Objectives: The objective of this study was to test the hypothesis that topical tetracaine would be safe to use for 24 hours and would not affect corneal healing, that patients would experience more pain relief, and that patients would perceive tetracaine to be more effective than saline eye drops for the treatment of pain caused by corneal abrasions. Methods:The study was a 12-month, prospective, double-blind, randomized trial of tetracaine versus saline set in the emergency department (ED) of a regional tertiary care teaching hospital. A total of 116 patients presenting with uncomplicated corneal abrasions were included in this study. The intervention was either undiluted, preservative-free, topical tetracaine hydrochloride 1% or saline, applied up to every 30 minutes while awake for 24 hours. Main safety outcome measures were repeat ED examinations at 48 hours with fluorescein staining and slit-lamp examination, 1-week and 1-month telephone interviews with additional examinations as needed, and monitoring of charts for complications. Secondary outcome measures were 100-mm visual analogue scale (VAS) pain scores recorded every 2 hours while awake for 48 hours and patient-perceived overall effectiveness using a numeric rating scale (NRS) of 0 to 10 obtained during telephone interviews.Results: At least one follow-up encounter was completed on each of the 116 patients. No complications specifically attributed to topical anesthetic use occurred in the 59 patients in the tetracaine group, and the binomial probability confidence interval (CI) of this occurring is 0 to 6.1. There was no significant difference in corneal healing as measured by the percentage of patients with persistent fluorescein uptake at 48 hours between the two groups (23.9% vs. 21.3%, difference = 2.6%, 95% CI = -14% to 20%, p = 0.761) or persistent symptoms at 48 hours (21.7% vs. 21.3%, difference = 0.4%, 95% CI = -16% to 17%, p = 0.957). There was no clinical difference in VAS pain scores between the groups. Patients in the tetracaine group rated the study drugs' overall effectiveness significantly higher on the NRS (7.7 vs. 3.9) compared to patients in the saline group (difference = 3.9, 95% CI = 2.4 to 5.3, p < 0.0005).Conclusions: Topical tetracaine used for 24 hours is safe, and while there was no significant difference in patient VAS pain ratings over time, patient surveys on overall effectiveness showed that patients perceived tetracaine to be significantly more effective than saline.ACADEMIC EMERGENCY MEDICINE 2014;21:374-382

Clinical VTE events are rare in medical patients, and medical VTE thromboprophylaxis needs to be more focused. The new guideline has performance characteristics th@satisfy this need.

There was no evidence that up to 24-hour topical tetracaine for the treatment of pain caused by SCA was unsafe; however, CIs were wide and some increased risks were observed for NSCAs.

Cattle are socioeconomically important animals with frequent and close contact with humans. Due to the size and power of these animals, injury and deaths related to contact with cows and bulls do occur. It is impossible to be certain of the worldwide burden of morbidity and mortality. It is clear however that trauma presents as specific injury patterns, often related to particular activities. Research identifies groups such as dairy farmers, veterinarians and abattoir workers who are at a higher risk of injury. The general public also increase their risk of injury just by being near cattle. The assessment and treatment of injuries due to cattle trauma should follow some clear and well-defined principles. Reduction in the frequency and severity of injury is possible and should be a priority.

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