Aortic Dissection of Unknown Origin in a Young Patient: A Case Report

Aortic dissection occurs when a tear develops in the wall of the aorta, which is rare in the young population. This fatal disorder is hard to diagnose, especially in young patients. We present the case of aortic dissection in a 15-year-old boy referred to the Emergency Department of Yazd University of Medical Sciences in November 2015. The patient presented to our department with sudden acute chest pain. Emergent computed tomography (CT) scanning of the brain, chest, and abdomen reflected bilateral pleural effusion, biluminal aorta, arterial flap in the upper part of the abdominal aorta, and dilated small bowl loop. The patient did not have any aortic dissection risk factors such as history of connective tissue disease, congenital heart disease, coarctation of the aorta, and hypertension. The only noticeable point in the patient’s history was swimming two hours before the onset of the chest pain. Aortic dissection is a rare differential diagnosis in children with acute sudden chest pain

Lidocaine induced seizure during rapid sequence intubation, a case report

به دلیل تاثیر مناسب و شروع اثر سریع، لیدوکائین به طور معمول برای ساپرس تغییرات همودینامیک ناشی از لوله گذاری داخل تراشه مورد استفاده قرار می گیرد. از جمله عوارض جانبی این دارو تشنج می باشد که متعاقب تجویز موضعی و وریدی آن به صورت موردی گزارش شده است. در این مقاله به معرفی بیماری می پردازیم که با شکایت از تنگی نفس شدید و پیشرونده به بخش اورژانس ارجاع گردید و در حین انجام لوله گذاری داخل تراشه با توالی سریع و به دنبال تجویز لیدوکائین وریدی دچار تشنج تونیک کلونیک جنرالیزه شد.The best choice for Patients who need intubation in the emergency ward is rapid sequence intubation in order to reduce laryngoscopic adverse effect and to have better condition for intubation. Lidocaine is one of the drugs used in premedication before induction and paralysis to attenuate laryngoscopic sympathetic reflex. We present a patient that had an episode of seizure immediately after administering lidocaine intravenously during rapid sequence intubation, not reported before

Seizure Following Lidocaine Administration during Rapid Sequence Intubation; a Case Report

Lidocaine is commonly used for suppressing hemodynamic instabilities resulting from endotracheal intubation due to its good effect and rapid onset of action. Seizure is one of the side effects of this drug, which has been reported following its topical and intravenous administration in some cases. In this article, we present a patient referred to the emergency department with complaint of severe and progressive shortness of breath who had a generalized tonic-clonic seizure following lidocaine administration during rapid sequence intubation

Compression of the Analgesic Effects of Intravenous Metoclopramide and Ondansetron in combination on Renal Colic in the Patients receiving Morphine

Background and Aim: The aim of this study was to compare the analgesic effects of I.V. ondansetron and I.V. metoclopramide in combination with morphine in relieving pain in the patients with acute renal colic receiving morphine in the emergency department. Materials and Methods: Patients were randomly divided into three groups of A, B and C. Group A patients were treated with 0.1 mg/kg intravenous morphine and 0.075 mg/kg I.V. ondansetron (maximum 4 mg), group B patients were treated with the same dose of intravenous morphine and 0.15 mg/kg metoclopramide (maximum 10 mg) and group C patients received the same dose of intravenous morphine and 5 cc normal saline. Pain intensity was assessed at the beginning of the study and 15, 30, 60 and 120 minutes after receiving the drug by Visual Analog Scale (VAS). Results: In this study, 150 patients were divided into three groups. The mean age of patients was 34.51 ± 7.84. There was no significant difference between the three groups in terms of gender distribution (P = 0.737) and mean age (P = 0.57). The mean VAS score was not significantly different in the three groups at the beginning of the study (P=0.338). But at the 15th minute VAS scores in the metoclopramide and ondansetron groups were significantly less than that of the control group (P=0.044). At the 30th minute, the difference in the pain intensity among the three groups was again insignificant (P=0.164). But at the 60th and 120th minutes, the VAS score in the metoclopramide group was significantly less than those of the other two groups. (P=0.033 and P=0.009). Also, intragroup analysis showed a significant decreasing trend in the VAS scores in the three groups during the study (P <0.001). Patient’s average length of stay in emergency department was 53±18 minutes in the metoclopramide group, 72±31 minutes in the ondansetron group and 80±31 minutes in the control group (P <0.001). In the metoclopramide group, 2 patients developed extrapyramidal complications. Conclusion: Our findings indicated that metoclopramide and ondansetron in addition to their antiemetic effects, have analgesic effects. The analgesic and antiemetic effects of metoclopramide and its effect on reducing the length of hospital stay were greater than those of ondansetro