Acute pain management in emergency department, low dose ketamine versus morphine, a randomized clinical trial

Background: Ketamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED). Objectives: This study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients. Methods: In this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0.2 mg/kg of ketamine while the 2nd group received 0.1 mg/kg of intravenous morphine. The pain intensity and complications were measured and compared every 15 minutes to 1 hour. Results: Fifteen minutes after drug injection in both groups, a significant reduction was found in average pain intensity compared to the initial pain (P = 0.01). At 15 minutes, no significant difference was found in both groups in regards to average pain intensity (P = 0.23). The average pain intensity at 30, 45, and 60 minutes in the group receiving morphine was lower than the ketamine group (P = 0.01, P < 0.001, P < 0.001 respectively). Two complications (drop in O2 saturation below 90 and flushing) were significantly greater in the morphine group. Conclusions: The results of this study suggest that LDK, at a dose of 0.2 mg/kg, in the earlier minutes leads to significant reduction of pain when compared to that of intravenous morphine. It also created fewer complications than morphine. © 2017, Anesthesiology and Pain Medicine

Acute pain management in emergency department, low dose ketamine versus morphine, a randomized clinical trial

Background: Ketamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED). Objectives: This study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients. Methods: In this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0.2 mg/kg of ketamine while the 2nd group received 0.1 mg/kg of intravenous morphine. The pain intensity and complications were measured and compared every 15 minutes to 1 hour. Results: Fifteen minutes after drug injection in both groups, a significant reduction was found in average pain intensity compared to the initial pain (P = 0.01). At 15 minutes, no significant difference was found in both groups in regards to average pain intensity (P = 0.23). The average pain intensity at 30, 45, and 60 minutes in the group receiving morphine was lower than the ketamine group (P = 0.01, P < 0.001, P < 0.001 respectively). Two complications (drop in O2 saturation below 90 and flushing) were significantly greater in the morphine group. Conclusions: The results of this study suggest that LDK, at a dose of 0.2 mg/kg, in the earlier minutes leads to significant reduction of pain when compared to that of intravenous morphine. It also created fewer complications than morphine. © 2017, Anesthesiology and Pain Medicine

Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures

Objectives To assess ECG changes in patients with tramadol-induced seizure(s) and compare these changes in lower and higher than 500 mg tramadol doses as a main goal. Material and methods In an analytical-cross sectional manner over 1 year, 170 patients with idiosyncratic seizure(s) after using tramadol, were studied. Full data were recorded for each patient. ECGs were taken from all the patients on admission and 1 h later and were assessed for findings. Results 70 of 170 patients (41.2) had used lower than 500 mg doses of tramadol while 90 patients (52.9) were included in the high dose group. Rate of female patients in the high dose group was significantly higher. The average age of patients in the high dose group was significantly lower (22.04 vs 25.76). The high dose group had significantly higher heart rates. There was no history of cardiovascular diseases; two patients had previous history of seizure. No significant difference was shown between low dose and high dose groups from the point of ECG changes. Discussion and conclusion Using doses higher than 500 mg is more frequently seen in women, young people and those who have not experienced previous use of tramadol. Terminal S wave, sinus tachycardia, and terminal R wave in the lead aVR are among the most common ECG changes in tramadol users. © 2016 The Emergency Medicine Association of Turke

Can intravenous acetaminophen reduce the needs to more opioids to control pain in intubated patients?

Aims: To evaluate the effect of intravenous (IV) acetaminophen on reducing the need for morphine sulfate in intubated patients admitted to the Intensive Care Unit (ICU). Settings and Design: Current study was done as a clinical trial on the patients supported by mechanical ventilator. Subjects and Methods: Behavioral pain scale (BPS) scoring system was used to measure pain in the patients. All of the patients received 1 g, IV acetaminophen, every 6 h during the 1 st and 3 rd days of admission and placebo during the 2 nd and 4 th days. Total dose of morphine sulfate needed, its complications, and the BPS scores at the end of every 6 h interval were compared. Results: Totally forty patients were enrolled. The mean pain scores were significantly lower in the 2 nd and 4 th days (4.33 and 3.66, respectively; mean: 4.0) in which the patients had received just morphine sulfate compared to the 1 st and 3 rd days (7.36 and 3.93, respectively; mean: 5.65) in which the patients had received acetaminophen in addition to morphine sulfate too (P < 0.001). Cumulative dose of morphine sulfate used, was significantly higher in the 1 st and 3 rd days (8.92 and 3.15 mg, respectively; 12.07 mg in total) compared to the 2 nd and 4 th days (6.47 mg and 3.22 mg, respectively; 9.7 mg in total) (P = 0.035). Conclusion: In our study, IV acetaminophen had no effect on decreasing the BPSs and need of morphine sulfate in intubated patients admitted to ICU. © 2016 Indian Journal of Critical Care Medicine

Assessment of Emergency Medical Education on Knowledge Alterations of Medical Students in Rasoul Akram Hospital (2005-2006)

