A comparison of cannula insufflation device performance for emergency front of neck airway.

BACKGROUND: Pediatric emergency front of neck airway guidelines recommend oxygenation via cannula cricothyroidotomy or tracheotomy. AIM: The primary aim was to measure test lung pressures and volumes generated by cannula insufflation devices recommended for emergency front of neck airway compared with a pressure limit of 50 cm H2 O and volume limit of 20 ml/kg. The secondary aim was to calculate pressure and volume variability. The primary end point was test lung expansion. METHOD: Adult, child, and infant airway models, each with three degrees of upper airway obstruction, were oxygenated using six cannula insufflation devices: 3-way stopcock, Rapid-O2 , Manujet, Enk oxygen flow modulator, Ventrain, and self-inflating bags. Test lung pressures and volumes were recorded. RESULTS: Pressures and volumes from all devices were highly variable, despite oxygen flow calibration and strict adherence to oxygen insufflation protocols. With upper airway occlusion, pressures >50 cm H2 0 were produced by Rapid-O2 and Enk oxygen flow meter in adult and infant lungs, 3-way stopcock in adult and child lungs, and Manujet in all lung sizes. Ventrain produced acceptable pressures <35 cm H2 O in all models. Test lung volumes >20 ml/kg were recorded in airway models with fully obstructed proximal airways using Rapid-O2 and Enk oxygen flow meter in infant lungs, and Manujet in all lung sizes. Rapid-O2 produced lung volumes >20 ml/kg in the infant model with partially obstructed and open upper airways. Test lung volumes >20 ml/kg were produced by the 3-way stopcock in adult, child, and infant models. Insufflation was unsuccessful with the self-inflating bag. Ventrain produced acceptable volumes <7 ml/kg in all airway models. CONCLUSION: Rapid-O2 , Enkoxygen flow meter, Manujet, and 3-way stopcock oxygenation devices produced highly variable and excessive airway pressures and volumes in models with obstructed upper airways. Self-inflating bag insufflation was unsuccessful. Ventrain was the only device that insufflated oxygen with acceptable pressures and volumes in adult, child, and infant airway models with any degree of airway obstruction.

Frontal fibrosing alopecia demographics: a survey of 29 patients.

Frontal fibrosing alopecia (FFA) is a form of scarring alopecia whose diagnosis is increasing globally. Although its etiology is unknown, FFA is thought to be a clinical subset of lichen planopilaris (LPP) that primarily affects postmenopausal women. Patients diagnosed with FFA between January 2006 and December 2013 at clinics of the Washington University Division of Dermatology (St. Louis, Missouri) were studied using patient surveys and chart notes to assess demographics, clinical features, medical history, and treatment. Twenty-nine patients were enrolled in the study, including 28 women and 1 man. The average age of disease onset was 55.4 years (range, 29-75 years). Many patients (55%) had a history of autoimmune diseases, including hypothyroidism (35%), mucocutaneous lichen planus (28%), psoriasis (7%), vitiligo (3%), systemic lupus erythematosus (3%), iritis (3%), Sjögren syndrome (3%), and ulcerative colitis (3%). Patients often identified a stressful inciting event prior to onset of hair loss. Patients tried an average of 3 different treatments for hair loss, with topical and intralesional steroids, hydroxychloroquine, topical calcineurin inhibitors, and excimer laser therapy being the most efficacious at limiting hair loss.

Spontaneous pneumoperitoneum: diagnostic and management difficulties.

Acute abdominal pain is a common presentation to the ED. Most patients undergo a chest radiograph as part of their initial investigations, which occasionally reveals pneumoperitoneum. Pneumoperitoneum on imaging suggests a perforated hollow abdominal viscus and therefore often constitutes a surgical emergency. However, if the patient is neither peritonitic nor septic a management dilemma is faced. Some cases of pneumoperitoneum might be managed conservatively thus avoiding unnecessary laparotomy. We present a case of recurrent spontaneous pneumoperitoneum with abdominal pain that was managed conservatively and discuss the possible aetiologies and management issues of spontaneous pneumoperitoneum.