Pulmonary Contusion and Traumatic Pneumatoceles in a Platform Diver with Hemoptysis.

BACKGROUND: Injuries in divers resulting purely from impact with the water are uncommon in the published literature. We present a case report of pulmonary contusion in a young diver. CASE REPORT: A young, healthy competitive platform diver landed flat on his back in the water from a dive of 10 meters. He complained of upper back pain and had an episode of hemoptysis after the dive. He was initially observed for 15 hours postinjury, and was discharged when three chest radiographs (CXRs) taken at 1, 7, and 11 hours postinjury did not show significant abnormalities. Thirty-six hours postinjury, the patient experienced repeat hemoptysis and returned to the emergency department, where a fourth CXR performed 43 hours postinjury was normal. A computed tomography (CT) scan revealed pulmonary contusion and traumatic subpleural pneumatoceles. The patient was admitted to the cardiothoracic ward for observation. He recovered well with conservative treatment and was discharged on the fifth day after injury with clearance for air travel. In this patient with a high-energy mechanism of rapid deceleration and hemoptysis at the scene, there may be grounds for performing a CT scan of the thorax at the time of the first presentation, although the CT findings did not change conservative management of this patient. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should recognize that a dive into water may generate sufficient impact to produce a pulmonary contusion. If the patient is clinically well and the CXR results are normal, the decision to initiate a CT scan and subsequent disposition may be based on clinical judgement and institutional practice.

Effect of Using an Audiovisual CPR Feedback Device on Chest Compression Rate and Depth.

INTRODUCTION: The aim of the study is to investigate the effect of using Automated External Defibrillator (AED) audiovisual feedback on the quality of cardiopulmonary resuscitation (CPR) in a manikin training setting. MATERIALS AND METHODS: Five cycles of 30 chest compressions were performed on a manikin without CPR prompts. After an interval of at least 5 minutes, the participants performed another 5 cycles with the use of real time audiovisual feedback via the ZOLL E-Series defibrillator. Performance data were obtained and analysed. RESULTS: A total of 209 dialysis centre staff participated in the study. Using a feedback system resulted in a statistically significant improvement from 39.57% to 46.94% (P=0.009) of the participants being within the target compression depth of 4 cm to 5 cm and a reduction in those below target from 16.45% to 11.05% (P=0.004). The use of feedback also produced a significant improvement in achieving the target for rate of chest compression (90 to 110 compressions per minute) from 41.27% to 53.49%; (P<0.001). The mean depth of chest compressions was 4.85 cm (SD=0.79) without audiovisual feedback and 4.91 (SD=0.69) with feedback. For rate of chest compressions, it was 104.89 (SD=13.74) vs 101.65 (SD=10.21) respectively. The mean depth of chest compression was less in males than in females (4.61 cm vs 4.93 cm, P=0.011), and this trend was reversed with the use of feedback. CONCLUSION: In conclusion, the use of feedback devices helps to improve the quality of CPR during training. However more studies involving cardiac arrest patients requiring CPR need to be done to determine if these devices improve survival.