Comparative Study of the Effect of Lidocaine Spray and Ice Spray on the Pain Intensity During Intramuscular Injection: A Randomized Clinical Trial.

BACKGROUND: Intramuscular injection is one of the most common, invasive, and painful ways to deliver medicine to the body. AIM: Since one of the nurse's duties is to employ different methods to reduce pain caused by treatment procedures, this study was conducted to determine the effect of lidocaine spray and ice spray on pain intensity at the muscle injection site. METHOD: A clinical trial was performed on 90 patients presenting to outpatient clinics of Neyshabur hospitals. The samples were selected using a computerized table of random numbers, and each participant was randomly assigned to one of the control, lidocaine spray, and ice spray groups. Pain severity was measured immediately after intramuscular injection using a numerical pain scale. Descriptive statistics along with statistical tests (chi-square, Fisher, etc.) were used to analyze the data in the R environment version 3.6.2. Ordinal logistic regression was used to compare pain intensity in the three groups by adjusting the effect of age variables and sensory disorders. RESULTS: The mean pain intensity was 3.44 without intervention, 2.63 with lidocaine spray, and 2.27 with ice spray. Statistical tests indicated a significant difference in pain intensity of intramuscular injection between the ice group and the control group (p = .010). Although lidocaine spray reduced the pain intensity, its effect was insignificant compared with the control group. CONCLUSIONS: Both ice and lidocaine spray can be effectively used to reduce the intensity of intramuscular injection pain; however, it seems that ice spray is a more effective, safe, and affordable method.

The effect of heparin concentration on results of venous blood gas of patients admitted to cardiac intensive care unit: A double-blind clinical trial.

Background: The aim of the present study was to investigate the effect of heparin (1000 IU/mL) in the blood sample on the results of venous blood gases of patients admitted to the cardiac intensive care unit. Materials and methods: The present double-blind randomized clinical trial study was performed on 282 samples from 141 patients admitted to the cardiac intensive care unit. Insulin syringes with heparin (1000 IU/mL) and heparin (5000 IU/mL) and 1 cc of blood sample were taken from the peripheral vein, then distributed in two syringes and given to the analyzer. Results: In the present study, the mean age of the samples was 49.96 ± 9.58. There was a statistically significant difference between the two groups in terms of values of partial pressure of carbon dioxide (PCO2) (P < 0.001), partial pressure of oxygen (PaO2) (P < 0.001), blood oxygen saturation (P < 0.001), bicarbonate ion (P < 0.001), excess base (P < 0.001), hemoglobin (P < 0.001), calcium (P < 0.001), potassium (P < 0.001), and sodium (P < 0.001) in the two groups. Conclusion: Overall, heparin (1000 IU/mL) led to a less disruption in the results of venous blood gases, and since it has not significantly increased the risk of clots, it is recommended to be used for venous blood gas sampling.

The cardiomyopathy of Friedreich's ataxia common in a family: A case report.

INTRODUCTION AND IMPORTANCE: Friedreich's Ataxia is an autosomal recessive disease and is usually associated with arterial dysfunction, muscle weakness, spasm in the lower extremities, scoliosis, bladder dysfunction, lack of reflexes in the lower extremities, and imbalance. Approximately 2.3 people have cardiomyopathy. In this article, we have reviewed a case of Friedreich's Ataxia with hypertrophic cardiomyopathy. CASE PRESENTATION: A 19-year-old woman with Friedreich's Ataxia has been protesting since she was 11 years old and complained of chest pains, dyspnea, and heart palpitations without a medical history. In ECG, Asymmetrical invert T wave diffuse, diffuse ST-segment depression, and left ventricular hypertrophy were observed. In echocardiography, the left ventricle was reported as hyperimmobile with increased EF (70-75%). CLINICAL DISCUSSION: In the present study, a patient with Friedrich Ataxia was diagnosed with chest pain, dyspnea, and palpitations without any medical history, and was discharged from the hospital after treatment. In the patients introduced and our patient, there was significant fibro-myocardial hypertrophy, in which the ventricular septal hypertrophy was marked by hypertrophic cardiomyopathy. CONCLUSION: Because early diagnosis of the disease is difficult, clinical signs and the patient's current profile at the time of referral will be very helpful.

Right ventricular undifferentiated pleomorphic sarcoma: A case report.

In this paper, a case of undifferentiated pleomorphic sarcoma in a patient with right-sided heart failure has been explored. A 61-year-old woman complaining from cough and dyspnea for a week following indistinctive surgery on right buttock area with reported pathology of malignant undifferentiated tumor presented to the hospital. Laboratory results indicated negative TPi enzyme and D.dimer of 4127.81 mg/L. In transthoracic echocardiography, a mass filling the entire right ventricular space was observed. A resection surgery was performed and the pathology was reported as primary cardiac sarcoma.

Mesenteric ischemia following large left ventricular fibroid thrombosis due to myocardial infarction: A case report.

INTRODUCTION: Left ventricular thrombosis is a common complication of acute myocardial infarction, usually occurring after anterior ST-elevation myocardial infarction, akinesis, and extensive dyskinesia of the apex, anterolateral, or anteroseptal. In this article, we report a case of myocardial infarction with left ventricular thrombosis. CASE PRESENTATION: A 45-year-old man was referred to our hospital with complaints of severe epigastric pain, sweating, fever, and tachycardia. In laboratory tests, findings for triose phosphate isomerase enzyme were negative, but on electrocardiography, the Q wave in the V1 and V2 leads and the biphasic T wave in the V2, V3, and V4 leads were evident. In Akinesian echocardiography, apical segmentation with a large organic, mobile, pedunculated thrombosis measuring 1.7 × 1.9 cm2 and an ejection fraction of 40% were reported. The patient then underwent emergency open cardiac surgery through a central sternotomy to remove the thrombosis. CLINICAL DISCUSSION: The clinical manifestations of left ventricular thrombosis include cerebral thromboembolism and systemic distal embolization, which are dangerous despite surgery. The echocardiography revealed that the left ventricular keratosis had been surgically removed through ventriculotomy. The patient experienced mesenteric ischemia during hospitalization, and due to the initial presentation of severe abdominal pain, it is not uncommon for the patient to be diagnosed with mesenteric ischemia before referral. The patient had the following vital signs: SPO2, 98%; BP, 96/63; PR, 91; RR, 19; and GCS, 10/15 and was treated in the intensive care unit. CONCLUSION: Our case highlights the importance of diagnosis and on-time treatment of post-large left ventricular fibroid thrombosis complications.