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:
The relationship between increased levels of cardiac troponins and morbidity and mortality of traumatic patients is not still well recognized.
Aim:
The aim of this study was to investigate the prognostic value of cardiac troponin I and T on admission in mortality of multiple trauma patients admitted to the emergency department.
Methods:
In this prospective follow-up study, the cardiac troponin I and T levels were measured in patients with multiple trauma referring to the emergency department (ED) between March 2014 and February 2015 at Imam Khomeini Hospital, Sari, Iran. Patients were followed prospectively until discharge from hospital or death.
Results:
The levels of cardiac troponins I and T in patients with multiple trauma were significantly associated with their mortality, especially at the level of 0.5 and 1.2 μg/dl (p<0.05). Multivariate regression analysis showed association of level of cardiac troponin I and T with patients’ mortality, after controlling for patients’ age, vital signs and GCS on admission. The sensitivity and specificity of troponin I at levels greater than 0.4 μg/dl in predict mortality in this study were as 65.5% and 55.3%, while the values for troponin T were 65.1% and 54.9%, respectively.
Conclusion:
Elevated cardiac troponin I and T levels provide excellent prognostic information regarding mortality in patients with multiple-trauma, independent of age, hemodynamic variables and GCS score.
Fecaloma is a very hard stool often located in the rectum of the sigmoid colon. A 63-year-old man with abdominal distention and urinary retention was admitted to an emergency department. Abdominal CT scans showed a urinary bladder displaced by fecaloma. Fecaloma is an infrequent cause of acute urinary retention, especially in bedridden patients with underlying diseases.
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: 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).
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