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Morphine in ED

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https://www.readbyqxmd.com/read/28894783/intravenous-lidocaine-versus-morphine-sulfate-in-pain-management-for-extremity-fractures-a-clinical-trial
#1
Arash Forouzan, Hassan Barzegari, Hassan Motamed, Ali Khavanin, Hamideh Shiri
INTRODUCTION: Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures. METHOD: In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28821365/can-low-dose-of-ketamine-reduce-the-need-for-morphine-in-renal-colic-a-double-blind-randomized-clinical-trial
#2
Saeed Abbasi, Nader Bidi, Babak Mahshidfar, Peyman Hafezimoghadam, Mahdi Rezai, Mani Mofidi, Davood Farsi
BACKGROUND: The combination of morphine with low doses of ketamine (MK) has been utilized in the Emergency Department (ED) compared with morphine and placebo (MP) for the treatment of acute pain in few studies. The purpose of this study was to compare the effect of MP with MK for the treatment of severe pain with renal colic of patients who had been referred to the ED. METHODS: This study is a double blind randomized clinical trial on patients with severe renal colic pain who were referred to the ED...
August 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28807069/a-pilot-project-demonstrating-that-combat-medics-can-safely-administer-parenteral-medications-in-the-emergency-department
#3
Steven G Schauer, Cord W Cunningham, Andrew D Fisher, Robert A DeLorenzo
Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration...
August 15, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28793374/pain-assessment-by-emergency-nurses-at-triage-in-the-emergency-department-a-qualitative-study
#4
Marilène Vuille, Maryline Foerster, Eliane Foucault, Olivier Hugli
AIM: To investigate the assessment of pain intensity in the specific context of triage. BACKGROUND: Acute pain affects most patients admitted in emergency departments (ED) but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28729010/evaluation-of-emergency-department-management-of-opioid-tolerant-cancer-patients-with-acute-pain
#5
Pina M Patel, Lauren F Goodman, Sheri A Knepel, Charles C Miller, Asma Azimi, Gary Phillips, Jillian L Gustin, Amber Hartman
CONTEXT: There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during Emergency Department (ED) encounters. OBJECTIVE: To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of PRN opioids during ED encounters based on home Oral Morphine Equivalents (OME) use. METHODS: We performed a retrospective cohort study of opioid-tolerant cancer patients who received opioids in our ED over a 2-year period...
July 17, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28663006/effect-of-an-emergency-department-opioid-prescription-policy-on-prescribing-patterns
#6
COMPARATIVE STUDY
Jerel Chacko, Josh Greenstein, Brahim Ardolic, Nicole Berwald
BACKGROUND: Staten Island University Hospital is located in NYC, where the opioid epidemic has resulted in significant mortalities from unintentional overdoses. In 2013 as a response to the rising threat to our community, our Emergency Department (ED) administration adopted a clinical practice policy focused on decreasing the prescription of controlled substances. The effects of this policy on our provider prescription patterns are presented here. METHODS: A retrospective chart review of patients prescribed opioids from the ED before and after policy implementation was performed...
September 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28611877/emergency-department-pain-management-following-implementation-of-a-geriatric-hip-fracture-program
#7
Scott D Casey, Dane E Stevenson, Bryn E Mumma, Christina Slee, Philip R Wolinsky, Calvin H Hirsch, Katren Tyler
INTRODUCTION: Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures. METHODS: We performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28601270/comparative-effectiveness-of-patient-controlled-analgesia-for-treating-acute-pain-in-the-emergency%C3%A2-department
#8
Polly E Bijur, Angela M Mills, Andrew K Chang, Deborah White, Andrew Restivo, Shaun Persaud, Clyde B Schechter, E John Gallagher, Adrienne J Birnbaum
STUDY OBJECTIVE: We assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesia compared with usual care and would differ by a clinically significant amount. METHOD: This was a pragmatic randomized controlled trial of patient-controlled analgesia and usual care (opioid and dose at physician's discretion) in 4 EDs...
June 7, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28544288/impact-of-hospital-best-practice-mandates-on-prescription-opioid-dispensing-after-an-emergency-department-visit
#9
Benjamin C Sun, Nicoleta Lupulescu-Mann, Christina J Charlesworth, Hyunjee Kim, Daniel M Hartung, Richard A Deyo, K John McConnell
OBJECTIVE: Washington State mandated seven hospital "best practices" in July 2012, several of which may affect emergency department (ED) opioid prescribing and provide a policy template for addressing the opioid prescription epidemic. We tested the hypothesis that the mandates would reduce opioid dispensing after an ED visit. We further assessed for a selective effect in patients with prior risky or chronic opioid use. METHODS: We performed a retrospective, observational analysis of ED visits by Medicaid fee-for-service beneficiaries in Washington State, between July 1, 2011, and June 30, 2013...
