Nihon rinsho. Japanese journal of clinical medicine
-
There is no "complete safety" in the medical treatment. Unavoidable events or human errors may frighten the patients' safety. Because of its characteristics, emergency medicine is one of the medical fields where treating the patients under the vast safety is difficult. ⋯ The implementation of the safety measures, such as minimum encounter, minimum probability, multiple detections, and minimum damage is helpful to prevent unfortunate outcomes. Since the emergency medicine treats the severely injured or critical ill patients, its daily works are the picture of the crisis management, and the most suitable environment to train the crisis management competence. The person in charge of crisis management of the institution should put the emergency department to practical use of medical staffs' crisis management training.
-
A role of acute hospitals providing emergency care is becoming important more and more in regional comprehensive care system led by the Ministry of Health, Labour and Welfare. Given few number of emergent care specialists in Japan, generalists specializing in both general internal medicine and family practice need to take part in the emergency care. In the way collaboration with specialists and regional primary care physicians is a key role in improving the quality of emergency care at acute hospitals. A pattern of collaborating function by generalists taking part in emergency care is categorized into four types.
-
Extracorporeal membrane oxygenation therapy (ECMO) is an artificial life support for severe respiratory and/or cardiac failure, and refractory cardiac arrest. It consists of a hollow-fiber membrane that oxygenates the blood and removes carbon dioxide and a centrifugal pump that drain blood from central venous circulation, pump through membrane, and return to the patients. ⋯ Veno-arterial ECMO offers hemodynamic support in addition to gas change for cardiac failure or refractory cardiac arrest. We describe the physiological principles and the clinical evidence supporting the use of ECMO in critically ill adult patients.
-
Fifteen years have passed since lung protective strategy to the patients with acute respiratory distress syndrome (ARDS) established. Recently, the new Berlin Definition of ARDS has been developed and this classified ARDS into three stages (mild, moderate, and severe ARDS), depending on the PaO2/FiO2. After this new definition of ARDS, each treatment to the patients with ARDS should be considered, depending on the severity of lung injury, such as prone position to the patients with severe ARDS, muscle paralysis to the patients with severe ARDS. In this review article, we review the history of lung protective strategy and ARDS definition, discuss the novel physiological approaches to minimizing ventilator-induced lung injury, and highlight a numbers of experimental/clinical studies to support these concepts.
-
It is necessary to treat the patient from the site of the emergency to raise a lifesaving rate of the patient. As a prime example would be out-of-hospital cardiac arrest. Once you start the treatment after hospital arrival, cardiac arrest patient can't be life-saving. ⋯ It is because of that the quantity and quality of the emergency life-saving technician are being enhanced. And also doctor-helicopter system have been enhanced. Medical control is a critical component of the improvement.