Recent uciem_medjem items

Now I am the Master: Transitioning from Learner to Teacher

Mon, 15 Jun 2026 00:00:00 +0000

Now I am the Master: Transitioning from Learner to Teacher

Emergency Department Pediatric Unscheduled Return Visits: Why do patients return and does it matter?

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: Unscheduled return visits are an important quality indicator in the emergency department. We aim to compare clinical characteristics and ED resource usage of pediatric high risk unscheduled return visits (HRURVs) between the index and return visit and explore root cause of HRURVs. Methods: A retrospective chart-review study conducted between November 1, 2014 and October 31, 2015. All patients who returned to the ED within 72 hours of discharge and were admitted or died on re-presentation were considered. Results: The incidence rate of HRURV in our study was 0.96% (95%, CI:0.81-1.13%). We found that significantly more patients were febrile on index visit than on the return visit. In contrast, HRURV patients had significantly more imaging, labs, IV fluids, ED consults and procedures on return visit. Also, the return visit length of stay (LOS) was significantly higher than on index visit (2.76±1.82 Vs. 5.88±0.44). Upon revisit, 2.2% of patients required ICU admission...

The Challenge Of Unilateral Leg Swelling In The Emergency Department

Mon, 15 Jun 2026 00:00:00 +0000

Unilateral calf swelling can pose a diagnostic challenge in the Emergency Department. There are several differential diagnoses for this presentation, and the management of one may be a contraindication for another. Point-of-care-ultrasound (POCUS) can be used to identify the aetiology and guide management with confidence. We present a case of an elderly patient with unilateral leg swelling in which DVT was initially suspected. However, POCUS demonstrated a ruptured Baker's cyst with associated calf haematoma. The use of POCUS by emergency physicians can avoid the consequences of unnecessary or harmful treatment and missed diagnosis of venous thromboembolic disease.

Factors Associated with Pediatric Emergency Department Avoidance During COVID-19 Pandemic: A Cross-sectional, Telephone-based Survey in Beirut, Lebanon

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: We aimed to explore avoidant behavior of parents of frequent pediatric Emergency Department (ED) users, reasons behind avoidance and healthcare seeking behaviors in avoiders during COVID-19 pandemic.

Methods: We conducted a cross-sectional telephone-based survey on parents of frequent pediatric ED users at a tertiary care center in Beirut between March and August 2021.

Results: A total of 240 frequent pediatric ED users were included. Female comprised 39.6% of the sample. Of the surveyed patients, 117 reported ED avoidance. ED avoidance was common among parents of patients with concern for their child contracting COVID-19 during an ED visit (aOR=1.28, p<0.001,95%CI[1.13, 1.45]). However, parents of patients with an underlying malignancy/hematologic disease were less likely to refrain from ED visits (aOR=0.29, p<0.001, 95%CI[0.14, 0.60]). Moreover, 97.9% of parents of patients with acute symptoms who avoided the ED reported the fear...

Imposter Syndrome

Mon, 15 Jun 2026 00:00:00 +0000

Imposter Syndrome

To Do, or Not to Do, That Is the Question

Mon, 15 Jun 2026 00:00:00 +0000

To Do, or Not to Do, That Is the Question

Pitfalls to Avoid while Interpreting Cholinesterase Activity Levels in Cholinesterase Inhibitor Pesticides Poisoning

Mon, 15 Jun 2026 00:00:00 +0000

The cholinesterase activity (AcCh) assay finds an important place in the diagnosis of acute poisoning by cholinesterase inhibitor pesticides, allowing the indication and the efficacy evaluation of antidote treatment with atropine and oximes. AcCh is also a biomarker of effect in occupational exposure to cholinesterase inhibitor pesticides. However, some factors may disrupt AcCh levels and distort the interpretation of the assay results. Hence, the present review aimed to summarize the factors and the variations that may have an impact on the interpretation of AcCh. Indeed, butyrylcholinesterase and acetylcholinesterase are subject to wide physiological individual variations, such as to age, weight and height. Genetic and pathological state may also be factors influencing AcCh levels. The consumption of drugs and daily exposure to some toxicants may also disrupt the AcCh levels, either by direct action on the enzyme or by disrupting its synthesis. In addition, analytical variations...

Refractory Hypoxemia? Is Positive End Expiratory Pressure Always the Answer?

Mon, 15 Jun 2026 00:00:00 +0000

Refractory Hypoxemia? Is Positive End Expiratory Pressure Always the Answer?

MEMC 2023 CONFERENCE ABSTRACTS - PART 1

Mon, 15 Jun 2026 00:00:00 +0000

MEMC 2023 CONFERENCE ABSTRACTS - PART 1

Can PANDAS Swear? A Curious Case of Coprolalia in a 15 Year Old Girl presenting to the Emergency Department

Mon, 15 Jun 2026 00:00:00 +0000

Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections, or PANDAS, is a diagnosis of children with an acute and fast onset of obsessions, compulsions or tics succeeding a Group A beta-hemolytic streptococcal infection. Coprolalia is a form of tics where the patient involuntarily says obscene and inappropriate words. We report a case of a 15-year old girl with a history of suspected PANDAS presenting to the emergency department with recurrent coprolalia without signs of a streptococcus infection. PANDAS and other neuropsychiatric syndromes can have different acute presentations. The ED physicians should be familiar with such disorders and presentations.

The Emergency Department Boarding Crisis

Mon, 15 Jun 2026 00:00:00 +0000

The Emergency Department Boarding Crisis

Bilateral Post Traumatic Avulsion of Patellar Apexes: A Case Report

Mon, 15 Jun 2026 00:00:00 +0000

Patellar tendon rupture and patellar apex rupture are established complications in patients with end stage kidney disease, however, little to no literature describes bilateral patellar avulsion. This is a case presentation of bilateral knee avulsion due to bilateral patellar tendon rupture at the level of the apexes in a patient with end stage kidney disease on dialysis. A 52 year old female presented to the emergency department for low energy traumatic event. On physical exam patient had bilateral patella alta with limited range of motion. On imaging, bilateral knee MRI was diagnostic of bilateral avulsion of patellar apexes. In light of the clinical and radiological findings, patient was admitted for surgical repair, in which a free tendon graft was placed. Post operation radiography showed good patellar placement and fixation. Upon discharge, patient was allowed partial weight bearing for the first 6 weeks, followed by full weight bearing. 1 year post surgery, patient was pain...

Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

Mon, 15 Jun 2026 00:00:00 +0000

Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

We Are At Risk

Mon, 15 Jun 2026 00:00:00 +0000

SURGEON GENERAL’S WARNING

Abortion is Health Care

Mon, 15 Jun 2026 00:00:00 +0000

Why are we making a statement on a political issue? Because this is not one. Bodily autonomy is not a political issue; it is a basic human right that has been turned into a political issue.

A Positive Outcome Post Alteplase, ECMO and Emergent Surgery in a Case of Massive Pulmonary Embolism Cardiac Arrest Complicated by Intra-Abdominal Bleeding

Mon, 15 Jun 2026 00:00:00 +0000

Acute pulmonary embolism is stratified into three groups: low-risk, moderate-risk, and high-risk. Highrisk PE, also known as massive pulmonary embolism (MPE), is defined as an acute PE with sustained hypotension, pulselessness, and persistent bradycardia. Herein, we present a case of a 44-year-old female presenting to the emergency department with shortness of breath, chest discomfort, and central cyanosis. She was found to have MPE and arrested twice during which she received alteplase and Advanced Cardiac Life Support. In the ICU, she arrested for the third time, was resuscitated, and a decision to initiate extracorporeal membrane oxygenation deemed reasonable. The patient deteriorated and was rushed to the operating room after detecting major intra-abdominal bleeding on FAST exam. Hepatic injury was suspected and liver packing was initiated. Patient was safely discharged home neurologically intact after a prolonged hospital stay.

COVID-19 & the Pied Piper Effect on Pediatric Emergency Department Attendances - A Single-Center Study Based in the UAE.

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: The coronavirus 2019 (COVID 19) is an ongoing pandemic that brought significant changes in the healthcare sector, including healthcare-seeking behaviours, population movement, and daily activities. The COVID 19 has significantly affected the influx of paediatric patients attending the emergency department at a tertiary hospital level. This paper aims to measure and study the magnitude and reasons behind the reducing number of children attendances. COVID-19 compares with the disappearing number of children attending PED's to Pied Piper of Hamelin, attracting kids away from their homes as in our old bedtime stories. Methods: Our paper is a single-centre, retrospective, observational study in the Paediatric Emergency Department (PED) and data obtained from Electronic Medical Records and ED Dashboard. We included all paediatric patients who registered in our PED during April, May, and June over three years (2018, 2019, and 2020), including their level of triage and...

Becoming the Senior Resident: Embracing Leadership in Emergency Medicine

Mon, 15 Jun 2026 00:00:00 +0000

Becoming the Senior Resident: Embracing Leadership in Emergency Medicine

The Efficacy of Table Top Simulation as a Didactic Adjunct for an Undergraduate Emergency Medicine Clerkship Curriculum: A Prospective Cross-Over Study

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: Simulation is used by many medical specialties, throughout the world, as an effective educational adjunct to clinical learning experiences. There is limited prospective research to support the use of table-top, low fidelity, simulation experiences as a suitable replacement for traditional lecture-based modalities in the context of undergraduate emergency medical education. We designed, implemented and evaluated sections of a table-top simulation-based curriculum for fourth year medical students participating in the department’s advanced emergency medicine clerkship. Methods: A prospective, randomized, cross over study comparing lecture-based learning activities to an experimental table-top simulation exercises based on a primary outcome objective, considering the quantitative acquisition of clinical knowledge, and a secondary outcome looking at the results of survey data, considering student perspectives on learning experience. Four student cohorts participated in...

Captivating Capnography – The Basics of End-Tidal CO₂

Mon, 15 Jun 2026 00:00:00 +0000

Capnography is most known for its use in confirming endotracheal tube placement and assessing the effectiveness of CPR. However, there are several other clinical scenarios where end tidal CO₂ (ET-CO₂) can provide us useful information.

Why I No Longer Teach ATLS

Mon, 15 Jun 2026 00:00:00 +0000

Why I No Longer Teach ATLS

MEMC 2025 CONFERENCE ABSTRACTS

Mon, 15 Jun 2026 00:00:00 +0000

Abstracts Presented at the XIIIth Mediterranean Emergency Medicine Congress - MEMC25 at Semmelweis University,

Budhapest, Hungary

August 14-17, 2025

High Level Disinfection at Bedside? High Level Disinfection Wipes for Ultrasound Probes in the ED

Mon, 15 Jun 2026 00:00:00 +0000

A 26-year-old woman presents with a oneday history of lower abdominal cramping. She reports a positive home pregnancy test, with her last menstrual period occurring six weeks ago. On examination, she is hemodynamically stable but has mild tenderness in the suprapubic region. You perform a bedside transvaginal ultrasound confirming a 6-week intrauterine pregnancy with an appropriate fetal heart rate and no adnexal masses. After reassuring her, you arrange follow-up with the on-call OB/GYN and discharge her within 90 minutes of her arrival. As you hand the transvaginal ultrasound probe to the ED technician, they ask for guidance on how to properly clean it.

Typically, probes used on the skin surface are cleaned after each use by removing visible contamination, followed by disinfection with a lowlevel disinfectant (LLD). LLDs, which are often alcohol- or quaternary ammonium compoundbased, are applied via spray or wipes.

However, internal probes, such...

What is ED Operations?

Mon, 15 Jun 2026 00:00:00 +0000

What is ED Operations?

