Background:Rapid Sequence Intubation (RSI) is a high-risk, time-critical procedure in emergency medicine. Standardizing its practice across a multinational workforce with diverse training backgrounds remains a persistent educational challenge. This mixed-methods program evaluation assessed a blended-learning RSI program's impact on self-reported physician confidence and perceived educational value within a tertiary emergency care setting. Methods:A retrospective evaluation was conducted for a blended-learning RSI curriculum delivered between 2020 and 2022. The program combined asynchronous online modules with a 4-hour, small-group simulation-based practical session. A voluntary, anonymous post-program survey was administered in 2025 following IRB approval. Outcomes included retrospective pre-post self-reported confidence (5-point Likert scale), satisfaction with program components, and qualitative feedback. No objective performance measures were assessed. Results:Forty-five of 141 eligible physicians completed the survey (adjusted response rate 42%). Self-reported low confidence decreased from 77.8% pre-course to 6.6% post-course, while high confidence increased from 22.2% to 93.4% (Cohen's d = 2.1). Improvements were consistent across professional grades. The simulation-based session received the highest satisfaction rating (mean 4.3/5). Qualitative analysis highlighted the value of realistic simulation, structured debriefing, and standardized checklists. Suggested improvements included more complex scenarios and enhanced online interactivity. Conclusion:Participation in a blended-learning RSI program was associated with substantial improvement in self-reported physician confidence and high satisfaction among a multinational emergency medicine workforce. These findings support the feasibility and perceived value of this educational approach for high-risk procedural training in similar settings, though objective competence was not evaluated.

This narrative review examines the evolution, organization, and performance of emergency medicine (EM) services in Qatar within a nationally coordinated healthcare system. Qatar operates a highly centralized public healthcare model serving approximately 2.9 million residents through a single national health region, which includes 31 primary healthcare centers and multiple secondary and tertiary hospitals, encompassing both teaching and non-teaching institutions. Emergency departments manage a wide spectrum of acute presentations, most commonly trauma, cardiovascular emergencies, respiratory illnesses, and undifferentiated medical conditions. The review explores key aspects of workforce development, including structured training pathways, residency programs, and interprofessional education initiatives, placing Qatar's experience within a broader global context. International literature indicates that challenges related to workforce sustainability, trainee well-being, retention, and standardization of education are widely shared across health systems, highlighting the universal relevance of these issues. Qatar's nationally coordinated approach to emergency care delivery, residency training, clinical governance, and quality improvement has strengthened workforce capacity, enhanced clinical performance, and improved system resilience. The transformation from a fragmented, generalist-driven service to a cohesive, specialty-led network demonstrates how coordinated planning, structured education, and infrastructure investment can achieve international standards of emergency care. By synthesizing these developments, this review provides insights and transferable lessons for other nations seeking to establish robust, high-quality EM services, illustrating the impact of systematic, evidence-based approaches on both patient care and health system performance.

Objective:Non-technical skills (NTS) are essential for safe emergency care but are inconsistently taught in undergraduate curricula. Video-assisted debriefing (VAD) may support reflection on team performance, but its feasibility within routine clerkships is underexplored. This study evaluated the feasibility of integrating VAD into a mandatory emergency medicine clerkship and descriptively explored learner perceptions and observed NTS performance. Methods:A convergent mixed-methods feasibility study was conducted within an 8-week final-year emergency medicine clerkship in Qatar (N=66). Weekly simulation sessions included structured NTS teaching and VAD. Feasibility was predefined as: participation ≥80%, survey completion ≥70%, and ≥50% of recordings technically suitable for faculty assessment using the Simulation Performance Assessment Tool-Modified (SPAT-M). Learner perceptions were explored through a post-clerkship survey and free-text reflections. Results:All 66 students completed the mandatory simulation curriculum; 46 (69.7%) completed the post-clerkship survey, narrowly below the predefined 70% threshold. Of 16 recordings screened, nine (56.3%) met technical criteria for SPAT-M analysis; seven (43.7%) were excluded for incomplete capture, audio failure, or poor image quality. Students reported high perceived NTS competence (median 4.0-4.5/5); faculty ratings of the nine usable recordings reflected competent-to-proficient performance (median 3.5-4.5). Situational awareness was the relatively lowest-rated domain and the most frequently reported area for development. Thematic analysis identified three themes: applying NTS in clinical practice, situational awareness as an area for development, and support for earlier longitudinal NTS integration. Conclusion:Integrating VAD into a mandatory emergency medicine clerkship was feasible, although survey completion narrowly missed the predefined threshold and technical limitations restricted structured assessment to 56.3% of recordings. Learners perceived VAD as supporting reflection on NTS performance. Further multi-institutional studies are needed to evaluate educational effectiveness and transfer to clinical practice.

