ABSTRACT
BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarified at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma. METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009–2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists. RESULTS:Of the 447 patients, 309 (69.1％) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3％) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures [95％CI 78.3 (63.6–89)] but the lowest in pneuomediastinum [95％CI 11.8 (1.5–36.4)]. The specificity of CXR was close to 100％ in detecting a wide array of entities. CONCLUSION:CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.
ABSTRACT
BACKGROUND:This study aimed to compare pantoprazole, a proton-pomp inhibitors (PPIs), and ranitidine, a H2 receptor antagonists (H2RA), in ceasing dyspeptic symptoms in the emergency department (ED). METHODS:This randomized, double-blinded study compared the effectiveness of 50 mg ranitidine (Ulcuran?) and 40 mg pantoprazole (Pantpas?), given in a 100 mL saline solution by an intravenous rapid infusion within 2–4 minutes in patients with dyspepsia presented to the ED. Pain intensity was measured at baseline, 30 and 60 minutes after the drug administration. RESULTS:A total of 72 patients were eligible for the study. Of these patients, 2 were excluded from the study because the initial visual analogue scale (VAS) scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study groups. Thirty-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed ultimately. The mean age of the patients was 36.6±15 years, and 26 (39.4％) patients were male. Both of the groups reduced pain effectively at 30 [27.6±28 (18 to 37) vs. 28.3±23 (20 to 37), respectively] and 60 minutes [39.6±39 (26 to 53) vs. 42.3±25 (33 to 51), respectively]. There were 13 (39.4％) patients in the pantoprazole group and 8 (24.2％) patients in the ranitidine group who required additional drug at the end of the study (P=0.186). CONCLUSION:Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.