Language：English   Publishing type：Research paper (scientific journal)  

The purpose of this study was to develop and validate an emergency medical technician (EMT) care patient satisfaction scale to measure patient satisfaction with prehospital emergency care. To date, patient satisfaction surveys of EMTs have been performed subjectively, e using each facility's questionnaire, without the use of a validated patient satisfaction scale. However, no specific scale has been devised to assess patient satisfaction with EMTs. The study population comprised patients who used an ambulance between November 2020 and May 2021 (N = 202). A survey instrument was administered to participants who provided informed consent. In the process of validating the patient satisfaction scale, an exploratory factor analysis (EFA) of construct validity was performed. The results of the EFA showed a factor structure consisting of five factors: "teamwork", "explanation and communication", "physical treatment and psychological support", "quickness of transport", and "environment in the ambulance". In addition, domain and summary scores showed good internal reliability (Cronbach's range = 0.82-0.94). The patient satisfaction scale developed in this study was designed and validated considering the role of EMTs and patients' needs for prehospital care. This scale may be useful in the development of assessments and interventions to improve patient satisfaction with EMTs.

DOI： 10.3934/publichealth.2023011

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本医療情報学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本医療情報学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本救急医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本救急医学会  

Ichushi

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DOI： 10.1016/j.brainres.2022.147949

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Background: Since the global outbreak of coronavirus disease 2019 (COVID-19), there have been several reports of mucormycosis as a secondary complication. However, the disseminated type of mucormycosis is extremely rare. Case: A 58-year-old male patient with COVID-19 started receiving venovenous extracorporeal membrane oxygenation because of severe respiratory failure. During hospitalization, intra-abdominal hemorrhage occurred and an emergency laparotomy was performed. Subsequently, the patient suffered septic shock, and part of the small intestines and the abdominal wall became necrotic. Finally, the patient died. At autopsy, he was diagnosed with disseminated mucormycosis. Conclusion: Disseminated mucormycosis should be considered in patients with COVID-19 with refractory sepsis unresponsive to broad-spectrum antimicrobial therapy.

DOI： 10.1016/j.idcr.2022.e01578

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BACKGROUND: In patients with coronavirus disease (COVID-19) due to severe acute respiratory syndrome coronavirus 2 infection, pneumomediastinum has been increasingly reported in cases of noninvasive oxygen therapy, including high-flow nasal cannula, and invasive mechanical ventilation. However, its pathogenesis is still not understood. CASE PRESENTATION: We report two cases of pneumomediastinum in acute respiratory distress syndrome (ARDS) caused by COVID-19. In both cases, control of spontaneous breathing with neuromuscular blocking agents resulted in resolution of pneumoperitoneum. CONCLUSION: The improvement of pneumomediastinum with control of spontaneous breathing suggested patient self-inflicted lung injury as a possible mechanism in this case series. In ARDS cases with pneumomediastinum, in addition to controlling plateau pressure with conventional lung protective ventilation, spontaneous breathing should be controlled if the patient's inspiratory effort is suspected to be strong.

DOI： 10.1002/ams2.796

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Language：Japanese   Publisher：(一社)日本救急医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本救急看護学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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INTRODUCTION: Malignant catatonia (MC) is a movement disorder syndrome characterized by immobility, rigidity, and consciousness disorders that develops in association with mental and physical diseases. It is often fatal due to hyperthermia, rhabdomyolysis, and acute kidney injury. Its clinical symptoms are similar to those of another disorder, neuroleptic malignant syndrome (NMS), and it is often difficult to distinguish between the 2 disorders. PATIENT CONCERNS: An Asian woman in her 60s with history of schizophrenia. She was admitted to our hospital because of symptoms such as fever, unconsciousness, and muscle rigidity. Blood tests showed kidney injury and high creatinine kinase levels. DIAGNOSES: At the time of admission, she had been diagnosed with NMS complicated by pulmonary aspergillosis and was undergoing treatment although there was no improvement. INTERVENTIONS: Subsequently, the administration of propofol, a gamma-aminobutyric acid A agonist, markedly improved the symptoms, and the diagnosis was corrected to MC. At the beginning of her hospitalization, she received dantrolene, bromocriptine, amantadine, and L-3,4-dihydroxyphenylalanine as treatment for NMS, but her symptoms did not improve. With propofol, which is used for sedation, her catatonic symptoms improved markedly. Quetiapine administration further improved the symptoms, and it eventually resolved completely. OUTCOMES: The patient's MC was in remission. Prolonged intensive care management resulted in a decline in activities of daily living, and she required rehabilitation at another hospital. CONCLUSION: This is the first report of MC with suspected involvement of pulmonary aspergillosis. MC differs from NMS, in that it is treated more effectively with gamma-aminobutyric acid A agonists. Although benzodiazepines are the first choice for the diagnosis and treatment of MC, they are ineffective for majority of patients with schizophrenia. However, even in such cases, propofol and quetiapine are effective, and they facilitate diagnosis and treatment.