Simulation-based medical education (SBME) is increasingly used in emergency medicine (EM) training to enhance clinical skills and decision-making. However, its impact on undergraduate clerkship performance and student perceptions in the Middle Eastern context remains underexplored. This study aimed to evaluate whether the integration of high-fidelity simulation into a medical student EM clerkship in Qatar improves academic outcomes and enhances student satisfaction with the learning experience. Two clerkship students cohorts were compared: 63 students in a lecture-based education (LBE) group in 2022 and 67 students in an SBME group in 2024. Multiple-choice question (MCQ) and objective structured clinical examination (OSCE) scores were analyzed using independent sample t-tests. Demographic variables (age, gender) were collected, and qualitative feedback from the SBME group was analyzed using descriptive content analysis. There were no statistically significant differences in academic performance between the lecture-based education (LBE) and simulation-based medical education (SBME) cohorts. The mean MCQ score was 29.2 (SD = 4.1) for the LBE group and 28.8 (SD = 4.3) for the SBME group (p = 0.588), with no meaningful difference (mean difference = +0.4, 95

Introduction: Dialysis disequilibrium syndrome is a serious complication occurring during hemodialysis initiation and after a break from hemodialysis, with a myriad of neurological symptoms. Case Presentation: We report a case of a 68-year-old woman with a history of hypertension, type 2 diabetes mellitus, and recently diagnosed end-stage kidney disease. She presented to the emergency room with disorientation and hypertensive urgency and had started hemodialysis 3 months prior but declined further treatment. Laboratory data revealed blood urea nitrogen of 151 mg/dL, creatinine of 18 mg/dL, bicarbonate level of 5 mEq/L, and potassium of 6.6 mEq/L. A temporary hemodialysis catheter was inserted, and dialysis was initiated with a blood flow rate of 300 mL/min and a dialysate flow rate of 600 mL/min, using an Optiflux 180NRe dialyzer (surface area 1.7 m2) for a duration of 3 h. The patient developed seizure activity after 2 h and 55 min, described as tonic-clonic seizure lasting 5 min. The urea reduction ratio was 57.6%, and the bicarbonate level increased from 5 to 16 mEq/L. She remained in a stuporous state, with no response to stimuli. She was transferred to the intensive care unit and received 20% mannitol 0.5 g/kg (40 g), followed by 3% hypertonic saline (30 mL bolus, then 50 mL/h infusion), with the aim of maintaining a serum sodium concentration between 145 and 155 mEq/L. Forty-eight hours later, she began to open her eyes to voice and consistently followed commands. Conclusion: Our patient’s dialysis disequilibrium syndrome severity correlated with the urea reduction ratio and severe metabolic acidosis, highlighting the importance of achieving a low urea reduction ratio (<40%) and a targeted rise in bicarbonate levels, both of which are risk factors for dialysis disequilibrium syndrome. In addition, the use of 3% saline and mannitol is an important preventive and rescue strategy.

