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Introduction: the Problem solving Learning (PSL) is an interactive method of teaching that allows students to learn at once clinical reasoning and acquisition of knowledge. The PSL is used to assess learner's competencies., Aim: To was to assess the educational relevance of PSL in emergency medicine and the perception of learners., Methods: Evaluative study carried out in an emergency department on 5th grade students of medical studies. We proceeded through a PSL dossier. Were assessed, the size of the effects of the PSL measured using the Cohen Index (d) reported to the Hattie's effect size scale. The perceptions of learners was assessed thanks to a questionnaire., Results: 42 students from the Faculty of Medicine of Tunis were enrolled in our study. The relative gain was greater than 40% in 90% of the cases and greater than 50% in 57% of the cases. The average rating of the PSL was 12.75 [8.5-17.85]. The effect size (d) of the PSL was 0.9 on the Hattie scale. The overall assessment of the PSL experience by the learners was very satisfactory in 66.5% of the cases and excellent in 33.5% of the cases., Conclusion: The PSL represents a major development in learning pedagogical strategies with a rather interesting impact and effect size. We strongly encourage the use of PSL as a learning tool in emergency medicine. Further impact studies at larger scales are needed to confirm our results.

Exertional heat stroke is defined as hyperthermia associated with neurological signs related to intense physical activity performed in a hot environment. This is a medical emergency and life-threatening. In this study, we investigated four cases of exertional heat stroke hospitalized at the military hospital in Tunis (Tunisia) to describe the clinical, therapeutic and preventive characteristics and factors favoring this disease. Four young soldiers, 23 to 44 years older, have developed Exertional heat stroke after Intense and prolonged exercise. Exercises were performed in May and June, in high ambient temperature, high humidity and lack of wind. Three soldiers were in battle dress, a backpack and their weapon. Our four subjects had overweight, were not sufficiently trained and were highly motivated. Insufficient hydration and a diet rich in carbohydrates were noted. Upon hospitalization, patients were febrile and had neurological disorders, neuromuscular disorders, rhabdomyolysis and hemoconcentration. The medical care consisted of a rehydration and oxygen.

Background: Echinococcus disease is endemic in our country. Surgical resection of the hydatid cyst with the use of a protoscolicidal solution in the operative field remains the standard treatment. The degradation of hydrogen peroxide results in considerable amounts of gaseous oxygen witch has proven protoscolicidal properties. This gas can enter the circulation and determine severe embolism., Aim: We report two cases of severe oxygen embolism with neurological signs during surgical treatment of thoracic hydatid cysts., Cases Report: We report 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax., Conclusion: The most important diagnostic criterion is the patient's history, because the clinical suspicion of embolism is based on the initial neurologic or cardio-respiratory symptoms and the direct relation between these symptoms and the use of hydrogen peroxide and imposes appropriate treatment before further examination including brain imaging. The treatment with hyperbaric oxygen is the first line treatment, thus, transfer to a hyperbaric oxygen facility should be accomplished without delay. The possibility of such serious complication leads us to use hydrogen peroxide with great care or to use other protoscolicidal solutions.

Aim: Evaluate the effect of intra and postoperative magnesium sulphate infusion on postoperative pain in abdominal surgery., Methods: Prospective double-blind randomized controlled study. Forty eight patients were randomly allocated to receive in the induction of anaesthesia, intraoperatively and six hours postoperatively either magnesium sulphate M Group (bolus 50 mg/kg and 0.5 g/h) or placebo (P Group). Patients were given a dose of morphine (0.1 mg/kg) IV, 45 min before the end of surgery. Sedation, pain scores, cumulative morphine consumption and adverse effects were recorded up to 24 hours postoperatively., Results: The duration of anaesthesia was similar in both groups. The time of the first demand of morphine was significantly longer in M Group then in P Group, respectively (18+/-5 min vs 7+/-1 min, p=0.03). Morphine consumption was significantly higher in control group than M group on the first postoperative day (52+/-4 mg vs 30+/-3 mg, p=0.0002). Pain scores were significantly lower in M group than in P group. Serum magnesium concentration was significantly higher in the M group. The frequency of side effects was similar in the two groups., Conclusion: The results of the study support magnesium sulphate as useful adjuvant for postoperative analgesia in abdominal surgery.