To compare the efficacy and adverse effects of Ketoprofen and Diclofenac in the treatment of acute musculoskeletal pain. Methods: In a prospective randomised clinical trial, patients admitted to an emergency department with acute musculoskeletal injuries requiring intramuscular (IM) injection for pain treatment were enrolled. The target study patients were Chinese adults who suffered from any musculoskeletal injuries of less than 12 hours. They received either 100 mg of Ketoprofen or 75 mg of Diclofenac. Pain was assessed by a 10-point visual analog score (VAS) and evaluations were performed at 30-minute intervals from treatment. Rescue analgesic was given if insufficient analgesia was achieved by one hour. The outcomes and the adverse effects were recorded. Results: We recruited 77 cases in the Diclofenac group and 74 cases in the Ketoprofen group. The demographic data with regards to age, sex and patterns of injury were comparable in both groups. Following the administration of treatment, both groups showed highly statistically significant (P<0.001) reduction in pain level at 30-minute and 60-minute intervals. Comparing the mean decrease of pain level, there was no statistically significant difference between the two groups at 30-minute interval (P=0.6) and 60-minute interval (P=0.5). In each group, there was one patient experiencing skin rash after treatment. Four patients in the Ketoprofen group and one in Diclofenac group required rescue medicine. With respect to the number of admission following treatment, there was no statistically significant difference between the two groups. Conclusions: Ketoprofen and Diclofenac are equally effective and safe in the treatment of acute musculoskeletal pain in Hong Kong Chinese population.

Color Doppler ultrasound is an effective method for detecting the presence of potential bleeders. Although the operative time will be a bit longer, the operation can be done under meticulous care and complete preparation, so that the conversion rate and the risk of fatal hemorrhage can be reduced, especially in patients with liver cirrhosis.

Maxillofacial injury is commonly seen in the practice of emergency medicine. Major maxillofacial injury itself can be life threatening. Apart from the danger of potential airway compromise, severe haemorrhage from branches of carotid artery causing haemorrhagic shock can occur. Blind techniques, such as packing or ligation of external carotid artery are the usual methods employed to stop the bleeding. However blind techniques carry a significant failure rate. A patient with severe maxillofacial injury and torrential haemorrhage is reported. The bleeding could not be controlled by oral and nasal packing. Emergency selective carotid angiography was performed to identify the source of bleeding and embolization of the bleeding branches successfully arrested the haemorrhage. Interventional radiology could be as effective, if not superior, as an operation in controlling bleeding in selective cases.

Hypotension poses a diagnostic challenge to emergency physicians who often have to exclude life-threatening conditions, make correct diagnosis and institute timely treatment. We presented a case of hydronephrosis causing the supine hypotensive syndrome. Management of the supine hypotensive syndrome and the use of emergency bedside ultrasound in evaluating hypotensive patients were discussed. (Hong Kong j.emerg.med. 2004;11:226-229)