The integration of artificial intelligence (AI) into medical education has gained significant attention, particularly with the emergence of advanced language models, such as ChatGPT and Gemini. While these tools show promise for answering multiple-choice questions (MCQs), their efficacy in specialized domains, such as Emergency Medicine (EM) clerkship, remains underexplored. This study aimed to evaluate and compare the accuracy of ChatGPT, Gemini, and final-year EM students when it comes to answering text-only and image-based MCQs, in order to assess AI’s potential for use as a supplementary tool in the field of medical education. In this proof-of-concept study, a comparative analysis was conducted using 160 MCQs from an EM clerkship curriculum, comprising 62 image-based questions and 98 text-only questions. The performance of the free versions of ChatGPT (4.0) and Gemini (1.5), as well as that of 125 final-year EM students, was assessed. Responses were categorized as “correct”, “incorrect”, or “unanswered”. Statistical analysis was then performed using IBM SPSS Statistics (Version 26.0) to compare accuracy across groups and question types. Significant performance differences were observed across the three groups (χ² = 42.7, p < 0.001). Final-year EM students demonstrated the highest overall accuracy at 79.4

BACKGROUND:The Arab Board of Emergency Medicine (ABEM) examination is a critical milestone for emergency medicine residents (EMRs) aiming to transition to independent practice. Prior to this study, no structured course had been administered to prepare EMRs for the ABEM examination. To address this gap, a five-day evening preparatory course was developed, designed to align with ABEM requirements and deliver updated, essential knowledge. This study aims to evaluate the impact of this newly introduced preparatory course on EMRs' success rates on the ABEM examination from 2017 to 2021. METHODS:The five-day in-person course was conducted annually in the evenings to accommodate both EMRs and faculty, scheduled approximately six weeks before the ABEM examination. The course content was specifically aligned with ABEM standards, focusing on relevant and contemporary knowledge. EMRs participated in assessments modeled after the ABEM examination, using standardized rubrics. Pass rates were compared to historical data, and demographic variables were thoroughly analyzed. Feedback was collected from both EMRs and faculty after each course to continuously refine and improve course content and delivery. RESULTS:Data were collected over a five-year period (2017-2021), with 49 emergency medicine residents (EMRs) (100%) participating in the course. The majority of participants were male (69.4%), and the cohort included graduates from diverse regions, including Sudan (22.4%) and Pakistan (18.4%). The overall pass rate for the Arab Board of Emergency Medicine (ABEM) examination significantly increased to 91.8%, compared to a pre-course pass rate of 60%. No significant impact on outcomes was observed based on factors such as gender, country of graduation, year of participation, or initial confidence levels. Feedback from both participants and faculty indicated high levels of satisfaction with the course, with recommendations for further content refinement and the inclusion of additional Objective Structured Clinical Examination (OSCE) stations. CONCLUSION:The findings demonstrate the significant impact of the newly introduced, face-to-face, five-day ABEM preparatory course on EMR pass rates, potentially serving as a model for similar programs in other specialties. The results highlight the importance of targeted, up-to-date instruction in improving the confidence and success of EMRs on the ABEM examination. Furthermore, the course's development and the incorporation of ongoing feedback played key roles in further enhancing the quality and effectiveness of the training program.

Introduction: The inclusion of artificial intelligence (AI) in the healthcare sector has transformed medical practices by introducing innovative techniques for medical education, diagnosis, and treatment strategies. In medical education, the potential of AI to enhance learning and assessment methods is being increasingly recognized. This study aims to evaluate the performance of OpenAI’s Chat Generative Pre-Trained Transformer (ChatGPT) in emergency medicine (EM) residency examinations in Qatar and compare it with the performance of resident physicians. Methods: A retrospective descriptive study with a mixed-methods design was conducted in August 2023. EM residents’ examination scores were collected and compared with the performance of ChatGPT on the same examinations. The examinations consisted of multiple-choice questions (MCQs) from the same faculty responsible for Qatari Board EM examinations. ChatGPT’s performance on these examinations was analyzed and compared with residents across various postgraduate years (PGY). Results: The study included 238 emergency department residents from PGY1 to PGY4 and compared their performances with ChatGPT. ChatGPT scored consistently higher than resident groups in all examination categories. However, a notable decline in passing rates was observed among senior residents, indicating a potential misalignment between examination performance and practical competencies. Another likely reason can be the impact of the COVID-19 pandemic on their learning experience, knowledge acquisition, and consolidation. Conclusion: ChatGPT demonstrated significant proficiency in the theoretical knowledge of EM, outperforming resident physicians in examination settings. This finding suggests the potential of AI as a supplementary tool in medical education.

