Pulmonary edema and tension pneumothorax following suicidal attempt with a carbon dioxide fire extinguisher

The case of a 56-year-old man is reported who inhaled carbon dioxide from a fire extinguisher with suicidal intent which resulted in pulmonary edema and tension pneumothorax. Because carbon dioxide displaces oxygen, oxygenation has to be primarily secured while considering self-protection. Additionally it should be considered that carbon dioxide is released from the extinguisher under high pressure and at an extremely low temperature so that symptoms of barotrauma and cryotrauma have to be expected. The lesson to be learnt from this is that in cases of intoxication not only the agents but the kinetics of incorporation have to be considered

Life-threatening post-tonsillectomy hemorrhage. Case report including suggestions for a prehospital emergency care algorithm

Ayoung woman suffered an out-of-hospital hemorrhage in her parents' home one week after having undergone tonsillectomy. She was initially awake when the emergency medical service personnel arrived. But because of severe aspiration of blood, she quickly became hypoxemic and required cardiac resuscitation. Endotracheal intubation failed so that airway had to be secured by means of cricothryrotomy. Under resuscitation care, she was taken to the university hospital. Despite surgical exploration of the pharyngeal and collar region as well as advanced life support, return of spontaneous circulation (ROSC) could not be achieved and the patient died. On the basis of this case report, an attempt is made to include all emergency procedures that are necessary in posttonsillectomy hemorrhage such as difficult airway management, bleeding control and hemodynamic support into auseful algorithm

Ultrasound-guided pericardiostomy of preclinical pericardial tamponade in assumed aortic dissection

In the differential diagnostics for causality of a preclinical circulatory arrest (out-of-hospital cardiac arrest, OHCA), a pericardial tamponade must be considered as a possible cause. In emergency medical services a pericardial tamponade usually follows severe trauma or occurs as a life-threatening complication of acute thoracic aortic dissection. In most cases the detection is simple by the use of miniaturized ultrasound devices while performing a focused echocardiography. Consequently, if a tamponade is the obvious cause of the OHCA, a pericardial puncture should be carried out with a suitable set. For this purpose, various sonographic techniques are available

Which patients benefit from transport with ongoing cardiopulmonary resuscitation? Retrospective analysis of 70 patients with refractory preclinical cardiac arrest

Background. Mortality in patients with out-of-hospital cardiac arrest (OHCA) remains very high despite advances in resuscitation algorithms. Most of these patients die at the scene and do not reach hospital. It is currently the subject of discussion whether transport to hospital with ongoing cardiopulmonary resuscitation (CPR) improves survival and neurological outcome in patients with OHCA. Objective. The aim of this study was to identify predictors of survival and good neurological outcome in patients after OHCA who were transported to hospital with ongoing CPR. Patients and methods. A total of 70 consecutive patients with refractory OHCA (mean age 54.7 +/- 15 years) transported to hospital with ongoing CPR were retrospectively analyzed. Neurological outcome was assessed after 30 days based on the Glasgow-Pittsburgh cerebral performance category (CPC). Results. After 30 days 82.9% of the patients enrolled in the trial died (CPC score of 5), 8 patients (11.4%) showed a good neurological recovery with CPC scores of 1-2 and 4 patients (5.7%) had a poor neurological outcome with CPC scores of 3-4. Predictors of good neurological outcome were witnessed arrest, initial defibrillatable rhythm and serum lactate levels on admission. In all patients with good outcome, the index event for OHCA was from cardiac causes. Conclusion. Selected patient collectives can benefit from transport to hospital with ongoing cardiopulmonary resuscitation (CPR)