Acute medicine & surgery
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Acute medicine & surgery · Apr 2018
ReviewA summary of the Japan septic disseminated intravascular coagulation study.
Over the past few decades, the large, international, randomized controlled trials of anticoagulant therapies for patients with sepsis have not yielded any improvement in mortality rates. However, in Japan, anticoagulant therapies are administered for sepsis patients with disseminated intravascular coagulation (DIC), but not for sepsis patients without DIC. ⋯ The JSEPTIC DIC study enrolled 42 intensive care units and included 3,195 patients with sepsis. The results of the JSEPTIC DIC study indicated the following: (i) anticoagulant therapy may be effective in sepsis-induced DIC patients at high risk for death, (ii) recombinant human soluble thrombomodulin administration and antithrombin supplementation are associated with survival benefits in patients with sepsis-induced DIC.
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Acute medicine & surgery · Apr 2018
Accuracy of the smaller superior mesenteric vein sign for the detection of acute superior mesenteric artery occlusion.
The smaller superior mesenteric vein (SMV) sign is a well-known computed tomography (CT) parameter for acute superior mesenteric artery (SMA) occlusion. This CT sign is potentially beneficial for the early diagnosis of acute SMA occlusion; however, few reports have documented this sign. The present study aimed to determine the accuracy of the smaller SMV sign for the detection of acute SMA occlusion. ⋯ The smaller SMV sign is an accurate and important CT parameter for the detection of acute SMA occlusion.
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Acute medicine & surgery · Apr 2018
Quality of dispatch-assisted cardiopulmonary resuscitation by lay rescuers following a standard protocol in Japan: an observational simulation study.
Bystander cardiopulmonary resuscitation (CPR) is essential for improving the outcomes of sudden cardiac arrest patients. It has been reported that dispatch-assisted CPR (DACPR) accounts for more than half of the incidence of CPR undertaken by bystanders. Its quality, however, can be suboptimal. We aimed to measure the quality of DACPR using a simulation study. ⋯ This current simulation study showed that the quality of DACPR carried out by lay rescuers can be less than optimal in terms of depth, hand placement, and minimization of pauses. Further studies are required to explore better DACPR instruction methods to help lay rescuers perform CPR with optimal quality.
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Acute medicine & surgery · Apr 2018
Case ReportsLemierre's syndrome presented with acute pancreatitis.
Lemierre's syndrome is a rare clinical condition that is characterized by infected internal jugular vein thrombosis with metastatic septicemia. The most common causative agent is Fusobacterium necrophorum. A previously healthy 37-year-old woman presented to our emergency department with nausea, vomiting, and diarrhea. She was admitted to the general practice unit with a diagnosis of acute pancreatitis then was subsequently transferred to the intensive care unit due to shock. Physical examination revealed tenderness on right side of the neck. Blood cultures were remarkable for F. necrophorum. Clinical symptoms led to subsequent ultrasound and computed tomography scan of the neck, confirming internal jugular vein thrombosis. ⋯ We report a case of Lemierre's syndrome that presented as acute pancreatitis. The high index of suspicion of this disease is important for early diagnosis.
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Acute medicine & surgery · Apr 2018
Risk factors for prolonged mechanical ventilation in patients with severe multiple injuries and blunt chest trauma: a single center retrospective case-control study.
Blunt chest trauma is common and is associated with morbidity and mortality in patients with multiple injuries, frequently requiring invasive mechanical ventilation. The aim of this study was to elucidate risk factors for prolonged mechanical ventilation (PMV). ⋯ Severe GCS (≤8), flail chest, or TTSS may be independent risk factors. Combining the three risk factors could provide high predictive performance for PMV.