Turning Foes to Friends: Establishing Collegiality in the ED

Mon, 15 Jun 2026 00:00:00 +0000

Turning Foes to Friends: Establishing Collegiality in the ED

Solutions for the “Vanishing Drug” Conundrum in Lebanon: A Change in the Subsidy System Coupled with a Digital Prescribing Platform

Mon, 15 Jun 2026 00:00:00 +0000

The shortage of foreign currency in Lebanon due to the multiple crises that the country has been facing since October 2019 poses a threat to the importation and availability of pharmaceutical products among other essential commodities. This has been remedied by an importation subsidy system for pharmaceuticals financed by the central bank’s foreign reserves. However, patients have recently experienced shortages of many drugs on pharmacy shelves. In this paper, we describe the pharmaceutical supply chain in Lebanon along with the subsidy system put in place by the central bank. We then propose recommendations to improve this subsidy system and enhance prescribing practices in order to ensure the continuous presence of medications on pharmacy shelves, and that the foreign currency supplied by the central bank is spent to the benefit of the Lebanese patient.

Assessment of Automated External Defibrillators and Cardiopulmonary Resuscitation Training in Lebanese Schools

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: Sudden cardiac arrest accounts for 5% to 10% of deaths among children. Survival following out-of-hospital cardiac arrest depends on quick recognition, early cardiopulmonary resuscitation (CPR) and defibrillation. In Lebanon, the survival rate of children following such arrests is low (16.7%). Consequently, this study assesses availability of automated external defibrillators (AED) and CPR/AED training in Lebanese schools. Methods: This is a cross-sectional phone-based survey study conducted using a randomized sample of 175 private, private-free and public schools - representative of all of the country regions. Results: Among surveyed schools, 99 responded with a complete participation (56.6% response rate). Most surveyed schools were public. 28% had at least one individual who underwent CPR or/and AED training, and only 2 schools had an AED. 4 schools reported a history of SCA, 3 of them were confirmed dead, and those 4 schools did not have an AED. The main...

How to Stand Up for Science and Fight Burnout

Mon, 15 Jun 2026 00:00:00 +0000

How to Stand Up for Science and Fight Burnout

Adding Insult to Injury: Resident Mistreatment in Emergency Medicine

Mon, 15 Jun 2026 00:00:00 +0000

Adding Insult to Injury: Resident Mistreatment in Emergency Medicine

IMGs are still MDs

Mon, 15 Jun 2026 00:00:00 +0000

What is an IMG you ask? IMG stands for International Medical Graduate. This includes anyone who attended and obtained their medical degree from outside the United States. Even though they may be a U.S. citizen and went to school outside the United States, they are still categorized as an IMG. However, you will have U.S. preceding the IMG, thus resulting in the title of US IMG versus non-US IMG (IMG that is not a U.S. citizen). But, in all seriousness, labelling an MD as an IMG not still an MD?

Brown Recluse Spider in the Mediterranean Region: A Review of the Literature

Mon, 15 Jun 2026 00:00:00 +0000

Spiders are eight-legged arthropods that belong tothe arachnids class and are found on every continentexcept Antarctica.1 As of 2020, there are over 48000recognized species of spiders with more than 5000in the Mediterranean area. Out of these, only twospiders, the Latrodectus tredecimguttatus and theLoxosceles rufescens are of medical significance in theMediterranean area.1 Although most spider bites arebenign; however, severe reactions and life-threateningenvenomation do occur.

Achenbach Syndrome: Minor Traumatic Injury as a Possible Etiology

Mon, 15 Jun 2026 00:00:00 +0000

Achenbach syndrome is a rare cause of acute bluish discoloration and swelling of one or more digits, of unknown etiology. The condition is self-limited and benign but is worrisome for both patients and healthcare providers due to its emulation of peripheral ischemia. Familiarity with the clinical features of Achenbach syndrome allows for rapid diagnosis and mitigation of costs and anxiety associated with unnecessary testing and referrals. We report a case of Achenbach syndrome associated with a puncture wound, which supports a traumatic etiology for this condition.

Beirut Port Blast 2020: New Lessons Learned in Mass Casualty Incident Management in the Emergency Department

Mon, 15 Jun 2026 00:00:00 +0000

Background: On August 4, 2020, Lebanon suffered its largest mass casualty incident (MCI) to date: the Beirut Port blast. Hospital emergency response to MCIs is particularly challenging in low- and middleincome countries, where emergency medical services are not well developed and where hospitals have to rapidly scale up capacity to receive large influxes of casualties. This article describes the American University of Beirut Medical Center (AUBMC) response to the Beirut Port blast and outlines the lessons learned.

Discussion: The Beirut Port blast reinforced the importance of proper preparedness and flexibility in managing an MCI. Effective elements of AUBMC's MCI plan included geographic-based activation criteria, along with use of Wi-Fi messaging systems for timely notification of disaster teams. Crowd control through planned facility closures allowed medical teams to focus on patient care. Pre-identified surge areas with prepared disaster cart deployment allowed...

Lessons Learned from the COVID-19 Pandemic: Physician Safety and Coverage in Lebanon

Mon, 15 Jun 2026 00:00:00 +0000

Similar to other countries, Lebanon experienced the challenges that the COVID-19 pandemic imposed on its healthcare system. Physicians, among other healthcare workers, felt the large toll of the pandemic. The growing number of physicians infected with the coronavirus has uncovered gaps in the policies and laws meant to protect and ensure physician safety. These include gaps in physician coverage for healthcare, disability, and death, in addition to particular vulnerabilities of trainee physicians, along with the absence of specific laws, strategies, and agencies to ensure the safety of the healthcare work environment. This paper highlights these gaps and proposes solutions to address them.

Oxygen is for the Weak

Mon, 15 Jun 2026 00:00:00 +0000

Oxygen is for the Weak

Are Emergency Physicians’ Brains Different?

Mon, 15 Jun 2026 00:00:00 +0000

Emergency physicians are used to not knowing all of the facts. Our professional brain is trained to gather all of the immediately available data which can reasonably be obtained within the time constraints of the emergency department and then decide and act. This timeframe can be seconds or minutes but not usually more than a couple of hours. We do not have the luxury of expansive history gathering, data collection, discussion, and reflection. Every emergency physician has had to come to terms with the stressful reality of having to decide something really important without enough information. We make the decision to admit or discharge and then have to move on to the next patient. Just think for a second about how long you really deliberate on whether or not to admit the 45-year-old guy with chest pain with the normal EKG. You do not have the luxury of time in making decisions and this is the dilemma of the decision-making process which separates different types of physicians. ...

