Therapeutic approaches for renal colic in the emergency department: a review article.

CONTEXT: Renal colic is frequently described as the worst pain ever experienced, and management of this intense pain is necessary. The object of our review was to discuss different approaches of pain control for patients with acute renal colic in the emergency department. EVIDENCE ACQUISITION: Studies that discussed the treatment of renal colic pain were included in this review. We collected articles from reputable internet databases. RESULTS: Our study showed that some new treatment approaches, such as the use of lidocaine or nerve blocks, can be used to control the severe and persistent pain of renal colic. CONCLUSIONS: Some new approaches are discussed and their impact on renal colic pain control was compared with traditional therapies. The effectiveness of the new approaches in this review is similar or even better than in traditional treatments.

Rapid Shallow Breathing Index Survey, a Predictor of non-Invasive Ventilation Necessity in Patients With Chronic Obstructive Pulmonary Disease Exacerbation: An Analytical Descriptive Prospective Study.

BACKGROUND: Patients with Chronic Obstructive Pulmonary Disease (COPD) are susceptible to respiratory failure which would ultimately lead to their hospitalization. Need to Non-Invasive Ventilation (NIV) is considered as the choice respiratory support in acute respiratory failure and is associated with a beneficial role in patients with COPD exacerbation. Hence, determining patients that would benefit NIV could be of great assistance. OBJECTIVES: We aimed at evaluating the use of Rapid Shallow Breathing Index (a ratio determined by the frequency (f) divided by the tidal volume (VT)) in NIV requirement in COPD patients. PATIENTS AND METHODS: In a prospective descriptive study, ninety eight patients over 40 years old with documented COPD exacerbation who were referred to emergency department of Imam Reza hospital, Tabriz, Iran were studied. Rapid Shallow Breathing Index (RSBI), ABG parameters and APACHE II scoring were measured in each patient. Quantitative data were analyzed by Student's t-test and One-way ANOVA and qualitative data were analyzed using chi square (X2). Findings were analyzed with SPSS software version 16. RESULTS: Patients requiring NIV included 43.9 % of all studied patients. RSBI and APACHE II score with sensitivity of 94.8 %, (cut off point = 110) and 72 % (cut off point = 14) respectively, had high diagnostic sensitivity and also the ability to predict patients requiring NIV. None of ABG parameters solely played a significant role in determining patients requiring NIV. CONCLUSIONS: RSBI and APACHE II score in patients with COPD exacerbation are of the ability to predict NIV requirement, as a predicting factor of Non-Invasive Ventilation requirement.