Acute medicine & surgery
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Acute medicine & surgery · Apr 2017
ReviewHigh-grade traumatic torso visceral injury with hemodynamic instability: effectiveness of transarterial embolization using n-butyl cyanoacrylate.
Trauma patients with uncontrolled hemorrhage encountering coagulopathy are often associated with poor outcome. Recently, the concept of damage control interventional radiology, which focuses on "speedy stoppage of bleeding" by interventional radiology among trauma patients with hemodynamic instability and acute traumatic coagulopathy, was proposed as an alternative to damage control surgery. N-butyl cyanoacrylate (NBCA) has been used as a liquid embolic agent in various non-traumatic situations, where it has been shown to have a high technical success rate and low recurrent bleeding rate, especially in patients with coagulopathy. ⋯ Among them, only four reports involving five trauma patients with torso visceral injuries were identified. Three of five patients who were hemodynamically unstable underwent AE using NBCA, resulting in the stabilization of hemodynamics. We concluded that AE with resuscitative endovascular balloon occlusion of the aorta as a damage control interventional radiology procedure might be acceptable for the hemodynamically unstable hepatic injury, and NBCA could be one of the effective hemostatic agents for this purpose, in cases of trauma-induced coagulopathy.
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Acute medicine & surgery · Apr 2017
Development of new equipment for intra-arrest brain cooling that uses cooled oxygen in the lungs: volunteer study.
Many experimental studies have reported that intra-arrest cooling during cardiac arrest is a promising treatment to mitigate brain injury. However, there is no clinically established method for cooling the brain during cardiac arrest. We hypothesized that, as blood flow in the lungs must be very slow during cardiopulmonary resuscitation, the blood could be cooled by ventilating the lungs with cooled oxygen like a radiator, and that this cooled blood would in turn cool the brain. The aim of this study was to develop equipment to cool oxygen for this purpose and to confirm its safety on a group of volunteers. ⋯ We successfully developed new equipment to cool oxygen and established its safety in a volunteer study.
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Acute medicine & surgery · Apr 2017
Inter-rater reliability of the American Society of Anesthesiologists physical status rating for emergency gastrointestinal surgery.
The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is used worldwide and has also been incorporated into various prediction rules. However, concerns have been raised regarding inter-rater agreement in various surgical fields. Although emergency gastrointestinal surgery is relatively common and associated with high postoperative mortality, a reliability study has not yet been undertaken in this field. The aim of the present study was to investigate the inter-rater reliability of ASA-PS for emergency gastrointestinal surgery. ⋯ The results of the present study revealed the consistency of ASA-PS ratings between anesthesiologists for emergency gastrointestinal surgery. The ASA-PS may serve as a reliable variable in the prediction rules for this field.