Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Rescue Therapy ◽  
Tertiary Care ◽  
Numeric Rating Scale ◽  
Controlled Study ◽  
Care Hospital ◽  
Acute Migraine ◽  
Pain Scores ◽  
Significant Difference

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals A comparison of pain registration by Visual Analog Scale and Numeric Rating Scale – a cross-sectional study of primary triage registration

2020 ◽  
Author(s):  
Jofrid Kollltveit ◽  
Malin Osaland ◽  
Marianne Reimers ◽  
Magnus Berle
Keyword(s):  
Emergency Department ◽  
Visual Analog Scale ◽  
Rating Scale ◽  
Emergency Admission ◽  
Numeric Rating Scale ◽  
University Hospital ◽  
Analog Scale ◽  
Cross Sectional ◽  
Significant Difference ◽  
Numeric Rating

BackgroundPain is a subjective sensation; self-reporting is important for quantifying pain intensity. There are several different validated tools for this, such as Visual Analog Scale and Numeric Rating Scale. In the clinic, these terms are often used as equivalent. The objective of this study was to examine correlation and agreement between the pain registration tools in triage in an emergency department.Materials and MethodsThe study was performed in the Department of Emergency Medicine at Haukeland University Hospital in the period June-August 2019. We registered the pain score with two tools in 200 unselected patients in emergency admission with pain. In addition, we registrered gender, age, triage and general department affiliation.ResultsWe found a strong correlation between the pain registration tools by Spearmans correlation test (rho=0,930, p<0,001). There were no significant difference between the pain registration tools within the subgroups. Bland-Altman analysis show agreement between the two pain registration tools.ConclusionsIn an Emergency Department triage is it acceptable to use Visual Analog Scale and Numeric Rating Scale as equivalent, as long as the correct terminology is used.

scholarly journals A prospective study of lornoxicam as pre-emptive analgesic in abdominal surgeries in tertiary care hospital in Salem, India

2017 ◽  
Vol 6 (7) ◽  
pp. 1778
Author(s):  
Mohammed Ziauddin Sarkhil ◽  
Hemant Kumar Dutt ◽  
Rajaram S.
Keyword(s):  
Rating Scale ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Care Hospital ◽  
Pain Rating ◽  
Pain Scores ◽  
Analgesic Regimen ◽  
Group A ◽  
Group B ◽  
Pain Rating Scale

Background: Preemptive analgesia, involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain.Methods: To determine the efficacy and safety of Lornoxicam when administered preemptively by using Wong-Baker FACES Pain Rating scale. The patients undergoing abdominal surgery were randomly categorized into group A and B of 25 each. Group A- Received Lornoxicam 8mg (1ml) one hour before surgery. Group B- Not received any analgesic before surgery. Primary measurement of the efficacy was done by using Wong-Baker Faces Pain Rating Scale at 2, 4, 8, 12 and 24 hour. All parameters were analyzed by using student t test.Results: Surgeries which were included in the study are hernia repair, open appendectomy, laparoscopic (appendectomy, cholecystectomy). Reduction in pain scores at 12th hourly and 24th hourly pain scores (<0.05) was significant. Tramadol usage decreased significantly with laparoscopic surgeries.Conclusions: In this study we could demonstrate that lornoxicam when used preemptively reduces the pain score slightly and reduces the requirement of post-operative analgesics significantly.

scholarly journals Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3437-3442
Author(s):  
Hamed Basir Ghafouri ◽  
Niloofar Abazarian ◽  
Mohammadreza Yasinzadeh ◽  
Ehsan Modirian
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Pain Score ◽  
Randomized Clinical Trial ◽  
Renal Colic ◽  
Rating Scale ◽  
Pain Scores ◽  
Intravenous Paracetamol ◽  
Significant Difference ◽  
Intranasal Desmopressin

Abstract Objective To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic. Design Randomized clinical trial. Setting This study was conducted in the emergency unit of a university hospital. Subjects Patients referred to the emergency room with renal colic. Primary Outcome Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol. Methods In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15 mg/kg) and intranasal desmopressin spray (40 μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60 minutes. Adverse effects and need for rescue analgesic (0.05 mg/kg max 3 mg morphine sulphate) were also recorded at the end of the study. Results Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15 minutes was more reduced and was clinically significant (&gt;3) in the desmopressin group (P &lt; 0.0001). There was no significant difference between mean pain scores in the two groups after 30 minutes (P = 0.350) or 60 minutes (P = 0.269), but the efficacy of the two drugs was significant in terms of pain reduction (&gt;6). Conclusions Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin.

