Management of Acute Trauma Pain in the Emergency Department – A Comparison of Intramuscular Ketorolac, Diclofenac and Tramadol

Introduction: Trauma is a chief cause of pain and suffering. Alarge number of studies have shown that pain relief provided topatients in the ED is grossly inadequate. Diclofenac, tramadoland ketorolac are the most commonly used intramuscularanalgesics and hence selected for this comparative study.The aim of this study was to compare the analgesic duration,efficacy and side effect profile of diclofenac, tramadol andketorolac administered intramuscularly in patients whopresented to the ED with acute trauma pain.Material and methods: In a prospective double-blinded study,90 patients presenting to the ED with musculoskeletal traumawere randomly selected and divided into 3 groups - GroupA received 1 ml (50mg) Diclofenac; Group B received 1ml(30mg) Ketorolac; Group C received 1ml (50mg) Tramadol.The efficacy of the drug was measured by observing: painscore, onset & duration of action, rescue drug use, and thepatient’s global impression of efficacy of drugs. Collecteddata was analysed using ANOVA.Results: The time taken to administer the first dose of rescueanalgesic was significantly (P <0.05) delayed in the Group B(276mins). Overall, mean scores were significantly better with(Group B) and were not significantly different between other(Group T) and (Group A).Conclusion: Ketorolac was a better analgesic compared todiclofenac and tramadol in managing acute trauma pain.

Simulation based learning methodology in pharmacology: knowledge and perception among second year medical under-graduate students

Background: Simulation-based learning (SBL) enhances problem-solving, improves skills in health care professionals. Authors assessed its use in teaching and learning pharmacology among medical undergraduates exposed to METIman, human patient simulator.Methods: Medical undergraduate students exposed to SBL for over a year (8 clinical pharmacology related scenarios) were asked to fill a validated questionnaire at the end of the academic year.Results: Of 145 students who underwent SBL, the data of 84 were analysed. The overall satisfaction score with SBL was highly significant in 79 (94%) with a score of 26-35. Participants opined that it increases the depth of experience (91.6%), provides a no risk learning and immediate feedback opportunity (93.4%), a good opportunity to come across rare scenarios (86.2%), enhances decision making, communication, teamwork and skill development (92%); opportunity of repeated learning and enhanced patient safety at hospitals (89.28%), reduces the dependency on patients (72.8%), good opportunity for crisis training (88.0%) were other factors favouring the use of SBL. Preference for an increase in the number of classes allotted to simulation (27.4%) and reducing the duration of class (9.6%) were the major suggestions. It is an excellent method to teach and make it interesting to learn pharmacology (80.0%)Total score varied between 23-35 with a mean盨D of 35�.64. None had a score of 7-15.Conclusions: SBL is an effective teaching and learning methodology with adequate participant satisfaction. It can be of immense utility as a learning tool with better outcome in learning, retention and recall.