Acute Medicine & Surgery最新文献

{"title":"Serial Serum Nicotine Concentration During VA-ECMO for Nicotine-Induced Cardiac Arrest: A Case Report.","authors":"Kensuke Minami, Takeshi Ebihara, Kazuo Harada, Hikaru Tamagawa, Yuto Sugimoto, Shunichiro Nakao, Ryosuke Takegawa, Tomoya Hirose, Hiroshi Matsumoto, Jun Oda","doi":"10.1002/ams2.70173","DOIUrl":"10.1002/ams2.70173","url":null,"abstract":"<p><strong>Background: </strong>Acute nicotine intoxication can cause cardiac arrest. We report a case of cardiac arrest managed with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) alongside serial serum nicotine monitoring.</p><p><strong>Case presentation: </strong>A 36-year-old woman collapsed after ingesting an unknown amount of liquid nicotine, up to 20 g. Emergency medical services found her in cardiac arrest with pulseless electrical activity (PEA). On arrival, she remained in cardiac arrest with PEA/asystole and severe acidosis, and VA-ECMO was established 82 min after ingestion. Cardiac function gradually improved, and VA-ECMO was discontinued on Day 3. However, she died on Day 28 from post-cardiac arrest brain injury. Liquid chromatography-mass spectrometry (LC/MS) revealed an admission serum nicotine concentration of 6.44 μg/mL, declining to 0.057 μg/mL within 18 h. This decline paralleled hemodynamic recovery.</p><p><strong>Conclusion: </strong>Although neurological outcome was unfavorable, VA-ECMO may provide temporary circulatory support during the toxic phase of massive nicotine intoxication.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":"e70173"},"PeriodicalIF":1.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149236451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influenza-Induced Rhabdomyolysis Leading to Hyperkalemic Cardiac Arrest Managed With Venoarterial Extracorporeal Membrane Oxygenation: A Case Report.","authors":"Yoshihiro Miyake, Tomohiro Abe, Kei Tokunaga, Shihoko Shimazu, Tatsuya Tanaka, Akira Sasaki, Masaru Hiyoshi, Toshiki Tanahashi, Kohei Moribayashi, Koichi Kaikita, Hidenobu Ochiai","doi":"10.1002/ams2.70172","DOIUrl":"10.1002/ams2.70172","url":null,"abstract":"<p><strong>Background: </strong>Influenza-induced rhabdomyolysis is an uncommon but serious complication that can cause life-threatening hyperkalemia. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for hyperkalemic cardiac arrest has rarely been described.</p><p><strong>Case presentation: </strong>A 48-year-old woman with influenza A developed severe rhabdomyolysis (creatine kinase: 255,240 U/L) and progressive hyperkalemia despite improved renal function and continuous renal replacement therapy. On hospital day 3, the patient experienced a hyperkalemic cardiac arrest and VA-ECMO was initiated after 29 min of low-flow time. Treatment for hyperkalemia was continued, and cardiac function gradually recovered, allowing the removal of ECMO on day 8. However, she later developed hemorrhagic complications related to mechanical circulatory support and died on hospital day 89.</p><p><strong>Conclusion: </strong>Influenza-induced rhabdomyolysis can cause rapid, life-threatening hyperkalemia, even in patients with improving renal function. Temporary mechanical circulatory support may serve as a bridge through the acute reversible phase, and device-related complications should be considered.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":"e70172"},"PeriodicalIF":1.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149226908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis Mimics in the ICU: A Qualitative Study of Physicians' Diagnostic Experiences in Japan","authors":"Daisuke Kasugai,&nbsp;Michiko Higashi,&nbsp;Kasumi Satoh,&nbsp;Genki Nakamura,&nbsp;Hiroaki Hiraiwa,&nbsp;Naruhiro Jingushi,&nbsp;Takanori Yamamoto,&nbsp;Yutaka Kondo","doi":"10.1002/ams2.70171","DOIUrl":"https://doi.org/10.1002/ams2.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sepsis mimics are non-infectious conditions that resemble sepsis, leading to diagnostic uncertainty, delayed disease-specific therapy, and unnecessary antibiotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured online interviews with seven physicians with experience in adult general intensive care unit (ICU) practice in Japan (October–December 2023) and analyzed data using Reflexive Thematic Analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four themes were generated: (1) Spectrum—participants described sepsis mimics as spanning hematologic malignancy, autoimmune/inflammatory disease, endocrine/metabolic crises, drug/toxic states, and other acute non-infectious conditions. (2) Diagnostic challenges—participants described phenotypic overlap, missing or fragmented history, organizational barriers to definitive testing in unstable patients, competing pathophysiology, and diagnostic masking by early corticosteroids. (3) Therapeutic and diagnostic strategies—participants described a sepsis-oriented initial approach with broad antibiotics and organ support, followed by reactive re-evaluation for nonresponse or early parallel work-up for selected mimics. (4) Triggers for re-evaluation—participants described reconsidering sepsis when the clinical course or physiology diverged from expectations, including discrepant hemodynamics, atypical fever patterns, focal physical signs, and metabolic abnormalities not readily explained by presumed infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sepsis mimics were described as diagnostically challenging in ICU practice because clinical trajectories can initially resemble sepsis and because diagnostic work-up is shaped by local organizational constraints. By mapping clinicians' reasoning processes and re-evaluation cues, our findings provide a framework for understanding diagnostic uncertainty and may inform educational efforts and future research on timely recognition of sepsis mimics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149205787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sports-Related Out-of-Hospital Cardiac Arrest due to External Causes, Including Commotio Cordis, at Schools in Japan","authors":"Kosuke Kiyohara,&nbsp;Mamoru Ayusawa,&nbsp;Masahiko Nitta,&nbsp;Taku Iwami,&nbsp;Ken Nakata,&nbsp;Yuri Kitamura,&nbsp;Tetsuhisa Kitamura","doi":"10.1002/ams2.70168","DOIUrl":"10.1002/ams2.