DOI： 10.1097/MD.0000000000025967

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NLM (Medline)  

DOI： 10.1097/MPA.0000000000001738

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BACKGROUND: Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer. CASE PRESENTATION: An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient's symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to. CONCLUSION: This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient's active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.

DOI： 10.1186/s12879-020-05739-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer  

DOI： 10.1186/s13613-020-00730-3

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title>
Whether central apnoea or hypopnoea can be induced by organophosphorus poisoning remains unknown to date. By using the acute brainstem slice method and multi-electrode array system, we established a paraoxon (a typical acetylcholinesterase inhibitor) poisoning model to investigate the time-dependent changes in respiratory burst amplitudes of the pre-Bötzinger complex (respiratory rhythm generator). We then determined whether pralidoxime or atropine, which are antidotes of paraoxon, could counteract the effects of paraoxon. Herein, we showed that paraoxon significantly decreased the respiratory burst amplitude of the pre-Bötzinger complex (<italic>p</italic> &lt; 0.05). Moreover, pralidoxime and atropine could suppress the decrease in amplitude by paraoxon (<italic>p</italic> &lt; 0.05). Paraoxon directly impaired the pre-Bötzinger complex, and the findings implied that this impairment caused central apnoea or hypopnoea. Pralidoxime and atropine could therapeutically attenuate the impairment. This study is the first to prove the usefulness of the multi-electrode array method for electrophysiological and toxicological studies in the mammalian brainstem.

Other Link： http://www.nature.com/articles/s41598-020-73003-5

DOI： 10.1038/s41598-020-73003-5

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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BACKGROUND: The efficacy and safety of the combined use of veno-venous extracorporeal membrane oxygenation (ECMO) and prone ventilation are currently not known for coronavirus disease 2019 (COVID-19). CASE PRESENTATION: We report two cases in which the combination of veno-venous ECMO and prone ventilation for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia were successfully carried out. Both patients had developed severe respiratory failure due to SARS-CoV-2 pneumonia, thus requiring veno-venous ECMO. Prone ventilation was also administered safely. CONCLUSION: Oxygenation and lung compliance gradually improved during prone ventilation, and both patients were successfully extubated. For patients with severe SARS-CoV-2 pneumonia who require veno-venous ECMO, the use of prone ventilation could be beneficial, and should be considered.

DOI： 10.1002/ams2.546

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J03405&link_issn=&doc_id=20200109580002&doc_link_id=%2Fda2jjsem%2F2019%2F002206%2F002%2F0761-0767%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fda2jjsem%2F2019%2F002206%2F002%2F0761-0767%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Background: Acute necrotizing encephalopathy (ANE), known as influenza-associated encephalitis, typically affects children. Case presentation: A 70-year-old woman was admitted to the hospital with altered consciousness, a high temperature, and severe hypotension. Computed tomography (CT) of the head showed no abnormalities; thus, a diagnosis of suspected severe heat stroke was made. On day 2, repeated head CT revealed bilateral symmetrical lesions to the thalamus, and a rapid influenza antigen test was positive. Based on the CT findings and the medical history of influenza, a differential diagnosis of ANE was made. Subsequently, brain edema spread across the whole brain, and the patient died on day 21. Conclusion: In elderly patients, differentiating ANE from severe heat stroke in a high-temperature environment is difficult because of the similarities in clinical symptoms due to multiple organ failure.

