[A Fatal Case of Fulminant Necrotising Fasciitis in a 47-Year-Old Male]. / Foudroyante nekrotisierende Fasziitis bei einem 47-jährigen Mann.

Necrotising fasciitis (NF) is a rare soft tissue infection characterized by rapid progressive necrosis. Initially patients usually present with nonspecific symptoms like fever, severe pain and skin lesions that progress rapidly. It requires prompt recognition and early treatment with extensive surgical debridement and intravenous antibiotics. Mortality despite adequate therapy is high, ranging between 15 and 46%. NF has previously been reported in literature. Some assumed premorbid conditions associated with NF are diabetes mellitus, chronic kidney injury, adiposity, peripheral artery occlusive disease, arterial hypertension, intravenous drug abuse and immunocompromised state. Here we present a fatal case of NF in a 47-year-old male patient without any comorbidity after minor trauma with a fulminant septic course.

Comparison of the over-the-head, lateral and alternating positions during cardiopulmonary resuscitation performed by a single rescuer with a bag--valve--mask device.

BACKGROUND: The 2005 guidelines for cardiopulmonary resuscitation (CPR) do not include a statement on performance of basic life support by a single healthcare professional using a bag-valve-mask device. Three positions are possible: chest compressions and ventilations from over the head of the casualty (over-the-head CPR), from the side of the casualty (lateral CPR), and chest compressions from the side and ventilations from over the head of the casualty (alternating CPR). The aim of this study was to compare CPR quality of these three positions. METHODS: 102 healthcare professionals were randomised to a crossover design and performed a 2-min CPR test on a manikin for each position. RESULTS: The hands-off time over a 2-min interval was not significantly different between over-the-head (median 31 s) and lateral (31 s) CPR, but these compared favourably with alternating CPR (36 s). Over-the-head CPR resulted in significantly more chest compressions (155) compared with lateral (152) and alternating CPR (149); the number of correct chest compressions did not differ significantly (119 vs 122 vs 109). Alternating CPR resulted in significantly less inflations (eight) compared with over-the-head (ten) and lateral CPR (ten). Lateral CPR led to significantly less correct inflations (three) compared with over-the-head (five) and alternating CPR (four). CONCLUSIONS: In the case of a single healthcare professional using a bag-valve-mask device, the quality of over-the-head CPR is at least equivalent to lateral, and superior to alternating CPR. Because of the potential difficulties in bag-valve-mask ventilation in the lateral position, the authors recommend over-the-head CPR.