The following pages contain brief summaries of issues of first impression identified by federal court of appeals opinions announced between August 18, 2017 and December 31, 2017. This collection, written by the members of the Seton Hall Circuit Review, is organized by circuit. Each summary briefly describes an issue of first impression, and is intended to give only the briefest synopsis of the issue, not a comprehensive analysis. This compilation makes no claim to be exhaustive, but aims to serve the reader well as a referential starting point. Preferred citation for the summaries below: First Impressions, 14 SETON HALL CIR. REV. [n] (2018).
以下是联邦上诉法院在2017年8月18日至2017年12月31日期间公布的意见中确定的第一印象问题的简要摘要。这个集合，写的成员西顿霍尔电路评论，是由电路组织。每个摘要简要地描述了一个问题的第一印象，并打算给问题的最简短的概要，而不是一个全面的分析。本汇编并不声称是详尽的，但旨在为读者提供一个参考起点。以下摘要首选引文:《第一印象》，14 SETON HALL CIR. REV. [n](2018)。
{"title":"First Impressions","authors":"J. E. Dougherty","doi":"10.1109/MCC.1993.10012","DOIUrl":"https://doi.org/10.1109/MCC.1993.10012","url":null,"abstract":"The following pages contain brief summaries of issues of first impression identified by federal court of appeals opinions announced between August 18, 2017 and December 31, 2017. This collection, written by the members of the Seton Hall Circuit Review, is organized by circuit. Each summary briefly describes an issue of first impression, and is intended to give only the briefest synopsis of the issue, not a comprehensive analysis. This compilation makes no claim to be exhaustive, but aims to serve the reader well as a referential starting point. Preferred citation for the summaries below: First Impressions, 14 SETON HALL CIR. REV. [n] (2018).","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"20 12 1","pages":"50-1"},"PeriodicalIF":0.0,"publicationDate":"2020-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46306912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-05Epub Date: 2019-10-30DOI: 10.1161/JAHA.119.013091
Nicholas C Chesnaye, Karolina Szummer, Peter Bárány, Olof Heimbürger, Hasan Magin, Tora Almquist, Fredrik Uhlin, Friedo W Dekker, Christoph Wanner, Kitty J Jager, Marie Evans
Background People with reduced glomerular filtration rate (GFR) often have elevated cardiac troponin T (cTnT) levels. It remains unclear how cTnT levels develop over time in those with chronic kidney disease (CKD). The aim of this study was to prospectively study the association between cTnT and GFR over time in older advanced-stage CKD patients not on dialysis. Methods and Results The EQUAL (European Quality Study) study is an observational prospective cohort study in stage 4 to 5 CKD patients aged ≥65 years not on dialysis (incident estimated GFR, <20 mL/min/1.73 m²). The EQUAL cohort used for the purpose of this study includes 171 patients followed in Sweden between April 2012 and December 2018. We used linear mixed models, adjusted for important groups of confounders, to investigate the effect of both measured GFR and estimated GFR on high-sensitivity cTnT (hs-cTnT) trajectory over 4 years. Almost all patients had at least 1 hs-cTnT measurement elevated above the 99th percentile of the general reference population (≤14 ng/L). On average, hs-cTnT increased by 16%/year (95% CI, 13-19; P<0.0001). Each 15 mL/min/1.73 m2 lower mean estimated GFR was associated with a 23% (95% CI, 14-31; P<0.0001) higher baseline hs-cTnT and 9% (95% CI, 5-13%; P<0.0001) steeper increase in hs-cTnT. The effect of estimated GFR on hs-cTnT trajectory was somewhat lower than a previous myocardial infarction (15%), but higher than presence of diabetes mellitus (4%) and male sex (5%). Conclusions In CKD patients, hs-cTnT increases over time as renal function decreases. Lower CKD stage (each 15 mL/min/1.73 m2 lower) is independently associated with a steeper hs-cTnT increase over time in the same range as other established cardiovascular risk factors.
