JACEP
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The hypothesis that the results of process measures of the quality of care would be improved in a busy municipal hospital emergency department by using a medical record audit and reviewing findings with house staff and those responsible for their training was tested over a one year period and, tentatively, rejected. Out of 21 audit items, 14 showed no significant change. Of the remaining seven, only three items showed significant improvement. Other mediating factors are related to quality of care in this setting such as patient/staff ratios, supervision, the focus of training programs, the physical plant, staff attitudes, behavior and questions of control.
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Monitoring data in 16 primates subjected to septic or hemorrhagic shock and resuscitated with various solutions is presented. From a paractical standpoint, central venous pressure and urine output appear to be the best indices to use in the emergency department for resuscitation of the shock victim. The sophisticated measurements such as cardiac output, thermodye volumes, pulmonary artery wedge pressure and oxygen consumption should be reserved for the individual with depressed cardiovascular reserves and who needs "fine tuning" of his volume status.