Comparison of two scores of short term serious outcome in COPD patients.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) related visits to the emergency department have increased substantially during the past decade. An important challenge facing emergency physicians when treating COPD patients is deciding on disposition. The aim of this study was to evaluate Integrated Pulmonary Index scoring to guide the disposition decisions of emergency physicians by comparing its compatibility with Ottawa COPD Risk Score. METHODS: This is a prospective methodological study, in which we compared the accuracies of the Integrated Pulmonary Index and Ottawa COPD Risk Score in predicting of the short-term serious outcomes in patients admitted to the emergency department with COPD exacerbation. Patients who admitted to our emergency department between 01.01.2019-31.03.2019 were evaluated. THE RESULTS: Among the 208 patients, there were 154 (74.0%) short-term serious outcomes. The AUCs were 0.915 and 0.943 for Integrated Pulmonary Index and Ottawa COPD Risk Score, respectively. The difference between AUCs for two scores was not statistically significant. The best cut-off point for Integrated Pulmonary Index and Ottawa COPD Risk Score were ≤3 and >4, respectively. For these best cut-off points, the sensitivity and specificity of Integrated Pulmonary Index were 92.9 and 87.1, respectively. The sensitivity and specificity of Ottawa COPD Risk Score were 99.3 and 85.2, respectively. Besides, the accuracy of Integrated Pulmonary Index was 91.3, and the accuracy of Ottawa COPD Risk Score was 95.7. CONCLUSIONS: Integrated Pulmonary Index was a potential candidate for evaluating respiratory status and prediction of short-term severe events in patients with acute COPD exacerbation in emergency departments.

Comparison of intravenous NSAIDs and trigger point injection for low back pain in ED: A prospective randomized study.

INTRODUCTION: Low back pain (LBP) is a common complaint originating from muscles Myofascial pain syndrome (MPS) is mainly associated with trigger points (TrP) in the muscle tissue. We compared the intravenously administered non-steroidal anti-inflammatory drug (NSAID) and trigger point injection (TPI) in the treatment of LBP patients admitted to the emergency department due to pain caused by TrPs. MATERIAL AND METHOD: After randomization, NSAID was administered intravenously in group 1 and TPIs were performed as specified by Travell and Simons in group 2. The TrPs were identified with the anamnesis and physical examination Demographic characteristics and vital signs of the patients were recorded. Pain scores were measured with the Visual Analogue Scale (VAS) at admission; and in minutes 5, 10, 15, 30, and 60. RESULTS: There were 32 patients in group 1 and 22 patients in group 2. The demographics, vital signs, and pain scores at admission were not statistically significantly different between the groups. The pain scores decreased significantly in the TPI group. During the 60 min' follow-up period, the mean VAS pain score decreased by 0.41 ±â€¯1.30 in the TPI group and by 2.59 ±â€¯2.37 in the NSAID group (p < 0.001). Respond the treatment was significantly higher group TPI than Group NSAID (21/22 vs 20/32 respectively, p = 0.008). CONCLUSION: In this small randomized study with several methodological limitations, TPI was superior to the intravenous NSAIDs in the treatment of acute LBP due to TrPs. TPI can be used in the emergency departments for the acute treatment of LBP in selected patients.

High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department.

Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.

Erector spinae plane block for bilateral lumbar transverse process fracture in emergency department: A new indication.

Plane blocks have become very popular in recent years with the introduction of ultrasonography into the regional anesthesia and algology practice. Ultrasound guided erector spinae plane (ESP) block was first described in 2016. ESP block involves injection of local anesthetics between erector spinae muscles and transverse process of thoracic or lumbar vertebrae and can block the dorsal and ventral rami of thoracolumbar spinal nerves. ESP block has been successfully reported to relieve the pain of multiple rib fracture in the emergency department (ED). Here we first report a novel indication for ESP block in ED; transverse process fracture of lumbar vertebra.