Hand hygiene promotion delivered by change agents—Two attitudes, similar outcome

2020 ◽  
Vol 41 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Yew Fong Lee ◽  
Mary-Louise McLaws ◽  
Loke Meng Ong ◽  
Suraya Amir Husin ◽  
Hock Hin Chua ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Tertiary Care ◽  
Change Agents ◽  
Controlled Study ◽  
Care Hospital ◽  
Hand Hygiene Improvement ◽  
Significant Difference ◽  
Hygiene Promotion ◽  
Hygiene Compliance

AbstractObjective:To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care.Design:Randomized-controlled study.Setting:Two internal medicine wards of a public, university-affiliated, tertiary-care hospital in Malaysia.Methods:We randomly allocated 2 wards to hand hygiene promotion delivered either by PICAs (study arm 1) or by MSCAs (study arm 2). The primary outcome was hand hygiene compliance using direct observation by validated auditors. Secondary outcomes were hand hygiene knowledge and observations from ward tours.Results:Mean hand hygiene compliance in study arm 1 and study arm 2 improved from 48% (95% confidence interval [CI], 44%–53%) and 50% (95% CI, 44%–55%) in the preintervention period to 66% (63%–69%) and 65% (60%–69%) in the intervention period, respectively. We detected no statistically significant difference in hand hygiene improvement between the 2 study arms. Knowledge scores on hand hygiene in study arm 1 and study arm 2 improved from 60% and 63% to 98% and 93%, respectively. Staff in study arm 1 improved hand hygiene because they did not want to disappoint the efforts taken by the PICAs. Staff in study arm 2 felt pressured by the MSCAs to comply with hand hygiene to obtain good overall performance appraisals.Conclusion:Although the attitude of PICAs and MSCAs in terms of leadership, mode of action and perception of their task by staff were very different, or even opposed, both PICAs and MSCAs effectively changed behavior of staff toward improved hand hygiene to comparable levels.

scholarly journals A randomized clinical study to compare pre-emptive analgesic efficacy of clonidine and diclofenac sodium in patients undergoing major surgeries at a tertiary care hospital

2020 ◽  
Vol 10 (1) ◽  
pp. 44
Author(s):  
Prachi Jain ◽  
Uma Bhosale ◽  
Shashank Desai
Keyword(s):  
Clinical Study ◽  
Literature Review ◽  
Rating Scale ◽  
Diclofenac Sodium ◽  
Tertiary Care ◽  
Analgesic Efficacy ◽  
Care Hospital ◽  
Pain Scores ◽  
Randomized Clinical Study ◽  
Study Results

Background: Pre-emptive analgesia is a method to achieve analgesia even before exposure to a noxious stimulus The purpose of pre-emptive analgesia is to reduce pain caused due to surgical incision triggered inflammatory mechanism activation; and to ensure a good post-operative pain control so that there is no development of chronic pain. Clonidine is an α2 adrenergic agonist thus it decreases the sympathetic outflow, while Diclofenac is a non-steroidal anti-inflammatory agent. Our literature review showed that both clonidine (150 μg) and diclofenac are efficacious pre-emptive analgesics. Literature review also revealed that there is no study available to compare pre-emptive analgesic efficacy as well as safety of oral clonidine with diclofenac, therefore present study was designed to compare pre emptive analgesic efficacy of these two drugs.Methods: This randomized clinical study included 100 patients from surgical departments, of either sex, between 18 to 70 years age and of American society of anesthesiologists (ASA) I/II grade. Patients were randomly allocated to two groups and received either of the treatments 30 minutes prior to induction of anesthesia. Pain scores were recorded using visual analog scale, facial rating scale and behavioral rating scale at awakening and at 1, 2, 4, 6 and 24 hours. Postoperative analgesic requirement over 24 hours was recorded. Data were analyzed using OpenEpi statistical softwares.Results: Significantly lower pain scores were observed in clonidine group as compared to Diclofenac at 4 and 6 hours (p<0.05) on all the pain scales. Clonidine group also required less postoperative analgesic as compared to diclofenac (p<0.05).Conclusions: Study results are strongly suggestive of greater pre-emptive analgesic efficacy of clonidine over diclofenac in major surgeries done under spinal anesthesia.

The influence of chief complaint on opioid use in the emergency department

2006 ◽  
Vol 2 (4) ◽  
pp. 228 ◽  
Author(s):  
Kathleen Puntillo, RN, DNSc, FAAN ◽  
Martha Neighbor, MD ◽  
Garrett K. Chan, APRN, BC, PhD ◽  
Roxanne Garbez, RN, MS, ACNP
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Patient Discharge ◽  
Numeric Rating Scale ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Pain ◽  
Nurses And Physicians ◽  
Time Of Admission ◽  
Numeric Rating

The aim of this study was to explore factors influencing emergency department (ED) clinicians’ use of opioids in treating selected patients. Patients who either received or did not receive opioids in the ED, as well as their nurses and physicians, were interviewed before patient discharge. We found that the decrease in patients’ mean (SD) pain intensity from the time of admission to the ED (7.3 ± 2.4 on a 0 to 10 numeric rating scale) to discharge (5.0 ± 2.9) was statistically significant (t93 = 8.4, p < 0.001, 95 percent CI = 1.7, 2.8) for all groups except those with trauma-related pain. The factor that most frequently led physicians of patients with abdominal pain and nurses in general to administer no opioids was that the patient was “not in that much pain.” However, the patients in question had self-reported pain scores that indicated moderate pain. Our findings lead us to conclude that clinicians inaccurately infer severity of patient pain. This in turn can influence the prescription of opioids and the patient’s decrease in pain.

scholarly journals Efficacy of Sodium Valproate and Olanzapine in treating bipolar affective disorder 'mania' at a tertiary care hospital in Nepal: A comparative study

2017 ◽  
Vol 4 (1) ◽  
pp. 27-35
Author(s):  
Lokeshwar Chaurasia ◽  
Sunil Kumar Shah ◽  
Sudarshana Magham Chetty
Keyword(s):  
Affective Disorder ◽  
Sodium Valproate ◽  
Rating Scale ◽  
Tertiary Care Hospital ◽  
Bipolar Affective Disorder ◽  
Tertiary Care ◽  
Care Hospital ◽  
Medical Sciences ◽  
Significant Difference ◽  
The Mean

Background and Objectives: Bipolar affective disorder, mania is the mood of an abnormally elevated arousal energy level or a state of heightened overall activation with enhanced affective expression together with lability of affect. The objective of the study was to compare the efficacy of sodium valproate and olanzapine in bipolar affective disorder, mania patients at a tertiary care hospital in NepalMaterial and Methods: A randomized observational prospective open label study was conducted for one and half year at College of Medical Sciences-Teaching Hospital (CMS-TH), Bharatpur, Nepal in the Psychiatry Department. Sixty patients diagnosed with bipolar affective disorder, mania were enrolled. 30 patients received sodium valproate and 30 patients received olanzapine. Patients were monitored and evaluated on baseline (day 0), day 7 and day 30 and compared to the baseline for the severity of illness using the 11-item Young Mania Rating Scale (YMRS).Results: The mean baseline YMRS score for all cases on sodium valproate (n=30) on day 0 was 38.87 ± 3.73, while it was reduced to 13.90 ± 1.95 (p < 0.001) on day 30. Similarly, the mean baseline YMRS score for all cases on olanzapine (n=30) on day 0was 40.83 ± 6.50, while it was reduced to 14.47 ± 2.83 (p < 0.001) on day 30.The mean decrease in YMRS score by sodium valproate was 64.24% and by olanzapine was 64.56%.Conclusion: Treatment with sodium valproate and olanzapine significantly improves the mean mania ratings score and there is no statistically significant difference in efficacy of both the drugs in patients diagnosed with bipolar affective disorder, mania.Janaki Medical College Journal of Medical Sciences (2016) Vol. 4(1): 27-35