DOI： 10.1002/ams2.418

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BACKGROUND: Agonal respiration following out-of-hospital cardiac arrest is associated with favorable neurological outcomes. Resuscitation using extracorporeal membrane oxygenation could contribute to achieving favorable neurological outcomes in patients with refractory cardiac arrest. CASE PRESENTATION: We report two cases of refractory cardiac arrest with non-shockable rhythms and agonal respiration; both patients were successfully resuscitated through extracorporeal cardiopulmonary resuscitation (ECPR). Both patients were breathing spontaneously upon arrival. One patient was asystolic and the other experienced pulseless electrical activity followed by ventricular fibrillation. Agonal respiration was observed in both and ECPR was implemented, leading to a favorable neurological outcome at discharge. CONCLUSION: The presence of agonal respiration has the potential to confer a favorable neurological outcome in patients with refractory cardiac arrest if maintained, even when the initial cardiac rhythm is not shockable. In these cases, resuscitation should not be abandoned, and ECPR should be considered.

DOI： 10.1002/ams2.398

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Language：Japanese   Publisher：(一社)日本災害医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本災害医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本災害医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

DOI： 10.1186/s12245-018-0205-8

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

Ichushi

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W.B. Saunders  

DOI： 10.1016/j.ajem.2018.05.008

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Language：Japanese   Publisher：市立函館病院  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01247&link_issn=&doc_id=20171124590002&doc_link_id=%2Fer5hakod%2F2017%2F004101%2F002%2F0006-0009%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer5hakod%2F2017%2F004101%2F002%2F0006-0009%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Case: Sibutramine is a weight loss agent that was withdrawn from the market in the USA and European Union because it increases adverse events in patients with cardiovascular diseases. However, non-prescription weight loss pills containing sibutramine can be still easily purchased over the Internet. A 21-year-old woman without history of cardiovascular diseases developed cardiac arrest. She was a user of a weight loss pills, containing sibutramine and hypokalemia-inducing agents, imported from Thailand over the Internet. Outcome: She was successfully resuscitated without any neurological deficits by using extracorporeal membrane oxygenation for refractory ventricular fibrillation. Conclusion: This case indicates that sibutramine can cause cardiac arrest even in subjects without pre-existing cardiovascular disease when combined with agents that promote QT prolongation.

DOI： 10.1002/ams2.275

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Language：Japanese   Publisher：(一社)日本外傷学会  

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CASE: A 44-year-old man intentionally stabbed himself in the anterior neck and left thorax with a fruit knife. Physical examination revealed two open wounds entering the thoracic cavity in the front chest, and a stab wound entering the trachea at the neck. Two chest tubes were initially inserted for the left lung injury with open hemopneumothorax. Nevertheless, the worsening oxygenation required positive pressure ventilation (PPV) with endotracheal intubation. OUTCOME: Right hemiparesis was found during weaning from PPV. Magnetic resonance imaging revealed multiple infarctions in the area of the bifrontal and right temporal lobes. Cerebral air embolism (CAE) was strongly suspected from the imaging findings and clinical course. CONCLUSION: We concluded that mechanical ventilation was strongly involved in the occurrence of CAE. If delayed abnormal neurological findings are observed in patients with penetrating lung injuries receiving PPV management, CAE should be considered.