Benign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo triggered by changes in head position caused by the displacement of otoliths from the utricle to the semicircular canals, particularly the posterior canal. This study explored the potential link between BPPV, the patient's preexisting conditions, and surgery-related factors including surgical positioning, duration of the procedure, exposure to vibratory forces, and anesthesia effects. This report presents two cases of BPPV following major joint replacement surgery. The first case involved a 65-year-old male with a history of diet-controlled diabetes who had undergone right-sided total hip replacement. The second case was that of a 60-year-old female with a history of osteoporosis managed with bisphosphonate therapy and left-sided knee replacement. Both patients developed vertigo symptoms one day postoperatively and were diagnosed with BPPV. In both cases, the Dix-Hallpike test confirmed the right-sided posterior canal BPPV diagnosis, and the patients were successfully treated using the Epley maneuver. Notably, there was no recurrence of vertigo at the four-week follow-up. These cases highlight the importance of considering BPPV in patients presenting with vertigo symptoms after joint replacement surgery, especially in the presence of comorbidities like diabetes and osteoporosis which possibly increase susceptibility to BPPV. This article presents two cases of benign paroxysmal positional vertigo (BPPV) following non-otologic surgery. It explores the pathophysiological mechanism underlying BPPV after such surgeries and also discusses the diagnosis and treatment approaches. This underscores the need for prompt diagnosis and treatment of BPPV to improve postoperative outcomes.

Rib fractures, common among trauma victims, lead to significant morbidity and mortality. Managing the associated pain is challenging, with IV opioids and thoracic epidural analgesia (TEA) being utilized. While epidural analgesia is often preferred for fractured rib pain, existing data encompasses both lumbar and thoracic approaches. This review aimed to compare TEA and IV opioids for persistent rib fracture pain. A comprehensive search across five databases yielded 987 articles, of which seven met the eligibility criteria. Outcomes were categorized into primary (pain reduction) and secondary (mortality, hospital/ICU stays, analgesia-related complications) endpoints. Analyzed with Review Manager (RevMan) Version 5.4.1 (2020; The Cochrane Collaboration, London, United Kingdom), the pooled data from two sources showed TEA significantly more effective in reducing pain than IV opioids (standardized mean difference (SMD): 2.23; 95%CI: 1.65-2.82; p < 0.00001). Similarly, TEA was associated with shorter ICU stays (SMD: 0.73; 95%CI: 0.33-1.13; p = 0.0004), while hospitalization duration showed no substantial difference (SMD: 0.82; 95%CI: -0.34-1.98). Mortality rates also did not significantly differ between TEA and IV opioids (risk ratio (RR): 1.20; 95%CI: 0.36-4.01; p = 0.77). Subgroup analysis revealed fewer pneumonia cases with TEA (RR: 2.06; 95%CI: 1.07-3.96; P = 0.03), with no notable disparities in other complications. While TEA's superiority in pain relief for rib fractures suggests it is the preferred analgesic, the recommendation's strength is tempered by the low methodological quality of supporting articles.

Background Differentiating sepsis from non-infectious systemic inflammatory response syndrome (SIRS) is challenging. Biomarkers like procalcitonin (PCT) aid early risk assessment and guide antibiotic use. This study aims to ascertain PCT's accuracy as a sepsis biomarker among adult emergency department admissions. Method The PRISMA guidelines were followed to search for relevant articles in five electronic databases between April 14th and August 4th, 2023: PubMed, Cochrane Library, ProQuest, EMBASEs, and ScienceDirect. Studies had to be published in English to avoid directly translating scientific terms. Besides, the inclusion criteria were based on the diagnosis of sepsis in adult patients admitted to an emergency department. QUADAS-2 tool provided by the Review Manager version 5.4.1 was utilized to assess the risk of bias in included studies. STATA (v. 16) software was used to perform the meta-analysis. Results Ten of 2457 studies were included. We sampled 2980 adult sepsis patients for the under-investigated role of PCT in ED sepsis diagnosis. PCT emerged as the primary early diagnostic biomarker with high levels (29.3 ± 85.3 ng/mL) in sepsis patients. Heterogeneity in outcomes, possibly due to bias in cohort and observational studies, was observed. Conclusion PCT tests offer moderate accuracy in diagnosing sepsis and stand out for rapidly and precisely distinguishing between viral and bacterial inflammations.

