A case report: anteroseptal ST elevation due to acute isolated right ventricular infarction
Dublin Core
Title
A case report: anteroseptal ST elevation due to acute isolated right ventricular infarction
Subject
Electrocardiogram, STEMI, RV myocardial Infarction
Description
Background Biomechanical reduction techniques for shoulder dislocations have demonstrated high reduction
success rates with a limited pain experience for the patient. We postulated that the combination of biomechanical
reduction techniques with the shortest length of stay would also have the lowest pain experience and the highest
first reduction success rate.
Methods A randomized multicenter clinical trial was performed to compare different biomechanical reduction
techniques in treating anterior shoulder dislocations without the use of invasive pain relief. Patients who were able to
perform adduction of the arm were randomly assigned to Cunningham, the modified Milch, and the scapular manip-
ulation technique. Those who were not able to do so were randomly assigned to modified Milch and the scapular
manipulation technique. Primary outcomes were emergency department length of stay and pain experienced during
the reduction process, measured by the numeric pain rating scale. Secondary outcomes were reduction time, reduc-
tion success, use of analgesics or sedatives, and complications.
Results Three hundred eight patients were included, of whom 134 were in the adduction group. In both groups,
no differences in emergency department length of stay and experienced pain were observed between the treat-
ment arms. In the adduction group, the modified Milch technique had the highest first reduction success rates
52% (p=0.016), within protocol 61% (p=0.94), and with sedation in the ED 100% (−). In the no-adduction group,
the modified Milch was also the most successful primary reduction technique with 51% success (p=0.040), within
protocol 66% (p=0.90), and with sedation in the ED 98% (p=0.93). No complications were recorded in any of the
techniques.
Conclusion A combination of biomechanical techniques resulted in a similar length of stay in the emergency
department and showed similar pain scores with an overall high success rate of reduction. In both groups, the modi-
fied Milch had the highest first-reduction success rate.
Trial registration Netherlands Trial Register NTR5839—1 April 2016. Ethical committee Noord-Holland with the
CCMO-number NL54173.094.15
success rates with a limited pain experience for the patient. We postulated that the combination of biomechanical
reduction techniques with the shortest length of stay would also have the lowest pain experience and the highest
first reduction success rate.
Methods A randomized multicenter clinical trial was performed to compare different biomechanical reduction
techniques in treating anterior shoulder dislocations without the use of invasive pain relief. Patients who were able to
perform adduction of the arm were randomly assigned to Cunningham, the modified Milch, and the scapular manip-
ulation technique. Those who were not able to do so were randomly assigned to modified Milch and the scapular
manipulation technique. Primary outcomes were emergency department length of stay and pain experienced during
the reduction process, measured by the numeric pain rating scale. Secondary outcomes were reduction time, reduc-
tion success, use of analgesics or sedatives, and complications.
Results Three hundred eight patients were included, of whom 134 were in the adduction group. In both groups,
no differences in emergency department length of stay and experienced pain were observed between the treat-
ment arms. In the adduction group, the modified Milch technique had the highest first reduction success rates
52% (p=0.016), within protocol 61% (p=0.94), and with sedation in the ED 100% (−). In the no-adduction group,
the modified Milch was also the most successful primary reduction technique with 51% success (p=0.040), within
protocol 66% (p=0.90), and with sedation in the ED 98% (p=0.93). No complications were recorded in any of the
techniques.
Conclusion A combination of biomechanical techniques resulted in a similar length of stay in the emergency
department and showed similar pain scores with an overall high success rate of reduction. In both groups, the modi-
fied Milch had the highest first-reduction success rate.
Trial registration Netherlands Trial Register NTR5839—1 April 2016. Ethical committee Noord-Holland with the
CCMO-number NL54173.094.15
Creator
Indah Sukmawati1,2*, Fang Qin Goh3
, Alfred Yip1
, Poay Huan Loh1 and Koo Hui Chan1
, Alfred Yip1
, Poay Huan Loh1 and Koo Hui Chan1
Source
https://doi.org/10.1186/s12245-023-00522-z
Date
2023
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Indah Sukmawati1,2*, Fang Qin Goh3
, Alfred Yip1
, Poay Huan Loh1 and Koo Hui Chan1, “A case report: anteroseptal ST elevation due to acute isolated right ventricular infarction,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12178.