Education in Point of Care Ultrasound

Mon, 15 Jun 2026 00:00:00 +0000

Widespread adoption of Point of Care Ultrasound (POCUS) in Emergency Medicine (EM) has accelerated over recent years. This increase in the use of POCUS has led to safety concerns by those outside our specialty about the use of ultrasound outside of radiology.

My Journey from ER to Palliative Care

Mon, 15 Jun 2026 00:00:00 +0000

My Journey from ER to Palliative Care

Association Between Teaching Status of Metropolitan Hospitals and Out of Hospital Cardiac Arrest Outcomes: A Retrospective Observational Study of Hospitals in the United States

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: The quality of care and patient outcome of out-of-hospital cardiac arrest (OHCA) are affected by different factors, one of which is the hospital teaching status. This study aims to assess the association between teaching status of hospitals and survival rates. Methods: This retrospective observational study utilized the Nationwide Emergency Department Sample (NEDS) database of the year 2014 (released in 2016). The study sample included OHCA 122,776 patients. Descriptive analysis was performed. Patients’ characteristics were compared according to the hospital teaching status. This was followed by a multivariate analysis to assess the impact of the hospital teaching status on the patients’ survival at hospital discharge after controlling for confounding factors. Results: A total of 122,776 patients with OHCA were included in this study. The average age was 65.91 years with male predominance (61.7%). Around 62.1% of patients were admitted to metropolitan...

First, Do No Harm

Mon, 15 Jun 2026 00:00:00 +0000

First, Do No Harm

Critical Care Education: How Early Is Too Early?

Mon, 15 Jun 2026 00:00:00 +0000

Critical Care Education: How Early Is Too Early?

MEMC 2023 CONFERENCE ABSTRACTS - PART 2

Mon, 15 Jun 2026 00:00:00 +0000

MEMC 2023 CONFERENCE ABSTRACTS - PART 2

Follow-Up Behavior of Patients Who Leave Without Being Seen from a Hybrid Point of Service Collection Emergency Department

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: This study aims to assess follow-up behaviors of patients who leave without being seen (LWBS) from a hybrid point of service (POS) collection model Emergency Department (ED). Methods: A cross-sectional survey was administered to patients who LWBS from a hybrid POS collection model ED, one-week post-ED visit, at an academic tertiary care medical center in Lebanon, between June 2016 and May 2017. Results: LWBS patients were found to be young, males, and present with conditions of lower urgency and presenting mainly with a musculoskeletal chief complaint. Majority (66.8%) left because of third party payer denial of visit coverage followed by cost of visit (12.6%) and wait times (12.6%). A greater percentage of those who LWBS due to financial reasons were male (64.1% vs 33.3%, p <0.001) and waited less (23.4 min vs 30.8 min, p=0.08) compared to those who left for non-financial reasons. The majority of LWBS patients sought medical care within the week after leaving...

Characteristics of High Utilizer Patients in the Emergency Department at a University Hospital in the Kingdom of Bahrain

Mon, 15 Jun 2026 00:00:00 +0000

Background: Emergency departments (EDs) around the world are facing a crippling crisis of overcrowding, a complex problem caused by a variety of factors. One contributing factor is the overutilization of EDs by patients with frequent visits. Objective: This study aims at measuring the prevalence of this phenomenon and better understanding the characteristics of high utilizers.

Methods: A retrospective review was conducted in a tertiary care teaching hospital, for patients aged 14 years and above during the year 2022. The definition of a high utilizer is set as any patient that fits the inclusion criteria with four or more visits to the ED during 1 year.

Results: The prevalence of high utilizers in our ED is 3.9%, accounting for 12.1% of visits in 2022, where 135 was the highest number of visits made by one patient. Visits mostly consisted of level 3, Yellow (48.9%) and level 4, Green (42.8%) triage. The top three chief complaints were sore throat (16.8%),...

Bridging the Gap Towards Developing Emergency Medicine: ED-based and -trained Attendings Outperform Attendings from Hospital Departments Rotating in the ED

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: In Greece, Emergency Departments (EDs) are currently staffed with medical personnel without formal training in Emergency Medicine (EM). These attendings come from various medical specialty training backgrounds. The aim of the study was how ED-based attendings who have been trained in the ED for more than a year, can handle medical emergency cases compared to attendings from other medical department in terms of ED length of stay (ED-LOS).

Methods: This is a retrospective observational study. We examined the “waiting time “(Time between ED arrival/triage and Time first seen by a Physician?) and the duration between when patients were first cared for in the ED by a physician until the decision to admit or discharge (“Care Time”) (Time between Seen by physician AND Disposition). We recorded time periods from 18 different days from the EMR dataset. The study was conducted in a large ED in Athens, Greece, with 120,000 ED visits per year. We enrolled 5572...

Is There Value in Screening Asymptomatic Patients with No Risk Factors for COVID-19 in the Emergency Department?

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: During the COVID-19 pandemic, screening asymptomatic admitted patients for COVID-19 became routine in order to minimize the potential risk of these individuals as silent but infectious hosts in the propagation of this pandemic. However, testing is costly and the value of this indiscriminate testing was not studied. Hence, our study aimed to determine the rates of positive COVID-19 PCR results in patients presenting to the emergency department (ED) with no suspicion for a COVID-19 infection at different times during the pandemic. Methods: This was a retrospective cohort study of asymptomatic patients presenting to the ED with no COVID infection risk factors, in an urban, tertiary care hospital in Lebanon, from March 2020 to January 2021, representing periods with different national incidence rates of COVID-19. We included patients of all ages, from the last 15 days of each month, who were tested for COVID-19 by PCR in the ED and who fulfilled the following “screening...

