Articles: emergency-services.
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To determine the sensitivity, specificity, and predictive values of a new rapid creatine kinase-MB (R-CK-MB) assay compared with a standard CK-MB (S-CK-MB) assay and to determine its potential use in the evaluation of emergency department patients with possible myocardial infarction. ⋯ The R-CK-MB assay demonstrated high sensitivity and specificity compared with the S-CK-MB assay. When used for patients in whom a cardiac care unit admission is not considered, the rapid assay may identify some patients with unsuspected myocardial infarction and prevent inadvertent discharge or admission to unmonitored beds.
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Widespread application of thrombolytic therapy has increased the importance of rapid triage and intervention for the patient who seeks treatment in the emergency department (ED) for suspected acute myocardial infarction. It has been suggested that all patients with acute myocardial infarction who might benefit from thrombolytic therapy should receive treatment within the first "golden hour" of arrival at the hospital ED. Busy urban medical centers, particularly public hospitals serving a large proportion of indigent patients, face special challenges in attempting to meet this goal. ⋯ Hospital administrators must recognize the unique problems created in the ED when inpatient beds are unavailable. The hospital must also have efficient bed turnover and a community-wide plan for dealing with patients when the ED "closes" to incoming ambulance traffic. Governmental entities must recognize the consequences of their actions in curtailing health care benefits for those who cannot afford care in private hospitals.
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To identify the incidence and major causes of patient and parental complaints in a pediatric emergency department. ⋯ Assessment of ED complaints is useful to highlight areas of patient dissatisfaction and develop plans for improving patient care.