A 14-year-old boy presented with fever and progressive respiratory distress, one week after an episode of pharyngitis. Although there was a concern about pulmonary embolism secondary to a lower extremity fracture, his presentation was most consistent with Lemierre syndrome. This syndrome is an uncommon but potentially lethal complication of otolaryngological infections. Early recognition and aggressive antibiotic therapy are critical elements in reducing mortality. Emergency physicians should be aware of this syndrome because its incidence appears to be increasing.
RÉSUMÉUn adolescent âgé de 14 ans s'est présenté à l'urgence avec de la fièvre et une détresse respiratoire progressive, une semaine après un épisode de pharyngite. Bien qu'une embolie pulmonaire découlant d'une fracture à une extrémité inférieure ait été évoquée, les symptômes de présenta-tion étaient plus évocateurs du syndrome de Lemierre. Ce syndrome est une complication peu courante mais potentiellement fatale des infections oto-laryngologiques. Son identification pré-coce et une antibiothérapie agressive sont des éléments cruciaux dans la réduction de la mortalité. Les médecins d'urgence doivent être sensibilisés à ce syndrome, car son incidence semble être en hausse.
Objective:
Using a simulated airway model, we compared ventilation performance by emergency medical services (EMS) providers using a traditional bag–valve–mask (Easy Grip®) resuscitator to their performance when using a new device, the SMART BAG® resuscitator, which has a pressure-responsive flow-limiting valve.
Methods:
We recruited EMS providers at an EMS educational forum and performed a randomized, non-blinded, prospective crossover comparison of ventilation with 2 devices on a non-intubated simulated airway model. Subjects were instructed to ventilate a Mini Ventilation Training Analyzer® as they would an 85-kg adult patient in respiratory arrest. After being randomized to order of device use, they performed ventilation for 1 minute with each device. Primary outcomes were ventilation rates and peak airway pressures. We also measured average tidal volume, gastric inflation volume, minute ventilation and inspiratory:expiratory (I:E) ratio, and compared our results to the American Heart Association standards (2005 edition).
Results:
We observed statistically significant differences between the SMART BAG® and the traditional bag–valve–mask for respiratory rate (12 v. 14 breaths/min), peak airway pressure (15.6 v. 18.9 cm H2O), gastric inflation (239.6 v. 1598.4 mL), minute ventilation (7980 v. 8775 mL), and I:E ratio (1.3 v. 1.1). Average tidal volume was similar with both devices (679.6 v. 672.2 mL).
Conclusion:
The SMART BAG® provided ventilation performance that was more consistent with American Heart Association guidelines and delivered similar tidal volumes when compared with ventilation with a traditional bag–valve–mask resuscitator.
This group of experts defined the educational core content supporting the specific scopes of practice that each certification level of wilderness EMS provider should have when providing patient care in the wilderness setting. Wilderness EMS providers are, indeed, providing health care and should thus function within defined scopes of practice and with physician medical director oversight.
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