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Background:This randomized, clinical trial evaluates the analgesic and safety of paracetamol and Morphine in management of headache.Objectives:This study aimed to evaluate the analgesic and safety effects of intravenous single dose of paracetamol, versus morphine in post trauma headache in emergency departments.Patients and Methods:This study was a single-center, prospective, randomized, double-blind clinical trial conducted on two groups treated with intravenous paracetamol and intravenous morphine. Thirty patients were enrolled in each group. Patients (18-55 years-old adults) complaining from headaches due to pure trauma were included in the study. The inclusion criteria required patients to have headachesof more than 40 mm on a 100 mm visual analogue scale without any pathological findings in their clinical examinations and imaging studies.Results:Mean duration required to treat the headache was 37.43 and 71.93 minutes in the groups administered paracetamol (group A) and morphine (group B), respectively. After 15 minutes of treatment, this changed to 31.7 ± 18.0 mm (95% CI 8.2 to 25.2) and 48.3 ± 14.1 mm (95% CI 8.2 to 25.2) in groups A and B, respectively. Headache of the patients of group A significantly mitigated in comparison with group B (P < 0.005). Headache of group Apatients was significantly mitigated 30 minutes after treatment (P < 0.005).Conclusions:Intravenous paracetamol is an effective and safe treatment for patients admitted to the emergency department with headaches caused by head trauma.

ObjectivesOne of the irritating features of migraine is emesis that can compromise taking oral medications. We designed this study to compare the effectiveness of granisetron and metoclopramide in reducing pain and treating emesis in migraine patients.MethodsWe included a total of 148 patients with migraine headache presenting to two referral hospitals in a prospective, double-blinded randomized controlled trial. We compared the effect of granisetron (2 mg intravenous) with metoclopramide (10 mg intravenous). Pain intensity and emesis episodes were recorded before drug administration, one, two and four 4 h after drug administration.ResultsOf the 148 patients, 47 were male and 101 were female. 75 patients received granisetron and 73 metoclopramide. Mean pain intensity before the administration of the medications was 7.67 ± 1.30 in granisetron group and 7.68 ± 1.13 in metoclopramide group with an insignificant difference. Mean pain intensity at one, two, and 4 h after drug administration was 3.20 ± 1.37, 2.39 ± 1.28, and 1.31 ± 0.52 in granisetron group and 5.04 ± 1.77, 4.1 ± 1.8, and 1.56 ± 0.68 in metoclopramide group (P = 0.03). Mean emesis episodes before drug administration were 1.85 ± 0.81 and 1.80 ± 0.77 in granisetron and metoclopramide groups, respectively. These episodes were 1.33 ± 0.66, 0.25 ± 0.49, and 0.04 ± 0.19 in granisetron group and 1.38 ± 0.73, 0.21 ± 0.47, and 0.41 ± 0.19 in metoclopramide group at one, two, and 4 h after the drug administration (P = 0.7).ConclusionTo came in conclusion, compared to metoclopramide, granisetron is a better choice in acute migraine ATTACK because it decreases the patients' pain as well as their emesis.

Background: Distal radius fracture is among the most common fractures of the long bones that are seen in all age groups. Treatment of these fractures in simple cases with displacement or intra-articular fractures is immobilizatgion, and if the fracture has dislocation, surgery may be required. Objectives: The aim of the study is a comparison of treatment efficacy and satisfaction in the methods of a long cast and thumb Spica cast in the patients with distal radius fractures without displacement. Methods: This study is a randomized clinical trial with a non blinded parallel design. Eighty patients with distal radius fractures without displacement were randomly assigned to long cast and thumb Spica cast groups. Patients were randomly using a random number table assigned to one of two long cast and thumb Spica cast methods. Both groups were examined at weeks 4 and 5 and after six weeks plaster was opened and after one week they were evaluated by DASH questionnaire. Performance (limitation of motion, grip strength) and patients' satisfaction was assessed in the two groups. Results: The mean age of patients was 49.87 ± 13.81 years. There were no significant differences between two groups regarding age (P = 0.84). In thumb Spica group 60% and in the long cast group 55% were male. There was no significant difference in sex distribution between treatment groups. The DASH scores in all subjects were 11.68 ± 5.53. Average total DASH score in thumb Spica cast group was 7.19 ± 6.80 and in the long cast was 16.02 ± 6.23. The mean of total DASH score in thumb Spica cast group was significantly higher than long cast group that presented better performance (limitation of motion, grip strength) in thumb Spica cast group respect to long cast group (P < 0.001). Satisfaction was similar between two groups (P = 0.40). Conclusions: Regarding better performance and treatment, thumb Spica cast is recommended as the preferred treatment for distal radius fractures without displacement.

Emergency physicians showed a promising performance in applying FAST in blunt abdominal trauma. The specificity of ultrasonographic diagnosis in the emergency physicians group and the radiologists group were comparable, while radiologists showed a higher performance regarding the sensitivity of the ultrasonographic diagnosis.

SUMMARYObjectivesLower back pain is one of the most common complaints among the general population and among health professionals. Multiple workplace-related risk factors may contribute to back pain among physicians. The aim of this study was to assess the prevalence of lower back pain among medical residents of different medical specialties and to evaluate the relevant risk factors.MethodsA Dutch Musculoskeletal Questionnaire (DMQ) was completed by 125 medical residents. Part I concerned general demographic information, part II evaluated workplace-specific factors, and part III assessed the individual characteristics of lower back pain.ResultsThe overall prevalence of lower back pain among residents was 56.8%, with 45.1% of men and 76.5% of women reporting lower back pain. A total of 94.4% of affected individuals believed that their lower back pain was related to their current job, and 72.6% claimed that the onset of lower back pain occurred after beginning medical work. Statistical analysis revealed a significant correlation between lower back pain and certain risk factors, such as working in the same position for long periods, repetitive movement (bending, twisting) of the lumbar region, working in uncomfortable postures, stress, walking, and standing for long periods. However, no significant relationship was found between lower back pain and heavy lifting, smoking, or prolonged sitting. The role of exercise as a protective factor in reducing the incidence of lower back pain was supported by the statistical analysis.ConclusionsThe prevalence of lower back pain among residents is high and is associated with a number of workplace-related risk factors.

Citation: Abri B, Shams-Vahdati S, Paknezhad S, Sepehri-Majd P, Alizadeh S. Blunt abdominal trauma and organ damage and its prognosis.

BACKGROUND:Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents (MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients. METHODS:This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department (ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death defi ned by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied. RESULTS:In the 100 patients, 21 (21%) patients were female and 79 (79%) male. Fortythree patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage (ICH) or intra-ventricular hemorrhage (IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services (EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes. CONCLUSIONS:The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries.