years, respectively. The majority of participants worked primarily in intensive care units (59%) or in emergency departments (22%). On average, the initial training lasted 45 ± 27 and 13 ± 13days for nurses and physicians, respectively. Only 20% of the initial training comprised seminars or hands-on workshops taught outside of routine clinical care. In all, 47% of the participants stated that they were not able to complete the entire initial training period. Only 49% had been officially certified for usage of the technical equipment in their department. Atotal of 35% reported feeling confident or somewhat confident in handling predictable tasks after initial training, but only 15% in handling acute emergencies. The present study revealed that initial training in intensive care and emergency medicine is frequently incomplete, unstructured, as well as inadequate and bears both safety and liability risks. New concepts are needed to improve the initial training across clinics.

Feasibility and safety of laparoscopy in acute non-traumatic emergency abdominal surgery: A prospective study

Introduction: The use of laparoscopy in emergency abdominal surgery is considered high-risk due to its elevated morbidity, requiring expertise in laparoscopic surgery. Objective: Assessing the feasibility, reproducibility, and safety of laparoscopy in non-traumatic acute abdominal surgery. Methods: Descriptive, prospective and evaluative study, conducted between February 2018 and October 2021. We have included in this study: acute appendicitis and its complications, lithiasis acute cholecystitis (LAC), peritonitis by perforation of peptic ulcer, adhesive acute intestinal obstruction, adnexal torsion, extra-uterine pregnancies, and non-specific acute abdominal pain. Results: We operated on 337 patients laparoscopically, with an average of 02 surgeries per medical shift. In 62.6%, surgeries were performed outside of regular working hours. We encountered temporary, material, and human difficulties in 10.8% of the cases. Average age of the patients is 38 years ±15 years. F/H sex ratio =1.29. Diagnostic accuracy of laparoscopy was 100 %. Intraoperative laparoscopic scanning corrected the preoperative diagnosis in 15.73% of cases. Average operative time was 52.09 min ± 24.14 min. One conversion recorded (0.3%). Rate of postoperative complications was 6.2%. These complications are classified at grade I according to the Clavien-Dindo classification in 85.71%. Only one patient (0.3%) required a second operation. Average length of overall hospitalization was 1.5 days. Conclusion: Our results suggest that emergency laparoscopy is feasible, safe, and reproducible. So it can claim to replace laparotomy in the management of acute, non-traumatic abdominal emergencies.

Evaluation of a mobile application for individuals at risk of myocardial infarction

Introduction: Applications are instruments of easy and fast access and low cost, but, to meet the needs of users, they must be validated to be offered. Validation is a process by which the reliability and relevance of the product are established, verifying if it has achieved the desired specific purpose. Objective: To evaluate the layout and content of an application for health education on risk factors and first aid procedures in cases of acute myocardial infarction. Methods: Methodological study of application evaluation. The application was built according to the assumptions of Design Thinking. The present study had the following stages: 1) construction of the evaluation form, 2) recruitment of the judges, 3) evaluation of the layout and 4) evaluation of the application content. The evaluation was composed of 21 judges, being 11 doctors and 10 nurses, from June to December 2019. For the evaluation of the layout and content, some strategies were used through the Delphi method, and the Content Validity Index (CVI) was calculated from the answers of the judges. Results: The application got global CVI of 0.98. Conclusions: The application presents scientifically adequate information for health education and necessary for situations of acute myocardial infarction emergencies.

The locked knee.

The acute locked knee is an orthopaedic emergency requiring prompt diagnosis and treatment. It can be classified as acute or chronic. The term 'locked knee' refers to a knee that demonstrates fixed flexion or which has a 'block' to complete extension. Some degree of active or passive extension may be achievable, but not full extension. The most frequent causes of a locked knee are a meniscal tear, rupture of the anterior cruciate ligament or loose bodies. Magnetic resonance imaging is the gold standard in diagnostic imaging. Knee arthroscopy is considered the gold standard in management. This article gives an overview of the presentation, assessment and management of the locked knee for core surgical, acute care common stem and emergency medicine trainees.

