ABSTRACT
A 59-year-old male presented to the emergency department complaining of severe posterior neck pain and progressive extremity weakness for 2 weeks. He was found to be quadriplegic with complete sensory and motor deficits at the C5 level and hypotensive. Diagnostic imaging revealed discitis/osteomyelitis at the C5-C6 and C6-C7 vertebral levels with multiple spinal epidural abscesses extending from C5-C7 with resulting severe spinal canal narrowing with cord compression. Imaging also showed a right vertebral artery occlusion, acute right posterior cerebral artery infarct, retropharyngeal abscess, and extensive paraspinal soft tissue myonecrosis. Vasopressors and broad-spectrum antibiotics were started. He was then transferred to a tertiary medical center where he underwent emergent cervical spine decompression surgery with laminectomy from C3-C7, paraspinal soft tissue debridement, and abscess incision and drainage. He suffered a complicated hospital course and despite aggressive treatment developed worsening infectious myelopathy and died in the hospital. This case involves the rare presentation of quadriplegia and acute cerebral infarction associated with necrotizing fasciitis and spinal epidural abscesses that originated from a retropharyngeal abscess. To date, there have been no cases documenting such a phenomenon, and epidural abscess has not been known to cause adjacent necrotizing fasciitis. Furthermore, vertebral artery thrombosis via mass effect from local infection leading to acute embolic stroke has never been reported. This report sheds light on rare sequela of a tracking retropharyngeal and epidural abscess. Prompt recognition, diagnosis, and treatment are vital to maintain infectious source control and preserve neurological function, although many develop persistent deficits.
ABSTRACT
BACKGROUND: Optimal cardiopulmonary resuscitation (CPR) performance is the foundation of successful cardiac arrest resuscitation. However, health care providers perform inadequate compressions. Better training techniques and real-time CPR feedback may improve compression performance. OBJECTIVE: We sought to evaluate the impact of a targeted training program combined with real-time defibrillator CPR feedback on chest compression performance in an international cohort of health care providers. METHODS: Physicians, nurses, respiratory therapists, and technicians from 6 hospitals in 5 countries (Taiwan, Singapore, China, Bahrain, and Kuwait) participated in a standardized resuscitation workshop. Chest compression was measured before and after didactics and activation of CPR feedback. Compressions were performed for 1 min on standard CPR manikins placed on a hospital bed and backboard and measured using ZOLL R Series defibrillators. The percentage of compressions meeting target values for depth and rate were compared before and after the workshop and activation of real-time CPR feedback. No depth maximum was defined to allow for mattress compression. RESULTS: Chest compressions were more likely to meet targets for depth (71-95%, odds ratio [OR] 8.61 [95% confidence interval {CI} 4.42-16.77], p < 0.001), rate (41-81%, OR 6.4 [95% CI 4.2-9.8], p < 0.001), and both depth and rate (5-42%, OR 2.4 [95% CI 6.7-22.9], p < 0.001) after the workshop and activation of real-time CPR feedback. CONCLUSIONS: A targeted training intervention combined with real-time CPR feedback improved chest compression performance among health care providers from various countries.
ABSTRACT
BACKGROUND: Cardiac arrest survival depends upon chest compression quality. Real-time audiovisual feedback may improve compression guideline adherence, particularly with the more specific 2015 guidelines. METHODS: Subjects included healthcare providers from multiple U.S. hospitals. Compression rate and depth were recorded using standard manikins and real-time audiovisual feedback defibrillators (ZOLL R Series). Subjects were enrolled before (nâ¯=â¯756) and after (nâ¯=â¯995) release of the 2015 guidelines, which define narrower compression targets. Subjects performed 2â¯min of continuous compressions before and after activation of feedback. The percentage of compressions meeting appropriate rate/depth targets was determined before and after release of the 2015 guidelines. RESULTS: An increase in compression guideline adherence was observed with use of feedback before [68.7% to 96.3%, p <â¯.001] and after [16.6% to 94.1%, pâ¯<â¯.001] release of the 2015 guidelines. The proportion of subjects requiring feedback to achieve adherence was higher for the 2015 guidelines [28.6% vs. 78.5%, OR 9.12, 95% CI 7.33-11.35, pâ¯<â¯.001]. CONCLUSIONS: The use of real-time audiovisual feedback increases adherence to chest compression guidelines, particularly with application of the narrower 2015 guidelines targets for compression depth and rate.