DOI： 10.1002/ams2.250

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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000449368

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Language：Japanese   Publisher：(一社)日本臨床救急医学会  

Ichushi

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DOI： 10.3171/2015.3.JNS141895

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DOI： 10.2176/nmc.oa.2015-0285

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Language：Japanese   Publisher：The Japanese Association for the Surgery of Trauma  

A 19-year old female was involved in a car accident and was diagnosed with multiple rib fractures, bilateral pulmonary contusions and pneumothorax, liver injury, and iliac open fracture. Because a computed tomography scan showed that the distance between the left ninth rib fracture end and the descending aorta was 12 mm, we initially planned conservative management for her injuries. However, on the fifth post-trauma day, CT showed bone particles migrating to the thoracic aorta (4 mm), and thoracoscopic surgery to excise the rib fragments was performed. Although traumatic rupture of the thoracic aorta is rare, in the present case, we were able to prevent descending aorta injury through prophylactic resection of the fractured rib ends.

Other Link： http://search.jamas.or.jp/link/ui/2016338450

DOI： 10.11382/jjast.30.23

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier  

DOI： 10.1016/j.jacme.2015.09.002

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Language：Japanese   Publisher：(一社)日本熱傷学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jemermed.2014.10.003

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Language：Japanese   Publisher：(一社)日本災害医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

Ichushi

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ajem.2013.12.023

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本アルコール・アディクション医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1128/AAC.00110-10

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心肺蘇生（Cardiopulmonary resuscitation：CPR）は一般市民にも普及しつつあり，心肺停止患者の救命率向上に貢献している。 しかしCPR に伴う合併症も少なからず報告されており，その度合いによっては心拍再開後の治療に大きく影響することがある。今回，CPR に伴う胃損傷から低体温療法中に大量吐血するも，内視鏡治療にて止血を行い，神経学的予後良好に生存退院となった１例を経験したので報告する。

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Language：Japanese   Publisher：市立函館病院  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：Japanese Association for Acute Medicine  

Head injuries produced by static loading mechanisms have been called low-velocity, crushing head injuries (CHI). If the injury is not fatal, there is usually no severe disturbance of consciousness, but CHI are characterized by damage to the cranial nerves caused by traction, stretching, and fractures of the cranial base due to the distortion of the skull. In this paper, we report on six cases of low-velocity CHI. There were four adults and two pediatric cases (less than five years of age). Cranial nerve palsy was observed in five cases. Skull base fractures traversing the clivus were recognized in four cases, optic canal fractures in two cases, and carotid canal fractures in two cases. The final neurological outcomes were as follows: full recovery (three cases), and minor (two cases) and severe (one case) morbidity. CHI is a rare condition with a unique injury mechanism and clinical symptoms. CHI patients present with a variety of cranial nerve injuries caused by distortion of the cranial base and the distribution of basilar skull fractures. In occupational accidents in adults and traffic accidents in children, CHI caused by static loading forces should be considered, and proper imaging studies are necessary to make an accurate diagnosis.

DOI： 10.3893/jjaam.23.415

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Language：English   Publishing type：Research paper, summary (international conference)  

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Language：English   Publishing type：Research paper, summary (international conference)  

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DOI： 10.15057/17519

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Language：Japanese   Publisher：(株)プラネット  

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Language：Japanese   Publisher：メディカ出版  

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DOI： 10.3893/jjaam.19.131

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Language：Japanese   Publisher：Japanese Association for Acute Medicine  

This case involves a 29-year-old male who had, until 8 years ago, undergone radiation therapy for pituitary germinoma and was taking 20mg hydrocortisone daily for panhypopituitarism. Suffering profuse diarrhea, he was transported to our emergency department with exhaustion and hypothermia. Hypothermia treatment started with electric blankets for surface rewarming and warm gastric lavage for internal rewarming. Hypotension resulted from rewarming and rewarming shock suspected. Fluid loading was performed with no response. Dopamine was started but hypotension continued. Acute adrenal insufficiency was suspected due to the patient&#039;s medical history and catecholamine resistant shock, so 100 mg of hydrocortisone was administered intravenously 11 hours after arrival. Blood pressure slowly increased, allowing gradual reduction of fluid loading and dopamine. Before administering the hydrocortisone, serum cortisol concentration was 1.4μg/dl. On the 4th day of hospitalization, the patient was transferred from ICU and on the 11th day received an ambulatory discharge. Acute adrenal insufficiency is well known, but emergency room encounters are rare. Symptoms vary and lab findings are non-specific, making diagnosis difficult. When faced with catecholamine resistant shock, early diagnosis and treatment can influence the prognosis. Based upon the patient&#039;s medical history and developments, acute adrenal insufficiency should initially be suspected and steroids administered.