背景 肾小球滤过率（GFR）降低的人通常会出现心肌肌钙蛋白 T（cTnT）水平升高。目前仍不清楚慢性肾脏病（CKD）患者的肌钙蛋白 T 水平是如何随时间变化的。本研究旨在前瞻性地研究未接受透析的老年晚期 CKD 患者随着时间推移 cTnT 与 GFR 之间的关系。方法和结果 EQUAL（欧洲质量研究）研究是一项观察性前瞻性队列研究，研究对象是年龄≥65 岁、未接受透析的 4 至 5 期 CKD 患者（事件估计 GFR，P2 较低的平均估计 GFR 与 23% （95% CI，14-31；PP2 较低）的 hs-cTnT 随时间的陡峭增加有关，其范围与其他已确定的心血管风险因素相同。
{"title":"Association Between Renal Function and Troponin T Over Time in Stable Chronic Kidney Disease Patients.","authors":"Nicholas C Chesnaye, Karolina Szummer, Peter Bárány, Olof Heimbürger, Hasan Magin, Tora Almquist, Fredrik Uhlin, Friedo W Dekker, Christoph Wanner, Kitty J Jager, Marie Evans","doi":"10.1161/JAHA.119.013091","DOIUrl":"10.1161/JAHA.119.013091","url":null,"abstract":"<p><p>Background People with reduced glomerular filtration rate (GFR) often have elevated cardiac troponin T (cTnT) levels. It remains unclear how cTnT levels develop over time in those with chronic kidney disease (CKD). The aim of this study was to prospectively study the association between cTnT and GFR over time in older advanced-stage CKD patients not on dialysis. Methods and Results The EQUAL (European Quality Study) study is an observational prospective cohort study in stage 4 to 5 CKD patients aged ≥65 years not on dialysis (incident estimated GFR, <20 mL/min/1.73 m²). The EQUAL cohort used for the purpose of this study includes 171 patients followed in Sweden between April 2012 and December 2018. We used linear mixed models, adjusted for important groups of confounders, to investigate the effect of both measured GFR and estimated GFR on high-sensitivity cTnT (hs-cTnT) trajectory over 4 years. Almost all patients had at least 1 hs-cTnT measurement elevated above the 99th percentile of the general reference population (≤14 ng/L). On average, hs-cTnT increased by 16%/year (95% CI, 13-19; <i>P</i><0.0001). Each 15 mL/min/1.73 m<sup>2</sup> lower mean estimated GFR was associated with a 23% (95% CI, 14-31; <i>P</i><0.0001) higher baseline hs-cTnT and 9% (95% CI, 5-13%; <i>P</i><0.0001) steeper increase in hs-cTnT. The effect of estimated GFR on hs-cTnT trajectory was somewhat lower than a previous myocardial infarction (15%), but higher than presence of diabetes mellitus (4%) and male sex (5%). Conclusions In CKD patients, hs-cTnT increases over time as renal function decreases. Lower CKD stage (each 15 mL/min/1.73 m<sup>2</sup> lower) is independently associated with a steeper hs-cTnT increase over time in the same range as other established cardiovascular risk factors.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"4 1","pages":"e013091"},"PeriodicalIF":0.0,"publicationDate":"2019-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90058197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-29DOI: 10.1002/9781119610038.ch12
{"title":"Getting the Right Stuff","authors":"","doi":"10.1002/9781119610038.ch12","DOIUrl":"https://doi.org/10.1002/9781119610038.ch12","url":null,"abstract":"","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"12 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50776229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-15DOI: 10.22037/EMERGENCY.V6I1.24027
F. Ramezani, S. Ahmadi, Gholamreza Faridaalee, Alireza Baratloo, M. Yousefifard
Introduction: There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS. Methods: A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE). Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI). Results: Finally, 8 articles included in the meta-analysis. The area under the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC = 0.97, 95% CI: 0.95 to 0.98). The sensitivity and specificity of the troponin-only MACS/history electrocardiogram alone MACS (HE-MACS) in the rule out of AMI were0.99 (95% CI: 0.98-0.99) and 0.22 (95% CI: 0.11-0.37), respectively, and for the original MACS were in order 0.99 (95% CI: 0.98-0.99) and 0.26 (95% CI: 0.20-0.34),. The sensitivity and specificity of the troponin-only MACS / HE-MACS in the rule out of MACE were 0.94 (95% CI: 0.92-0.96) and 0.22 (95% CI: 0.12-0.39) compared to the 0.99 (95% CI: 0.98-0.99) and 0.27 (95% CI: 0.22-0.33) for the original MACS. Conclusion: The findings of this study showed that original MACS, troponin-only MACS, and HE-MACS are able to rule out AMI and MACE. However, further studies are needed in developing countries to confirm its external validity.
