Comparing the antiemetic effects of ondansetron and metoclopramide in patients with minor head trauma

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

Comparison of the analgesic effect of intravenous acetaminophen and morphine sulfate in rib fracture; a randomized double-blind clinical trial

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

Comparison of intravenous ketamine with morphine in pain relief of long bones fractures: a double blind randomized clinical trial

The selective medication for pain control in many clinical situations is morphine but its complications prevent its widespread use. Ketamine has been introduced as an alternative for morphine in some studies. However, the efficacy of its solitary use has not yet been evaluated. Therefore, the present study was undertaken to evaluate the effect of ketamine alone in relieving pain in trauma patients referring to an emergency unit. In this double-blind clinical trial, patients with long bone fractures were randomly divided into two groups of treatment with intravenous [IV] morphine at a dose of 0.1 mg/kg and treatment with IV ketamine at a dose of 0.5 mg/kg. Pain severity of the patients was recorded before and 10 minutes after injection based on numeric rating scale. The means in the two groups were compared using independent t-test. Then the Kaplan-Meier curve and log rank analysis were used to evaluate the success of treatment. 126 patients were included in this study. The mean ages of the patients in the morphine and ketamine groups were 33.6 +/- 14.3 and 35.1 +/- 13.5 years, respectively [P=0.54]. After therapeutic intervention, the pain severity significantly decreased in ketamine [2.7 +/- 1.8; P<0.0001] and morphine [2.4 +/- 1.5; P<0.0001] groups, with a similar effect of both medications on alleviating pain [P=0.28]. The success rate of the treatment at 10-minute interval in groups receiving ketamine and morphine were 59 [93.65%] and 61 [96.8%] patients, respectively [P=0.62]. The results of the present study showed that administration of ketamine at a low dose [0.5 mg/kg] results in a significant decrease in the severity of acute pain in patients with fractures of long bones. This palliative effect is very similar to that of morphine

Diagnostic accuracy of ultrasonography in the initial evaluation of patients with penetrating chest trauma

Traumatic chest injuries [TCI] are one of the most common causes of referring to the emergency departments, with high mortality and disability. This study was designed to evaluate the diagnostic accuracy of ultrasonography versus chest X ray [CXR] in detection of hemo-pneumothorax for patients suffering penetrating TCI. The present cross-sectional study was performed to evaluate the diagnostic accuracy of ultrasonography in penetrating TCI victims referred to the emergency department of Shahid Kashani and Alzahra Hospitals of Isfahan, Iran, from July 2012 to June 2013. Bedside ultrasonography and plain CXR was done on arrival and three hours after admission. The results of ultrasonography and radiography were separately evaluated by an emergency medicine specialist and a radiologist, who were blind to the aims of the study. Then, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and kappa coefficient was considered to evaluate the accuracy of ultrasonography. In this research, 64 patients with penetrating chest trauma were assessed [98.4% male]. The mean age of them was 25.6 +/- 8.5 years [rang: 13-65]. The plain radiography revealed the eight [12.5%] cases of pneumothorax and one [1.6%] hemothorax. The findings of primary ultrasonography also showed the same number of hemo-pneumothorax. Sensitivity and specificity of primary ultra-sound in diagnosis of pneumothorax were 100% [95% Cl: 60.7- 100] and 100.0% [95% Cl, 92.0% to 100.0%] and in detection of hemothorax were 100% [95% Cl: 50.5-100] and 100% [95% Cl: 92.8-100], respectively. Sensitivity and specificity of ultrasound in the third hour were 100% [95% Cl: 31.3-100] and 100% [95% Cl: 91.4-100], respectively. Findings of the present study have shown that ultrasonography has an acceptable diagnostic accuracy in the initial assessment of patients with penetrating chest trauma. However, because of its dependency on operator proficiency and other limitations more studies are needed in this area

Accuracy of ultrasonography in confirmation of adequate reduction of distal radius fractures

Restoration of normal anatomic alignment is a key component of the treatment of distal radius fractures [DRF]. This study aimed to evaluate the accuracy of ultrasonography [US] in determining the adequacy of closed reduction in these fractures. DRF patients admitted to the emergency department of Al-Zahra Hospital, Isfahan, Iran from September 2011 to 2012, were enrolled. After closed reduction, the adequacy was investigated through both US and control plain radiography. Then, sensitivity, specificity, positive and negative predicative values of US in confirmation of closed reduction was evaluated. In addition, inter-rater agreement between the two diagnostic tools was analyzed by calculating Cohen's kappa coefficient. Finally, 154 pa-tients were evaluated [females: 53.9%] with mean age of 40.03 +/- 14.7 [range: 22-73]. US had sensitivity, specifici-ty, positive and negative predictive value of 99.3% [95%CI: 96.2-99.9], 100.0% [95%CI: 62.9-100.0], 100.0% [95%CI: 97.5-100.0], and 88.9% [95%CI: 51.7-98.1] in confirmation of the adequate reduction, respectively. In addition, inter-rater reliability was 0.94 [95%CI: 0.89-0.99; p<0.0001]. It seems that US could be considered as a highly sensitive, accurate, easy to use, noninvasive and safe tool for guidance and confirmation of closed reduction in DRF