The Na+ and K+ electrochemical gradients across cell membranes are believed to be maintained by the action of a Na+, K+-pump. In human erythrocytes this pump exchanges internal Na+ for external K+ in approximately a 1.5 ratio. Thus, when Na+-loaded/K+-depleted erythrocytes are incubated in physiological conditions they tend to recover their original low Na+/high K+ content. Surprisingly, in erythrocytes from healthy donors the net Na+ extrusion/K+ influx ratio exceeds the 1.5 ratio predicted for Na+, K+-pump-mediated fluxes whereas it is similar to this value in erythrocytes from essential hypertensive patients and some of their descendants. We now report that this difference is due to the presence of a Na+, K+-co-transport system in normal erythrocytes which extrudes both internal Na+ and K+ and is functionally deficient in erythrocytes of essential hypertensive patients and some of their descendants. No difference in passive Na+ permeability could be detected between normotoensive and hypertensive subjects.

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those dying in hospital with obstructed airways had less severe non-respiratory injuries than those dying with clear airways. The same tendency could be discerned when the lowest 10% were considered, although the numbers of patients were very small. These results suggest strongly that airway obstruction contributes to the death of some patients in the first 72 hours of hospital care. They do not indict airway management in those who die before they reach hospital. Discussion This study is presented as much for its method as for its results. The introduction of the ISS will do much to help to measure performance that has hitherto been the subject of speculation. Improvement in the data retrieval systems available to accident units is, however, essential if full use is to be made of auditing techniques. Because no retrieval system was available this work was based on cumulative mortality rather than the much more satisfactory concept of mortality ratio. It follows that no observations could be made on the undoubtedly important role of airway management in the survivors. The policy adopted for the prehospital care of accident victims remained constant throughout the five years under review (1971-5). Ambulance crews were trained in basic resuscitation techniques and called out hospital staff only to care for trapped patients. The results would suggest that this quality of care is optimum with regard to airway management and that no improvement in survival could be expected if more advanced training were introduced. In contrast, airway management during the first 72 hours in hospital does not appear to be satisfactory.

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