Comparison of Ventilation With One-Handed Mask Seal With an Intraoral Mask Versus Conventional Cuffed Face Mask in a Cadaver Model: A Randomized Crossover Trial.

STUDY OBJECTIVE: We compare received minute volume with an intraoral mask versus conventional cuffed face mask among medics obtaining a 1-handed mask seal on a cadaver model. METHODS: This study comprised a randomized crossover trial of adult US Army combat medic volunteers participating in a cadaver laboratory as part of their training. We randomized participants to obtain a 1-handed mask seal during ventilation of a fresh unembalmed cadaver, first using either an intraoral airway device or conventional cuffed face mask. Participants obtained a 1-handed mask seal while a ventilator delivered 10 standardized 750-mL breaths during 1 minute. After a 5-minute rest period, they repeated the study with the alternative mask. The primary outcome measure was received minute volume as measured by a respirometer. RESULTS: Of 27 recruited participants, all completed the study. Median received minute volume was higher with the intraoral mask compared with conventional cuffed mask by 1.7 L (95% confidence interval 1.0 to 1.9 L; P<.001). CONCLUSION: The intraoral mask resulted in greater received minute volume received compared with conventional cuffed face mask during ventilation with a 1-handed mask seal in a cadaver model. The intraoral mask may prove a useful airway adjunct for ventilation.

Cultivated child abuse: a 2-year-old with hyponatremic seizures.

Hyponatremia leading to seizures is well described in children. Hyponatremia is defined as a serum sodium of less than 135 mEq/L and can be acute or chronic. The seizure threshold in hyponatremia is markedly increased at a level of 125 mEq/L or less. Hyponatremia is one of the most common electrolyte disturbances and occurs in both the inpatient and outpatient setting. The 3 types of hyponatremia are hypovolemic, euvolemic, and hypervolemic. The diagnosis is made through serologic and urinary laboratory studies. We present the case of a 2-year-old girl with recurrent hyponatremic seizures, who was resuscitated twice within a short period at our institution. Her hyponatremia coupled with the seizures was initially thought to be secondary to salt-wasting renal disease, adrenal insufficiency, or even syndrome of inappropriate antidiuretic hormone secretion. The case took an interesting twist, which led us to conclude that this was an uncommon yet not unheard of form of child abuse.