A Double-Blind, Randomized, Active-Controlled Study for Post-Hemorrhoidectomy Pain Management with Liposome Bupivacaine, a Novel Local Analgesic Formulation

2012 ◽  
Vol 78 (5) ◽  
pp. 574-581 ◽  
Author(s):  
Eric Haas ◽  
Erol Onel ◽  
Howard Miller ◽  
Madhu Ragupathi ◽  
Paul F. White
Keyword(s):  
Rating Scale ◽  
Area Under The Curve ◽  
Numeric Rating Scale ◽  
Controlled Study ◽  
Opioid Use ◽  
Double Blind ◽  
Local Infiltration ◽  
Pain Scores ◽  
Liposome Bupivacaine ◽  
Post Hoc

This randomized, active-controlled study evaluated the extent and duration of analgesia after administration of liposome bupivacaine (LB), a novel formulation of bupivacaine, compared with bupivacaine HCl given via local infiltration in excisional hemorrhoidectomy. One hundred patients were randomly assigned to receive a single dose of bupivacaine HCl 75 mg (0.25% with 1:200,000 epinephrine) or LB 66, 199, or 266 mg upon completion of hemorrhoidectomy. Postoperative pain intensity was assessed using a numeric rating scale at rest to calculate a cumulative pain score (area under the curve). Cumulative pain scores were significantly lower with LB at each study dose ( P < 0.05) compared with bupivacaine HCl 72 hours after surgery. Post hoc analysis showed that mean total postoperative opioid consumption was statistically significantly lower for the LB 266-mg group compared with the bupivacaine HCl group during the 12- to 72-hour postoperative period ( P = 0.019). Median time to first opioid use was 19 hours for LB 266 mg versus 8 hours for bupivacaine HCl ( P = 0.005). Incidence of opioid-related adverse events was 4 per cent for LB 266 mg compared with 35 per cent for bupivacaine HCl ( P = 0.007). Local infiltration with LB resulted in significantly reduced postsurgical pain compared with bupivacaine HCl in patients after hemorrhoidectomy surgery.

Assessment of Daily Burden and Factors for Overcrowded Emergency Department at Tertiary Care Hospital of Karachi

2021 ◽  
pp. 30-35
Author(s):  
Arsala Faridi ◽  
Farah Ahmad ◽  
Areej Zehra ◽  
Afreen Fazal
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Patient Flow ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional ◽  
Study Duration ◽  
Number Of Patients ◽  
Significant Difference

Background: When in emergency room there is no enough area left to serve or to admit the subsequent sick patients who may require urgent attention and observation the setting is called as the overcrowded emergency room. Due to overcrowded emergency department the quality of services provided by the staff and doctors is compromised ultimately patients with severe diseases are ignored and this may be one of the causes for causalities. Objective: To assess the daily burden and factors responsible for overcrowding at emergency department of tertiary care hospital of Karachi. Methodology: It was a cross sectional study conducted at tertiary care hospital of Karachi from October 2020 to January 2021. Data of patients coming to adult emergency department of either gender were collected.  Patients age <14 were excluded as these were referred to pediatric emergency department. Data collection was done according to Canadian emergency department triage and acuity scale (CTAS). Results: Total number (N) of patients who visited emergency department in study duration was 13434. The mean number of patients who visited ED was 141±13during our study duration. There was no any significant difference in presenting complaint. Delay in investigations was found to be a reason of prolong stay and overcrowding in ED in our setting. Conclusion: Overcrowding of patients in our ED of our setting was a common problem. The number of staff, doctors and beds were not matching the number of patient flow in the department. The main reason of prolong stay in ED was delay in investigations.

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