Objectives:To determine the accuracy of the Broselow tape on estimating body weights of selected Saudi children.Methods:This is prospective study of children aged 7 days to 13 years who attended the Emergency Department of King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia, from June 2015 to September 2015. Only children <34 kg were enrolled for the study and children with triage categories I and II were eliminated to avoid delay in providing appropriate treatment in these circumstances.Results:The relationship between the actual and tape estimated body weights showed a correlation coefficient of 0.945 (p<0.001) for all children. When adjusting the correlation coefficient related to weight groups, the correlation coefficient was 0.911 (p<0.001) for children with body weights between 10 to 25 kg.Conclusion:The Broselow tape measurements do not provide satisfactory results for all children in the selected population, but do provide highly correlated measurements for those children with body weights between 10 and 25 kg.

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region. Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors. Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

Gallstone ileus is an uncommon complication of calculus cholecystitis through the formation of a biliary enteric fistula. The risk of mechanical obstruction caused by gallstones is increased with its size, in addition to chronic constipation, neoplasm and diverticulitis, to name a few. Here, we present a case of an 89-year-old male patient who presented with signs of bowel obstruction, which was found to be a gallstone impacted in the sigmoid colon. Considering the patient’s stable condition and his comorbidities, a conservative approach was opted including IV fluids, fleet enema and bowel rest. Colonoscopy was performed and confirmed the passage of the stone. With no consensus regarding the management, the literature emphasizes a tailored approach to each case considering all possible operative and non-operative approaches. Some reports show promising results with non operative management. Gallstone ileus remains a challenging case, and further studies for the best treatment modalities are needed.

Digoxin is used to treat heart failure and arrhythmias. Even though its used is decreased, the toxicity of digoxin still remains a problem for physicians. We present a case of a middle-aged male pharmacist, diabetic, who intentionally ingested a toxic dose of digoxin and insulin with his random blood glucose (RBS) of 40mg/dl. He was hemodynamically stable and his ECG showed no arrhythmias. His initial investigations showed normal potassium level and digoxin level of >7.51ng/ml. He was closely observed in the emergency Department (ED). Patient was admitted to the hospital for close observation. Even though the patient's digoxin level was toxic; his potassium levels were within the normal limits, and his vitals and serial ECGs were all unremarkable. These Findings shine the light regarding the insulin and digoxin, in that the insulin maybe a life saving intervention in case of digoxin toxicity.