Saving the Suffering Lebanese Healthcare Sector Immediate Relief while Planning Reforms

Mon, 15 Jun 2026 00:00:00 +0000

In October 2019, an already strained economy in Lebanon suffered a sapping shock leading to a palpable shortage of US dollars, limitations on foreign currency withdrawals and transfers, substantial devaluation of the Lebanese currency, and massive loss of purchasing power. The economic downfall had a crippling effect on all healthcare sectors including hospitals, healthcare providers, and the pharmaceutical and medical supplies industry. The outbreak of COVID-19 further aggravated the crisis. To address the health care crisis, Lebanon needs a dual tracked plan, with immediate measures to tackle the short-term urgency and a medium/long term effort to address the health sector’s structural issues. In this paper, we present some essential reforms needed in the short-term. The approach focuses on maintaining access to healthcare for all, enhancing primary and urgent care centers, controlling readmission, defined as subsequent admission of a patient within a month for the same health...

Psoriasis and Heart Failure: Literature Review and a Case Challenge

Thu, 11 Jun 2026 00:00:00 +0000

Psoriasis is a disease characterized by chronic inflammation with a global prevalence of 1-2%. It has a strong genetic component with a systemic immunological response mainly driven by T helper (Th) 1 and 17 lymphocytes. The relationship between HF and psoriasis is not well-described. In this paper we describe 2 cases of concomitant psoriasis and heart failure. Furthermore, we revisit the pathogenesis of those entities and discuss the available evidence on their association, and the proper evaluation of psoriasis in the management of heart failure in patients present with both diseases.

Together for Emergency Medicine in the United Arab Emirates!

Thu, 11 Jun 2026 00:00:00 +0000

As I began writing this article, I was stunned realizing that September 2019 marks the anniversary of a ten-year journey for the specialty of emergency medicine (EM) in the United Arab Emirates (UAE). I had returned home to the UAE after 17 years’ acquiring and refining knowledge and skills as well as building experience and expertise abroad. This included medical school studies in Ireland,1 an Emergency Medicine (EM) Residency training in Montreal, Quebec2, a Prehospital Care fellowship in Toronto, Ontario,3 a Disaster Medicine fellowship in Boston, Massachusetts4, and finally a public health graduate degree in Baltimore, Maryland5. Throughout that time spent in nations where EM was well-developed, I was persistently asking myself, “What can I learn from here to allow me to develop EM back home?”. This challenging journey was certainly exciting and beneficial and exposed me to so many different “systems”, to their strengths and weaknesses, to the different approaches used to...

Descriptive Characteristics of Subarachnoid Hemorrhage in a Lebanese Sample

Thu, 11 Jun 2026 00:00:00 +0000

Introduction: Subarachnoid hemorrhage (SAH) is a life-threatening condition characterized by bleeding into the subarachnoid space. Most data regarding non-traumatic SAH is from the U.S. and Europe with a paucity of studies from the Middle East. Therefore, this study aims at assessing the characteristics of SAH patients and describing associated factors and outcomes in a sample of SAH patients presenting to an emergency department in a regional tertiary-care medical center in Lebanon. Method: A retrospective medical chart review was conducted on all patients presenting to the emergency department with non-traumatic SAH from September 2009 to September 2016 using hospital discharge diagnosis (ICD-9 code 430); descriptive analyses were carried out to map patients’ characteristics, clinical presentation and potential factors. Results: Within the span of seven years, 94 patients presented with non-traumatic SAH with a mean age of 55 years and a predominance of female gender...

The Mediterranean Journal of Emergency Medicine & Acute Care: Why

Thu, 11 Jun 2026 00:00:00 +0000

Certainly, we cannot launch a new open access journal such as MedJEM without justifying why we aredoing so and what will be different about it. First, we believe the specialty of emergency medicine (EM) as well as emergency, urgent and acutecare around the Mediterranean basin have reached over the last three decades a level of development,complexity and needs that require the establishment of a regional internationally-driven medical journal.The publication of such a journal constitutes a major milestone in the development of any specialty ingeneral - and of EM and emergency medical services in particular.

Establishing Emergency Medicine in Iran: a Post-implementation Perspective

Thu, 11 Jun 2026 00:00:00 +0000

In the 1990s, a comprehensive evaluation of national emergency care (EC) system was performed by the Iranian Ministry of Health and Medical Education (I-MOHME) to identify gaps in timely and proper EC delivery. It was then concluded that a refurbished patient-centered specialty, namely emergency medicine (EM), could reduce or close these gaps.

ED Visits and Admission Profile pre- and during COVID-19 Pandemic

Thu, 11 Jun 2026 00:00:00 +0000

Introduction: COVID-19 pandemic has had catastrophic effects on the healthcare system. Emergency departments (EDs) are among the most affected areas. The purpose of our study is to explore the pandemic’s effect on patients’ ED visits and admissions. Methods: This was a retrospective study using data from medical record system of King Hamad University Hospital. We examined ED visits and hospital admissions over two 12-month time spans before and during the pandemic. Monthly visits were classified according to several parameters, and ED revisits within 72 hours were also compared between both periods. Results: There was an overall decrease of 11.05% in total ED visits during the pandemic. Disproportionate decrease was seen in visits by pediatric cases under 18 years (49.54%) and patients older than 65 years (1.41%). Conversely, there was a significant increase in visits among adults. Referrals from local health centers to the ED during the pandemic decreased significantly (23.92%),...

Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department

Thu, 11 Jun 2026 00:00:00 +0000

Introduction: Abdominal pain is a frequent reason for Emergency Department (ED) admission; it amounts for around 5–10% of all ED visits. Early assessment should focus on immediately distinguishing cases of acute abdomen that require urgent surgical intervention. The clinical localization of pain is crucial, suggesting an initial evaluation of the origin of the abdominal pain; however, imaging is often required for final diagnosis. Ultrasound (US) represents a rapid imaging modality that is readily available in the ED and does not involve radiation or contrast agent administration. A new generation of portable, battery-powered, low-cost, hand-carried ultrasound devices have become available recently; these devices can provide immediate diagnostic information in patients presenting with abdominal pain in ED.The aim of the study was to demonstrate the diagnostic usefulness of a bedside pocket-sized ultrasound (BPU) device (Vscan from General Electrics) in non-traumatic patients complaining...