The Role of Neutrophil/Lymphocyte Ratio in Ovarian Torsions

Aim: Ovarian torsion is among the gynecological emergencies. Laboratory and imaging methods are used for diagnosis. Symptoms are generally nonspecific, making it difficult to differentiate from other acute abdominal emergencies. This study aims to investigate the diagnostic value of neutrophil-lymphocyte ratio (NLR) in addition to imaging methods for the diagnosis of ovarian torsion. Material and Methods: A total of 120 patients were included in the study. The study was planned retrospectively. The patients included in the study were analyzed in three different groups. Those with follicular cysts were in Group 1, those with simple cysts were in Group 2, and those with ovarian torsion were in Group 3. The groups were compared in terms of laboratory parameters and demographic characteristics. Results: When the groups were compared in terms of mean age, it was found that the mean age of Group 3 was significantly lower than Group 1 (p

Understanding and treating pulmonary embolism in acute settings

Background: High-risk pulmonary embolism (PE), encompassing a small but critical subset of cases, is associated with severe hemodynamic instability and high mortality rates. Representing 5–10% of all PE cases, high-risk PE is a leading cause of cardiovascular mortality, contributing to significant patient morbidity and mortality. Aim: This review aims to elucidate the management strategies and clinical approaches for high-risk PE, particularly in acute emergency settings. It seeks to provide a comprehensive overview of diagnostic and therapeutic strategies based on current guidelines. This review aimed to gain insights about treatment and management of PE via EMS and pharmacists. Methods: A thorough literature search was conducted using PubMed and Google Scholar, focusing on high-risk pulmonary embolism from the inception of these databases until October 1, 2023. The review included 147 articles comprising case reports, clinical trials, and systematic reviews. The search emphasized high-quality studies and guidelines, including those from the European Society of Cardiology (ESC) and the American Heart Association (AHA). Results: The review highlights the critical role of systemic thrombolytics (ST) in managing high-risk PE, despite their underutilization. It discusses the ESC and AHA guidelines for classifying PE risk and outlines the pathophysiology of right ventricular failure.

Hospital Outcome of Hypertensive Non-ST Elevation Myocardial Infarction Patients in Diabetic and Non-Diabetic Groups

Objective: Acute myocardial infarction is one of the leading causes of all acute emergencies and is becoming an important public health problem in the developing countries. Non-ST elevation myocardial infarction (NSTEMI) is more heterogeneous in their presentation and may be poorly characterized in clinical practice, leading to greater variation in diagnosis and treatment. Patients with diabetes and hypertension who develop a NSTEMI are at increased risk for poor hospital outcome. This study is aimed to assess the differences between hypertensive diabetic and hypertensive non-diabetic patients with NSTEMI and to evaluate the prognostic impact of selected clinical and laboratory parameters on the occurrence of hospital complications. Methods: This was a cross-sectional analytical study. All the adult hypertensive patients of newly diagnosed NSTEMI with or without diabetes mellitus admitted in Ibrahim Cardiac Hospital & Research Institute, Dhaka who fulfilled the inclusion and exclusion criteria were enrolled. The study population comprised of 100 hypertensive patients with their first NSTEMI, and were divided into two groups according to the presence of type 2 diabetes mellitus. Group I (n = 40) patients were diabetic and Group II (n = 60) were non-diabetic. Hospital outcome of the study population was recorded. The incidence of in hospital adverse clinical events in the two groups was compared by using the odds ratio of the two binomial proportion analyses. Results: Among 100 hypertensive NSTEMI patients, 40% were diabetic (Group I) and 60% were non-diabetic (Group II). Mean age was 58.1±10.2 years in case of diabetic group (Group I) and 56.3±10.5 years in non-diabetic group (Group II) ranging from 30-70 years. Male patients (66%) were predominant in the study. Most common clinical presentation was chest pain which was 77.5% in Group I and 83.3 % in Group II followed by sweating (12.5% and 16.7%), dyspnea (10.0% and 11.7%), syncope (5.0% and 6.7%) and atypical chest pain (2.5% and 3.3%) respectively. Smoking was the commonest risk factor which was 62.5% in Group I and 75% in Group II followed by dyslipidemia (32.5% and 36.7%), family history of IHD (30% and 23.3%) and obesity (22.5% and 13.3%) respectively. Diabetic hypertensive patients had significantly higher heart rate, hypertensive peaks and more episodes of asymptomatic ST segment depression. Most common in hospital complications were heart failure (30% and 16.7%), arrhythmias (22.5% and 6.7%), renal failure (10% and 5.0%), cerebral ischemia (7.5% and 1.7%), death (7.5% and 3.3%) and cardiogenic shock (5.0% and 3.3%) in Group I and Group II respectively. Conclusion: In hospitals, adverse clinical events were more frequent in diabetic hypertensive individuals compared to non-diabetics. Bangladesh Heart Journal 2024; 39(1): 17-23