引言：关于曼彻斯特急性冠状动脉综合征（MACS）决策规则在检测急性冠状动脉综合症（ACS）中的价值，目前还没有达成共识。因此，本系统综述和荟萃分析的目的是总结评估MACS在ACS诊断中价值的临床证据。方法：在Medline、Embase、Scopus和Web of Science数据库上进行文献检索。结果包括急性心肌梗死（AMI）和主要心脏不良事件（MACE）。数据在STATA 14.0统计程序中进行分析，结果报告为受试者操作特征总结（SROC）、敏感性、特异性、阳性和阴性似然比以及95%置信区间（95%CI）的诊断优势比。结果：共有8篇文章纳入荟萃分析。MACS的SROC下面积在排除AMI（AUC=0.99，95%CI:0.97至0.99）和MACE（AUC=0.097，95%CI:0.95至0.98）中表现优异，与原始MACS的0.99（95%CI:0.98-0.99）和0.26（95%CI:0.20-0.34）相比，排除MACE的仅肌钙蛋白的MACS/HE-MACS的敏感性和特异性分别为0.94（95%CI:0.92-0.96）和0.22（95%CI=0.12-0.39）。结论：本研究结果表明，原始MACS、仅肌钙蛋白的MACS和HE-MACS能够排除AMI和MACE。然而，还需要在发展中国家进行进一步的研究，以确认其外部有效性。
{"title":"Value of Manchester Acute Coronary Syndromes Decision Rule in the Detection of Acute Coronary Syndrome; a Systematic Review and Meta-Analysis","authors":"F. Ramezani, S. Ahmadi, Gholamreza Faridaalee, Alireza Baratloo, M. Yousefifard","doi":"10.22037/EMERGENCY.V6I1.24027","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.24027","url":null,"abstract":"Introduction: There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS. Methods: A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE). Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI). Results: Finally, 8 articles included in the meta-analysis. The area under the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC = 0.97, 95% CI: 0.95 to 0.98). The sensitivity and specificity of the troponin-only MACS/history electrocardiogram alone MACS (HE-MACS) in the rule out of AMI were0.99 (95% CI: 0.98-0.99) and 0.22 (95% CI: 0.11-0.37), respectively, and for the original MACS were in order 0.99 (95% CI: 0.98-0.99) and 0.26 (95% CI: 0.20-0.34),. The sensitivity and specificity of the troponin-only MACS / HE-MACS in the rule out of MACE were 0.94 (95% CI: 0.92-0.96) and 0.22 (95% CI: 0.12-0.39) compared to the 0.99 (95% CI: 0.98-0.99) and 0.27 (95% CI: 0.22-0.33) for the original MACS. Conclusion: The findings of this study showed that original MACS, troponin-only MACS, and HE-MACS are able to rule out AMI and MACE. However, further studies are needed in developing countries to confirm its external validity.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48849235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-15DOI: 10.22037/EMERGENCY.V6I1.24028
F. Ramezani, Amir Bahrami-Amiri, A. Babahajian, K. Shahsavari Nia, M. Yousefifard
Introduction: Ubiquitin C-terminal hydrolase-L1 (UCH-L1) is one of the promising candidates, with an acceptable diagnostic value for predicting head computed tomography (CT) scan findings. However, there has been a controversy between studies and still, there is no general overview on this. Therefore, the current systematic review and meta-analysis attempted to estimate the value of UCH-L1 in predicting intracranial lesions in traumatic brain injury. Methods: Two independent reviewers screened records from the search of four databases Medline, Embase, Scopus and Web of Science. The data were analyzed in the STATA 14.0 statistical program and the findings were reported as a standardized mean difference (SMD), summary receiver performance characteristics curve (SROC), sensitivity, specificity, and diagnostic odds ratio with 95% confidence interval (95% CI). Results: Finally, the data of 13 articles were entered into the meta-analysis. The mean serum level of UCH-L1 was significantly higher in patients with CT-positive than in TBI patients with CT negative (SMD = 1.67, 95% CI: 1.12 to 2.23, I2 = 98.1%; p <0.0001). The area under the SROC curve for UCH-L1 in the prediction of intracranial lesions after mild TBI was 0.83 (95% CI: 0.80 to 0.86). Sensitivity, specificity and diagnostic odds ratio of serum UCH-L1 was 0.97 (95% CI: 0.92 to 0.99), 0.40 (95% CI: 0.30 to 0.51) and 19.37 (95% CI: 7.25 to 51.75), respectively. When the analysis was limited to assessing the serum level of UCH-L1 within the first 6 hours after mild TBI, its sensitivity and specificity increased to 0.99 (95% CI: 0.94 to 1.0) and 0.44 (95% CI: 0.38 to 0.052), respectively. In addition, the diagnostic odds ratio of 6-hour serum level of UCH-L1 in the prediction of intracranial lesions was 680.87 (95% CI: 50.50 to 9197.97). Conclusion: Moderate level of evidence suggests that serum/plasma levels of UCH-L1 have good value in prediction of head CT findings. It was also found that evaluation of serum/plasma level of UCH-L1 within the first 6 hours following TBI would increase its predictive value. However, there is a controversy about the best cutoffs of the UCH-L1.
