Objective:To evaluate the efficacy and safety of intramuscular ketamine and haloperidol in sedation of severely agitated patients in emergency department (ED).  Methods: This randomized, double-blind clinical trial study was performed on agitated patients referring to two university educational hospitals. Patients were randomly assigned to receive intramuscular (IM) haloperidol (5 mg) or IM ketamine (4 mg/kg). The primary outcome was time to adequate sedation (AMSS ≤ +1). Secondary outcomes included the need for additional sedatives, required intubation, duration of hospitalization, and side effects. Results:The 90 agitated patients were enrolled. The mean age was 30.37±7.36 years (range 18–56); 74% (67/90) were men. The mean time to adequate sedation in ketamine group (7.73 ± 4.71 minutes) was significantly lower than haloperidol group (11.42 ± 7.20 minutes) (p= 0.005). 15 minutes after intervention, the sedation score did not differ significantly in both groups (Ketamine:0.14 ± 0.59 vs. Haloperidol: 0.30 ± 0.60; p=0.167). The incidence of complications was not significantly different between groups. The physician's satisfaction from the patients’ aggression control was significantly higher in ketamine group.  Conclusion:These data suggest ketamine may be used for short-term control of agitated patients, additional studies are needed to confirm if ketamine is safe in this patient population. Given rapid effective sedation and the higher physician satisfaction of ketamine in comparison to haloperidol, it may be considered as a safe and appropriate alternative to haloperidol.IRCT Code: IRCT20180129038549N5

Background:Pelvic fracture (PF) is the second-most prevalent cause of mortality after brain trauma among multiple trauma patients. Our aim was to examine the reliability of suggestive criteria for having no PF (NPF) according to the common reported clinical signs and symptoms (CSSs).Materials and Methods:In the current prospective study, 3527 patients with multiple trauma were recruited according to the guideline of emergency medicine. Information on age, gender, pelvic pain or tenderness, sacrum and coccyx pain or tenderness, the ability to active straight leg raising (SLR), and distracting injury was collected, and PF was examined by either X-ray or computed tomography (CT) scan.Results:The CSS sensitivity of NPF was 39.75% and the specificity was 100%. The no distracting injury was not significantly different according to the CSS criteria and results of X-ray and CT scan (P = 0.269); however, the difference of other criteria was significant (P < 0.0001). No pelvic pain or tenderness and the ability to active SLR considerably affected the prediction of NPF (P < 0.0001). No distracting injury can be omitted from the criteria without any effect on specificity, but with increased sensitivity (60.8% with three criteria vs. 39.7% with four criteria).Conclusion:According to our results, it can be said that due to the high predictive value of our suggestive criteria, it could be applicable as the important criteria for defecting NPF among patients with the possibility of PF. This approach can reduce the necessity of imaging in these patients which helps to reduce the health cost and hazards of X-ray used for imaging and exhaustion of medical devices.

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Objective: The aim of this study was to use ultrasonography for the diagnosis and confirmation of Pulled Elbow treatment. Methods: This descriptive cross-sectional study initiated in 2014 and continued until 2015. We used simple sampling method and recruited 60 samples among patients aged 4 months to 6 years. The apparatus used in this study was an ultrasonogram with transducer 12 MHz probe. Ultrasound evaluation of both hands was undertaken and after reduction, the physical examination was performed to confirm the diagnosis made by ultrasonography. Then, the results were recorded by a physician in a checklist and entered into SPSS software (version 20) for further analysis. Results: In this study, 60 children with pulled elbow injuries were studied. Of these, 27 patients (45%) were girls (female) and 33 (55%) were boys (male). This indicates the higher incidence of injury among males than females. The highest incidence of pulled elbow injury was observed in children aged 3 (15%). The accuracy of ultrasonography method for the confirmation of treatment was reported to be 92%. Conclusion: This study aimed to confirm the considered therapeutic method based on the result of ultrasonography performed after the treatment. Accordingly, the sensitivity and specificity of ultrasonography in confirming the considered therapeutic method for the treatment of pulled elbow was obtained higher than 90%.