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Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM
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This is an Open Access Journal

Open Access journal
ISSN (Print) 2642-7168 - ISSN (Online) 2642-7184
Published by eScholarship

[73 journals]

Outpatient Management of Cancer Patients During the COVID-19 Pandemic
- Abstract: 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 11th, 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.
  PubDate: Fri, 25 Dec 2020 00:00:00 +000
Point-of-Care Ultrasound Appearance of Cystic Ovarian Teratoma Causing
Ovarian Torsion
- Abstract: 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...
  PubDate: Tue, 24 Nov 2020 00:00:00 +000
Volunteer-Operated Field Medical Tents During Civilian Protests in Beirut,
Lebanon: Challenges and Lessons
- Abstract: 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.
  PubDate: Mon, 23 Nov 2020 00:00:00 +000
A Brief Report on the Beirut Port Explosion
- Abstract: 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.
  PubDate: Sun, 18 Oct 2020 00:00:00 +000
Non-Invasive Ventilation in the Elderly at Emergency Department:
Epidemiological Data and Results
- Abstract: 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...
  PubDate: Mon, 3 Aug 2020 00:00:00 +0000
Can Ultrasound Aid in the Diagnosis of Gout and Septic Arthritis in the
Setting of Monoarticular Joint Pain'
- Abstract: 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.
  PubDate: Wed, 1 Jul 2020 00:00:00 +0000
Evaluating Disparities Affecting Time from Emergency Department Door to
Electrocardiogram in Chest Pain Patients
- Abstract: 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...
  PubDate: Tue, 24 Mar 2020 00:00:00 +000
Characteristics of Attempted Suicide in the Middle East and North Africa
Region: The Mediating Role of Arab Culture and Religion
- Abstract: 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...
  PubDate: Sun, 15 Mar 2020 00:00:00 +000
Farewell to a Friend - with "Love"
- Abstract: 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.
  PubDate: Thu, 13 Feb 2020 00:00:00 +000
USMLE Scores Do Not Predict the Clinical Performance of Emergency Medicine
Residents
- Abstract: 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,...
  PubDate: Wed, 1 Jan 2020 00:00:00 +0000
Mass Casualty Management in the Emergency Department - Lessons Learnt in
Lebanon - Part I
- Abstract: 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.
  PubDate: Wed, 1 Jan 2020 00:00:00 +0000
The International Medical Graduate
- Abstract: 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.
  PubDate: Wed, 1 Jan 2020 00:00:00 +0000
Mass Casualty Management in the Emergency Department – Lessons Learned
in Beirut, Lebanon - Part II
- Abstract: 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...
  PubDate: Thu, 12 Dec 2019 00:00:00 +000
Psoriasis and Heart Failure: Literature Review and a Case Challenge
- Abstract: 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.
  PubDate: Wed, 9 Oct 2019 00:00:00 +0000
Together for Emergency Medicine in the United Arab Emirates!
- Abstract: 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...
  PubDate: Wed, 9 Oct 2019 00:00:00 +0000
The Mediterranean Journal of Emergency Medicine & Acute Care: Why
- Abstract: 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.
  PubDate: Wed, 9 Oct 2019 00:00:00 +0000
Establishing Emergency Medicine in Iran: a Post-implementation Perspective
- Abstract: 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.
  PubDate: Wed, 9 Oct 2019 00:00:00 +0000
Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage
Abdominal Pain in the Emergency Department
- Abstract: 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...
  PubDate: Wed, 9 Oct 2019 00:00:00 +0000
Impact of Internally Developed Electronic Prescription on Prescribing
Errors at Discharge from the Emergency Department
- Abstract: 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...
  PubDate: Wed, 9 Oct 2019 00:00:00 +0000

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