Background: Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. ObjectiveThis international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. MethodsThis multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri–cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). ResultsData collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. ConclusionsBystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team’s next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. International Registered Report Identifier (IRRID)DERR1-10.2196/58780

BACKGROUND:Student-led clinic is an educational-professional training environment where students are leading the care of patients under the supervision of licensed health care professionals. This study aims to explore medical students' experiences in leading family medicine clinics in Qatar. METHODS:The study used a qualitative descriptive method. To collect the data, the researchers have used semi-structured interviews. To recruit students, a convenience sampling strategy was used by sending a call to participate to all students who completed the rotation and met the inclusion criteria. An inductive thematic analysis was employed to data analysis. RESULTS:Ten students participated in the study. Data analysis revealed six themes. These are: Student led clinic as transitional and transformative stage, Challenges faced by students, coping strategies, protective factors, implications of the experience and students' reflections for future rotations. The study revealed that students experienced a mixture of anxiety and excitement during the transition to leading clinics. Challenges included patient-related challenges such as language barriers, challenges related to personal skills such as time and knowledge, and institutional challenges that included limited supervisor availability and balancing academic responsibilities with clinic duties. Coping strategies included continuous knowledge revision, seeking advice from colleagues, and employing creative tools to overcome language barriers. CONCLUSION:Leading family medicine clinics has an impact on students such as enhancing their time management, diagnostic abilities, communication skills, and confidence. Support from supervisors, team members, patients, and colleagues play a crucial role in students' experiences. This transitional experience supports the shift from self-perception as students perceiving themselves as physicians.

Benign paroxysmal positional vertigo (BPPV) is a medical condition where patients develop symptoms of vertigo, "room spinning," associated with nausea and vomiting. BPPV is believed to be caused by a disturbance in the inner ear vestibular system. Trauma has been recognized as one of the risk factors for this condition. BPPV can be easily diagnosed and treated by bedside maneuvers. Due to a lack of awareness among some treating clinicians, patients may have to wait for a long time before the correct management is offered. We share two cases of BPPV in 15- and 16-year-old male school students who developed posterior canal BPPV following a head injury during a rugby game. Both patients continue to have vertigo symptoms for several weeks before the final diagnosis. BPPV symptoms completely resolved following the Epley maneuver. Frontline clinicians need to diagnose and treat BPPV early to prevent the persistence of these debilitating symptoms. As far as we are aware, no previous study has published the occurrence of BPPV in young adolescent rugby players.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2, which was first discovered in Wuhan, China. The disease has grown into a global pandemic causing mild to moderate symptoms in most people. The disease can also exhibit serious illnesses, especially for patients with other chronic diseases such as cardiovascular diseases, diabetes, chronic respiratory disease, or cancer. In such cases of severe illness, high flow nasal oxygen (HFNO) has been used to provide oxygenation to COVID-19 patients. However, the efficiency of HFNO remains uncertain, prompting the conduction of this systematic review to evaluate the effectiveness of the therapy. A thorough search for relevant and original articles was carried out on five electronic databases, including ScienceDirect, PubMed, Cochrane Library, Embase, and Google Scholar. No time limitation was placed during the search as it included all the articles related to COVID-19 from 2019 to 2022. The search strategy utilized in this systematic review yielded 504 articles, of which only 10 met the eligibility criteria and were included. Our meta-analysis reveals that HFNO success rate was higher than HFNO failure rates (0.52 (95% CI; 0.47, 0.56) and 0.48 (95% CI; 0.44, 0.53), respectively), however, the difference was statistically insignificant. HFNO was associated with a significant decrease in mortality and intubation rates (0.28 (95% CI; 0.19, 0.39) and 0.28 (95% CI; 0.18, 0.41), respectively). Our statistical analysis has shown that significantly lower ROX index (5.07 ± 1.66, p = 0.028) and PaO2/FiO2 (100 ± 27.51, p = 0.031) are associated with HFNO failure, while a significantly lower respiratory rate (RR) (23.17 ± 4.167, p = 0.006) is associated with HFNO success. No statistically significant difference was observed in SpO2/FiO2 ratio between the HFNO success and failure groups (154.23 ± 42.74 vs. 124.025 ± 28.50, p = 0.62, respectively). Based on the results from our meta-analysis, the success or failure of HFNO in treating COVID-19 adult patients remains uncertain. However, HFNO has been shown to be an effective treatment in reducing mortality and intubation rates. Therefore, HFNO can be recommended for COVID-19 patients but with close monitoring and should be carried out by experienced healthcare workers.

