Esophageal Obturator Airway; Its Use and Complications. Two Case Reports of Pharyngoesophageal Perforation. Kenneth R. Johnson, J r . , h4.D. Michael G. Genovesi, h4.D. Kenneth H. Lasser, B.A. UCLA School of Medicine, Los Angeles, California. The esophageal o b t u r a t o r airway i s a device designed fbr assisting artificial ventilation i n lieu of' placement of a n e n dotracheal tube. T h e airway is hllndly hut easily introduced through t h e oropharynx a n d advanced into t h e esophagus. A cuff a t t h e distal e n d i s inflated, a n d t h e esophagus is occluded. A mask is t h e n placed occluding t h e nose a n d mouth, a n d a resuscitation h a g or mechanical ventilator 1s attached to t h e tube. Air holes proximal to t h e cuff allow a i r to flow from t h e ventilator bag into t h e p h a r y n x , larynx, t r a c h e a a n d lungs. T h e alrway h a s been found to be a n effective a n d reliably safe m e a n s of providing a n artificial airway. It preventsgastric dilitation a n d aspiration by esophageal occlusion. It i s not totally without hazard however. Two cases of pharyngoesophageal t r a u m a a r e reported, t h e first being a high esophageal t e a r found a t post lnortem exa m i n a t i o n , a n d t h e second being a pyriform s i n u s laceration noted on admission to t h e hospital. A hrief discussion of t h e therapy of' pharyngoesophageal perforations is given. T h e t r e a t m e n t for cervical esophageal perforations is conservative a n d fbr thoracic esophageal perfbrations is surgical. Despite these two complications. o u r experience with over 1,000 cases leads us to t h e conclusion t h a t t h e esophageal obturator airway is safe a n d effective. It should he used whenever persons unskilled in dlrect endotracheal i n t u b a tion a r e participating in cardiopulmonnr. resuscit;rtive efl forts.
"Call For Help": An Algorithm for Emergency Care of Burns. J o e C. hlcKinley, B.S.N., R.N. Carl Jelenko, 111, M.D. Burn Investigation Laboratories, Medical College of Georgia, Augusta, Georgia We have been increasingly distressed a t t h e n u m b e r s of ~ n d i v i d u a l swith b u r n s of a variety of severities a n d a g e s transferred t o o u r B u r n Service a f t e r inappropriate - if a n y - resuscitation a n d care. For example, d u r i n g October - November, 1974. \vc a d mitted 20 p a t i e n t s with b u r n s of' 141.8% BSA. Six, includi n g o n e 2-year-old with a 3% BSA scald lesion, h a d received inadequate, incorrect or n o fluld resuscitation. Four had clear evidence of post-burn pulmonary injury which h a d been ignored for a s long a s five days first identified a n d m a n aged on a r r i v a l a t o u r institution. Two were severely anemic, and four had received no topical antibacterial t h e r a p y . -