EC was more effective in patients with acute AF and resulted in a shorter length of stay in the ED than PC. Adverse events were small in number and transient in both groups of patients. Clinical trials registration number NCT00933634.

Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF) and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1%) were admitted to intensive care unit (ICU) within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p = 0.0018) and the severity of trauma score (p < 0.0002) were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

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The usual treatment of pain in acute renal colic is analgesic in intravenous (IV) route. We tried a rapid, non-painful, non-invasive route of administration using intranasal ketorolac plus fentanyl versus IV standard treatment with non steroidal anti-inflammatory drug plus opioid for the relief of pain in renal colic presenting patients to an Emergency Department (ED). We conducted a prospective nonblinded clinical trial. A sample of 82 adult patients with clinical diagnosis of acute renal colic was included to receive either intravenous ketorolac plus fentanyl or intranasal ketorolac plus fentanyl. Pain score was rated by using a 10 cm visual analogue scale at 0, 30 and 60 minutes after the treatment. Primary outcome was pain reduction. Secondary outcomes were adverse events and rescue treatment. Eighty-two patients were enrolled. The first forty-one patients received intranasal ketorolac plus fentanyl and the second forty-one received intravenous ketorolac plus fentanyl. There were not statistically significant differences in reduction of pain between the two groups at 30 and 60 minutes (P-value at 30=0,225; P-value at 60=0,312) although the trend was in favour of IV group. There were no significant differences between the groups with regard to secondary outcomes (adverse events and rescue treatment). Intranasal ketorolac and fentanyl are equivalent in analgesic effect to intravenous ketorolac and fentanyl treatment for ED patients with acute renal colic and the intranasal treatment can be considered a valid alternative to the standard intravenous treatment. IntroductionFive to fifteen percent of the population is found to be affected by urinary stones during their lifetime and the 50% of this population shows recurrent calcolosis within 5-10 years from the first symptons. 1 The classic presentation of a renal stone is acute, colicky flank pain radiating to the groin. In the Emergency Department (ED), 2 initial management of renal colic is based on rational and fast diagnostic process, rapid and effective pain control.Ketorolac and morphine administered with intravenous (IV) route are the drugs of choice to treat pain in acute renal colic. For the treatment of severe pain is useful to combine non-steroidal anti-inflammatory drugs (NSAIDs) and opioids.3-5 However, the insertion of a IV cannula is not always easy in the agitated patient suffering for renal colic. The intranasal route for the administration of NSAIDs and opiates such as ketorolac and fentanyl, is a new and valid alternative method to provide safe and effective analgesia in patients with trauma and burns. Materials and Methods Study designThis study was a prospectic non-blinded trial. The Institutional review board of our center approved the study, and all patients gave written informed consent. Study setting and populationThe patients were adults aged >18, presenting in ED with classical clinical symptoms of renal colic (sudden monolateral flank pain with inguinal irradiation) with a 10-cm visual analogue scale (VAS) greater than or equa...

Objectives: The usual treatment of pain in acute renal colic is analgesic in intravenous (IV) route. We tried a rapid, non painful, non-invasive route of administration using intranasal fentanyl versus IV standard treatment (non steroidal anti-inflammatory drug (NSAIDs) plus morphine) for the relief of pain in renal colic presenting to an Emergency Department (ED). Methods: We conducted a prospective non-blinded randomized clinical trial. A sample of 63 adult patients with clinical diagnosis of acute renal colic was included to receive either intravenous morphine (5 mg) plus ketorolac (30 mg) or intranasal fentanyl (3 μg/kg). Pain score were rated by using a 10 cm visual analogue scale at 0,30 and 60 minutes after the treatment. Primary outcome was pain reduction. Secondary outcomes were adverse events and rescue treatment. Results: Sixty-three patients were enrolled. Thirty patients received nasal fentanyl and thirty-three received intravenous morphine plus ketorolac. Morphine-ketorolac therapy was statistically significant more effective than nasal fentanyl therapy in visual analog scores at 30 minutes: the difference in mean visual analog scale between the two groups was 1.74 cm (95% confidence interval 0.29 to 3.2; P=0.018) at 30 minutes. There were not statistically significant differences between the two groups at 60 minutes. There were no significant differences between the groups with regard to secondary outcomes (adverse events and rescue treatment). Conclusions: A combination of intravenous morphine plus ketorolac offers pain relief superior to nasal fentanyl treatment for ED patients with acute renal colic

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The aim of the present study was to evaluate the relationship between a bedside ultrasound evaluation during an episode of acute respiratory failure and the patient’s outcome. A retrospective observational study was conducted in the emergency departments (EDs) of two hospitals in Como (Sant’Anna Hospital and Valduce Hospital) over two years. Two hundred and twenty eight adult patients with acute respiratory failure were recruited for the study. One hundred and eight patients (group A) received immediately a bedside ultrasound diagnostic test by expert investigastors at the time of ED admission, while 120 patients (group B) were evaluated and managed without a preliminary ultrasound diagnostic approach. The concordance between initial and final diagnosis was statistically significant in group A vs group B (P<0.01). In-hospital mortality was significantly lower in group A as compared with group B [3 (2.7%) vs 6 (5%), respectively; P<0.01]; in group A only nine patients (8.3%) compared with seventeen patients (14.1%) in group B (P<0.01) were transferred to the intensive care unit for monitoring and treatment. The study proposed is not able to recommend the procedure because it is a retrospective design. In spite of this, our study supports the routine use of ultrasonography for the evaluation of patients having acute respiratory failure