{"title":"Ubiquitin C-Terminal Hydrolase-L1 (UCH-L1) in Prediction of Computed Tomography Findings in Traumatic Brain Injury; a Meta-Analysis","authors":"F. Ramezani, Amir Bahrami-Amiri, A. Babahajian, K. Shahsavari Nia, M. Yousefifard","doi":"10.22037/EMERGENCY.V6I1.24028","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.24028","url":null,"abstract":"Introduction: Ubiquitin C-terminal hydrolase-L1 (UCH-L1) is one of the promising candidates, with an acceptable diagnostic value for predicting head computed tomography (CT) scan findings. However, there has been a controversy between studies and still, there is no general overview on this. Therefore, the current systematic review and meta-analysis attempted to estimate the value of UCH-L1 in predicting intracranial lesions in traumatic brain injury. Methods: Two independent reviewers screened records from the search of four databases Medline, Embase, Scopus and Web of Science. The data were analyzed in the STATA 14.0 statistical program and the findings were reported as a standardized mean difference (SMD), summary receiver performance characteristics curve (SROC), sensitivity, specificity, and diagnostic odds ratio with 95% confidence interval (95% CI). Results: Finally, the data of 13 articles were entered into the meta-analysis. The mean serum level of UCH-L1 was significantly higher in patients with CT-positive than in TBI patients with CT negative (SMD = 1.67, 95% CI: 1.12 to 2.23, I2 = 98.1%; p <0.0001). The area under the SROC curve for UCH-L1 in the prediction of intracranial lesions after mild TBI was 0.83 (95% CI: 0.80 to 0.86). Sensitivity, specificity and diagnostic odds ratio of serum UCH-L1 was 0.97 (95% CI: 0.92 to 0.99), 0.40 (95% CI: 0.30 to 0.51) and 19.37 (95% CI: 7.25 to 51.75), respectively. When the analysis was limited to assessing the serum level of UCH-L1 within the first 6 hours after mild TBI, its sensitivity and specificity increased to 0.99 (95% CI: 0.94 to 1.0) and 0.44 (95% CI: 0.38 to 0.052), respectively. In addition, the diagnostic odds ratio of 6-hour serum level of UCH-L1 in the prediction of intracranial lesions was 680.87 (95% CI: 50.50 to 9197.97). Conclusion: Moderate level of evidence suggests that serum/plasma levels of UCH-L1 have good value in prediction of head CT findings. It was also found that evaluation of serum/plasma level of UCH-L1 within the first 6 hours following TBI would increase its predictive value. However, there is a controversy about the best cutoffs of the UCH-L1.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41488872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-18DOI: 10.22037/EMERGENCY.V6I1.23141
A. Mirhaghi, M. Ebrahimi
Triage is sorting patients based on acuity in order to manage care in the emergency department (ED) {Mirhaghi, 2017 #60}(1). Medical institutes are trying to develop triage scales compatible with their own culture of care. A triage scale must be precise and comprehensive enough to guide triage nurses and eliminate uncertainty.
{"title":"Regression to Middle Effect May Threaten Validity of Triage Scales; a Letter to Editor","authors":"A. Mirhaghi, M. Ebrahimi","doi":"10.22037/EMERGENCY.V6I1.23141","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.23141","url":null,"abstract":"Triage is sorting patients based on acuity in order to manage care in the emergency department (ED) {Mirhaghi, 2017 #60}(1). Medical institutes are trying to develop triage scales compatible with their own culture of care. A triage scale must be precise and comprehensive enough to guide triage nurses and eliminate uncertainty.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43553017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-18DOI: 10.22037/EMERGENCY.V6I1.22546
Parisa Eizadi, M. Jalili, A. Dehpour
Introduction Appropriate pain relief enhances patient satisfaction and reduces patient anxiety. This study aimed to compare oral oxycodone with intravenous (IV) morphine sulfate (MS) in pain management of acute limb trauma. Method In this randomized double-blind clinical trial, patients over 14 years old, with acute isolated limb trauma were randomized to receive either 5mg IV MS or 5 mg oral oxycodone. Pain intensity and adverse effects of medications were recorded 0, 30 and 60 minutes after drug administration and compared between the groups. Result 58 patients were studied. Pain intensity was similar between the two studied groups at 30 minutes (P = 0.834) and 60 minutes (P = 0.880) after drug administration. Furthermore, there was no significant difference between the two groups regarding decrease in pain within the defined time interval. Drowsiness was reported more frequently in MS group after 30 minutes (p = 0.006). Patients in MS group asked for more rescue analgesia. Other adverse effects were similar in both groups. Conclusion Oral oxycodone is as effective as IV morphine sulfate in treatment of acute musculoskeletal pain following blunt limb trauma.