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To describe the characteristics and outcomes of sports-related out-of-hospital cardiac arrest (OHCA) due to external causes, including commotio cordis, during school-supervised sports activities in Japan's elementary schools, junior high schools, high schools, and technical colleges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>OHCA data (2008–2022) were obtained from the Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS)—a nationwide database of OHCAs occurring under school supervision across Japan. We identified sports-related OHCAs with external causes and summarized patients' characteristics, bystander interventions, available response intervals, and survival outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 30 sports-related OHCA cases due to external causes. The most frequently played sports were soccer/futsal (<i>n</i> = 8), baseball (<i>n</i> = 8), and swimming (<i>n</i> = 4). The leading etiology was commotio cordis (<i>n</i> = 15), followed by drowning (<i>n</i> = 8). Among the 15 cases meeting our operational definition of commotio cordis, automated external defibrillator (AED) pads were applied in 14 (93%), shocks were delivered in 13 (87%), and 12 (80%) achieved a favorable neurological outcome. Among other external causes (<i>n</i> = 15), ventricular fibrillation occurred in 4/15 (27%), AED pads were applied in 7/15 (47%), shocks were rare (1/15, 7%), and 1/15 (7%) achieved favorable neurological outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nationwide case-level reconstruction revealed distinct mechanism-to-response pathways. Although these descriptive data cannot establish the causal effects of the public access defibrillation programs or other interventions on outcomes, they highlight potentially actionable, mechanism-specific opportunities for emergency response and prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apixaban-Associated Sublingual Hematoma Causing Pseudo-Ludwig's Angina","authors":"Eiryu Sakihara,&nbsp;Masahiro Kashiura,&nbsp;Takashi Moriya","doi":"10.1002/ams2.70170","DOIUrl":"10.1002/ams2.70170","url":null,"abstract":"<p>Apixaban-associated sublingual hematoma can mimic Ludwig's angina and cause delayed airway obstruction despite a stable initial presentation. Clinicians should prioritize airway monitoring and anticoagulation reversal and avoid routine surgical drainage unless infection is suspected.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial Calcium Monitoring Revealed Primary Hyperparathyroidism in Severe Acute Pancreatitis: A Case Report","authors":"Mitsuki Yokota,&nbsp;Hajime Nakajima,&nbsp;Takeshi Ebihara,&nbsp;Kensuke Minami,&nbsp;Kazuhiro Yoneda,&nbsp;Yusuke Katayama,&nbsp;Jun Oda","doi":"10.1002/ams2.70167","DOIUrl":"10.1002/ams2.70167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypocalcemia is commonly monitored as a severity marker in acute pancreatitis, whereas hypercalcemia is an uncommon but important clue to primary hyperparathyroidism (PHPT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 42-year-old man without gallstones, tumor, or alcohol use developed severe acute pancreatitis, with organ failure persisting beyond 48 h. His corrected calcium level was at the lower reference limit on admission but rose from Day 3, exceeded the upper reference limit on Day 4, and reached a peak of 18 mg/dL on Day 21. Intact parathyroid hormone was elevated, and cervical ultrasonography showed a parathyroid mass. PHPT was diagnosed on Day 24. Severe hypercalcemia with concomitant renal dysfunction required continuous hemodiafiltration, cinacalcet, elcatonin, and zoledronic acid. Parathyroidectomy on Day 35 confirmed parathyroid adenoma, and serum calcium normalized on Day 36. He required drainage of intra-abdominal abscesses and was transferred for rehabilitation on Day 170.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with severe acute pancreatitis, a calcium level that is not elevated on admission does not exclude PHPT. A rise in serum calcium during the clinical course can be an important diagnostic clue prompting re-evaluation for PHPT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Airway Strategy for Madelung's Disease With Severe Obstructive Sleep Apnea","authors":"Taiga Ishihara,&nbsp;Gaku Kawamura,&nbsp;Michiko Ushio,&nbsp;Kanji Uchida","doi":"10.1002/ams2.70166","DOIUrl":"10.1002/ams2.70166","url":null,"abstract":"<p>A 61-year-old man with Madelung's disease presented for excision of a cervical lipoma (Figure 1A,B). Fiberoptic examination revealed posterior pharyngeal wall bulging with airway narrowing (Figure 1C), and computed tomography showed diffuse fat surrounding the anterior neck and spine (Figure 1D). Severe obstructive sleep apnea, a perioperative risk factor [<span>1, 2</span>], prompted preoperative continuous positive airway pressure initiation.