Acute management of rape survivors in Lebanon: overview and challenges

Thu, 11 Jun 2026 00:00:00 +0000

The management of survivors of rape in the Lebanese healthcare setting remains ambiguous. National initiatives have been established to train first-line responders to provide adequate care for these survivors; however, management often remains suboptimal. This article explores current practices and challenges faced in the management of survivors of rape and proposes recommendations for the advancement of care in this setting.

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department

Thu, 11 Jun 2026 00:00:00 +0000

Introduction: Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions. Methods: We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included...

Farewell to a Friend - with "Love"

Thu, 11 Jun 2026 00:00:00 +0000

Peter Rosen, MD, FAAEM, one of the main founding fathers and mothers in the field of emergency medicine, passed away in Tucson, Arizona, on the 11th of November 2019 from complications of chronic diseases, with his best friend and wife Ann at his side. He was 84 years old.Dr. Rosen dedicated decades of his life advocating and promoting the field of emergency medicine as a medical discipline and academic specialty, one that stands in parity with all other primary categorical specialties.

A Dermatologic Condition Mimicking Brown Recluse Spider Bite

Thu, 11 Jun 2026 00:00:00 +0000

Loxosceles genus represents a wide number of species including the brown recluse spider. This spider is known worldwide for causing serious injuries resulting from its bite. The diagnosis of brown recluse spider bite is challenging as the injury clinically resembles other conditions and cannot be confirmed unless the spider was observed. We present a case of a 46-year-old male who presented to the emergency department with sudden onset of two painful punctate lesions. We discuss the clinical presentation, investigation and approach; additionally, we briefly highlight the main points with regards to presentation, diagnosis and management of this condition.

Emergency Physicians Should Give Ketamine to Patients with Acute Suicidal Ideation

Mon, 8 Jun 2026 00:00:00 +0000

Acute suicidal ideation (SI) represents about 1% of all adult emergency department (ED) visits in the U.S. and has increased over the past few decades, especially in the wake of the COVID-19 pandemic.

Search Terms for Conducting Systematic and Scoping Reviews in the Middle East and North Africa (MENA) Region and the Arab World: An Example on COVID-19

Mon, 27 Apr 2026 00:00:00 +0000

Background: In the field of scientific research, it is well recognized that the starting point for such efforts necessitates a proper and thorough literature search using reliable databases. Objectives: The aim of this article is to present future researchers with a guide that provides a well-defined set of search terms (MeSH terms and keywords) for the Middle East and North Africa (MENA) region, the Arab world, and countries within them. Methods: Selecting the proper search terms for the 26 countries and COVID-19 required a systematic approach for building a search strategy. MeSH and keyword searching was initially conducted in Medline (OVID) and replicated in PubMed. Discussion: Based on the described methodology, we extracted and compiled an extensive and comprehensive collection of search terms pertaining to the countries of the Arab world, MENA region, and COVID-19. Conclusions: This guide will facilitate conducting systematic and scoping reviews, using...

A Case Report of Toxicity from Ingestion of a Hospital Antiseptic Solution Containing 1-Propanol and 2-Propanol

Thu, 6 Oct 2022 00:00:00 +0000

In the midst of the COVID-19 pandemic, the increased risk of exposure to 1-propanol has led the United States Food and Drug Administration to issue a warning about toxicity of 1-propanol-contaminated brands of hand sanitizers. We report a mixed intoxication with 1-propanol and 2-propanol in a patient who unintentionally ingested approximately 300 mL of hospital topical antiseptic solution and who presented to the emergency department with nausea, vomiting, and decreased level of consciousness. The patient developed an anion gap metabolic acidosis without an osmolar gap, elevated serum lactate, and undetectable serum beta-hydroxybutyrate. One hour later, he developed chest pain and was found to have an ST-segment elevation myocardial infarction. The patient underwent urgent coronary angiography and stenting of the totally occluded mid-segment of the Left Anterior Descending coronary artery. The patient recovered and was discharged home after 7 days.

MENATOX 2020 CONFERENCE ABSTRACTS

Sun, 8 May 2022 00:00:00 +0000

Abstracts Presented at the Middle East and North Africa Clinical Toxicology Association Annual Conference in Istanbul, Turkey February 19 - 22, 2020

MENATOX 2021 CONFERENCE ABSTRACTS

Sun, 8 May 2022 00:00:00 +0000

Abstracts Presented at the Middle East and North Africa Clinical Toxicology Association Annual Conference & Scientific Meeting March 28-31, 2021

Use National Early Warning Score In The Prognosis Of Stroke Patients In The Emergency Department

Tue, 26 Apr 2022 00:00:00 +0000

Introduction: Few scoring systems are used in the emergency department to identify critically ill patients and anticipate patients' deterioration such as National Early Warning Score (NEWS). This study aimed to evaluate NEWS in patients with acute stroke and its relationship with treatment and type of stroke and patient outcome.

Methods: In this prospective cross-sectional descriptive-analytical study, all patients over 18 years of age with a diagnosis of ischemic stroke, who presented through the emergency department, were involved. The variables of interest were collected; the NEWs score was calculated for each patient.

Results: In assessing NEWS and its relationship with outcome based on the ROC curve, the area under the curve was equal to 0.417. Considering the high intensity of NEWS above 7, sensitivity, specificity, positive predictive value, negative predictive value, PLR, and NLR were 16.67%, 98.77%, 83.33%,...

An Overview of the State of Emergency Medicine in Syria

Wed, 20 Apr 2022 00:00:00 +0000

Introduction: Emergency medicine is a developing specialty in low-to-middle income countries. The specialty was in its infancy in Syria when the war started a decade ago. Syria has since experienced civil war, unrest, famine, and financial collapse that has strained its healthcare system. There is limited research and information regarding Emergency Medicine residencies and training in Syria. Therefore, this article describes the growing and current state of Emergency Medicine and its training in Syria.