{"title":"Oral Oxycodone Compared With Intravenous Morphine Sulfate for Pain Management of Isolated Limb Trauma; a Randomized Clinical Trial","authors":"Parisa Eizadi, M. Jalili, A. Dehpour","doi":"10.22037/EMERGENCY.V6I1.22546","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.22546","url":null,"abstract":"Introduction\u0000Appropriate pain relief enhances patient satisfaction and reduces patient anxiety. This study aimed to compare oral oxycodone with intravenous (IV) morphine sulfate (MS) in pain management of acute limb trauma.\u0000\u0000\u0000Method\u0000In this randomized double-blind clinical trial, patients over 14 years old, with acute isolated limb trauma were randomized to receive either 5mg IV MS or 5 mg oral oxycodone. Pain intensity and adverse effects of medications were recorded 0, 30 and 60 minutes after drug administration and compared between the groups.\u0000\u0000\u0000Result\u000058 patients were studied. Pain intensity was similar between the two studied groups at 30 minutes (P = 0.834) and 60 minutes (P = 0.880) after drug administration. Furthermore, there was no significant difference between the two groups regarding decrease in pain within the defined time interval. Drowsiness was reported more frequently in MS group after 30 minutes (p = 0.006). Patients in MS group asked for more rescue analgesia. Other adverse effects were similar in both groups.\u0000\u0000\u0000Conclusion\u0000Oral oxycodone is as effective as IV morphine sulfate in treatment of acute musculoskeletal pain following blunt limb trauma.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48129107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-02DOI: 10.22037/EMERGENCY.V6I1.23065
A. Amini, Ali Arhami Dolatabadi, Hamid Kariman, H. Hatamabadi, Elham Memary, S. Salimi, Shahram Shokrzadeh
Introduction Need for procedural sedation and analgesia (PSA) is felt in emergency department (ED) more and more each day. This study aimed to compare the effectiveness of low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination with regular dose of propofol and fentanyl combination for induction of deep sedation. Methods In this single-blind clinical trial, candidate patients for sedation and analgesia aged more than 15 and less than 60 years old, with pain score ≥6 were allocated to one of the groups using block randomization and were compared regarding onset of action, recovery time, and probable side effects. Results 125 patients with the mean age of 37.8 ± 14.3 years were randomly allocated to each group. 100% of the patients in group 1 (5 drugs) and 56.5% of the patients in group 2 (2 drugs) were deeply sedated in the 3rd minute after injection. The 2 groups were significantly different regarding onset of action (p = 0.440), recovery time (p = 0.018), and treatment failure (p < 0.001). Conclusion Low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination was more successful in induction of deep sedation compared to regular dose of propofol and fentanyl combination. Recovery time was a little longer in this group and both groups were similar regarding drug side effects and effect on vital signs.
