The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Efficacy and safety of nebulized morphine given at 2 different doses compared to intravenous titrated morphine in trauma pain.
Our aim was to compare the efficacy and safety of intravenous (IV) titrated morphine with nebulized morphine given at 2 different doses in severe traumatic pain. ⋯ Nebulized morphine using boluses of 10 mg has similar efficacy and better safety than IV titrated morphine in patients with severe posttraumatic pain. Increasing nebulized boluses to 20 mg increases the effectiveness without increasing side effects.
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We evaluated the ratio of delta neutrophil index (DNI) to albumin (A) in patients receiving early goal-directed therapy (EGDT) to determine the prognostic significance of the DNI/A ratio as a marker of early mortality in critically ill patients with suspected sepsis. ⋯ The ratio of DNI to serum albumin on ED admission is a promising prognostic marker of 28-day mortality in patients with severe sepsis receiving EGDT.
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Increasing the value of health care delivery is a national priority, and providers face growing pressure to reduce cost while improving quality. Ample opportunity exists to increase efficiency and quality simultaneously through the application of systems engineering science. ⋯ In this study, Lean-based reorganization of laboratory process flow significantly increased process efficiency. Broader application of systems engineering science might further improve health care quality and capacity while reducing waste and cost.
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Pediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children. ⋯ Factors other than the type of analgesia are important determinants of prehospital pain relief and are likely to impact on clinical care and research. Clinical audit and research projects should stratify patients according to patient as well as management factors to maximize service improvement.