Acute medicine & surgery
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Acute medicine & surgery · Jan 2020
Case ReportsSuccessful treatment with artificial pancreas for a patient who attempted suicide using a high-dose insulin s.c. injection.
Artificial pancreas is usually used to manage hyperglycemia. We controlled prolonged hypoglycemia induced by insulin overdose using artificial pancreas. ⋯ The STG-55 artificial pancreas was very useful and convenient for controlling blood glucose levels in our insulin overdose patient.
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Acute medicine & surgery · Jan 2020
Activities of daily living status and psychiatric symptoms after discharge from an intensive care unit: a single-center 12-month longitudinal prospective study.
In post-intensive care syndrome (PICS), long-term survivors of critical illness present various physical and mental symptoms that can persist for years after discharge. Post-intensive care syndrome in Japan has not been well described, so this study aims to elucidate its epidemiology. ⋯ At 3 and 12 months after ICU discharge, over half of our Japanese patients suffered ADL disability and/or psychiatric symptoms. The ADL disability improved at 1 year, but psychiatric symptoms did not.
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Acute medicine & surgery · Jan 2020
ReviewBasic point-of-care ultrasound framework based on the airway, breathing, and circulation approach for the initial management of shock and dyspnea.
Ultrasound (US) carried out and interpreted by clinicians at the bedside is now called point-of-care US (POCUS). Clinical studies on POCUS have been carried out based on the ideas of "creation", "extraction", and "combination". "Creation" refers to findings for the upper airway and lung being obtained at the bedside. "Extraction" refers to findings suitable for POCUS being extracted from comprehensive US, including echocardiography, abdominal US, and whole-leg US. "Combination" refers to these POCUS applications being combined for the comprehensive assessment of patients with trauma, shock, or dyspnea. Emergency and critical care physicians have many opportunities to encounter trauma or non-trauma patients with shock, dyspnea, or both. ⋯ Therefore, we propose a basic POCUS framework based on the systematic airway, breathing, and circulation approach for the initial management of shock and dyspnea in adult patients. In this article, we update and review each application of POCUS and their combination in this framework. Furthermore, we propose the practical usage of the framework based on clinical presentations to improve the management of shock and dyspnea.
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Acute medicine & surgery · Jan 2020
Case ReportsProtracted course of coronavirus disease with severe acute respiratory distress syndrome: a case report.
Coronavirus disease (COVID-19) is a growing concern worldwide. Approximately 5% of COVID-19 cases require intensive care. However, the optimal treatment for respiratory failure in COVID-19 patients is yet to be determined. ⋯ We report a protracted case of COVID-19 in a critically ill patient in Japan. Although prone ventilation could contribute to treating hypoxemia, its efficacy in preventing mortality from COVID-19 is unknown.
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Acute medicine & surgery · Jan 2020
Validation of chief complaints, medical history, medications, and physician diagnoses structured with an integrated emergency department information system in Japan: the Next Stage ER system.
Emergency department information systems (EDIS) facilitate free-text data use for clinical research; however, no study has validated whether the Next Stage ER system (NSER), an EDIS used in Japan, accurately translates electronic medical records (EMRs) into structured data. ⋯ Chief complaints, medical history, medications, and physician's ED diagnoses in EMRs were well-translated into existing categories or coding by the NSER system.