Comment on: Acute abdominal pain and emergency laparotomy: bundles of care to improve patient outcomes.

Comment on: Acute abdominal pain and emergency laparotomy: bundles of care to improve patient outcomes.

Author response to: Comment on: Acute abdominal pain and emergency laparotomy: bundles of care to improve patient outcomes.

Author response to: Comment on: Acute abdominal pain and emergency laparotomy: bundles of care to improve patient outcomes.

Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments

ObjectiveImproving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions.MethodsThe LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR).ResultsComments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic.ConclusionPatients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.

A study of clinical profile of acute medical illnesses in geriatric patients

Background: Population aging is transforming the world. Elderly people are the most rapidly growing population group worldwide, which eventually include India also. The objective of the study was to provide the health care needs of this growing numbers of the vulnerable heterogeneous population, reliable data are still lacking and with recognition of the need the present study was designed. Materials and methods: A prospective observational study which was conducted at the department of medicine, Civil Hospital, Ahmedabad for the duration of 2 years, in which total 100 patients who was ≥65 years of age with acute emergency illness were included and data were collected. Results: Patients had common symptoms like breathlessness (45%) and giddiness (39%) and commonly encountered clinical conditions were cerebrovascular stroke (31%) and acute LVF (19%). Hypertension was the most common disease associated with CV stroke, acute LVF and IHD. Hypertension (44) and hypertension and diabetes (40) together were the commonly encountered co-morbidities. Most patients with co-morbidities were found complaint to their medicines. Among study participants, 87% of diabetics had also hypertension as compared to 81.5% nondiabetics who were suffering from hypertension. Conclusion: Most common acute medical illness in geriatric population is due to the chronic co-morbid conditions. It is crucial to maintain chronic morbidity in a timely manner to minimize the complication. Post-acute care may be aimed to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility.

Study of Risk Factors for Morbidity in Emergency Abdominal Laparoscopy Surgery

Introduction: Emergency laparoscopy is regarded as a challenging and high-risk domain due to the requisite expertise in both laparoscopic and emergency surgery. Additionally, the physical fatigue of surgical teams and the urgency context contribute to potential increased morbidity rates in emergency surgery. Furthermore, a primary concern with laparoscopy is the frequency of deep collections. The objective of our study was to evaluate the risk factors for morbi-mortality associated with laparoscopic intervention in non-traumatic acute abdominal emergencies. Materials and Methods: A descriptive, prospective, evaluative study was conducted between February 2018 and October 2021, encompassing 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Among the 337 operated patients, perioperative morbidity was 0.3%, and postoperative morbidity was 6.2% (21 patients). These postoperative complications were classified as grade I in 85.71% of cases (18 patients). The mean age of the patients was 38 years ± 15 years. Body mass index (BMI) was above 25 in 179 patients (53.11%). The mean operative time across all pathologies was 52.09 minutes ± 24.14 minutes (Range: 14-178 minutes). The average overall hospitalization duration was 1.5 days (Range: 1 to 8.5 days).The only factor correlated with the occurrence of postoperative complications was obesity (p=0.003). Conclusion: Emergency laparoscopy does not exacerbate morbidity and can be safely performed for the management of acute abdominal emergencies.

