Annals of emergency medicine
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Thirty-eight emergency cricothyrotomies were performed over a 3-year period. This was the first airway control maneuver attempted in 5 patients, 3 of whom had facial and/or neck injury, one apneic with upper airway hemorrhage, and one with aortobronchial fistula. The remaining 33 procedures were performed only after other airway management failed. ⋯ Twelve of the 38 patients were long-term survivors. There was one long-term complication, a longitudinal fracture of the thyroid cartilage during forceful placement of an oversized tube (8 mm inner diameter) through the cricothyroid membrane. This required operative repair and left the patient with severe dysphonia.
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A six-bed observation ward has been an integral part of our community hospital emergency department for 10 years. During a recent 4-month period, 574 patients were admitted with 65 different clinical presentations. ⋯ Guidelines have been developed which avoid most potential pitfalls in the use of an observation ward. Significant flexibility is gained and improved patient care is possible with the addition of an observation ward to the emergency department.