ABSTRACT
Objective: To compare the analgesiceffects of Nitrous oxide and morphine sulfate in patients with acute renal colic due to urolithiasis
Methods: This was randomized clinical trial being performed in Imam Hossein hospital affiliated with Shahid Beheshti University of Medical Sciences during a 1-year period from May2013 to May2014. A total of number of 100 patients, with an age range of 20-50 years, who presented with renal colic secondary to urolithiasis confirmed by ultrasonography were randomly assigned to receive morphine sulfate injection [0.1 mg/kg] with 100 mg diclofenac suppository [n=50] or Entonox exhalation [50% nitric oxide and 50% oxygen]for 30-minutes with 100 mg diclofenac suppository [n=50]. Quantitative measurement was of pain was performed according to a visual analogue scale [VAS], before, 3, 5, 10 and 30-minute after the intervention. The pain severity and side effects were measured between two study groups
Results: The baseline characteristics of the patients in two study groups were comparable. The frequencies of pain persistence [at least 50%] at 3-, 5-, 10- and 30-minute intervals in morphine sulfategroup were 96%, 80%, 50% and 8%, respectively; these frequencies in Entonex were 82%, 42%, 12% and 2%, respectively [p<0.001]. Cox regression modeling showed that use of Entonox was the only effective agent in the success of treatment, compared to the use of morphine, i.e. use of Entonox increased the success of treatment up to 2.1 folds compared to the use of morphine [HR=2.1; 95% CI: 1.2-3.6; p=0.006]
Conclusion: The results of the present study demonstrate that inhalation of Entonox is an effective and safe analgesic regimen for acute renal colic. It acts more rapidly and is more potent in relieving renal colic when compared to morphine sulfate.Entonox can be regarded as an appropriate alternative to analgesics like opioids in this ground
ABSTRACT
Physical design of the emergency department [ED] has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not