ABSTRACT
Objective: To evaluate the efficacy and safety of intramuscular ketamine and haloperidol in sedation of severely agitated patients in emergency department [ED]
Methods: This randomized, double-blind clinical trial study was performed on agitated patients referring to two university educational hospitals. Patients were randomly assigned to receive intramuscular [IM] haloperidol [5 mg] or IM ketamine [4 mg/kg]. The primary outcome was time to adequate sedation [AMSS
Results: The 90 agitated patients were enrolled. The mean age was 30.37+/-7.36 years [range 18+56]; 74% [67/90] were men. The mean time to adequate sedation in ketamine group [7.73]4.71 minutes] was significantly lower than haloperidol group [11.42+/-7.20 minutes] [p=0.005]. 15 minutes after intervention, the sedation score did not differ significantly in both groups [Ketamine: 0.14+/-0.59 vs. Haloperidol: 0.30+/-0.60; p=0.167]. The incidence of complications was not significantly different between groups. The physicianfs satisfaction from the patientsf aggression control was significantly higher in ketamine group
Conclusion: These data suggest ketamine may be used for short-term control of agitated patients, additional studies are needed to confirm if ketamine is safe in this patient population. Given rapid effective sedation and the higher physician satisfaction of ketamine in comparison to haloperidol, it may be considered as a safe and appropriate alternative to haloperidol. Trial registration number: IRCT20180129038549N5
ABSTRACT
Nausea and vomiting are the most common complications after minor head trauma that increases the risk of intracranial pressure rising. Therefore, the present study was aimed to compare the antiemetic effects of metoclopramide and ondansetron in the treatment of post-traumatic nausea and vomiting. The study was a controlled, randomized, double blind clinical trial, which was conducted in the first 6 months of 2014 in emergency department Al-Zahra and Kashani Hospitals in Isfahan, Iran. The patients with minor head trauma associated with nausea and vomiting were randomly divided into 2 groups: treatment with metoclopramide [10mg/2ml, slow injection] and treatment with ondansetron [4mg/2ml, slow injection]. The comparison between the 2 groups was done regarding antiemetic efficacy and side effects using SPSS 21 statistical software. 120 patients with minor head trauma were distributed and studied into two groups of 60 patients [mean age 35.6 +/- 14.1 years; 50.0% male]. Administration of both ondansetron and metoclopramide significantly reduced the severity of nausea [P<0.001]. Changes in the severity of nausea in both groups before and after the treatment revealed that nausea had been decreased significantly in both groups [P < 0.001]. The incidence of fatigue [p=0.44], headache [p=0.58] and dystonia [p=0.06] had no significant difference in the two groups but the incidence of drowsiness and anxiety in the metoclopramide group was significantly higher [P < 0.001]. The present study indicated that the treatment effectiveness of ondansetron and metoclopramide are similar. However, incidence of drowsiness and anxiety in the metoclopramide was considerably higher. Since these complications can have adverse effects on the treatment of patients with brain injury, it is suggested that it may be better to use ondansetron in these patients
ABSTRACT
Rib fracture is one of the common causes of trauma disabilities in many events and the outcome of these patients are very extensive from temporary pain management to long-term significant disability. Control and management of the pain in such patients is one of the most important challenges in emergency departments. Thus, the aim of the present study was assessing the efficacy of IV acetaminophen in pain control of patients with rib fracture.: In this double-blind clinical trial, 54 patients over 18 years of age, referred to two educational hospitals with rib fracture, were entered. Patients were randomly categorized in two groups of morphine sulfate [0.1 milligram per kilogram of body weight] and IV acetaminophen [1gram], as single-dose infused in 100 cc normal saline. The pain severity was measured by numeric rating scale [NRS] on arrival and 30 minutes after drug administration. At least three scores reduction was reported as therapeutic success. The mean and standard deviation of patients' age was 41.2 +/- 14.1 years. There is no difference in gender [p=0.24] and age frequency [p=0.77] between groups. 30 minutes after drug administration the mean of pain severity were 5.5 +/- 2.3 and 4.9 +/- 1.7 in morphine and acetaminophen groups, respectively [p=0.23]. Success rate in morphine and acetaminophen groups were 58.6% [95% Cl: 39.6-77.7] and 80% [95% Cl: 63.2-96.7], respectively, [p=0.09]. Only 3 [5.6%] patients had dizziness [p=0.44] and other effects were not seen in any of patients. The findings of the present study shows that intravenous acetaminophen and morphine have the same therapeutic value in relieving the pain of rib fracture. The success rate after 30 minutes drug administration were 80% and 58.6% in acetaminophen and morphine groups, respectively. Presentation of side effects was similar in both groups