<p style="text-justify: inter-ideograph; text-align: justify;"><strong>Background and objectives:</strong> Education and management are considered two integrated and non-separable requirements of an emergency department (ED). Despite the emphasis on teaching of essentials of approaching and management of critical patients, medical students do not acquire the necessary knowledge to handle these patients during their rotation in different specialties other than emergency medicine (EM). This study aims to evaluate the changes in EM knowledge of interns during their one month rotation in ED of Rasoul Akram Hospital.  </p><p style="text-justify: inter-ideograph; text-align: justify;"><strong>Methods:</strong> In a 15-month period, 226 interns were entered into this study. A pretest was taken at the beginning of their one-month internship period. Then, the interns were provided with a handbook, which was prepared and revised according to the approved curriculum of Ministry of Health and Medical Education of Iran and latest emergency medicine textbooks. The interns were taught by several lecture and practical sessions. At the end of their EM internship period, a post-test was taken and the change of their emergency medical knowledge was assessed by comparison of pre-and post-test results. </p><p style="text-justify: inter-ideograph; text-align: justify;"><strong>Results:</strong> The results showed a significant increase of mean post-test scores compared with the pretest scores. Also, there was a significant difference between the scores obtained by males and those obtained by females (P < 0.001). </p><p style="text-justify: inter-ideograph; text-align: justify;"><strong>Conclusion: </strong>The one-month EM training significantly improved the level of interns’ knowledge.  </p&gt

Assessment of Emergency Medical Education on Knowledge Alterations of Medical Students in Rasoul Akram Hospital (2005-2006)

Background and objectives: Education and management are considered two integrated and non-separable requirements of an emergency department (ED). Despite the emphasis on teaching of essentials of approaching and management of critical patients, medical students do not acquire the necessary knowledge to handle these patients during their rotation in different specialties other than emergency medicine (EM). This study aims to evaluate the changes in EM knowledge of interns during their one month rotation in ED of Rasoul Akram Hospital. Methods: In a 15-month period, 226 interns were entered into this study. A pretest was taken at the beginning of their one-month internship period. Then, the interns were provided with a handbook, which was prepared and revised according to the approved curriculum of Ministry of Health and Medical Education of Iran and latest emergency medicine textbooks. The interns were taught by several lecture and practical sessions. At the end of their EM internship period, a post-test was taken and the change of their emergency medical knowledge was assessed by comparison of pre-and post-test results. Results: The results showed a significant increase of mean post-test scores compared with the pretest scores. Also, there was a significant difference between the scores obtained by males and those obtained by females (P < 0.001). Conclusion: The one-month EM training significantly improved the level of interns’ knowledge. Keywords: Student, Medical; Curriculum; Education; Emergency Medicin

Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial

Background: The combination of morphine with low doses of ketamine (MK) has been utilized in the Emergency Department (ED) compared with morphine and placebo (MP) for the treatment of acute pain in few studies. The purpose of this study was to compare the effect of MP with MK for the treatment of severe pain with renal colic of patients who had been referred to the ED. Methods: This study is a double blind randomized clinical trial on patients with severe renal colic pain who were referred to the ED. Patients were enrolled with pain severity of at least 6 of the 10 visual analogue scales (VAS). Patients were divided into two groups: Morphine 0.1 mg/kg and placebo (MP group) and morphine 0.1 mg/kg and ketamine 0.15 mg/kg (MK group). Pain of patients was studied in 10, 30, 60, 90, and 120 min after injection. Results: Totally, 106 patients were enrolled in study groups. Assessment of the average pain during 120 min at 10 and 30 min after the start in the drug, MK group was significantly lower than the MP group (p = 0.019 and p = 0.003 respectively). Conclusion: Given that combinations of morphine with low doses of ketamine in patients with renal colic pain causes more pain and morphine consumption reduction then this combination is suggested as an alternative treatment that could be utilized in patients with renal colic. © 201

Ice reduces needle-stick pain associated with local anesthetic injection

Background: Local anesthetic injections are widely used in the emergency department for different purposes. Pain management for such injections is of great importance to both patients and the healthcare system. Objectives: Our study aimed to determine the effectiveness and safety of cryotherapy in patients receiving local anesthetic injections. Methods: Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second did not. The pain severity, length and depth of the laceration, and the other necessary information before and after the pain-reducing intervention were measured, documented, and compared at the end of the study. Pain scores were measured using a numerical rating scale before and after the procedure, and the differences were compared using a t-test. Results: Ninety subjects were enrolled in the study, 45 in each group. There were no statistical differences between the 2 groups in terms of baseline preoperative and operative characteristics (P > 0.05). The pain scores in the cryotherapy group were significantly lower before and after the procedure (P < 0.001). There was no statistically significant difference between the 2 groups for wound infection (P = 0.783). Conclusions: Cooling the injection site prior to local anesthetic injection is an effective and inexpensive method to reduce the pain and discomfort caused by the injection. � 2016, Kowsar Medical Publishing Company. All rights reserved