August 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28515805/is-computed-tomography-defined-obstruction-a-predictor-of-urological-intervention-in-emergency-department-patients-presenting-with-renal-colic
#10
Peter Alexander Massaro, Avinash Kanji, Paul Atkinson, Ryan Pawsey, Tom Whelan
INTRODUCTION: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). METHODS: We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED...
March 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/28500651/predictors-of-response-in-emergency-department-patients-receiving-intravenous-opioids-for-severe-pain
#11
Jacob A Radcliff, Rachel M Rafeq, Jane F Bowen, Laura Pontiggia, Sanchita Sen
OBJECTIVE: The primary objective of this study was to identify significant environmental and patient characteristics of emergency department (ED) patients who responded to intravenous (IV) hydromorphone and IV morphine for severe pain. Secondary objectives were to 1) investigate the individual effect of the significant environmental and patient characteristics of responders and 2) assess the nature and strength of the correlation of initial dose and change in pain score from arrival to pre-administration...
May 13, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28411112/morphine-use-in-the-ed-and-outcomes-of-patients-with-acute-heart-failure-a-propensity-score-matching-analysis-based-on-the-eahfe-registry
#12
Òscar Miró, Víctor Gil, Francisco J Martín-Sánchez, Pablo Herrero-Puente, Javier Jacob, Alexandre Mebazaa, Veli-Pekka Harjola, José Ríos, Judd E Hollander, W Frank Peacock, Pere Llorens
OBJECTIVE: The objective was to determine the relationship between short-term mortality and intravenous morphine use in ED patients who received a diagnosis of acute heart failure (AHF). METHODS: Consecutive patients with AHF presenting to 34 Spanish EDs from 2011 to 2014 were eligible for inclusion. The subjects were divided into those with (M) or without IV morphine treatment (WOM) groups during ED stay. The primary outcome was 30-day all-cause mortality, and secondary outcomes were mortality at different intermediate time points, in-hospital mortality, and length of hospital stay...
April 12, 2017: Chest
https://www.readbyqxmd.com/read/28321141/adjunct-analgesic-use-for-acute-pain-in-the-emergency-department
#13
James Priano, Brian Faley, Gabrielle Procopio, Kevin Hewitt, Joseph Feldman
Purpose: Multimodal analgesia is common practice in the postoperative setting, but the utility of adjunctive analgesia in the emergency department (ED) is less understood. The primary objective of this study was to analyze ED prescriber ordering habits for adjunct nonopioid pain medication for opioid-naïve patients who require intravenous (IV) morphine or hydromorphone for acute pain. Secondary objectives were to assess initial and total opioid consumption in morphine equivalent units (MEU), pain scores, and ED length of stay (LOS) between groups...
February 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28320545/haloperidol-undermining-gastroparesis-symptoms-hugs-in-the-emergency-department
#14
Rene Ramirez, Philip Stalcup, Brandon Croft, Michael A Darracq
BACKGROUND: Gastroparesis associated nausea, vomiting & abdominal pain (GP N/V/AP) are common presentations to the emergency department (ED). Treatment is often limited to antiemetic, prokinetic, opioid, & nonopioid agents. Haloperidol (HP) has been shown to have analgesic & antiemetic properties. We sought to evaluate HP in the ED as an alternative treatment of GP N/V/AP. METHODS: Using an electronic medical record, 52 patients who presented to the ED w/GP N/V/AP secondary to diabetes mellitus and were treated w/HP were identified...
August 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28279542/the-use-of-ketamine-for-acute-treatment-of-pain-a-randomized-double-blind-placebo-controlled-trial
#15
Billy Sin, Tamara Tatunchak, Mohammad Paryavi, Maria Olivo, Usman Mian, Josel Ruiz, Bupendra Shah, Sylvie de Souza
BACKGROUND: Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain. OBJECTIVE: The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED. METHODS: This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain...
