Acute medicine & surgery
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Acute medicine & surgery · Jul 2019
ReviewDiagnosis of sepsis-induced disseminated intravascular coagulation and coagulopathy.
Disseminated intravascular coagulation (DIC) is a frequent complication in sepsis. Once patients develop DIC, the mortality rate increases significantly. Moreover, recent studies have suggested that coagulation disorder plays a significant role in the development of organ dysfunction in sepsis. ⋯ As other countries do not provide DIC-specific treatments, early diagnosis is not necessary, and this situation has led to a significant gap. However, as overt-DIC is a late-phase coagulation disorder, a need for early detection has been advocated, and members of the ISTH have recently proposed the category of sepsis-induced coagulopathy. In this review, we introduce the strengths and weaknesses of the major criteria including JAAM-DIC, ISTH overt-DIC, sepsis-induced coagulopathy, and Japanese Society on Thrombosis and Haemostasis-DIC.
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Acute medicine & surgery · Jul 2019
The efficacy of a trauma call system: challenges in managing severe trauma at a rural emergency center without full-time emergency physicians.
There have been some reports about the efficacy of trauma team activation. In November 2015, we implemented a trauma call system, wherein a general surgeon, neurosurgeon, and orthopedic surgeon are called to the emergency department when severe trauma patients are transferred to our emergency department. In this study, we evaluated the efficacy of this trauma call system. ⋯ Our trauma call system did not significantly improve the mortality of trauma patients with an Injury Severity Score ≥16. However, it was effective for reducing the time from the arrival to the start of contrast-enhanced computed tomography or transcatheter arterial embolization.
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Acute medicine & surgery · Jul 2019
Case ReportsParaplesia after surfing in a young female novice surfer: a case report on surfer's myelopathy.
Surfer's myelopathy is a non-traumatic spinal cord injury that was first described in a publication in 2004. However, most emergency physicians are not familiar with this rare disease. ⋯ Emergency physicians must be better informed about surfer's myelopathy. Novice surfers and instructors should be educated on the early signs and symptoms of this condition.
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Acute medicine & surgery · Jul 2019
Case ReportsSuccessful support by veno-arterial extracorporeal membrane oxygenation for severe septic shock caused by Aeromonas hydrophila.
Septic shock is a subset of sepsis accompanied by profound circulatory and cellular metabolism abnormalities. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide temporary cardiac support to improve organ perfusion, hemodynamic support by VA-ECMO for adult patients with septic shock is still controversial. ⋯ Veno-arterial extracorporeal membrane oxygenation is a viable treatment option for adult patients with refractory septic shock accompanied by cardiac dysfunction. Further research is warranted to identify the candidates for support by VA-ECMO in a timely fashion.