Maryland medical journal (Baltimore, Md. : 1985)
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Patients experiencing ischemic chest pain represent one of the most common emergencies in prehospital emergency medical service (EMS) systems. Recent national guidelines for emergency department and EMS care of chest pain and acute myocardial infarction (AMI) patients have quantified standards for time to evaluation and treatment. Prehospital EMS systems and hospitals will need to change their processes of care for chest pain patients to meet or exceed these national guidelines. ⋯ Based upon the information gathered and considering qualities essential to future performance, the task force made recommendations for changes to Howard County's EMS system. This study reports the task force recommendations and describes those implemented thus far. Changes to the EMS system are quantified, descriptive data from the system are reported, and future goals are presented.
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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.