{"title":"Low-Dose Fentanyl, Propofol, Midazolam, Ketamine and Lidocaine Combination vs. Regular Dose Propofol and Fentanyl Combination for Deep Sedation Induction; a Randomized Clinical Trial","authors":"A. Amini, Ali Arhami Dolatabadi, Hamid Kariman, H. Hatamabadi, Elham Memary, S. Salimi, Shahram Shokrzadeh","doi":"10.22037/EMERGENCY.V6I1.23065","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.23065","url":null,"abstract":"Introduction\u0000Need for procedural sedation and analgesia (PSA) is felt in emergency department (ED) more and more each day. This study aimed to compare the effectiveness of low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination with regular dose of propofol and fentanyl combination for induction of deep sedation.\u0000\u0000\u0000Methods\u0000In this single-blind clinical trial, candidate patients for sedation and analgesia aged more than 15 and less than 60 years old, with pain score ≥6 were allocated to one of the groups using block randomization and were compared regarding onset of action, recovery time, and probable side effects.\u0000\u0000\u0000Results\u0000125 patients with the mean age of 37.8 ± 14.3 years were randomly allocated to each group. 100% of the patients in group 1 (5 drugs) and 56.5% of the patients in group 2 (2 drugs) were deeply sedated in the 3rd minute after injection. The 2 groups were significantly different regarding onset of action (p = 0.440), recovery time (p = 0.018), and treatment failure (p < 0.001).\u0000\u0000\u0000Conclusion\u0000Low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination was more successful in induction of deep sedation compared to regular dose of propofol and fentanyl combination. Recovery time was a little longer in this group and both groups were similar regarding drug side effects and effect on vital signs.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48773332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-26DOI: 10.22037/EMERGENCY.V6I1.22475
Abdolkarim Pajoum, F. Fahim, M. Akhlaghdoust, N. Zamani, Zeinab Amirfirooz, Mahnaz Dehdehasti
Introduction: Some studies have reported creatinine phosphokinase (CPK) as a new emerging way in predicting the outcomes of poisoned patients. This study aimed to evaluate the association of serum CPK level in the first 24 hours with outcomes of poisoned patients. Methods: This retrospective cross-sectional study was performed using the medical profiles of poisoned patients aged between 13 and 70 years old who were referred to the emergency department of a big referral medical toxicology center during 6 years and whose necessary data for this study was available. Results: 318 patients with the mean age of 34.9±14.5 years were studied (77.1% male). The mean serum CPK level of patients was 4693.1 ± 10303.8 (35–89480) IU/L. There was no significant correlation between serum CPK level and cause of poisoning (r= 0.16; p=0.51), age (r = -0.021; p = 0.651), sex (r = 0.131; p = 0.281), seizure (r = -0.022; p = 0.193), level of consciences (r = -0.138; p = 0.167), and duration of hospital stay (r= 0.242, p = 0.437). The mean serum CPK level was significantly higher in ICU admitted (p<0.0001), AKI (p<0.0001), hyperkalemia (p<0.0001), hypophosphatemia (p=0.045), and hypocalcaemia (p=0.008) cases. The best cut off point of serum CPK level in predicting acute kidney injury (AKI) was estimated to be 10000 IU/L (sensitivity = 83.8% and specificity = 68.8%). Conclusion: It seems that CPK could be considered as a candidate tool for screening the intoxicated patients in need for ICU admission and at risk for AKI.
{"title":"Rhabdomyolysis and Acute Poisoning; a Brief Report","authors":"Abdolkarim Pajoum, F. Fahim, M. Akhlaghdoust, N. Zamani, Zeinab Amirfirooz, Mahnaz Dehdehasti","doi":"10.22037/EMERGENCY.V6I1.22475","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.22475","url":null,"abstract":"Introduction: Some studies have reported creatinine phosphokinase (CPK) as a new emerging way in predicting the outcomes of poisoned patients. This study aimed to evaluate the association of serum CPK level in the first 24 hours with outcomes of poisoned patients. Methods: This retrospective cross-sectional study was performed using the medical profiles of poisoned patients aged between 13 and 70 years old who were referred to the emergency department of a big referral medical toxicology center during 6 years and whose necessary data for this study was available. Results: 318 patients with the mean age of 34.9±14.5 years were studied (77.1% male). The mean serum CPK level of patients was 4693.1 ± 10303.8 (35–89480) IU/L. There was no significant correlation between serum CPK level and cause of poisoning (r= 0.16; p=0.51), age (r = -0.021; p = 0.651), sex (r = 0.131; p = 0.281), seizure (r = -0.022; p = 0.193), level of consciences (r = -0.138; p = 0.167), and duration of hospital stay (r= 0.242, p = 0.437). The mean serum CPK level was significantly higher in ICU admitted (p<0.0001), AKI (p<0.0001), hyperkalemia (p<0.0001), hypophosphatemia (p=0.045), and hypocalcaemia (p=0.008) cases. The best cut off point of serum CPK level in predicting acute kidney injury (AKI) was estimated to be 10000 IU/L (sensitivity = 83.8% and specificity = 68.8%). Conclusion: It seems that CPK could be considered as a candidate tool for screening the intoxicated patients in need for ICU admission and at risk for AKI.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48310418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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