the Month -
Overcrowding: Is There a Solution?
Linares, M.D., Ryan Keller, M.D.
Virtually all patients
who visit an emergency department in the United States are guaranteed one
thing: some sort of waiting period prior to seeing a physician. As emergency
departments across the country become more crowded yearly, patients become
more frustrated with lengthening waiting times, physicians and nurses strain
to increase throughput, administrators struggle to keep up with increasing
staffing demands, and health insurance agencies look for ways to keep health
care costs under control.
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Even more worrisome is the increased risk of poor patient outcomes that accompany crowded ED settings
(1). Furthermore, the problem is not an American phenomenon; European
(4,5) and Chinese
(6) emergency departments face similar challenges.
The neurological abnormalities of children with a history of intrauterine exposure to ethanol, cocaine, FemdomZzz.com opiates, and marijuana are reviewed. Ethanol causes fetal alcohol syndrome (FAS) which is characterized by mental retardation, intrauterine and postnatal growth retardation, and peculiar dysmorphic features. Cocaine is implicated in congenital malformations, behavioral abnormalities during the neonatal period, sudden infant death syndrome (SIDS), psychomotor developmental delay, and cognitive deficits. Opiates have been linked to intrauterine and postnatal growth retardation, neonatal abstinence syndrome, SIDS, and psychomotor development and cognitive deficits. Marijuana may produce intrauterine growth retardation, dysmorphic features, behavioral abnormalities during the neonatal period, psychomotor development and cognitive deficits, and sleep abnormalities. The pathogenesis of the syndromes of intrauterine exposure to these drugs is complex and probably involves multiple mechanisms. These include nutritional deficiencies, dysfunction of neurotransmitter systems, disturbances of neuronal growth and differentiation, and genetic disregulation of brain development. The best treatment of these syndromes is prophylaxis. The care of children with history of intrauterine exposure to drugs is complex and requires a good pediatric follow-up, and an early intervention program while the mother or both parents continue with the drug addiction therapy
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