Objective The aim of this review was to evaluate the efficacy and safety of prochlorperazine (PCP) in patients with acute migraine headache in the emergency department (ED). Methods Electronic databases (Medline, Scopus, Web of Science, and Cochrane) were searched for randomized clinical trials that investigated the effect of PCP on headache relief. The outcomes were the number of patients without headache or with reduced headache severity, the number of adverse events, and the need for rescue analgesia. Results From 450 citations, 11 studies (n = 771) with 15 comparison arms met the inclusion criteria. Overall, PCP was more effective than placebo (OR = 7.23; 95% CI = 3.82‐3.68), metoclopramide (OR = 2.89; 95% CI = 1.42‐5.86), and other active comparators (OR = 3.70; 95% CI = 2.41‐5.67) for headache relief. The odds ratio of experiencing adverse events with PCP compared with placebo was 5.79 (95% CI = 2.43‐13.79). When PCP compared with other active comparators, no statistical difference was found regarding the overall number of adverse events (OR = 1.88; 95% CI = 0.99‐3.59). However, PCP significantly increased the odds of akathisia/dystonia (OR = 2.55; 95% CI = 1.03‐6.31). The request for rescue analgesia was significantly lower in the PCP group compared with other groups (16% vs 84%; OR = 0.16; 95% CI = 0.09‐27). Conclusions For adult patients with acute migraine, PCP could effectively abort the acute attack and reduce the request for rescue analgesia in the ED. However, compared with placebo, PCP could increase the risk of adverse events.

Introduction:Traumatic brain injury (TBI) is of the most challenging public health problems.Aim:The aim of this study was to investigate the epidemiology of mild TBI, frequency of clinically important head injuries identifiable on computed tomography (CT) scans and also short-time outcomes of mild TBI in elderly population in north of Iran.Patients and Methods:A prospective epidemiological study was conducted at the Emergency department of Imam Khomeini general hospital, Mazandaran, Iran. Inclusion criteria were age older than 60, Glasgow coma scale (GCS) score of 13-15, and a single head trauma. Data were collected by retrospective chart review, interview with patients or their caregivers and contact with them after a week from time of discharge or transferring to another wards.Results:Response rate was estimated at 67.8% (n: 122/180). Mean age of patients was 65.54±6.42 years. 82% of patients were younger than 70. Mean time from head trauma to hospital admission was 270 minutes. In majority of patients, mechanism of trauma was fall (28%) and then interpersonal violence (25%). 6.6% (95% CI: 2.87 to 12.5%) of patients suffered from important radiologically head injuries and 2.5% (95% CI: 0.5-7.00) were readmitted to hospital within a week.Conclusion:Time to admission for minor TBI in elderly patients was too long and could be of clinical concern. Considering the lower prevalence of important radiologically head injury among elderly population, using any clinical guideline for indication of CT scan may be more cost-effective than routine use of CT scan. Although short term outcomes of minor TBI were less threatening and not lethal but these patients need follow-up.

Introduction: Acute urinary retention due to benign prostatic enlargement is one of the clinical complaints that patients refer to the emergency department. Selective α-blockers are used after urinary catheterization. Recently, the use of nitrate compounds has been shown to relieve bladder neck and to treat acute urinary retention. Objective: The aim of this study was to survey the addition of Isosorbide di nitrate to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. Methods: This is a randomized, double-blind placebo-controlled clinical trial. In all, 78 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department were divided into two groups and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus isosorbide dinitrate 40 mg extended-release tablets daily for 3 days. At the same first visit, the catheter was removed and the ability to void in same time and 1 month later was assessed in each group. Results: After catheter removal, 27 (67.5%) patients in the tamsulosin plus placebo group and 31 (81.6%) in the tamsulosin plus isosorbide dinitrate group voided successfully after 3 days (p = 0.155). After 1 month, 20 (50.0%) patients taking tamsulosin plus placebo and 23 (60.5%) taking tamsulosin plus isosorbide dinitrate could void, yet indicating no significant difference (p = 0.350). Conclusions: Addition of isosorbide dinitrate to α-blockers has advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone, although was not statistically significant.

