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Objectives: Ultrasound (US) airway indexes were frequently compared with other scoring systems such as Mallampati score and Cormack - Lehane classification system, but to the best of our knowledge never with LEMON. Here, in this study, we evaluated the accuracy of some recommended airway US parameters in terms of screening difficult airway using the LEMON criteria as a reference., Methods: This was a cross-sectional diagnostic accuracy study in which people with at least 18 years old coming to the emergency departments for any reason who had consent for participation, were enrolled with the simple random sampling method. Hyo-mental distance (HMD), skin to epiglottis distance (EP), and peri-epiglottic space to epiglottis to vocal cord ratio (PEP/E. VC) were the US indexes that were calculated in all participants. Using a preprepared checklist, measured US parameters were recorded. For each participant, the LEMON score variables were also assessed and recorded, and the cutoff point for considering as a difficult airway case, based on LEMON score, was 2. Demographic characteristics of the participants were also registered., Results: A total of 299 cases with a mean age of 41.1 years (95% confidence interval [CI]: 39.3-42.9), were participated. Based on LEMON score ≥2, 20 participants (6.7%) were categorized in difficult airway group. Comparison of the PEP/E. VC ( P = 0.007) and EP distance ( P = 0.049) of the participants based on LEMON score showed a statistically significant difference; but comparison of the means of HMD in the two groups was not statistically significant ( P = 0.144). The median of EP of the participants was 7.70 mm (interquartile range [IQR]: 6.70-9.40). The best cutoff point of EP distance for evaluating a difficult airway was 12.27 mm and more with the sensitivity of 35% and the specificity of 86.96% (accuracy = 0.614; 95% CI: 0.492-0.736). The median of PEP/E. VC was 1.01(IQR: 0.79-1.23). The best cutoff point of PEP/E. VC for evaluating a difficult airway was 0.88 and less with the sensitivity of 70% and the specificity of 67.38% (accuracy = 0.701; 95% CI: 0.583-0.818)., Conclusion: As per our results, PEP/E. VC and EP distance measured with sonography can be used in distinguishing the difficult airway, using the LEMON criteria as the reference. However, further studies are needed to use PEP/E. VC and EP distance as a part of reliable indexes., Competing Interests: None declared., (Copyright: © 2023 Turkish Journal of Emergency Medicine.)

Objectives: This study aimed to compare the efficacy of intravenous (IV) morphine plus ibuprofen or ketorolac versus IV morphine alone in controlling renal colic pain in the emergency department., Methods: This double-blind, randomized clinical trial was conducted during November 2018 and March 2019 in Iran. Patients aged 18-65 years with acute renal colic and numerical rating scale (NRS) score of higher than 6 of 10 were enrolled to the study. They were randomly assigned to I, K, and control groups receiving 5 mg morphine with 800 mg ibuprofen ( n = 65), 5 mg morphine with 30 mg ketorolac ( n = 65), or only 5 mg morphine ( n = 65) intravenously, respectively. NRS was evaluated 0, 15, 30, 60, and 120 min after injection., Results: A total of 195 participants took part in the study. The presence of stone in pelvis area was higher in I group ( P = 0.027). The mean rescue analgesic dose was higher in the control group and lower in K group ( P = 0.031). From the 15 th min, the NRS reduction in I and K group was higher than the control group ( P < 0.001), but the difference between I and K group was not statistically significant in total ( P = 1.0) or in the all follow-up time intervals (15 th P = 0.864, 30 th P = 0.493, 60 th P = 0.493, and 120 th min P = 1.0). The largest difference in pain reduction was observed in 120 th min and mean of NRS was 2.9 (95% confidence interval [CI]: 2.6-3.3), 2.9 (95% CI: 2.6-3.3) and 7.0 (95% CI: 6.7-7.4) in I, K and control group, respectively. The adverse effects showed in 18.5%, 20.0%, and 13.8% of I, K, and control group, respectively., Conclusion: IV ibuprofen plus morphine and IV ketorolac plus morphine had similar effects in reducing renal colic pain but were more effective than IV morphine alone., Competing Interests: Conflicts of interest None Declared., (Copyright: © 2022 Turkish Journal of Emergency Medicine.)

Objectives: In this study, we aimed to investigate the accuracy of recognition of stroke in the Emergency Room (ROSIER) Scale in the diagnosis of patients with acute ischemic stroke (AIS) transferred to the emergency department (ED)., Methods: The present study was a multicenter study. Records from patients suspected of stroke, who referred to the ED were reviewed. Demographic, clinical, and diagnostic data were extracted and then entered in checklists. ROSIER Scale was used to evaluate the possible diagnosis in this study. The definitive diagnosis of a stroke was made based on neurologist's assessment and clinical and neuroimaging findings, mainly brain magnetic resonance imaging (MRI). Receiver operating characteristic (ROC) curve analysis was conducted for assessing the accuracy of ROSIER in discrimination of stroke., Results: The data of 356 suspected stroke patients were analyzed. Of all, 186 patients (52.2%) were male, and the mean age was 65.2 (standard deviation = 14.0) years ranging from 26 to 95 years. One hundred and fifty-one patients (42.4%) had AIS based on the final diagnosis. The area under the ROC curve was 0.85. The best cutoff point for ROSIER scale was ≥1 with a sensitivity of 85.4% (95% confidence interval [CI]: 78.8, 90.6%) and specificity of 65.8% (95% CI: 58.9, 72.3%)., Conclusion: Based on the findings, although the best cutoff point was the same as the original (derivation) study, its sensitivity (85.4% vs. 92%) and specificity (65.8% vs. 86%) were considerably lower., Competing Interests: Conflicts of interest None Declared., (Copyright: © 2021 Turkish Journal of Emergency Medicine.)

Objectives: Digital nerve block is a painful procedure. Several methods have been proposed to decrease the injection pain. Applying an ice pack is a pertinent choice due to its effectiveness on pain reduction, convenience, and low costs. In this study, the degree of injection pain reduction was assessed after applying an ice pack to the site of anesthetic injection., Methods: One hundred participants with traumatic finger injury were assessed. Digital nerve block was performed in fifty patients in the intervention group after 6 min of ice application. In the control group, this procedure was done without ice. The primary outcome was the difference between the needle stick and infiltration pain scores with and without ice pack. The secondary outcome the patient satisfaction score. The protocol of this study was approved by the Institutional Review Board, and it is registered in the Iranian Registry of Clinical Trials., Results: The pain score was assessed using a Numeric Rating Scale. Both the needle skin and infiltration pain scores were statistically significantly lower in the intervention group ( P < 0.001). The mean and median needle stick pain scores were 1.5 and 1.0 in the intervention group and 6.8 and 7.0 in the control group, respectively. Moreover, the mean and median infiltration pain scores were 2.7 and 2.0 in the intervention group and 8.5 and 9.0 in the control group, respectively. Patient satisfaction score was significantly higher in the intervention group., Conclusions: Ice pack is inexpensive, readily available, and is easy to apply. We recommend this method to reduce the injection pain before digital nerve block in the emergency department., Competing Interests: Conflicts of interest None declared., (Copyright: © 2019 Turkish Journal of Emergency Medicine.)