J Emerg Med
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The objective of this study was to implement a system of continuous quality improvement to reduce delays in the administration of thrombolytic therapy for patients with acute myocardial infarction in the emergency department (ED). The setting was a community hospital ED with an annual census of approximately 40,000 patients. The participants included all patients presenting to the ED with a diagnosis of acute myocardial infarction eligible for thrombolytic therapy. ⋯ In the postintervention period, the performance level of the new process was evaluated and the results were compared with those in the preintervention period. In the postintervention period, the median elapsed time from ED admission to thrombolysis was 40 min, which was significantly shorter that the median preintervention time of 62 min. This study successfully applied the theory of continuous quality improvement to reduce the delays to thrombolytic therapy for patients with acute myocardial infarction in the ED.
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Cutaneous myiasis (myia: Greek word for fly) is an infestation of fly maggots in the skin. A case of human botfly (Dermatobia hominis) myiasis presenting to a Canadian emergency department is described. ⋯ However, the rapidity of international air travel permits this exotic tropical infestation to present in any region. Obtaining a history of recent travel to an endemic area is the key to making the diagnosis and instituting appropriate treatment.