Pyoderma gangrenosum is rarely seen in the surgical disciplines. In the described case the patient was initially diagnosed with necrotizing fasciitis and admitted to the intensive care unit suffering from septic shock. The automated implantable cardioverter defibrillator (AICD), the suspected focus for infection, had already been removed. Following weeks of broad spectrum antibiotics and wound debridement without clinical improvement the alternative diagnosis of pyoderma gangrenosum was reached. Consequently the patient was treated with immunosuppressive therapy and his condition improved rapidly such that he was ultimately discharged to rehabilitation.

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Background Over the past year, there has been a significant increase in rapid antigen test (RAT) detection of SARS-CoV‑2 COVID-19. Antigen detection is usually inferior to real-time reverse transcription polymerase chain reaction (RT-PCR) in terms of sensitivity and specificity. The aim of this study was to evaluate a RAT for specificity and sensitivity in an asymptomatic collective. Methods The study was carried out in January 2021 at a hospital located in a district with a 7-day index and an average of more than 100 cases per 100,000 inhabitants. COVID-19 patients are treated at this hospital. All employees with symptoms typical of COVID-19 were not allowed to go to work. We used RAT by Roche® (Roche Diagnostics GmbH, D-68305 Mannheim) and RT-PCR on our employees. The testing was done voluntarily. We performed RT-PCR and RAT using two swab tubes at the same time. Results We could correlate 919 RAT to 919 RT-PCR tests. 12 people tested positive in RAT. All 12 tests were validated by RT-PCR. There was not one incorrect positive result in RAT. In one person COVID-19 was not detected by RAT, but then positively identified with a RT-PCR. In the group of positive RAT, the mean cycle threshold (CT) value was 19.95. Our results showed a sensitivity of 92.3%, CI (confidence interval) [0.78; 1.00] and a specificity of 100.00% CI [1.0; 1.0]. Conclusion RAT can be an important tool for screening for SARS-CoV‑2 COVID-19 at the point of care. With low cost and resource needs, high specificity, and high specificity, RAT are performed best during the early stages of SARS-CoV‑2 COVID-19, when the viral loads are high.

Background Advanced airway management (AAM) is part of the standard treatment during advanced cardiac life support (ACLS). Current studies underline the importance of a first-pass intubation success (FPS) during in-hospital ACLS. It was shown that a failed initial intubation attempt in out-of-hospital cardiac arrest (OHCA) patients in the emergency department is an independent risk factor for the decreased effectiveness of ACLS measured by the return of spontaneous circulation (ROSC). Objective This study first examines the association between prehospital FPS and ROSC in adults with OHCA and second identifies factors associated with FPS and ROSC. The initial hypothesis was that FPS would increase the probability of ROSC as well as decrease the time to ROSC. Material and methods A retrospective multicenter analysis of 180 adult non-traumatic OHCA patients on whom advanced airway management (AAM) was performed between July 2017 and December 2018 in five different German physician-staffed ambulance stations. For information on FPS the Intubation Registry, and for information on ROSC the German Resuscitation Registry were used. In addition to yes/no questions, multiple answers and free text answers are possible in those questionnaires. The main outcome variables were ‘FPS’, ‘ROSC’ and ‘time to ROSC’. Mann-Whitney tests, χ2-tests, Fisher’s exact tests and multivariate binary logistic regressions were used for the statistical evaluation. Demographic factors, characteristics of the performer, selected equipment, laryngoscopy type, intubation method, medications, verification of tube position, respiratory evaluation, complications and time to ROSC were examined with respect to the influence on FPS. Concerning ROSC, the following factors were examined: demographic factors, initial heart rhythm, initial breathing, medications, defibrillation and AAM. Results An FPS was recorded in 150 patients (83.3%), and ROSC was achieved in 82 patients (45.5%) after an average time of 22.16 min. There was a positive association between FPS and ROSC (p = 0.027). In patients with FPS, a trend for shorter time to ROSC was observed (p = 0.059; FPS 18 min; no FPS 28 min). The use of capnography (odds ratio, OR = 7.384, 95% confidence interval, CI 1.886–28.917) and complications during AAM (OR = 0.033, 95% CI: 0.007–0.153) were independently associated with FPS. The independent factor associated with ROSC was FPS (OR = 5.281, 95% CI: 1.800–15.494). Conclusion In prehospitally resuscitated adult OHCA patients with AAM, FPS is associated with a higher chance of ROSC.

Zusammenfassung Hintergrund und Fragestellung In der prähospitalen Notfallmedizin ist ein erweitertes Atemwegsmanagement eine wichtige Fähigkeit für Notärzte und Notärztinnen . Sein Erfolg bestimmt die Komplikationen und die Sterblichkeit der Patient(inn)en. Ziel der Studie war es, das prähospitale erweiterte Atemwegsmanagement der bodengebundenen Rettungsdienste in zwei vergleichbaren deutschen Städten zu charakterisieren. Material und Methoden Retrospektive Analyse eines prähospitalen Atemwegsmanagementregisters (intubationsregister.de) im Jahr 2018, mit einem Vergleich der Patientenfaktoren, der Intubationssituation, der Charakteristika des Rettungsteams und des Rettungsdiensts in zwei mittelgroßen Städten in Deutschland. Ergebnisse Trotz ähnlicher Demografien und vergleichbarer Strukturen der Rettungsdienste fanden sich relevante Unterschiede in der Intubationssituation, dem Ausbildungsgrad der Notärzte und Notärztinnen, der Art der verwendeten Muskelrelaxanzien, der Verfügbarkeit der Videolaryngoskopie, dem Erfolg des ersten Intubationsversuchs und Komplikationen. Diskussion Eine strukturierte Erhebung des prähospitalen Atemwegsmanagements und ein Vergleich zwischen den Rettungsdiensten unterschiedlicher Städte können relevante Unterschiede aufzeigen und neue Ansatzpunkte für eine verbesserte Patientenversorgung bieten. Weitere Untersuchungen sind notwendig, um die Ergebnisse zu bestätigen und weitere Fragestellungen anschließen zu können.