Acute medicine & surgery
-
Acute medicine & surgery · Oct 2016
Targeted age, device deployment, and problems associated with pediatric defibrillation in pediatric prehospital emergency medical care settings in Japan.
The use of automated external defibrillators was expanded to include infants according to the 2010 cardiopulmonary resuscitation guidelines in Japan. However, deployment has been slower for pediatric patients in Japan, because there are fewer appropriate pediatric patients for automated external defibrillators than adults. This study aimed to investigate the targeted age range for pediatric defibrillation and device deployment of defibrillators for pediatric patients in prehospital emergency medical care settings in Japan, and present the issues associated with automated external defibrillators. ⋯ Pediatric prehospital emergency medical care in Japan is inadequately equipped for pediatric defibrillation. It will be necessary to use age-appropriate defibrillators as the targeted age range for automated external defibrillators rapidly expands to include infants.
-
Acute medicine & surgery · Oct 2016
A national survey examining recognition, demand for antivenom, and overall level of preparedness for redback spider bites in Japan.
Redback spiders are rapidly becoming a nationwide problem in Japan. The domestic production of antivenom for redback spider bites has been started because of extremely low supply. The purpose of this study was to investigate the ability of emergency physicians to recognize redback spider bites and to examine the demand for antivenom and identify the ideal choice for storage. ⋯ The recognition of redback spider bites was low; however, the demand for antivenom was high. The storage of antivenom within their own prefectures or regions was considered to be the best option for initial supply planning. Emergency medical service centers are also good candidates for storage and safe use of antivenom.
-
Acute medicine & surgery · Oct 2016
Analysis of consumption of medical resources in terms of intensive care unit/hospital stay and severity using Japan Trauma Data Bank.
We analyzed the length of intensive care unit or hospital stay of trauma patients to assess the consumption of medical resources using the Japan Trauma Data Bank. ⋯ Based on the Japan Trauma Data Bank data for many trauma patients, there are numerous cases of long-term stay ≥15 days in intensive care in patients who could not be transferred to a general ward and who consumed the medical resources in the critical care department.
-
Acute medicine & surgery · Oct 2016
ReviewLactate, a useful marker for disease mortality and severity but an unreliable marker of tissue hypoxia/hypoperfusion in critically ill patients.
Early aggressive hemodynamic resuscitation using elevated plasma lactate as a marker is an essential component of managing critically ill patients. Therefore, measurement of blood lactate is recommended to stratify patients based on the need for fluid resuscitation and the risks of multiple organ dysfunction syndrome and death. Hyperlactatemia is common among critically ill patients, and lactate levels and their trend may be reliable markers of illness severity and mortality. ⋯ However, hyperlactatemia can also result from aerobic glycolysis, unrelated to tissue dysoxia, which is unlikely to respond to increases in systemic oxygen delivery. Because hyperlactatemia may be simultaneously related to, and unrelated to, tissue hypoxia, physicians should recognize that resuscitation to normalize plasma lactate levels could be over-resuscitation and may worsen the physiological status. Lactate is a reliable indicator of sepsis severity and a marker of resuscitation; however, it is an unreliable marker of tissue hypoxia/hypoperfusion.