Lipemic serum in a child with new onset diabetes mellitus presenting in severe diabetic ketoacidosis: A case report

Abstract Diabetic Ketoacidosis (DKA) presents as an acute emergency in children with type 1 diabetes mellitus. The mortality associated with DKA is more in developing countries and in children less than 5 years of age. Cerebral edema, sepsis, shock and renal failure are the identified causes for mortality. Severe hyperlipidemia and pancreatitis are less recognised causes for mortality in children with DKA. We report a 6-year-old female child who presented with lipemic serum due to severe hyperlipidemia associated with DKA. With adequate management of DKA as per the guidelines, hyperlipidemia also resolved and no further episodes were noted on follow up. Knowledge about this rare entity could help the clinicians regarding the prompt recognition, evaluation and management of hyperlipidemia and thus help in reduction of mortality associated with the same.

A A retrospective observational study in assesment of role of sonography in adnexal masses and its histopathological correlation in tertiary care centre.

Background- Adnexal masses (masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician–gynaecologist and often present diagnostic and management dilemmas. Types of adnexal mass ranges from benign ovarian and non-ovarian to primary and secondary malignant ovarian masses. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy. Transvaginal ultrasonography remains the gold standard for evaluation of adnexal masses. The management of the adnexal masses varies according to age at presentation, whether benign or malignant, acute emergency or chronic presentation. Aim- The study aimed to determine the causes of adnexal masses and correlation of ultrasonographic and histopathologic findings of the adnexal masses. Methods- This is a retrospective observational study, performed in the Department of Obstetrics and Gynaecology, in tertiary care hospital. Operative and demographic details of patients operated for adnexal masses over a period of one year was obtained from case records of patient. Results- Among 90 cases studied, 86.66%(78) cases of adnexal masses was of ovarian origin followed by 11.66%(7) was of tubal origin. Among 90 cases of adnexal masses, 91.11%(82) cases were benign , 4.44%(4) were of borderline and malignant. Most common ovarian cause of adnexal mass was endometriotic cyst(22.22%) followed by serous cyst adenoma(20%) The highest sensitivity was found for follicular cyst (87.5%) followed by dermoid and serous cyst adenoma (83.33%). Malignancy was found in 8 cases among which 6 were correctly reported by USG resulting in sensitivity of 75%. Conclusion- It was concluded from the current study findings that sonography was primary modality and best screening tool for evaluation of pelvic masses. Ultrasound has high sensitivity for correctly diagnosing benign versus malignant pelvic lesions. Sonography was observed to be best modality to differentiate between solid and cystic pelvic masses.

The Impact of the Critical Care Resuscitation Unit on Quaternary Care Accessibility for Rural Patients: A Comparative Analysis.

Previous research suggests that patients from rural areas who are critically ill with complex medical needs or require time-sensitive subspecialty interventions face worse healthcare outcomes and delays in care when compared to those from urban areas. The critical care resuscitation unit (CCRU) at our quaternary care center was established to expedite the transfer of critically ill patients or those who need time-sensitive intervention. This study investigates if disparities exist in treatments and outcomes among patients transferred to the CCRU from rural versus urban hospitals. This is a retrospective study of adult, nontrauma patients admitted to the CCRU via interhospital transfer from outside facilities from January 1 to December 31, 2018. Patients transferred from within our institution or with missing clinical data were excluded. Multivariable logistic regressions were performed to measure the association between patients' demographic and clinical factors with in-hospital mortality. We analyzed 1381 nontrauma patients, and 484 (35%) were from rural areas. Median age was 59 [47-69], and 629 (46%) were female. Median sequential organ failure assessment was 3 ([1-6], p=0.062) for both patients transferred from urban and rural hospitals. There was no significant difference between groups with respect to most demographic and clinical factors, as well as types of interventions after CCRU arrival, including emergent surgical interventions within 12 hours of arrival at the CCRU. Rural patients were more likely to be transferred for care by the acute care emergency surgery service than were patients from urban areas and were transferred over a significantly greater distance (difference of 53 kilometers (km), 95% CI: -58.9-51.7 km, P < 0.001). Transfer from rural areas was not associated with increased odds of in-hospital mortality (OR: 0.90, 95% CI: 0.60, 1.36; P=0.63). Thirty-five percent of patients transferred to the CCRU came from rural areas, which house 25% of the state population of Maryland. Patients transferred from rural counties to the CCRU faced greater transport distances, but they received the same level of care upon arrival at the CCRU and had the same odds of in-hospital mortality as patients transferred from urban hospitals.

