BACKGROUND: Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI. METHODS: In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded. RESULTS: Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups. CONCLUSION Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

BACKGROUND: Assessing and evaluating mental health status can provide educational planners valuable information to predict the quality of physicians'' performance at work. These data can help physicians to practice in the most desired way. The study aimed to evaluate factors affecting psychological morbidity in Iranian emergency medicine practitioners at educational hospitals of Tehran.METHODS: In this cross sectional study 204 participants (emergency medicine residents and specialists) from educational hospitals of Tehran were recruited and their psychological morbidity was assessed by using a 28-question Goldberg General Health Questionnaire (GHQ-28). Somatization, anxiety and sleep disorders, social dysfunction and depression were evaluated among practitioners and compared to demographic and job related variables.RESULTS: Two hundreds and four participants consisting of 146 (71.6％) males and 58 (28.4％) females were evaluated. Of all participants, 55 (27％) were single and 149 (73％) were married. Most of our participants (40.2％) were between 30–35 years old. By using GHQ-28, 129 (63.2％) were recognized as normal and 75 (36.8％) suffered some mental health disorders. There was a signifi cant gender difference between normal practitioners and practitioners with disorder (P=0.02) while marital status had no significant difference (P=0.2). Only 19 (9.3％) declared having some major mental health issue in the previous month.CONCLUSION: Females encountered more mental health disorders than male (P=0.02) and the most common disorder observed was somatization (P=0.006).