Background: The aim of this study was to investigate the positive predictive value of CT scan findings and clinical signs in choice of clinical management of renal colic patients referred to the emergency department of Imam Hospital in Sari in 2020-2021. Method: A cross-sectional study was performed on all patients with renal colic who were admitted to the emergency department in Sari Imam Khomeini Hospital, in 2021. 167 patients with acute renal colic in terms of clinical manifestations, laboratory findings, and CT scan findings were evaluated.Results: In the present study, 55 patients (32.9%) underwent TUL treatment and 112 patients (67.1%) had spontaneous excretion. 48.9% of people with clinical symptoms of abdominal pain and 27% of people without symptoms of abdominal pain finally underwent TUL treatment (p = 0.008). The incidence of TUL in patients with stone size> 5 mm was significantly higher than those with stones ≤5 mm (P <0.001) and the majority of patients with stones in the upper and middle third of the ureter were in the TUL group. The majority of patients had spontaneous excretion despite stones in the lower third and UVJ (p = 0.021).

BackgroundSeptic shock, a complication characterized by altered tissue perfusion, is associated with high mortality if left untreated. Renal resistive index (RRI) reflects changes in intrarenal perfusion. Therefore, the present study aimed at investigating changes in RRI during resuscitation of patients with septic shock and evaluating its relationship with other micro- and macrociculatory perfusion parameters.MethodsThe present prospective observational study was performed on all patients referring to the emergency department intensive care unit (ED-ICU) diagnosed with septic shock from July 2018 to September 2019. Demographic characteristics of the study subjects were recorded and their hemodynamic, paraclinical, and RRI values were measured at three time points of on arrival, and 30 and 120 minutes and six hours after admission, by ultrasound.ResultsA total of 109 subjects entered data analysis; their mean age was 67.62 ± 14.67 years, of which 65 (59.1) were male. The RRI values were 0.71 ± 0.27, on arrival, at 30 and 0.70 ± 0.1 on 60 minutes, at six hours after treatment onset, respectively, showing that RRI values decreased during the study, which was statistically significant (P-value= 0.00). ConclusionA decrease in RRI value during resuscitation is associated with an increase in MAP in patients with septic shock. Accordingly, RRI can be used as an indicator of microcirculatory perfusion in the treatment process and volume assessment of patients with septic shock.

Introduction: Pain control is one of the treatment priorities and the most important children's rights because children experience painful events since birth and during childhood due to common childhood illnesses or accidents. The aim of this study was to compare the analgesic effect of intranasal ketamine and fentanyl in children. Method: The present research is a double blind randomized clinical trial conducted on 80 children aged 3-13 years who were admitted to the Emergency Department of Sari Imam Hospital. The patients who met the inclusion criteria were randomly divided into two groups using random number generator and 40 patients were considered per group. Data were analyzed using SPSS, Mann-Whitney-U test and wilcoxon paired test. Findings: The fi ndings showed that the analgesic effect of ketamine and fentanyl are similar among the studied children and there is no signifi cant difference. In ketamine group there was signifi cant difference between the mean of pain, systolic blood pressure, diastolic blood pressure, heart rate and respiratory rate variables before and after taking ketamine, according to Willcoxon statistics and sig. smaller than 0.05. In fentanyl Group, there was signifi cant difference between the mean of pain, systolic blood pressure, heart rate and respiratory rate variables before and after taking fentanyl, according to Willcoxon statistics and sig. smaller than 0.05. There was no signifi cant difference between ketamine and fentanyl analgesic effect in terms of parental satisfaction and there was also no signifi cant difference between medical team's level of satisfaction with ketamine and fentanyl analgesic effect. Conclusion: Considering that the analgesic effect of intranasal ketamine and fentanyl on the pain control among the studied children is similar, their prescription is recommended. It is also recommended to simultaneously measure children's level of anxiety and effect of these drugs on their anxiety because children have different experiences of pain and anxiety affects measuring pain severity in future studies.

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Due to the presence of mental disorder in the substance-dependent patients, it is recommended to help treat them by providing them with education, psychotherapy, and psychiatric medication.