Annals of emergency medicine
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Comparative Study
Prehospital endotracheal tube airway or esophageal gastric tube airway: a critical comparison.
This study compares two similar groups of patients in cardiopulmonary arrest with ventricular fibrillation (VF). In the survival study group of 296 patients, 148 patients received an endotracheal tube airway (ETA) and 148 patients received an esophageal gastric tube airway (EGTA), the improved version of the esophageal obturator airway (EOA). ⋯ Training time was longer for the ETA. We conclude that both airways have a place in the prehospital setting.
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A 12-year-old victim of an automobile-pedestrian accident appeared to develop severely compromised cardiac output shortly after intubation and positive pressure ventilation. Anteroposterior and lateral chest films showed air within the pericardial sac. ⋯ The patient remained hemodynamically stable throughout the hospital stay and was subsequently discharged. Documentation of this degree of tamponade from air in the pericardium is quite uncommon.
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A coordinated approach to quality assurance is essential for managing the complexities of health care in the emergency department. Nearly every activity in the emergency care setting has implications that fall under the quality assurance umbrella. ⋯ The program follows traditional quality assurance concepts for monitoring structure, process, and outcome elements of emergency care. Key principles that are the foundation of the program include active participation by all staff levels (clinical and nonclinical), standardized documentation, and specifically defined review mechanisms.