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Objectives: Aortic dissection is a life-threatening condition, with a high mortality rate. It can be classified into Stanford type A or type B. This study reports the clinical presentation, risk factors, systolic blood pressure, and the mortality rate of patients with confirmed aortic dissection on computed tomography (CT) imaging. Mortality rate on weekends, weekdays, daytime, and night-time were also reported. Methods: A retrospective review of electronic health records of all patients requiring CT aortogram in the emergency department (ED) between 2013 and 2022 were examined. Patients with confirmed acute aortic dissection on CT were included. Presenting symptoms, demographics, and mortality rate were described and reported for type A and type B aortic dissection. Results: Of 315 patients, 65 had confirmed acute aortic dissection on CT imaging. The mean age at presentation was 50.6 years and the majority of the cohort were male (83%). Chest pain was the most common symptom (43%). A history of hypertension was present in 65% of the subjects. D-dimer was elevated in 95% of the patients. The overall in-hospital mortality was 18.5%, with a mortality rate of 40% in type A aortic dissection. Conclusion: Aortic dissection can occur with various symptoms, and therefore, requires a high index of suspicion. Chest X-ray has a low sensitivity in detecting aortic dissection and should not be used to rule out aortic dissection. D-dimer can be used as a diagnostic assay in ruling out aortic dissection. Type A aortic dissection has the highest mortality rate and hence necessitates prompt intervention.

Background: Dental needle aspiration is a rare complication of oral procedures given the advances in medical technology. Aspirations in general may also be asymptomatic, apart from the possible remote history of upper airway irritation at the time of induction. Clinicians should take a detailed history and examination, along with appropriate diagnostic imaging before discharging these patients from the emergency department. Case presentation: A young patient presented with an acute complaint of pain and coughing post-dental procedure. On arrival at the emergency department, she was vitally and clinically stable, without signs of respiratory distress. There were no complaints reported apart from minor throat pain. Imaging done in the emergency department revealed the presence of a 32 mm needle in the distal airway. She underwent emergency flexible bronchoscopy, and the foreign body was removed under direct visualization. The patient remained stable throughout the procedure and had an uneventful stay until discharge. Conclusion: While needle aspiration is a relatively uncommon occurrence, its early detection is always critical before further damage to local structures can occur. Regardless of presentation and symptoms, basic imaging is mandatory before the disposition is decided. [SJEMed 2024; 5(1.000): 058-060]

Aim: We aimed to describe the most prominent features of COVID-19 on the chest X-ray (CXR) and to classify them using the radiographic assessment of lung edema (RALE) score. Furthermore, we aimed to correlate the RALE scores with clinically significant outcomes namely intensive care unit (ICU) admission and intubation from the emergency versus during hospital stay. In-hospital, death was studied as a secondary endpoint for severe RALE score. Materials and Methods: A retrospective cohort study was conducted on patients presenting to the emergency department (ED) of a tertiary hospital between the periods of March 2020 to August 2020. Included patients were symptomatic, COVID-19 positive by nasopharyngeal real-time polymerase chain reaction (RT-PCR), who also performed an initial CXR in the ED. Two experienced radiologists interpreted the CXRs and categorized them using RALE score into normal mild, moderate, and severe for further correlation with clinical endpoints. Results: From the 404 CXRs, most were categorized as mild and characteristically CXRs had bilateral lower and mid-zone ground-glass opacities. The frequency of intubation and ICU admission increased as the RALE score worsened with a statistically significant p value of

Background: Community-acquired bacterial pneumonia (CAP), skin and soft-tissue infection (SSTI), and urinary tract infection (UTI) are frequently encountered in the emergency department (ED) but treated with varied antibiotic regime. We aimed to assess the antibiotic prescribing practice in ED for CAP, SSTI, and UTI based on hospital guideline adherence (choice, dose, and duration of antibiotic). To the authors' knowledge, this is the first study to address this issue by a dual model of physician survey and prescription review from the ED perspective. Methods: One hundred ED physicians were surveyed followed by a cross-sectional study of 300 uncomplicated adult ED outpatient infections (100 CAP, 100 SSTI, and 100 UTI) from August 2017 to August 2018 retrospectively at Rashid Hospital in Dubai. Results: Most of the participants (91%) had never been in an antibiotic stewardship. 30%, 52%, and 48% were not aware of CAP, SSTI, and UTI hospital guidelines, respectively. Majority (58%) of physicians preferred a parenteral first dose of empirical therapy. Mean age of patients was 45.14 ± 17.8 years and the majority were males (55.7%). The most frequently prescribed antibiotics were β-lactams (n = 157, 52.3%, 95% CI 46.5-58.1). Non-adherence to guidelines was noted in 59% (95% CI 53.2-64.6) of cases; the frequency was highest for UTI (75%), followed by CAP (71%) and SSTI (31%). The most common cause of non-adherence was incorrect drug choice (n = 126, 42%,95% CI 36.3-47.8). Conclusion: High rates of physician non-compliance to guidelines for outpatient empirical antibiotic prescriptions exists in the ED with incorrect drug choice being the most common cause. [SJEMed 2022; 3(1.000): 017-024]

Objectives: Several studies promoted anosmia as a possible isolated symptom for coronavirus disease 2019 (COVID-19). No studies used feasible methods of smell testing that the public would use to address the accuracy of these claims. Methods: This is a single-center study conducted between April 2020 and June 2020. The sense of smell was tested in vitally stable suspected COVID-19 patients with no/mild upper respiratory tract infection symptoms prior to nasopharyngeal swabbing for reverse-transcriptase polymerase chain reaction. Patients were instructed to close their eyes. Each nostril was tested separately while the other was blocked with the patient’s index finger. Patients inhaled from 2 concealed vials (coffee and strawberry essence) consecutively, kept within 30 cm of the nostril for 60 s. Patients who could not identify both odors with both nostrils were recorded as “anosmia.” Results: Out of 346 eligible subjects, 43 had anosmia of which 26 (60%) tested COVID-19 positive. χ2 test showed a p value