Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jul 1999
Review[Recent advances in the management of severely burned patients].
With recent advances in the systemic care of burns, patients with burns covering 80% of their body surface can frequently survive. The percentage of total body surface area burn for an expected 50% mortality rate has improved to 98% for children and 72% for adults in one burn center in the USA. From the results of 11 burn units in Tokyo, the mortality rate of burn patients with a prognostic burn index of 90-100 was 51.4%. ⋯ Early eschar excision and wound closure by immediate grafting have further reduced the mortality rate from extensive full-thickness burns. The use of bilayer artificial skin has improved the survival and cosmetic results of early eschar excision in patients with massive full-thickness burns. Cultured autologous epidermal sheets hold promise if used on an appropriate dermal bed.
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Trauma patients who receive exsanguinating torso injuries often develop hypothermia, metabolic acidosis, and coagulopathy before death. A new strategy for trauma surgery has been developed to avoid the occurrence of these events and hence prevent trauma deaths. The strategy is called "damage control surgery" and consists of three maneuvers: a) damage control; b) restoration of physiologic stability; and c) definitive surgery. ⋯ Planned reoperation is usually possible within 36 hours after the initiation of intensive care. Some patients who undergo damage control develop abdominal compartment syndrome characterized by increased intraabdominal pressure, increased peak airway pressure, decreased urine output, and decreased cardiac output. Early decompression surgery should be considered in such patients.
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Nihon Geka Gakkai zasshi · Jul 1999
Review[Progress in interventional radiology (IVR) in emergency medicine].
IVR has attracted much attention in Japan over the past decade, and it is expected to be rapidly developed and widely used. Not surprisingly, IVR has already become essential in emergency medicine. This paper addresses IVR of the thoracic and abdominal areas and the pelvis in emergency medicine, in particular the recent IVR focus on the vasculature. ⋯ Continuous regional arterial infusion of protease inhibitor, in an attempt to cure severe acute pancreatitis, significantly reduced the infectious rate at the necrotic lesion, and its resulting mortality rate. It is certain that great progress has been made in emergency medicine. We also should realize that it is desirable to be well versed even in new IVR.
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In July 1997 we began support of paramedics who would respond to emergency scenes using a telecommunications system based in the hospital emergency unit. However, since no telecommunications system that could be employed on the actual clinical site was available, we had to develop a new system. ⋯ Based on 57 cases of clinical telemedical intervention, the system has enabled high-quality decision making by specialists without the need for them to travel to the scene or transport X-rays films, ultrasonographic reports, or endoscopic results. If this newly developed telecommunications system is employed for telemedical interventions in medical facilities in remote areas or on remote islands, medical consultations for Japanese individuals overseas, night-time first aid in urban areas, and in disaster situations, the physicians on both side of the line will be able to obtain a wealth of timely information, greatly influencing outcome in both emergency and nonemergency cases.
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Nihon Geka Gakkai zasshi · Jul 1999
Review[Out-of-hospital cardiac arrest and the Utstein style: utilization of an international standardized format to evaluate surgical outcome].
The Utstein style is the recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest. The Utstein style was, originally developed to analyze out-of-hospital cardiopulmonary arrest due to cardiac etiology. However trauma remains a major cause of out-of-hospital cardiac arrest and it is recommended that it also be reported accurately by the Utstein style. ⋯ MAST is has been shown to be beneficial experimentally in traumatic shock and cardiac arrest, but this has not been confirmed clinically and Mast is used rarely. Emergency room resuscitative thoracotomy is a common treatment for cardiac arrest due to trauma. There have been no survivors among those who experienced trauma-related cardiac arrest and showed no signs of life before transport to a hospital, although the survival rate of cardiac arrest due to penetrating chest injury is relatively high, clinical date should be accumulated following the Utstein style to determine the indications for these treatments.