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Purpose: Increased intracranial pressure (ICP) is one of the prevalent symptoms of trauma, especially traumatic headache, which requires quick action for the diagnosis and treatment. The optic nerve sheath diameter (ONSD) is a newly proposed technique for the detection of an increase in ICP. The aim of this study was to assess the efficacy of this new diagnostic method in patients with increased ICP induced by trauma. Methods: This prospective study was conducted between December 2016 and February 2017. The patients with traumatic headache and who had been diagnosed with increased ICP using clinical signs and computed tomography scan were compared to the voluntary healthy group. In each patient, measurements were performed employing ultrasound three times on each eye in an axial region, and the mean of these sizes was obtained as the ONSD. Results: A total of 112 participants were examined. The mean ONSD measurement of the patients and the voluntary healthy group was 6.01 ± 0.76 and 3.41 ± 0.56 mm in the right eye, 6.11 ± 0.75 and 3.39 ± 0.54 mm in the left eye, and 6.06 ± 0.75 and 4.02 ± 1.07 mm in both sides, respectively. The ONSD in the right and left sides had high and significant correlation in the patients ( r = 0.929, P < 0.000) and voluntary healthy ( r = 0.630, P < 0.000) group. The mean ONSD of one of the patients was 6.24 ± 0.56 mm, and in another patient with no clinical sign of increased ICP, the mean ONSD was 4.61 ± 0.09 mm. Conclusions: Ultrasound performed on the diaphragm of the optic nerve with acceptable sensitivity can detect patients with an increase in ICP and can be efficacious in expediting the action needed to reduce ICP. Due to the sensitivity and specificity of the ultrasound and high accuracy of the diameter of optic nerve sheath in detecting increase in ICP, as well as considering the fact that ultrasound is a noninvasive and available technique; it can be performed at the patient's bedside.

Hymenoptera stings are self-limiting events or due to allergic reactions. Sometimes envenomation with Hymenoptera can cause rare complications such as acute encephalopathy, peripheral neuritis, acute renal failure, nephrotic syndrome, silent myocardial infarction, rhabdomyolysis, conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy. The mechanism of peripheral nervous system damage is not clearly known. In our studied case after bee sting on face between the eyebrows with little erythema and 1 × 1 cm in size, bilateral blindness developed and gradually improved. Lateral movement of eyes was restricted with no pain. Involvement of cranial nerves including II, V, and VI was found. With conservative therapy after a year significant improvement has been achieved.

Background: Analgesics such as opioids are commonly used for pain control in emergency departments. correlated respiratory side effects and central nervous system depression confine opioids application as analgesic medication. New pain control choices such as Nitric oxide and Ketamine may be alternatives. This study evaluates efficacy of Nitric Oxide versus Ketamine in purpose of pain reduction in limbs fractures. Methods: In a randomized clinical study, 75 patients that were referred to the emergency department with pain, which has been caused by bone fractures, were randomly assigned into 2 groups: receiving ketamine with an intravenous bolus dose of 0.3 mg/kg versus mixture of 50% nitrous oxide/50% Oxygen. The pain score in the groups were measured and compared by the Visual Analog Scale consecutively at arrival and 5, 10, 15 minutes after intervention. Results: Fifteen minutes after the intervention, the score of pain in patients receiving ketamine, reached 2.5 from 8.86 at the baseline. This is while in the second group, 15 minutes after the treatment, reached to 5.02 from 9.52 at the baseline. The amount of pain reduction in both groups was statistically significant. A point-by-point comparison of the amount of the pain did not show significant differences in both groups. Conclusions: The findings of this study showed that both ketamine and Nitrous Oxide/Oxygen mixture are effective in alleviating the pain of patients with limb's fracture, however, there is no precedence between these medications as a pain killer.