May 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28236471/erectile-dysfunction-in-patients-with-chronic-pain-treated-with-opioids
#16
Raquel Ajo, Ana Segura, María-Del-Mar Inda, César Margarit, Pura Ballester, Emi Martínez, Guillermina Ferrández, Ángel Sánchez-Barbie, Ana M Peiró
INTRODUCTION AND OBJECTIVE: Chronic pain is associated with comorbidities that have an impact on the quality of life of patients and, among others, affect their sexual functioning. One of the most relevant side effects of opioid analgesics is erectile dysfunction (ED), due in part to the inhibition of the gonadal-pituitary-hypothalamic axis and the decline in testosterone levels. To evaluate ED and effectiveness of treatment in men with chronic pain treated with long-term opioids. MATERIAL AND METHODS: Prospective observational study lasting 3 years, where the intensity of pain (visual analogue scale, 0-10cm), erectile function (IIEF-EF, range 1-30 points), quality of life (EQ-VAS, 0-100mm), quality of sexual life (MSLQ-QOL, 0-100 points), anxiety/depression (HAD, 0-21 points) and testosterone levels, was assessed in patients who reported sexual dysfunction (ED or libido modification)...
July 21, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/28149030/sympathetic-crashing-acute-pulmonary-edema
#17
REVIEW
Naman Agrawal, Akshay Kumar, Praveen Aggarwal, Nayer Jamshed
Sympathetic crashing acute pulmonary edema (SCAPE) is the extreme end of the spectrum of acute pulmonary edema. It is important to understand this disease as it is relatively common in the emergency department (ED) and has better outcomes when managed appropriately. The patients have an abrupt redistribution of fluid in the lungs, and when treated promptly and effectively, these patients will rapidly recover. Noninvasive ventilation and intravenous nitrates are the mainstay of treatment which should be started within minutes of the patient's arrival to the ED...
December 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28066825/a-blinded-randomised-placebo-controlled-trial-investigating-the-efficacy-of-morphine-analgesia-for-procedural-pain-in-infants-trial-protocol
#18
Rebeccah Slater, Caroline Hartley, Fiona Moultrie, Eleri Adams, Ed Juszczak, Richard Rogers, Jane E Norman, Chetan Patel, Kayleigh Stanbury, Amy Hoskin, Gabrielle Green
Infant pain has both immediate and long-term negative consequences, yet in clinical practice it is often undertreated. To date, few pain-relieving drugs have been tested in infants. Morphine is a potent analgesic that provides effective pain relief in adults, but there is inconclusive evidence for its effectiveness in infants. The purpose of this study is to establish whether oral morphine provides effective analgesia for procedural pain in infants. A blinded, placebo-controlled, parallel-group randomized, phase II, clinical trial will be undertaken to determine whether morphine sulphate administered orally prior to clinically-required retinopathy of prematurity (ROP) screening and heel lancing provides effective analgesia...
November 15, 2016: Wellcome Open Research
https://www.readbyqxmd.com/read/28059034/midazolam-plus-haloperidol-as-adjuvant-analgesics-to-morphine-in-opium-dependent-patients-a-randomized-clinical-trial
#19
Mohammad Afzalimoghaddam, Maryam Edalatifard, Amir Nejati, Mehdi Momeni, Nader Isavi, Ehsan Karimialavijeh
BACKGROUND: Tolerance to opioids among opium-dependent patients creates obstacles for proper pain management of these patients in the emergency department (ED). The aim of the present study was to investigate the efficacy of intramuscular (IM) haloperidol plus midazolam on morphine analgesia among opium-dependent patients. METHODS: Opium-dependent adults who were admitted to the ED for new-onset severe pain in the limbs or abdomen (within 24 hours of admission and a pain score of over six, using a numerical rating scale [NRS]) were recruited...
January 6, 2017: Current Drug Abuse Reviews
https://www.readbyqxmd.com/read/28025373/trends-in-opioid-analgesic-use-in-encounters-involving-physician-trainees-in-u-s-emergency-departments
#20
Maryann Mazer-Amirshahi, Peter M Mullins, Christie Sun, Jesse M Pines, Lewis S Nelson, Jeanmarie Perrone
BACKGROUND: Opioid analgesic use has increased dramatically in emergency departments (EDs), but the relative contribution of physician trainees has not been explored. We assessed trends in opioid utilization focusing on ED encounters where a physician trainee was involved. METHODS: We studied ED visits from the National Hospital Ambulatory Medical Care Survey, 2001-2011. Adult ED visits in which an opioid was administered in the ED or prescribed at discharge were stratified by whether or not there was trainee involvement...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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