ABSTRACT
INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
ABSTRACT
The incorrect insertion of a chest drain can cause serious harm or even death. All elective drains should be inserted in the 'triangle of safety' in line with the British Thoracic Society guidelines. The aim of this study was to test the awareness of junior doctors involved in inserting chest drains with these guidelines. Fifty junior doctors were questioned. Participants were asked to grade their experience of chest drain insertion and mark on a diagram where they felt was the optimum site for inserting a drain for a large pneumothorax in an elective situation. Only 44% (n=22) of doctors indicated they would insert a chest drain within the safe triangle. Level of experience, seniority and specialty all had an effect on knowledge of the correct site. Of those who had inserted drains unsupervised, 48% (n=16) would site the drain outside the safe triangle as would 75% (n=6) of those who had performed the procedure supervised. Only 25% of medics knew where to insert a drain, compared with 58% of doctors working in surgery. The majority of junior doctors do not have the basic knowledge to insert a chest drain safely. Further training in this procedure is needed for junior doctors.
