Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients especially upon arrival at the emergency department. Resuscitative point-of-care ultrasound could be used for rapid initial diagnosis and better management. In this study, the results of using the RUSH (Rapid Ultrasound in Shock) exam to determine the type of shock in the emergency department are compared to the final diagnosis of patients. This was a single-center prospective study in which all patients with an unknown type of shock and no prior treatment were included. Parallel to the standard resuscitative management and diagnosis of the emergency team, the RUSH exam was performed blindly on the patient by an emergency medicine staff who was not part of the patient's caregiving team. The results of the RUSH exam were then compared to the final diagnosis of the patients and the 48-h outcome. Twenty-five patients were enrolled in this study. The overall kappa correlation of the RUSH exam compared with the final diagnosis was 0.84 which is an almost perfect agreement. The overall sensitivity of the RUSH exam was 88 % and the specificity was 96 %. Although the mortality rate was 64 %, there was not a significant relationship between mortality and the protocol used for diagnosis. The RUSH exam could be used in emergency wards to detect types of shock.

Although bariatric surgery is a safe and effective procedure in the treatment of adolescent morbid obesity, long-term data is scarce regarding its nutritional and developmental complication in this growing population of patients.

Despite recent advances in anesthesiology and postoperative care, postoperative nausea and vomiting are common complaints. Although acupuncture techniques have received attention in anesthesiology, the ideal technique and selection of the most appropriate acupuncture points are still under debate. This study compared the efficacy of two simultaneous acupuncture points with that of a single point in the prevention and treatment of postoperative nausea and vomiting following general anesthesia through a double-blind, randomized, controlled trial involving 227 surgical patients undergoing general anesthesia who were randomly assigned into two groups. The first group received acupuncture by stimulation only on the PC6 point (single group), and the second group underwent concomitant stimulation of the PC6 and the L14 acupuncture points (combined group) during surgery under general anesthesia. The prevalences of postoperative nausea and vomiting were compared between the two groups. No significant differences were observed between the two groups (p>0.05). Of 115 patients in the combined group, 80 (69.6%) complained about nausea and vomiting compared with 96 (85.7%) in the single group, a significantly lower proportion (p<0.05). Our findings favor a combination of PC6 and LI4 stimulation for the treatment of postoperative nausea and vomiting.

BackgroundThere were numerous studies using acupuncture for pain relief and in most, the effect of this technique on preventing migraine attacks has been investigated. In those several studies that surveyed the effect of acupuncture on treatment of migraine headaches, the conclusion was not completely persuaded and they suggested further researches on this topic.ObjectivesThe purpose of this study is to examine the effect of acupuncture on controlling acute migraine attacks.MethodsThis study was a single blinded randomized clinical trial that was conducted on patients with a diagnosis of acute migraine attacks. At the time of reference, the patient’s pain intensity was measured and recorded in a written checklist. Acupuncture was done in the intervention group with thin metallic needles, which enter certain points in the ear’s skin; including shen men, autonomic, thalamus, frontal, and temple. In the placebo group, similar needles were used, however, they were inserted into unusual points. Thereafter, in 30 minutes, one, two, and four hours after the treatment, the pain intensity was also asked and compared with the reference time’s score.ResultsA total of 60 patients with the mean age of 31.4 ± 7.6 years were enrolled and 83.3% of them were women. There was no significant difference between two groups in terms of the baseline characteristics of participants including age, sex and pain duration before admission (P > 0.05). According to the results, there was a significant difference between the two groups on the checkpoints of 15, 30, 45, and 60 minutes after acupuncture (P < 0.05); however, the pain scores were not statistically different between the two groups on two, three, and four hours after intervention (P > 0.05).ConclusionsBased on the findings of our study, although the pain score was lower in the intervention group than the control group during first hour after the acupuncture, there was no significant change in pain score thereafter. Comparison of the two groups showed no differences between acupuncture and placebo acupuncture on decreasing the mean pain score.