High blood pressure (HBP) is usually prominent after the onset of acute ischemic stroke (AIS). Although previous studies have found that about half of patients with AIS have a background of hypertension, there is no clear etiology for HBP in AIS. The literature reveals discrepancies in the relationship between HBP and clinical outcomes of AIS, pointing toward the contested effect of blood pressure (BP) reduction clinical outcomes. Thus, the potential benefits and hazards of HBP treatment were explored in the context of clinical outcomes after AIS. An electronic database and a manual search were carried out to identify all the articles related to this topic and published between 2000 and January 2023. The Review Manager software was also used to perform the meta-analysis and quality appraisal. In analyses related to patients not treated with reperfusion therapies, mortality, and dependency outcomes were categorized as short-term (<3 months) or long-term (≥3 months). Our search strategy yielded 2459 articles, of which only 15 met the inclusion criteria. The results of our meta-analysis demonstrate that in patients not treated with reperfusion therapies, BP lowering had no significant impact on either short-term or long-term mortality (risk ratio (RR): 1.18; 95% confidence interval (CI): 0.81-1.73; p = 0.39, and RR: 1.04; 95% CI: 0.77-1.40; p = 0.81, respectively) and dependency (RR: 1.12; 95% CI: 0.97-1.30; p = 0.11, and RR: 0.98; 95% CI: 0.90-1.07; p = 0.61, respectively). Furthermore, BP lowering prior to reperfusion showed no significant effect on mortality (RR: 0.7; 95% CI: 0.23-2.26; p = 0.58), but it did significantly reduce the risk of dependency (RR: 0.89; 95% CI: 0.85-0.94; p < 0.00001). When the dataset was restricted to patients who had successful reperfusion, intensive BP lowering (target systolic BP <120 mmHg) was found to increase the risk of dependency (RR: 1.23; 95% CI: 1.09-1.39; p = 0.0009). In addition, BP reduction had an insignificant effect on the risk of recurrent strokes and combined vascular events (RR: 1.00; 95% CI: 0.54-1.84; p = 1.00, and RR: 0.99; 95% CI: 0.70-1.41; p = 0.95, respectively). Lowering BP in patients not treated with reperfusion therapies is not beneficial in reducing the risk of either short or long-term mortality and dependency. However, BPR before reperfusion reduces the risk of dependency, while aggressive BPR (target systolic blood pressure (SBP) <120 mmHg) after successful reperfusion increases the risk of dependency. Therefore, we recommend BPR as early as possible for patients undergoing reperfusion therapies but suggest against aggressive BPR in patients who have undergone successful reperfusion.

Assessment tools, such as the mini-clinical evaluation exercise (mini-CEX), have been developed to evaluate the competence of medical trainees during routine duties. However, their effectiveness in busy environments, such as the emergency department (ED), is poorly understood. This study assesses the feasibility, reliability, and acceptability of implementing the mini-CEX in the ED. PubMed, Google Scholar, ScienceDirect, Scopus, and Web of Science databases were scoured for observational and randomized trials related to our topic. Moreover, a manual search was also conducted to identify additional studies. After the literature search, data were extracted from studies that were eligible for inclusion by two independent reviewers. When applicable, meta-analyses were performed using the Comprehensive Meta-Analysis software. In addition, the methodological quality of studies was evaluated using the Newcastle-Ottawa Scale. Of the 2,105 articles gathered through database and manual searches, only four met the criteria for inclusion in the review. A combined analysis of three studies revealed that trainee-patient interactions averaged 16.05 minutes (95% CI = 14.21-17.88), and feedback was given in about 10.78 minutes (95% CI = 10.19-11.38). The completion rates for mini-CEX were high: 95.7% (95% CI = 87.6-98.6) for medical trainees and 95.8% (95% CI = 89.7-98.3) for assessors. Satisfaction with mini-CEX was notable, with 63.5% (95% CI = 51.5-74.1) of medical trainees and 75.7% (95% CI = 63.9-84.6) of assessors expressing contentment. Qualitative data from one study demonstrated that 70.6% of faculty members could allocate suitable time for mini-CEX during their clinical shifts. The mini-CEX is a feasible and acceptable assessment tool within the ED. Furthermore, there is evidence to suggest that it might be reliable.

Oligoanalgesia, the undertreatment of trauma-related pain using standard analgesics in prehospital and emergency departments, has been extensively documented as one of the major challenges affecting the effective treatment of trauma-related pain. When administered in low doses, methoxyflurane has been highlighted by numerous medical works of literature to provide an effective, nonopioid, nonnarcotic treatment alternative to standard analgesics for prehospital and emergency department use. Low-dose methoxyflurane has been associated with fast-pain relief in adult patients manifesting moderate-to-severe pain symptoms. This systematic review and meta-analysis aimed to assess the clinical implication of low-dose methoxyflurane use in prehospital and emergency departments in adult patients with moderate-to-severe trauma-related pain. Moreover, the review aimed at assessing the risk stratification associated with using low-dose methoxyflurane in prehospital and emergency departments. The systematic review and meta-analysis performed a comprehensive search for pertinent literature assessing the implications and risks of using low-dose methoxyflurane in adult patients exhibiting moderate-to-severe trauma-related pain in prehospital settings. A comparison between the use of low-dose methoxyflurane and standard-of-care analgesics, placebo, in prehospital settings was reported in four clinically conducted randomized controlled trials (RCTs). These RCTs included the STOP! trial, InMEDIATE, MEDIATA, and the PenASAP trials. A meta-analysis comparing the time taken to achieve first pain relief on initial treatment of patients with moderate-to-severe trauma-related pain favored the use of low-dose methoxyflurane to the standard-of-care analgesics (mean difference = -6.63, 95% confidence interval = -7.37, -5.09) on time taken to establish effective pain relief. Low-dose methoxyflurane has been associated with superior and faster pain relief in prehospital and emergency departments in adult patients exhibiting moderate-to-severe trauma-related pain compared to other standard analgesics.

We aim to discuss the efficacy and adverse effects of using ketamine in agitated patients in the emergency department (ED) compared with the combination therapy of haloperidol with benzodiazepine. This systematic review followed Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. An electronic search from PubMed/Medline, Cochrane library, and Google Scholar was conducted from their inception to 30th April 2022. We included agitated patients in ED who were given infusion with ketamine only. Our comparative group was patients infused with combined therapy of haloperidol and benzodiazepine. We did not include letters, case reports, abstracts, conference papers, appraisals, reviews, and studies where full text was unavailable. We did not put any language restrictions. Three studies were selected in our manuscript (one cohort and two randomized controlled trials). All three studies showed that ketamine was used to achieve sedation in less time than the other group. However, two studies reported significantly more adverse effects in ketamine-infused groups. We concluded that ketamine use is superior when its primary focus is to sedate the patient as quickly as possible, but it carries some side effects that should be considered. However, we still need more studies assessing the efficacy of ketamine in agitated patients presenting in the ED.