Annals of emergency medicine
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From January 1978 through March 1984, 115 cases of acute carbon monoxide poisoning were treated with hyperbaric oxygen. Exposure resulted from accidental sources (n = 39), attempted suicide (n = 47), and smoke inhalation (n = 29). Forty-one victims were never unconscious, 30 victims were unconscious at the scene but awoke before arriving at the hospital, and 44 victims were unconscious in the ED. ⋯ The remaining 102 patients recovered fully. Carboxyhemoglobin levels did not correlate with clinical findings, thereby demonstrating the variability between carbon monoxide exposure and impairment of the cellular cytochrome system. Hyperbaric oxygen therapy facilitates the rapid removal of carbon monoxide from the hemoglobin and cytochrome systems while reoxygenating compromised tissues, and it can be an effective treatment in reducing mortality and morbidity.
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Quality assurance (QA) is an increasingly important element in the administrative management of the ED. The need to critically self-evaluate physician performance, allocate scarce resources, and conduct careful risk management requires a methodology well met by a comprehensive QA plan. ⋯ The means by which such wide-ranging issues can be brought into a single comprehensive plan require an efficient and flexible model of ED administration that includes problem identification, resolution and monitoring, risk management, and sensible administration. The QA elements of monitoring, assessment, improvement, documentation, generic screening, and standards of care are examined.