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Introduction:Knowing the basic life support (BLS) technique is an essential requirement for all individuals of a community in order to save lives in an emergency. The awareness level about the proper techniques of BLS is questionable among medical personnel. Aim of the research: This prospective observational study was conducted to assess the awareness level of the basic resuscitation principles in Southwest Iran. Material and methods: The aspects that were asked in this questionnaire include the following items: the basic resuscitation stages, and methods of assessment and resuscitation with regard to airway, respiration, and blood circulation in the victims according to age group. Results: In total, 202 people employed in the hospital participated in this study. The mean scores of those who had already completed BLS education was 8.45 ±2.42 and in the individuals who had heard about these technique it was 7.31 ±2.71 (p = 0.002). This relation was statistically significant. The knowledge of specialised assistants was significantly higher than health care providers and their assistants as well as medical intern groups (p < 0.001). In addition, the knowledge of nursing experts was significantly higher than the health care providers and their assistants (p = 0.004) and medical interns (p = 0.002). Conclusions:This study showed that the awareness level of the cardiopulmonary resuscitation principles among different health care departments (health care providers, nurses, and physicians) is low, and holding education courses with a minimum of 6-month intervals is necessary. In addition, for medical interns, basic medical education should start from basic medical sciences. StreszczenieWprowadzenie: Znajomość podstawowych zabiegów resuscytacyjnych (BLS) to podstawowy wymóg dla wszystkich osób, które zajmują się ratowaniem życia w nagłych przypadkach. Poziom znajomości tych technik wśród personelu medycznego budzi wątpliwości. Cel pracy: Prospektywne badanie obserwacyjne przeprowadzono w celu oceny znajomości podstawowych zasad resuscytacji w południowo-zachodnim Iranie. Materiał i metody: Pytania w kwestionariuszu dotyczyły takich zagadnień, jak podstawowe etapy i metody resuscytacji, metody oceny dróg oddechowych, oddychania i krążenia krwi u ofiar w zależności od grupy wiekowej. Wyniki: Łącznie w badaniu uczestniczyły 202 osoby zatrudnione w szpitalu. Średnie wyniki osób, które ukończyły edukację na temat BLS, wynosiły 8,45 ±2,42, a osób, które słyszały o tych technikach -7,31 ±2,71 (p = 0,002). Różnica była statystycznie istotna. Znajomość technik BLS wśród wyspecjalizowanych ratowników była znacznie wyższa niż wśród pracowników ochrony zdrowia i personelu pomocniczego oraz stażystów (p < 0,001). Ponadto wiedza pielęgniarek była znacznie wyższa niż pracowników ochrony zdrowia i personelu pomocniczego (p = 0,004) oraz stażystów (p = 0,002).

IntroductionFentanyl is a lipid soluble, highly potent opioid. The lipid solubility of fentanyl makes it an ideal opioid to be administrated by inhalation. The current study compared ketamine infusion and nebulized fentanyl in bone fracture pain relief.MethodsIn this double-blind, randomized clinical trial, patients aged 18 to 55 years who were admitted to the emergency department (ED) with limb fracture were recruited. A total of 127 patients were included in the study, 51.1% (65) of whom were male and 48.9% (62) of whom were female. The patients were divided equally into two groups: Group I received 100 cm3 IV infusion of normal saline and 4 μg/kg of 50 μg/ml nebulized fentanyl; Group II received 0.4 mg/kg ketamine in 10 min and 5 cm3 nebulized normal saline. Pain was assessed using a visual analog scale just before treatment and 5, 10, 15, 30, and 60 min post-treatment.ResultsBefore intervention, the pain scores of both groups showed no significant difference. However, log linear analysis in both groups showed a significantly decrement during the follow up (60 min) (p < 0.0001). Multiple comparison analysis showed that pain scores were significantly higher in the patients of Group I. Moreover, patients in Group I required additional treatment.ConclusionKetamine can be used as an alternative non-invasive treatment to successfully relieve pain in patients with limb fractures.

Background:More than half of the patients attending emergency centers need analgesics. Injectable analgesics are currently the most common pain control strategy, but entail complications. Fentanyl is one of the most commonly used pain-relief opiates available in various forms.Objective:The present study aims to compare analgesic effects of nebulized against intravenous fentanyl for controlling pain due to limb fracture.Method:The present double-blind clinical trial recruited 213 patients presenting with fractured limbs to emergency departments. The first group of patients received 1 micg/kg of intravenous fentanyl citrate from a solution of 50 micg/ml and 5 ml of normal saline in nebulized form (group A), and the second group intravenously received 5 ml of normal saline and 4 micg/kg of 50 micg/ml solution of fentanyl citrate in nebulized form, whose volume reached 5 ml with the addition of normal saline (group B). Then, pain level was frequently measured and compared in the two groups for 20 minutes.Results:The results obtained showed reduced pain level in both the groups. However, point-by-point comparison of pain in the two groups revealed significantly greater pain reduction in intravenous fentanyl group (P<0.001). The need for adjuvant pain relief medication was 8.3% in intravenous fentanyl group and 24% in nebulized fentanyl group, with a significant difference between the two groups (P=0.002).Conclusion:According to the results, although nebulized fentanyl is effective in controlling pain due to limb fracture, it was less effective than intravenous type, and unable to control pain in many cases.