Methods: A mixed methods approach using a systematic review and semi-structure interviews was utilized. MEDLINE, EMBASE and PsychINFO were searched from inception until March 9, 2022. Eligible studies were specific to emergency medicine and discussed the training of emergency medicine physicians in Syria. Semi-structured key informant interviews and a review of the Ministry of Health website were utilized to supplement information regarding...

Reforming Healthcare Practice in View of the Economic Crisis in Lebanon: The Case of Cardiovascular Care

Wed, 20 Jan 2021 00:00:00 +0000

Since the fall of 2019, Lebanon has been facing an economic crisis that has imposed many challenges on its healthcare system in its entirety. In this review, we propose a methodology to inform healthcare policy and apply it on cardiovascular disease (CVD) healthcare with emphasis on ischemic heart disease (IHD). The main goal of this methodology is reducing unnecessary expenditure while maintaining quality and access. CVD, and particularly IHD, is the most common reason for hospitalizations in Lebanon. Lebanon also has a high density of catheterization labs, higher than countries with higher prevalence of disease. Additionally, we found coronary to be are more expensive in comparison to other countries. To reduce healthcare costs without compromising quality and access we propose solutions targeting healthcare financing, payment for services, healthcare organizations, behaviors of providers, payers, and patients, and above all government regulation.

Outpatient Management of Cancer Patients During the COVID-19 Pandemic

Fri, 25 Dec 2020 00:00:00 +0000

Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China. In no time, SARS-CoV- 2 found its way to the whole world, to be declared as a pandemic by the World Health Organization (WHO) on March 11^th, 2020. As this disease continues to take its toll on the world as a whole, we, at the American University of Beirut Medical Center (AUBMC), believe that it is essential to protect those who are at a particularly high-risk for contracting the virus, namely cancer patients. Besides complying with all the protective measures recommended by WHO, we developed quality improvement plans for the outpatient management of febrile neutropenia, pneumonia and pulmonary embolism in cancer patients. The aim of such plans is to offer adequate management for cancer patients on an outpatient basis, whenever possible, and thus limit their admission rates together with their risk of contracting the novel virus, SARS-CoV- 2.

Point-of-Care Ultrasound Appearance of Cystic Ovarian Teratoma Causing Ovarian Torsion

Tue, 24 Nov 2020 00:00:00 +0000

We present a case of ovarian torsion due to a nine-centimeter cystic ovarian teratoma diagnosed on transabdominal point-of-care ultrasound (POCUS). A 29-year-old female presented with abrupt onset of 10/10 left lower quadrant pain for one hour. She had a known left-sided ovarian cyst. Patient was normotensive, not tachycardic, and afebrile. Bimanual exam showed a seven-centimeter left, adnexal mass. POCUS revealed a nine-centimeter cystic structure in the left adnexa with a three-centimeter echogenic focus, consistent with a dermoid plug. A radiology-performed transvaginal ultrasound confirmed the left sided mass with absent blood flow. Emergent diagnostic laparoscopy showed the cyst was torsed twice and was found to contain adipose tissue and hair on pathologic evaluation consistent with a benign cystic teratoma. The patient did well postoperatively and was discharged the next day. Ovarian torsion is a gynecologic surgical emergency. The characteristic appearance of...

Volunteer-Operated Field Medical Tents During Civilian Protests in Beirut, Lebanon: Challenges and Lessons

Mon, 23 Nov 2020 00:00:00 +0000

In October 2019, the worsening political, economic, and perceived corruption in Lebanon led to civil unrest. In anticipation of injuries, a group of healthcare professionals and social activists summoned paramedics, nurses, and physicians through social media, to provide medical assistance in the protest area. These volunteers established a physician-led advanced first-aid tent, whose aim was to reduce the patient load on Emergency Departments in local hospitals. We present the experience of volunteers, lessons learned, and challenges faced during the establishment of the physician-led first aid tent. In this manuscript, we discuss the following aspects of our efforts that can serve as relevant lessons we learned about medical volunteerism: spontaneity in volunteerism, operations, location and storage, supplies, roaming team, coordination with emergency services, safety, documentation, communication, special situations, and transition from acute to primary care.

A Brief Report on the Beirut Port Explosion

Sun, 18 Oct 2020 00:00:00 +0000

Over the past year, Beirut has witnessed a civil revolution, the COVID-19 pandemic, its worst economic crisis in decades, and most recently one of the largest non-nuclear explosions in history. This explosion had devastating effects on the city’s social, economic, and health infrastructure.

Posterior Knee Dislocation Following a Knee Arthroplasty

Mon, 5 Oct 2020 00:00:00 +0000

Total knee arthroplasty is one of the most commonly performed surgeries in the United States. Complications following knee arthroplasty are uncommon, especially dislocations. Knee dislocations can be associated with popliteal artery injuries, which are potentially catastrophic and limb threatening. Emergency Department (ED) physicians should be familiar with the management of knee dislocations and complications following total knee arthroplasty. A 61-year-old female presented to the ED with acute right knee pain approximately 10 weeks after undergoing a total knee replacement for tricompartmental osteoarthritis. While at her first outpatient physical therapy evaluation, the patient felt a pop while going from a seated to standing position. Subsequently, she experienced a popping sensation and was unable to bear weight or extend the knee. On exam, she was in obvious pain, her surgical scar was well healed, and her knee was flexed...

Non-Invasive Ventilation in the Elderly in the Emergency Department: Epidemiological Data and Results

Mon, 3 Aug 2020 00:00:00 +0000

Introduction: Non-invasive ventilation (NIV) could be a good alternative in elderly people with acute respiratory failure (ARF), to procure them a respiratory support while avoiding as much as possible the complications of invasive ventilation.

Methods: This is an observational retrospective study conducted at the emergency department (ED) of a tertiary care, university-based teaching hospital. Data of elderly patients (≥ 65 years) admitted to ED between January 2017 and April 2018 for ARF and requiring NIV were collected and analyzed using SPSS 22 software.

Results: Sixty six patients (≥ 65 years) requiring NIV for acute respiratory failure (ARF) were included. The mean age was 76 years (± 7), the median Charlson index was 5. Acute respiratory failure was related to acute heart failure in 68%, acute exacerbation of chronic obstructive pulmonary disease in 53% and pneumonia in 39% of cases. Forty eight percent had more than one etiologic diagnosis. Hypercapnic acute...

