Are Pediatric Manual Resuscitators Only Fit for Pediatric Use? A Comparison of Ventilation Volumes in a Moving Ambulance.

Background: The manual resuscitator device is the most common method of ventilating patients with respiratory failure, either with a facemask, or with an advanced airway such as an endotracheal tube (ETT). Barotrauma and gastric inflation from excessive ventilation volumes or pressure are concerning complications. Ventilating adult patients with pediatric manual resuscitator may provide more lung-protective tidal volumes based on stationary patient simulations. However, use of a pediatric manual resuscitator in mobile simulations contradictorily generates inadequate tidal volumes.Methods: Sixty-two emergency medical services (EMS) clinicians in a moving ambulance ventilated a manikin using pediatric and adult manual resuscitators in conjunction with oral-pharyngeal airway, i-gel, King LTS-D, or an endotracheal tube.Results: Oral-pharyngeal airway data were discarded due to EMS clinician inability to produce measurable tidal volumes. Mean ventilation volumes using the pediatric manual resuscitator were inadequate compared to those with the adult manual resuscitator on all other airway devices. In addition, i-gel, King LTS-D, and endotracheal tube volumes were statistically comparable. Paramedics ventilated larger volumes than emergency medical technicians.Conclusions: Using a pediatric manual resuscitator on adult patients is not supported by our findings.

Cecal Volvulus Diagnosed with a Whirl Sign: A Case Report.

Cecal volvulus is responsible for about 1.9% of all colonic obstructions in the United States.1 Common physical exam findings are abdominal distension with generalized abdominal tenderness; however, the presentation can vary.2 A 64-year-old female presented with right upper quadrant abdominal pain associated with nausea and vomiting. On physical examination, Murphy sign was present. A comprehensive ultrasound was negative for cholecystitis. The diagnosis of cecal volvulus was made using computed tomography (CT), which demonstrated a "whirl sign." Surgery was consulted and emergently took the patient to the OR for a detorsion and right hemicolectomy. The patient made a full recovery with return of normal bowel function on post-op day 3. Additionally, no further adverse effects reported on follow-up. This case report further emphasizes the importance of maintaining a wide differential for patients with abdominal pain regardless of the location in the abdomen. In addition, when suspecting a bowel obstruction, the "whirl sign" is a visual diagnosis suggestive of a cecal volvulus requiring emergent surgical consultation. Topics: Cecal volvulus, abdominal pain, whirl sign, right upper quadrant, CT.