DOI： 10.3893/jjaam.19.131

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Language：Japanese   Publisher：Japanese Association for Acute Medicine  

A 63-year-old female was admitted to our Emergency Department 18 hrs after ingesting 0.9 L of distilled white liquor and about 150 ml of liquid fertilizer (Hyponex®), in an attempted suicide. Hyperkalemia and methemoglobinemia (arterial methemoglobin 25.6%) were present. Following admission, the level of methemoglobin gradually decreased and at 12 hrs after admission, the level had returned to normal. The patient was discharged on the third day of hospitalization. Deaths due to Hyponex? have been reported but there have been no reports of it leading to the development of methemoglobinemia. Methemoglobin is produced when nitrates are reduced to nitrites within the body. We suspected oxidation of hemoglobin to methemoglobin by nitrates within the blood. Reports of poisoning by liquid fertilizer are uncommon, but caution is advised because there is the possibility that it may lead to methemoglobinemia.

DOI： 10.3893/jjaam.18.713

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The patient was a 62-year-old male. The patient had collapsed an estimated 5 days before being discovered and was transported to our hospital after first being brought to another hospital. The patient was treated in the ICU for hyperglycemic coma and infectious disease. On the third day of hospitalization, sudden respiratory arrest occurred following suction induced irritation, and nasal intubation was performed. Antificial ventilation was undertaken. Following those clinical course, stimulation evoked worsening rigidity and autonomic dysfunction in the limbs. On the seventh day of hospitalization, tetanus was diagnosed and treatment for tetanus was begun. Under intensive care, the patient's status improved. On the 82nd day of hospitalization, the patient changed hospitals for rehabilitation. Even though clinical signs indicating tetanus were present from the first day of hospitalization, it was very difficult to establish correct diagnosis due to comorbid conditions. This case showed the importance of early diagnosis of tetanus from the clinical symptoms, anticipation of the condition worsening and early treatment.

DOI： 10.3893/jjaam.17.645

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Language：Japanese   Publisher：医学図書出版  

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We report a case of an abdominal aortic aneurysm which ruptured into the inferior vena cava indicated by CT and angiography in a patient that had been transferred to our hospital with a diagnosis of acute cardiac failure. The patient was a 73-year-old male who had been examined at another hospital for chest pain, hypotension, vomiting and vertigo and had been admitted to our hospital for examination of acute cardiac failure of unknown cause. A pulsating giant mass was palpable in the abdomen, and a continuous murmur was also audible in the abdomen. The patient showed no anemia or abdominal pain, but CT indicated the possibility of the rupture of an abdominal aortic aneurysm into the inferior vena cava. Emergency surgery was successfully performed following confirmation of the rupture by angiography. The results of this case indicate the need to consider a ruptured abdominal aortic aneurysm as a possible cause of symptoms resembling acute cardiac failure.

DOI： 10.3893/jjaam.14.467

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Language：Japanese   Publisher：Japanese Association for Acute Medicine  

We report a case of an abdominal aortic aneurysm which ruptured into the inferior vena cava indicated by CT and angiography in a patient that had been transferred to our hospital with a diagnosis of acute cardiac failure. The patient was a 73-year-old male who had been examined at another hospital for chest pain, hypotension, vomiting and vertigo and had been admitted to our hospital for examination of acute cardiac failure of unknown cause. A pulsating giant mass was palpable in the abdomen, and a continuous murmur was also audible in the abdomen. The patient showed no anemia or abdominal pain, but CT indicated the possibility of the rupture of an abdominal aortic aneurysm into the inferior vena cava. Emergency surgery was successfully performed following confirmation of the rupture by angiography. The results of this case indicate the need to consider a ruptured abdominal aortic aneurysm as a possible cause of symptoms resembling acute cardiac failure.

DOI： 10.3893/jjaam.14.467

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