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Introduction: Acute respiratory distress syndrome, a severe manifestation of COVID‐19, prompts the critical intervention of endotracheal intubation (ETI). However, ETI is associated with complications, notably post‐intubation hypotension (PIH), linked to an increased adverse prognosis. Our purpose was to investigate risk factors for PIH in COVID‐19 patients in the emergency department (ED). Methods: This observational study was conducted at the Afzalipour Hospital, Iran. Adult COVID‐19 patients undergoing ETI were included, with data collected on demographic variables, medical history, and hemodynamic parameters. PIH was defined as the occurrence of any of the following: reduction of systolic blood pressure (SBP) to 90 mmHg or less; reduction of mean arterial pressure (MAP) to 65 mmHg or less; reduction of SBP by at least 20% of the initial value; or the need for vasopressor support during the 30 min after intubation. Results: Among 145 patients, the mortality rate was 82.7%, and PIH occured in 22.7%. Univariate analysis revealed associations between PIH and initial SBP (SBP‐0) and initial MAP. Multivariable regression revealed that each 1 mmHg decrease in SBP‐0 increased the risk of PIH by 5%. Patients with SBP‐0 of less than 116 mmHg had a PIH odds ratio of 4.1. A history of hypertension (HTN) or ischemic heart disease (IHD) increased the likelihood of PIH sixfold. The receiver operating characteristic curves for SBP‐0 had an area under the curve (AUC) of 0.67 (95% CI: 0.54–0.79), lower than the AUC of 0.77 (95% CI: 0.64–0.86) for the model incorporating SBP‐0, history of HTN or IHD, and total severity score. Despite this, the Z score comparing the AUCs of SBP‐0 and the multivariable model did not indicate a statistically significant difference. Conclusions: History of HTN or IHD, as well as low SBP‐0, are independently associated with an increased risk of PIH in COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Aims: Pain can create physical and psychosocial discomfort. Pain management of patients with opioid misuse history can be challenging, in part due to their tolerance to opioids. Clonidine is an alpha‐2 agonist that has been used for the reduction of anxiety and pain. The aim of this study was to investigate the effect of oral clonidine on pain outcomes in patients with a history of opioid use disorder presenting with orthopaedic fractures in the emergency room. Methods: In this blinded clinical trial in the emergency department, 70 opioid‐dependent patients with orthopaedic fractures were divided into a control group of 35 and an intervention group of 35 subjects. Initially, 0.2 mg of oral clonidine was given to the intervention group and the control group received placebo tablets. Pain levels were recorded based on the Numerical Rating Scale rating before intervention, at 30 min, 1 h after intervention and at disposition from the emergency room (3‐6 h after intervention). The total morphine requirement was also recorded. Results: The pain score of the clonidine group was significantly lower than that of the control group at 1 h and at disposition time. The amount of morphine required was significantly reduced in the clonidine group (P < 0.05). Oral clonidine had no significant effect on pulse rate. Oral clonidine was more effective for pain reduction in lower limb injuries. Conclusion: Oral clonidine significantly reduced pain and the need for morphine in opioid‐dependent patients with orthopaedic fractures. [ABSTRACT FROM AUTHOR]

Given the limited capacity of intensive care units in many countries, it is crucial to identify reliable prognostic markers to optimize poisoning patients management and improve outcomes. This study aimed to assess the predictive value of three variables, namely the initial QTc interval (iQTc) measured within two hours of admission, the delayed QTc interval (dQTc) measured between 6 and 12 hours of entry, and the QTc interval trend over time (ΔQTc), for mortality in patients with undifferentiated poisoning. A retrospective case series was conducted on 70 patients with undifferentiated poisoning admitted to the intensive care unit (ICU) of Afzalipour Hospital between March 21, 2021, and March 20, 2023. The results of the multivariate analysis revealed that dQTc, base deficit, and creatinine were independently associated with mortality (P value < 0.001). The dQTc had the highest predictive ability, with an area under the curve (AUC) of 0.84, followed by ΔQTc with an AUC of 0.76, and iQTc with an AUC of 0.67. Additionally, the results of the Generalized Estimating Equation model with repeated measurements revealed a higher odds ratio for dQTc (OR, 6.33; 95% CI, 2.54–15.79) compared to iQTc (OR, 4.92; 95% CI, 1.71–14.17). The study concluded that monitoring the dQTc interval could provide valuable prognostic information in acute poisoning cases. [ABSTRACT FROM AUTHOR]

Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aimof predicting five distinct outcomes in cases of non-variceal UGIB. Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding. Results: A total number of 320 patients were enrolled, with 44 (13.75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76). Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion. [ABSTRACT FROM AUTHOR]

Background: Anesthesia decreases brain cognitive function, memory and pain, and also leads to the loss of consciousness. In this study, midazolam and propofol-sedated trauma patients undergoing lower limb surgery were evaluated for stress levels after neuraxial anesthesia. Materials and methods: This double-blind randomized clinical trial was conducted on patients with lower extremity fractures due to trauma, who were candidates of elective lower extremity orthopedic surgery. Patients were randomly divided into two groups of propofol-sedated patients (n=110) and midazolam-sedated patients (n=110) after neuraxial anesthesia. Then, all patients underwent spinal anesthesia using 3 ml of 0.5% bupivacaine (3 mg/kg). Propofol (25-75 µg/kg/minute) was infused, and 1-2 mg of midazolam was injected PRN until patients reached the score of 3 on the Modified Observers' Assessment of Alertness/Sedation Scale (MOAA/S). Results: Preoperative sedation/alertness scores of patients in the two groups did not differ significantly from one another. Penetrating memories in the midazolam group was higher than the propofol group (P<0.05). Personal relationship problem was more significant in the midazolam group than the propofol group (P<0.05). Inability in controlling emotional feelings was higher in the midazolam group compared to the propofol group (P<0.001). Conclusion: Our findings indicated that a sub-hypnotic dose of propofol provided a superior sedation and amnesia compared to midazolam. Aspects of stress, including penetrating memories, personal relationship problems, inability to control emotional feelings, and lack of depression during spinal anesthesia were better managed by propofol compared to midazolam. [ABSTRACT FROM AUTHOR]

Objectives: Methadone can be fatal due to respiratory failure even in little doses. This study aimed to evaluate the possible risk factors of death and/or intubation in methadone-poisoned children of 12 years or younger., Design: Retrospective routine database study., Setting: The only tertiary hospital for children poisoning in Tehran., Patients: Four hundred fifty-three methadone-poisoned patients aged 12 or younger were studied between 2001 and 2012., Main Outcome Measures: In-hospital mortality and intubation/mechanical ventilation., Results: Of a total of 475 children included, 22 were excluded due to coingestion of other drugs. Three (0.66 percent) expired and 12 (2.65 percent) were intubated during the course of hospital stay. Intubation (p < 0.001), fever (T axillary ≥ 37.5°C, p = 0.01), being unresponsive at presentation (p = 0.02), tachycardia (p = 0.01), acidosis (p = 0.03), leukocytosis (p = 0.02), and longer hospital stay (p = 0.01) associated with death. Mortality (p < 0.001), fever (p = 0.004), aspartate aminotransferase (AST; p = 0.006), alanine transaminase (p = 0.04), creatinine (p = 0.005), corrected QT (QTc) interval in triage electrocardiogram (p = 0.02), and longer hospital stay (p = 0.005) associated with intubation in univariate analysis. However, after running regression analysis, only fever, QTc ≥ 480 ms, tachycardia, and AST independently associated with intubation and death. Axillary T ≥ 37.45 °C with an accuracy of 91.9 (95% confidence interval [CI] 88.8-94.2) and odds ratio of 9.3 (95% CI 2.5-34.9) predicted intubation, and T ≥ 37.75 with an accuracy of 96.0 (95% CI 93.5-97.5) and odds ratio of 47.4 (95% CI 4.1-550.1) predicted death., Conclusion: A methadone-poisoned child presenting with tachycardia, fever, abnormal AST, or an initial prolonged QTc interval should be managed with great caution.