Healthcare Professional's Knowledge of the Systemic ABCDE Approach: A Cross-Sectional Study.

Background and aim Assessing the knowledge of healthcare professionals regarding the Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is crucial since it prioritizes the initial assessment and treatment of patients who are critically ill, regardless of the underlying cause or their age. Since adherence requires knowledge, this study aimed to evaluate the knowledge level of the ABCDE approach among healthcare professionals. Methods This cross-sectional study among healthcare professionals was performed from April to August 2023 in Taif City, Saudi Arabia. The study included healthcare professionals employed in departments exposed to patients with critical illnesses and excluded those from other specialties and individuals from outside Taif City. Data was collected via Google Forms using a previously validated questionnaire designed to assess the ABCDE approach knowledge among healthcare professionals. Statistical analysis was conducted using IBM SPSS, version 26. Results The study included 242 healthcare professionals with a mean (SD) age of 35.77 (9.93) years. About half of the participants were female (52.5%) nurses (50.8%) and had been working in intensive care units (ICU) and neonate intensive care units (NICU) (41.4%). The mean (SD) of the participants' working experience was 9.28 (8.295) years. The overall mean test score was 52.94 % (SD 16.27). The mean knowledge score among males was significantly higher than females (56.37% vs. 49.85%, respectively) (p-value= 0.001). The mean knowledge score was significantly higher among medical specialists and residents (63.308% and 55.67%) than among nurses (46.34%) (p-value <0.001). Attending an advanced trauma life support course and theoretical lecture significantly impacted the total knowledge score among the participants (p-values= 0.001 and <0.001, respectively). The total knowledge significantly increased with age (r: 0.265, p-value <0.001). Years of experience correlated with total knowledge score; with increasing years of experience, the total knowledge was significantly increased (r: 0.248, p-value <0.001). Conclusion The ABCDE approach is a valuable tool for the initial examination and treatment of patients in acute medical and surgical emergencies. The findings indicate that there is a need for further awareness programs and training on the ABCDE approach, as the total knowledge score among healthcare professionals was found to be suboptimal. Further research is needed to assess the association between knowledge level and clinical performance in different healthcare settings within Saudi Arabia.

Competency in electrocardiogram interpretation among medical interns and residents of internal medicine and ER residents

Background: For both undergraduate and graduate medical students, understanding how to interpret an ECG is essential. It has been demonstrated that accurate ECG interpretation influences the course of care for several acute cardiovascular emergencies, such as acute myocardial infarction, arrhythmias, and cardiac arrest patients. Aim: This study aims to assess the Competency in Electrocardiogram Interpretation Among Medical interns and Residents of Internal Medicine and ER residents. Methods: A descriptive cross-sectional study was conducted including intern medical students at Taif University and IM and ER residents who are actively doing residency training programs in Taif Hospitals including (King Abdul-Aziz Specialist Hospital, Al-Hada Armed Forces Hospital, and King Faisal Hospital). The survey was conducted from November 01, 2022, to November 30, 2023. ECGs were selected from the ECG textbooks and ECG web blogs and will be reviewed by two cardiologists. After the ECG strip selection, the reviewed structured questionnaires were distributed to the survey participants. Results: A total of 163 medical interns and residents were included. Exact 79 (48.5%) aged less than 25 years and 84 (51.5%) aged 25 years or more with a mean age of 25.1 ± 3.2 years old. A total of 88 (54%) were females. Overall ECG competency level among medical interns and internal medicine and ER residents. A total of 59 (36.2%) had an overall high competency level with ECG, 79 (48.5%) had moderate ECG competency, and 25 (15.3%) had a low competency level. The overall competency score ranged from 1 to 10 with a mean score of 6.6 ± 1.9 points out of 10. Receiving training and having an ACLS course was significantly associated with competence level (P&amp;lt; 0.05). Conclusion: In conclusion, the current study showed that medical interns and residents in Taif showed an average competence level regarding ECG interpretation with higher competence e among those who were trained and received ACLS courses.