Acute medicine & surgery
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Acute medicine & surgery · Oct 2018
Overview of doctor-staffed ambulance use in Japan: a nationwide survey and 1-week study.
In Japan, standard prehospital care is provided by emergency medical services teams. Doctor-staffed ambulances play a role in facilitating the immediate treatment of critically ill patients to increase the survival rates. However, little is known about their activities. We revealed the present situation of doctor-staffed ambulances in Japan. ⋯ Doctor-staffed ambulances have the advantage of deployment at night and in urban areas compared to doctor-staffed helicopters. Among the 73 hospitals that responded to the questionnaire, doctor-staffed ambulances were dispatched almost as frequently as doctor-staffed helicopters. However, doctor-staffed ambulances did not receive adequate funding. Future data collection is necessary to determine the efficacy of doctor-staffed ambulances among hospitals that operate this service.
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Acute medicine & surgery · Oct 2018
Case ReportsSevere acute respiratory distress syndrome in a patient with AIDS successfully treated with veno-venous extracorporeal membrane oxygenation: a case report and literature review.
Several successful uses of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome in patients with novel HIV/AIDS infection have been reported; however, the therapeutic keys have not always been discussed.A 47-year-old man was admitted with progressive shortness of breath. He was in respiratory failure with a PaO2/FIO2 ratio of 110.8 requiring intubation. Chest computed tomography showed diffuse ground glass opacities. An HIV infection was suspected, and a diagnosis of acute respiratory distress syndrome was made. Based on clinical indications, treatment for Pneumocystis jirovecii pneumonia and concomitant bacterial infection was started. ⋯ In acute respiratory distress syndrome in patients with HIV/AIDS refractory to treatment, ECMO should be considered. Post-ECMO antiretroviral therapy could improve outcomes.
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Acute medicine & surgery · Jul 2018
Characteristics distinguishing abusive head trauma from accidental head trauma in infants with traumatic intracranial hemorrhage in Japan.
To identify markers for detecting abusive head trauma (AHT) and its characteristics in the Japanese population. ⋯ The age range of AHT in Japan is significantly different from that of countries in Europe and North America because of familial and sociocultural situations. Absence of bruising, and rib or long bone fractures did not reduce the likelihood of AHT. Subdural hematoma without findings of an impact to the head strongly suggested AHT. Abusive head trauma is a global problem, however, diagnosis and defensive measures likely need to be tailored to accommodate cultural risk factors.
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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.