J Emerg Med
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain.
Acute low back pain is a common problem in the emergency department (ED). Effective management of acute pain enhances early rehabilitation and recovery. Given the importance of inflammatory mediators in pain generation and the adverse effects associated with opioids, it is logical to expect that a non-opioid agent with antiinflammatory and analgesic properties would provide excellent analgesia with fewer adverse effects. ⋯ Patients in the ACOD group reported significantly more adverse drug events and serious adverse drug events. Seven patients--all in the ACOD group--withdrew from the study because of adverse drug events. Based on comparable efficacy and a superior adverse event profile, ketorolac was preferable to acetaminophen with codeine for the treatment of acute low back pain in the ED.
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Randomized Controlled Trial Comparative Study Clinical Trial
Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidol.
Patients presenting to the emergency department with acute agitation frequently require physical and chemical restraint. To determine the efficacy of lorazepam vs. droperidol, we conducted a prospective, randomized study of violently agitated patients requiring chemical restraint. Patients were randomized to receive either lorazepam or droperidol i.v. ⋯ We conclude that droperidol produces a more rapid and better sedation than lorazepam at the doses used in this study in agitated patients requiring chemical restraint. Lorazepam is more likely to require repeat dosing than droperidol. Methamphetamine toxicity was present in the majority of patients in this study.
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Randomized Controlled Trial Clinical Trial
The use of analgesics in patients with acute abdominal pain.
Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. ⋯ No adverse events or delays in diagnosis were attributed to the administration of analgesics. We conclude that physical examination does change after the administration of analgesics in patients with acute abdominal pain and that a larger study is needed to evaluate analgesic safety in this subpopulation of emergency department patients.
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Randomized Controlled Trial Clinical Trial
The efficacy of intravenous droperidol in the prehospital setting.
Droperidol is used for sedating combative patients in the emergency department (ED). We performed a randomized, prospective, double-blind study to evaluate the efficacy of droperidol in the management of combative patients in the prehospital setting. Forty-six patients intravenously received the contents of 2-cc vials of saline or droperidol (5 mg). ⋯ At 10 min, this difference was highly significant. Eleven patients in the saline group (48%) required more sedation after arrival in the ED versus 3 patients (13%) in the droperidol group. We conclude that droperidol is effective in sedating combative patients in the prehospital setting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Interpleural block for patients with multiple rib fractures: comparison with epidural block.
Interpleural block (IPB) was compared with epidural block (EB) in 17 adults with unilateral multiple rib fractures and hemopneumothorax. The study was a randomized, crossover, before-after trial on the first and second hospital days. An IPB catheter was inserted along with a chest tube, and an upper thoracic EB was also established in the same patient. ⋯ Serum levels of lidocaine were similar and in the safe range. The technique of IPB seemed to be easier than EB. In conclusion, IPB with lidocaine is as effective for pain relief as EB.