Internal and emergency medicine
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Demand for emergency ambulances has been increasing in developmentally advanced countries, and in Japan demand has been increasing due to the aging population since 2008, when the total population began to decrease. However, we do not know how acceleration of the aging population relates to the demand for emergency ambulances. Thus, we estimated future demand for emergency ambulances in Japan. ⋯ The number of emergency ambulance dispatches has increased since 2008, and it is expected to continue to increase until around 2023 or 2024, when it will reach a peak of ~6.2 million per year. Similarly, the number of emergency transports is expected to continue to increase until 2022 or 2023, when it will reach a peak of ~5.3 million per year. Although we need to be careful when evaluating numbers predicted for the remote future due to methodological limitations, the findings might be useful for updating emergency medical care systems to prepare for future increases in demand.
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Chest ultrasonography is a useful tool to assess extravascular lung water at bedside. In presence of interstitial-alveolar imbibition, vertical artifacts arising from the pleura are detected; these are called B-lines. Although a positive linear correlation between B-lines and extravascular lung water has been shown in symptomatic heart failure patients, the subclinical phase of pulmonary imbibition and the clearance of B-lines after rapid body fluid removal have been less investigated. ⋯ Moreover, B-lines reduction was significantly related to weight loss. Ultrasound performed at the bedside can detect lung water and intravascular overload and their reduction after dialysis in yet asymptomatic patients. These observations add further evidence regarding the use of lung ultrasound and inferior vena cava measurement in estimating volume overload and monitoring the response to therapy both in hemodialysis and congestive heart failure patients.