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Objective:The aim of this study was head-to-head comparison of the efficacy and rate of adverse events of metoclopramide, ibuprofen and dexketoprofen for the acute treatment of migraine attack in the real-life conditions of a busy emergency department (ED).Methods:This was a prospective, observational, cross-sectional study. All patients who presented to the ED with a headache fulfilling the inclusion criteria were enrolled. All patients were treated by the attending emergency physicians in their daily routine. If an IV treatment in the ED was found indicated by the EP, they selected one of the options in the written departmental migraine treatment protocol.Results:During the study period, 54 patients met the inclusion criteria. The median change in the pain score was significantly different among treatment options (p<0.0001). The median pain score change at the end of the 30 minutes for treatment groups were 7.5 mm (IQR: 7.0-8.0), 5.0 mm (IQR: 4.75-7.0), and 7.0 mm (IQR: 6.0-7.25), respectively (p=0.0002). All three groups were found to be significantly different from each other in the post-hoc analysis.Conclusion:All drugs compared in this study are effective in the relief of migraine headache. However, IV dexketoprofen seems to be faster and more effective than metoclopramide and ibuprofen.

ObjectiveWe evaluated the sensitivity and specificity of bedside ultrasound (US) for determining the success of reduction of displaced distal radius fractures. In addition, we determined the ability of US to diagnose causes of unsuccessful reduction.MethodsIn a prospective, double-blind fashion, patients over 18 of age whose acute distal radius fracture was to be reduced were approached for inclusion. The closed reductions were performed by orthopedics residents. Post-reduction, the fracture was checked by an Emergency Medicine (EM) resident by US. Ultrasound images were evaluated by an EM attending physician blinded to X-ray findings and post-reduction X-ray images were evaluated by an orthopedic surgeon blinded to the US findings.ResultsSixty patients agreed to participate in the study. Of these, reduction was deemed successful by X-ray in 40 (66.7%). Of these 40, 39 (97.5%) were found to be successful reductions by US. In the 20 of 60 (33.3%) patients with unsuccessful reduction by X-ray, 19 (95%) were considered unsuccessful reductions by US. In evaluating the success of distal radius fracture reduction, compared to X-rays, US was 97.5% (95% CI 86.8 to 99.9) sensitive and 95% (95% CI 75.1 to 99.9) specific; its positive predictive value was 97.5% (95% CI 85.2 to 99.6) and negative predictive value 95% (95% CI 73.2 to 99.2).ConclusionsUltrasonography is highly sensitive and specific in determining the success of distal radius fracture reduction.

Owing to the advancements in medicine, new information is obtained regarding cancer, new antineoplastic agents are developed. Frequent use of these new pharmacological agents emergency physicians to be vigilant about their side effects. We present a case of adrenal crisis in a patient with non-small cell lung cancer (NSCLC), caused by an immunomodulatory drug; nivolumab. While adverse events are related to other immunomodulatory drugs have been reported in literature, our case is the first nivolumab-related adrenal failure to be reported. A patient with lung cancer presented to the emergency room(ER) with nausea and vomiting. Hyponatremia, hyperkalemia, persistent hypoglycemia led to the diagnosis of adrenal crisis. Having direct effect on the immune system, these drugs were claimed to be highly reliable. However, there is no reliable data on the side effect profile of these agents. It should be kept in mind that life-threatening auto-immune reactions may occur.