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ObjectiveAerosols and droplets are the main vectors in transmission of highly contagious SARS-Cov-2. Invasive diagnostic procedures like upper airway and gastrointestinal endoscopy have been declared as aerosol generating procedures. Protection of health care workers is crucial in times of COVID-19 pandemic.MethodsWe simulated aerosol and droplet spread during upper airway and gastrointestinal endoscopy with and without physico-mechanical barriers using a simulation model.ResultsA clear plastic drape as used for central venous access markedly reduced visualized aerosol and droplet spread during endoscopy.ConclusionA simple and cheap drape has the potential to reduce aerosol and droplet spread during endoscopy. In terms of health care worker protection, this may be important particularly in low- or moderate-income countries.

ObjectiveTo evaluate leg-heel chest compression without previous training as an alternative for medical professionals and its effects on distance to potential aerosol spread during chest compression.Methods20 medical professionals performed standard manual chest compression followed by leg-heel chest compression after a brief instruction on a manikin. We compared percentage of correct chest compression position, percentage of full chest recoil, percentage of correct compression depth, average compression depth, percentage of correct compression rate and average compression rate between both methods. In a second approach, potential aerosol spread during chest compression was visualized.ResultsThere was no significant difference between manual and leg-heel compression. The distance to potential aerosol spread could have been increased by leg-heel method.ConclusionUnder special circumstances like COVID-19-pandemic, leg-heel chest compression may be an effective alternative without previous training compared to manual chest compression while markedly increasing the distance to the patient.

Das Verstandnis der Regulation des Elektrolyt- und Wasserhaushalts ist Voraussetzung fur die richtige Therapie im Notfall. In diesem Artikel werden die Elektrolyte Natrium und Kalzium besprochen. Eine Hypernatriamie tritt haufig bei Dehydratation auf und hat als wichtigste Differenzialdiagnose im Notfall den seltenen Diabetes insipidus. Die haufig vorkommende Hyponatriamie hat dagegen eine Reihe von Differenzialdiagnosen mit unterschiedlichen Therapien, die vom Notfallmediziner beherrscht werden mussen. Das Serumkalzium ist fur die Nervenfunktion wichtig. Eine hyperkalzamische Krise fuhrt zur Dampfung des Zentralnervensystems (ZNS; Koma) und zum hypovolamischen Schock. Eine Hypokalzamie lost eine Erregung des peripheren Nervensystems (Tetanie) aus und ist klinisch nicht von einer Hyperventilationstetanie zu unterscheiden. Bei den Elektrolytstorungen sind die Diagnosestellung und die Therapieeinleitung oft schon in der Notaufnahme moglich.

Objective To evaluate the effect of strategies to reduce the spread of simulated aerosol during chest compressions on manikin and cadaver experimental models. Methods To evaluate aerosol-spread we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a further approach we applied nebulized detergents into the airways of human cadavers and detected the simulated spread on the same way. Among others we did recordings with undergoing compression-only-CPR, with a surgical mask or an oxygen mask on the patients face and with an inserted supraglottic airway device with and without a connected airway filter. Results Most aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask and of an oxygen mask on the patient's face deflected the spread. Inserting a supraglottic airway device connected to an airway filter lead to a remarkable reduction of aerosol-spread. Conclusion The early insertion of a supraglottic airway device connected to an airway filter before starting chest compression may be beneficial for staff protection during CPR.

ObjectiveTo evaluate aerosol-spread in cardiopulmonary resuscitation (CPR) using different methods of airway management. Knowledge about aerosol-spread is vital during the SARS-CoV-2-Pandemic.MethodsTo evaluate feasibility we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a second approach we applied nebulized detergents into human cadavers by an endotracheal tube and detected aerosol-spread during chest compressions the same way. We did recordings with undergoing compression-only-CPR, with a surgical mask and with an inserted laryngeal tube with and without a connected airway filter.ResultsMost aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask deflected the spread. Inserting a laryngeal tube connected to an airway filter lead to a remarkable reduction of aerosol-spread.ConclusionThe early insertion of a laryngeal tube connected to an airway filter before starting chest compression may be good for two things – the treatment of hypoxemia as the likeliest cause of cardiac arrest and for staff protection during CPR.

Repeated vomiting may lead to profound loss of fluid and electrolytes. We describe a case with life-threatening acid-base disturbances due to vomiting. A 38-year-old man presented to an emergency department with weakness and decreased urine output after having vomited up to 20 times per day over a period of 7 days. Arterial blood gas analysis revealed a metabolic alkalosis with partial respiratory compensation. Initial management consisted of oxygen therapy and intravenous fluid therapy with normal saline and potassium chloride. To prevent further gastric losses of HCl, proton-pump inhibitors and metoclopramide were administered. The vomiting was caused most likely by a temporary duodenal stenosis due to portal hypertension of unknown etiology. In our opinion, this case demonstrates the successful management of a life-threatening condition by simple measures. Despite extensive diagnostic procedures, the effective treatment of the underlying condition consisted of watchful waiting.

A 70-year-old woman presented with atrial fibrillation and a new systolic murmur. Transthoracic echocardiography (see Supplementary material online, Video S1 ) and magnetic resonance imaging (see Supplementary material online, Video S2 ) revealed a 4 × 6 cm mass in the left atrium reaching to the mitral valve ( Panel A ) resulting in elevated pressure gradients and mild–moderate mitral regurgitation ( Panel A ). Transoesophageal echocardiography depicted a mass infiltrating the left atrial posterolateral wall and auricle with contact to the posterior mitral leaflet (see Supplementary material online, Videos S3 and S4 ). During surgery, a tumour of 1.5 cm …