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2 results

  • Migraine and undifferentiated headache

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 243-253

  • Summary

    Based upon their widespread effective use and reported results from meta-analysis of five RCTs, topical NSAIDs are the analgesic treatment of choice for traumatic corneal abrasions (CAs). There are no studies on the use of oral or parenteral NSAIDs in CA. Opioids have not been directly assessed as analgesics for CA. Oxycodone with acetaminophen (paracetamol) is useful as a rescue analgesic in patients failing topical NSAIDs. The ophthalmology literature makes frequent reference to the analgesic utility of bandage contact lenses in CA. However, this approach is not recommended for ED use since NSAIDs work well and the contact lens approach is associated with potential infectious complications, and limited study of cycloplegic use in CA is available. There has been limited study of cycloplegic use in CA. An RCT showed no benefit as assessed by either pain score improvement or need for rescue oral analgesics.

  • Lack of consensus on corneal abrasion management: results of a national survey

  • Lisa Calder, Sowmya Balasubramanian, Ian Stiell
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 6 / Issue 6 / November 2004
    Published online by Cambridge University Press:
    21 May 2015, pp. 402-407
    Print publication:
    November 2004
    • Article
      • You have access
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  • Objectives:

    Our objective was to determine the practice patterns of Canadian emergency physicians with respect to the management of traumatic corneal abrasions.

    Methods:

    After developing our instrument and pilot testing it on a sample of emergency residents, we randomly surveyed 470 members of the Canadian Association of Emergency Physicians, using a modified Dillman technique. We distributed a pre-notification letter, an 18-item survey, and appropriate follow-up surveys to non-responders. Those members with an email address (n = 400) received a Web-based survey, and those without (n = 70) received a survey by post. The survey focused on the indications and utilization of analgesics (oral and topical), cycloplegics, eye patches and topical antibiotics.

    Results:

    Our response rate was 64% (301/470), and the median age of respondents was 38 years. Most (77.7%) were male, 71.8% were full-time emergency physicians, 76.5% were emergency medicine certified, and 64.4% practised in teaching hospitals. Pain management preferences (offered usually or always) included oral analgesics (82.1%), cycloplegics (65.1%) and topical nonsteroidal anti-inflammatory drugs (NSAIDs) (52.8%). Only 21.6% of respondents performed patching, and most (71.2%) prescribed topical antibiotics, particularly for contact lens wearers and patients with ocular foreign bodies. Two-thirds of the respondents provided tetanus toxoid if a foreign body was present, and 46.2% did so even if a foreign body was not present. Most respondents (88.0%) routinely arranged follow-up.

    Conclusions:

    This national survey of emergency physicians demonstrates a lack of consensus on the management of traumatic corneal abrasions. Further study is indicated to determine the optimal treatment, particularly regarding the use of topical NSAIDs.