A significant portion of medical students learning is dedicated to clinical education, especially in the field of Emergency Medicine (EM). Clinical rotations in the Emergency Department (ED) are of utmost importance, given the vital role emergency medicine plays within the healthcare system. Emergency departments represent the forefront of medical care, frequently addressing life-threatening circumstances that necessitate swift decision-making, advanced clinical expertise, and the capacity to operate effectively under pressure. Familiarizing medical students with this high-stakes environment provides them with critical competencies, including acute care management, collaborative teamwork, and proficient communication skills, all of which are relevant across various medical disciplines. In this regard, the Society for Academic Emergency Medicine outlines a four-year curriculum for emergency medicine training. First-year students learn basic first aid, CPR, and the local EMS system. Second-year students apply pathophysiology to acute presentations and practice diagnosis skills. Third-year students refine history-taking and examination techniques, working with residents in lower-acuity areas and beginning differential diagnoses. Throughout, students focus on professionalism, communication, and teamwork, preparing them for future roles in emergency medicine.

Objective: Bladder diverticula, while not exceptionally rare in clinical practice, presents a significant diagnostic challenge, particularly in remote pre-hospital emergencies where technological limitations and the absence of specialized medical expertise prevail. This report aims to emphasize the role of screening ultrasound in the pre-hospital setting, Case Presentation: A patient experiencing severe lower abdominal pain presented at a basic emergency service (BES) for the third time presenting the same symptoms. Renal and pelvic ultrasound screening was performed, revealing suspected bladder distention and adjacent fluidfilled cavities, consistent with multiple bladder diverticula. Subsequently, the patient was referred to a referral central hospital for management by medical experts. Comprehensive evaluation confirmed the findings of the BES. Conclusion: The results of the screening ultrasound enabled the BES team to initiate clinical interventions to mitigate the patient’s discomfort. Screening ultrasound was crucial in identifying imaging markers that provided the physician with clinical data for correct and prompt patient orientation.

Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture. Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the thigh and an open wound on the medial side. Radiographs and computed tomography angiography revealed a left distal third femoral fracture with ipsilateral SFA injury. We performed fracture reduction external fixation following SFA reconstruction using a 5-cm saphenous vein autograft. Prophylaxis fasciotomy was not performed. At a 6-month follow-up, the wound was well-healed, the Doppler ultrasound showed good blood flow at the reconstructed artery, and a rigid callus entirely covered the fracture. At 1-year follow-up, the patient could walk with full weight-bearing. Maximum knee range of motion was restored, and the patient could return to daily activities. Conclusion: Vascular injury after femoral shaft fracture is rare, and accurate diagnosis with timely and appropriate surgery plays a crucial role in achieving limb salvage, reducing the risk of complications, and improving the overall quality of patient life.

Objective: Penetrating injuries in the maxillofacial region pose a great challenge due to the anatomical complexity inherent to the area compounded with vital functions such as vision and airway. This paper highlights the importance of meticulous preoperative planning and a concerted effort of a multidisciplinary team in managing penetrating maxillofacial injuries. Case Presentation: A 38-year -old man reported to the emergency department with a knife impacted in the medial wall of the orbit, travelling up to the base of the cranium. A CT scan aided in evaluating the site, depth, and relation of the foreign body to the adjacent structures. A team of oral and maxillofacial surgeons, ENT and neurosurgeon successfully retrieved the knife and the patient recovered with no morbidities. Conclusions: Penetrating injuries in the maxillofacial region are rare and there is a dearth of documentation in literature. A quick response with proper preoperative planning and a team approach is paramount in the successful management of these patients.

Objective: Chest pain is amongst the most frequently occurring symptoms in patients presenting to the emergency department (ED). Accurate and fast risk stratification is paramount for identification of patients with immediate risk of acute coronary syndrome (ACS). The present study has compared different scoring systems like HEART (History, ECG, Age, Risk factors, Troponin), Thrombolysis in Myocardial Infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores and their efficacy in predicting incidence of major adverse cardiac events (MACE). Methods: The present prospective observational study was conducted on 199 patients who presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scores were calculated with collected patient data which was further evaluated for efficacy by calculating area under ROC curves (AUCs). Data were analyzed by using R statistical software version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicates statistical significance. Results: In the current study, 76 (38%) patients reported MACE. The HEART score identified the largest number of patients as high risk 74 (37%) and among them 69 patients developed a MACE. The AUC of HEART score was the highest with 0.96 (95% CI: 0.93-0.98), followed by TIMI score with 0.815 (95% CI: 0.75-0.873) and the GRACE score with 0.814 (95% CI: 0.75- 0.813). The sensitivity of HEART score of ≥7 for MACE was found to be 90.78%, specificity was 95.96%, positive predictive value (PPV) was 93.24% and negative predictive value (NPV) was 94.4%. The sensitivity of GRACE score was 39.4%, specificity was 95.16%, PPV was 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was 95.96%, PPV was 82.14% and NPV was 69.18%. Conclusion: The HEART score showed higher efficacy in predicting risk levels in patients and incidence of MACE in comparison with GRACE and TIMI scores in the included study cohort.

Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients. Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC). We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables. Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P<0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P<0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P<0.001). Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.

Objective: Renal infarction which is a rare phenomenon can be missed on the patient’s work up making its incidence low. Case Presentation: We report a 68-year-old lady with known history of hypertension presented with epigastric pain and vomiting for 4 days. During her stay in the emergency room, she developed sudden onset of left-sided weakness. Electrocardiogram was normal sinus rhythm. Computed tomography scan of the abdomen showed acute pancreatitis with partial impingement of superior mesenteric vein. Conclusion: Imaging s showed cholelithiasis without evidence of cholecystitis and lower pole right renal infarct likely secondary to obstruction of the right lower renal artery due to calcified plaques at their origin from the aorta. Subsequently, the patient was kept on antiplatelets and planned for discharge uneventfully.

Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed. Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air. Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.

Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P<0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.

Introduction: Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse. Superficial skin or soft tissue infection can also lead to occasional septic bursitis. Infrapatellar bursa has two parts, superficial and deep bursae. Superficial bursa inflammation reactive to adjacent superficial skin infection may occasionally lead to secondary bursitis. Case Presentation: We report a rare finding of acute right knee pain with extraordinary amount of fluid collection within superficial part of infrapatellar bursa in an elderly male patient. A secondary, septic and massive superficial infrapatellar bursitis was unusual in its appearance mimicking neoplastic lesion. Judicious use of clinical assessment and imaging helped to diagnose the condition. Conclusion: Early diagnosis and treatment of bursitis can ensure optimal outcome and it can be used to check further complications. Atypical presentation of any bursitis should be acknowledged and the judicious use of clinical assessment and imaging is critical for prompt diagnosis and treatment.