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.
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.
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.
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.
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