Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation.

BACKGROUND: Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation techniques is poorly understood. METHODS: A prospective randomised clinical trial was undertaken in January 2004 in 70 candidates randomly assigned to training in mouth-to-mouth, mouth-to-mask or mouth-to-face shield ventilation. Each candidate was trained for 10 min, after which tidal volume, respiratory rate, minute volume, peak airway pressure and the presence or absence of stomach inflation were measured. 58 subjects were reassessed 1 year later and study parameters were recorded again. Data were analysed with ANOVA, chi(2) and McNemar tests. RESULTS: Tidal volume, minute volume, peak airway pressure, ventilation rate and stomach inflation rate increased significantly at reassessment with all ventilation techniques compared with the initial assessment. However, at reassessment, mean (SD) tidal volume (960 (446) vs 1008 (366) vs 1402 (302) ml; p<0.05), minute volume (12 (5) vs 13 (7) vs 18 (3) l/min; p<0.05), peak airway pressure (14 (8) vs 17 (13) vs 25 (8) cm H(2)O; p<0.05) and stomach inflation rate (63% vs 58% vs 100%; p<0.05) were significantly lower with mouth-to-mask and mouth-to-face shield ventilation than with mouth-to-mouth ventilation. The ventilation rate at reassessment did not differ significantly between the ventilation techniques. CONCLUSIONS: One year after a single episode of ventilation training, lay persons tended to hyperventilate; however, the degree of hyperventilation and resulting stomach inflation were lower when a mouth-to-mask or a face shield device was employed. Regular training is therefore required to retain ventilation skills; retention of skills may be better with ventilation devices.

[Avalanche emergencies. Review of the current situation]. / Der Lawinennotfall. Eine aktuelle Ubersicht.

In North America and Europe around 140 persons die every year due to avalanches, approximately 35 in North America, 100 in the European Alps, and 5 in other parts of Europe. Most of the victims are skiers and snowboarders. This article outlines the specific pathophysiology of avalanche burials, such as hypoxia, hypercapnia, and hypothermia and also other factors which influence survival. Strategies to minimize the mortality due to avalanches and the on-site treatment of buried persons are discussed. Finally, possibilities to reduce the number of avalanche deaths are pointed out.