Maryland medical journal (Baltimore, Md. : 1985)
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Saint Joseph Medical Center has had two years experience with operating a chest pain center (CPC) in its emergency department. The CPC has resulted in improved treatment for patients with myocardial infarction. The CPC has led to the utilization of primary angioplasty as a preferred strategy for acute myocardial infarction. The CPC has allowed rapid rule-out of acute coronary syndromes in the emergency department thereby avoiding hospital admission in 31% of patients with chest pain of possible cardiac origin.
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Many clinicians do not realize the costs associated with delirium. Francis and Kapoor found that patients who had had delirium had higher two-year mortality rates and greater loss of independence than control patients. ⋯ Levkoff and coworkers found that delirium was associated with no change in mortality, but that it was associated with prolonged hospital stays and an increased risk of institutional placement among community dwelling elderly. Poor outcomes might be avoided, in part, with early diagnosis and appropriate management of delirium.
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The painful vaso-occlusive crises that complicate sickle cell anemia can be difficult and frustrating for both patient and physician. We describe our experience using an oral morphine protocol for the treatment of sickle cell crisis pain. ⋯ The oral morphine regimen was associated with a significant reduction in the number of ED visits, total number of hours spent in the ED, and the proportion of visits that ended in admission to hospital (P < 0.01). The protocol is a useful tool for providing consistent oral analgesia to patients with sickle crisis pain.