Can Ultrasound Aid in the Diagnosis of Gout and Septic Arthritis in the Setting of Monoarticular Joint Pain?

Tue, 7 Apr 2020 00:00:00 +0000

Monoarticular joint pain is commonly encountered in the emergency department (ED) with a broad differential diagnosis. Septic arthritis represents a “can’t miss” diagnosis while gout represents a chronic, painful arthropathy. Traditionally these diagnoses are made with arthrocentesis in addition to history, physical exam, imaging and laboratory studies. Ultrasound (US) represents a novel modality that may aid in the diagnosis of gout without requiring arthrocentesis. Furthermore, the sonographic features of gout may exclude the diagnosis of septic arthritis. Additional research is required in the ED setting to better clarify the role of US in these two disease states.

Evaluating Disparities Affecting Time from Emergency Department Door to Electrocardiogram in Chest Pain Patients

Tue, 24 Mar 2020 00:00:00 +0000

Introduction: For patients presenting to an emergency department with a chief complaint of chest pain, current American Heart Association guidelines recommend that time from emergency department arrival to completion of electrocardiogram be 10 minutes or less. The aim of this study is to evaluate if differences still exist amongst a diverse patient population presenting to a busy urban emergency department with a chief complaint of chest pain. Methods: This retrospective study looked at 3,419 patients who presented to the Emergency Department with any complaint of chest pain during the medical screening examination. Arrival time and time of first electrocardiogram along with age, gender, race, ethnicity and primary language were extracted from electronic health records. Results: For all patients, the mean time to electrocardiogram was 12.5 minutes (95% CI: 12.1-12.7) and 49.9% of all patients received an electrocardiogram within 10 minutes of arrival. Mean time for men was...

Characteristics of Attempted Suicide in the Middle East and North Africa Region: The Mediating Role of Arab Culture and Religion

Sun, 15 Mar 2020 00:00:00 +0000

The general lack of awareness of mental health in the Middle East and North Africa (MENA) region, particularly within its Arab countries, accounts for limited mental health services and stigmatization of psychiatric conditions in the region. Suicide is a drastic consequence of mental health neglect. Suicidal attempts are one form of presentation to emergency departments (ED) in healthcare centers across the Arab countries in the MENA region. We collected data from various research studies in the region to narrate such presentations. This epidemiological country-by-country summary includes the characteristics of suicidal attempts in the Arab region, with a focus on methods, causes, and management of cases. The summary demonstrates that suicidal attempts in this part of the world share sociocultural and logistic grounds. The prominent archetypes of suicidal attempts are middle-aged Arab women ingesting poisonous substances secondary to familial or interpersonal stressors. We...

Mass Casualty Management in the Emergency Department – Lessons Learned in Beirut, Lebanon - Part II

Wed, 1 Jan 2020 00:00:00 +0000

The first article in this series (Part I) discussed the abundant exposure of our emergency department (ED) to mass casualty incidents (MCIs), particularly over the past 14 years. This experience led us to define practical strategies that emergency departments can use to develop their own MCI response plans. In the first part, our main focus was to highlight the abrupt nature of MCIs and the subsequent need to use disaster drills. Additionally, we discussed the importance of having a tiered response and activation as well as other lessons learned from our experience to maximize the preparedness of the emergency department to receive mass casualty.In this article, we discuss the optimal way to triage patients. In addition, we will tackle the best methods for documentation and communication, which are vital yet overlooked during mass casualty incidents. We will also elaborate on what we learned from dealing with outbursts of anger and violence in the ED during MCIs and how to ensure...

USMLE Scores Do Not Predict the Clinical Performance of Emergency Medicine Residents

Wed, 1 Jan 2020 00:00:00 +0000

Background: Scores on “high-stakes” multiple choice exams such as the United States Medical Licensing Examination® (USMLE) are important screening and applicant ranking criteria used by residencies.Objective: We tested the hypothesis that USMLE scores do not predict overall clinical performance of emergency medicine (EM) residents.Methods: All graduates from our University-based EM residency between the years 2008 and 2015 were included. Residents who had incomplete USMLE records were terminated, transferred out of the program, or did not graduate within this timeframe were excluded from the analysis. Clinical performance was defined as a gestalt of the residency program’s leadership and was classified into three sets: top, average, and lowest clinical performer. Dissimilarities of the initial blind rankings were adjudicated during a consensus conference.Results: During the eight years of the study period,...

Mass Casualty Management in the Emergency Department - Lessons Learned in Beirut, Lebanon - Part I

Wed, 1 Jan 2020 00:00:00 +0000

Over the last century, mass casualty incidents (MCIs) affected many nations and their emergency departments. The unscheduled arrival of large number of injured victims over a short period of time often causes major chaos and crowding. When a rapid surge in operational needs overwhelms available Emergency Department (ED) resources and personnel, the chaos and overwhelming mismatch between needs and resources can quickly spread to the rest of the hospital.1, 2 Nonetheless, as the front door of the hospital, the ED plays a pivotal role in determining the quality and effectiveness of an institution’s MCI response. This requires effective planning, which translates into preparedness. Unfortunately, many EDs are overburdened even on regular days. Damaged infrastructure further compounds the challenge.

The International Medical Graduate

Wed, 1 Jan 2020 00:00:00 +0000

International medical graduates (IMGs) are graduates of medical schools located outside the United States (U.S.) and Canada. IMGs face various challenges on the road to U.S. residency training. These challenges include sitting for the United States Medical Licensing Examinations (USMLEs) to obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). After that, IMGs are faced with a foreign application process whereby they must apply for and secure a position in a residency program through the Electronic Residency Application System (ERAS) and the National Resident Matching Program (NRMP). Once accepted into a residency program, IMGs who are not US citizens or legal permanent residents are challenged with securing a visa to be able to practice in the U.S. In this article, we elaborate on these processes and highlight the challenges IMGs may face along the way.

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