Comparison between traction-countertraction and modified scapular manipulation for reduction of shoulder dislocation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>One of the most common joint dislocations presented to the emergency department (ED) is anterior shoulder dislocation (ASD). Various techniques for the treatment of this abnormality have been suggested. In this study, we evaluated the efficacy and success rate of modified scapular manipulation (MSM) as a painless procedure compared to traction-countertraction (TCT) for reduction of ASD.</p><p><b>METHODS</b>Patients with ASD who were presented to ED of Baqiyatallah Hospital, Tehran during 2011 were included. They were randomly divided into MSM group or TCT group and then pain at reduction, time of reduction, duration of hospitalization, and success rate were compared. In TCT group, reduction was performed using sedative and antipain medications.</p><p><b>RESULTS</b>Ninety seven patients (81.6% male) with a mean age of 34.15 years±13.48 years were studied. The reduction time between both groups showed a significant difference (470.88 seconds±227.59 seconds for TCT group, 79.35 seconds±82.49 seconds for MSM group, P<0.001). The success rate in MSM group in the first and second effort were 89% and 97% whereas 73% and 100% in the TCT group respectively (P<0.001).</p><p><b>CONCLUSION</b>It seems that the manipulation technique can be more successful than the TCT method at the first effort whilst the second effort has the opposite results. Also MSM can be safer, cheaper and more acceptable for patients than TCT as a standard traditional method.</p>

Intramuscular midazolam for pediatric sedation in the emergency department: a short communication on clinical safety and effectiveness

Procedural sedation in children continues to be a problem in the emergency department [ED]. Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients. The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting. We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were folio wed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were I compared using SPSS ver. 16 software. I The mean age was 5.50 +/- 2.70 years, the mean weight was 19.50 +/- 6.63 kilograms and 16 patients [53.3%] were females. The most common adverse effect was euphoria [66.66%] and vertigo [6.7%]; 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation [P value < 0.05]. Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemo-dynamic side effects