</p><p>Cervical lipomatosis predicted failure of emergency front-of-neck access [<span>3</span>], and a maximum mouth opening of two fingerbreadths indicated difficult direct laryngoscopy [<span>4</span>]. Awake oral fiberoptic intubation was performed under nebulized lidocaine with intravenous fentanyl-droperidol sedation, and a 7-mm endotracheal tube was advanced without resistance. Had intubation failed, the plan was to abort while maintaining spontaneous ventilation and postpone surgery [<span>5</span>].</p><p>An initial absent cuff leak prompted continued intubation with daily retesting, while diuretics corrected positive fluid balance, gradually restoring the leak. Methylprednisolone was administered on postoperative Day 6; a spontaneous breathing trial confirmed readiness. On Day 7, extubation proceeded with extracorporeal membrane oxygenation on standby and pre-secured vascular access.</p><p>In Madelung's disease, where both intubation and emergency surgical airway may fail, awake intubation, which allows abortion if needed, should be chosen at induction, and extubation should not proceed without considering extracorporeal rescue.</p><p>This work was supported by the Japan Society for the Promotion of Science, JP26K11829.</p><p>The authors have nothing to report.</p><p>Written informed consent for publication was obtained from the patient.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Hour-by-Hour ICU Admission Timing and 24-h Mortality: A Single-Center Retrospective Observational Study","authors":"Kazuhiro Shirakawa,&nbsp;Yoshihiro Katsura,&nbsp;Hiroaki Watanabe,&nbsp;Ryutaro Seo,&nbsp;Koichi Ariyoshi","doi":"10.1002/ams2.70163","DOIUrl":"10.1002/ams2.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Prior studies of ICU admission timing often use broad categories (day vs. night), potentially masking hour-level effects. We examined hour-by-hour ICU admission timing and mortality, with attention to nighttime periods and routine handovers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center retrospective observational study in a closed ICU with 24/7 on-site intensivist coverage, using prospectively registered data from the Japanese Intensive Care Patient Database. Adults (≥ 18 years) admitted to the E-ICU between April 2017 and July 2025 were included. Admission hour (0–23) was modeled as a continuous exposure using restricted cubic splines (reference 14:00). The primary outcome was 24-h mortality and the secondary outcome was ICU mortality. Multivariable logistic regression was adjusted for demographics, APACHE II, invasive mechanical ventilation at admission, comorbidities, diagnostic categories, admission source, and post-cardiac arrest status. Bootstrap resampling was used to estimate 95% confidence intervals. Additional analyses examined handover, nighttime, and 24-h periodic patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5724 patients, 24-h and ICU mortality were 3.4% and 10.6%, respectively. Compared with 14:00, adjusted odds of 24-h mortality were higher in the early morning. The early-evening estimate was imprecise, with the 95% CI including unity. In contrast, ICU mortality showed no clear temporal pattern. Handover comparisons showed no clear mortality association; nighttime admission was not associated with higher mortality, and cosinor analysis was nonsignificant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hour-by-hour analysis showed higher adjusted odds of 24-h mortality in the early morning, whereas evidence of an increase in the early evening was inconclusive. Direct comparisons of handover periods showed no clear association with mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Scalp Laceration in the Elderly: Association Between Age and Red Blood Cell Transfusion Despite Anatomically Minor Injury","authors":"Hidemasa Okumura,&nbsp;Hiroto Chiba,&nbsp;Daiki Nakaji,&nbsp;Hiroka Hosaka,&nbsp;Nobuyuki Hattori,&nbsp;Tomohiko Takeuchi,&nbsp;Ayumi Tomonaga,&nbsp;Takuro Endo,&nbsp;Masayuki Iwashita,&nbsp;Taichiro Tsunoyama,&nbsp;Takashi Suzuki","doi":"10.1002/ams2.70164","DOIUrl":"10.1002/ams2.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Scalp lacerations without intracranial injury are generally considered anatomically minor traumas. However, elderly patients may experience unexpected clinical deterioration due to persistent bleeding after trivial injury. Such cases may represent clinically urgent conditions when physiological deterioration is taken into consideration. Evidence of the outcomes of isolated scalp lacerations in elderly patients remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of data from the Japan Trauma Data Bank (2019–2023) was conducted. Patients with isolated scalp lacerations, identified using Abbreviated Injury Scale codes, were included. Patients with intracranial injuries or injuries to other body regions were excluded. Patients were categorized into elderly (≥ 65 years) and non-elderly (&lt; 65 years) groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 304 patients were included, of whom 181 (59.5%) were elderly. Elderly patients required red blood cell (RBC) transfusion within 24 h more frequently than non-elderly patients (14.0% vs. 2.6%, <i>p</i> = 0.001). Furthermore, the rate of interhospital transfer after acute trauma management was significantly higher in elderly patients than in non-elderly patients (13.1% vs. 3.4%, <i>p</i> = 0.004). Multivariable logistic regression analyses were performed to identify factors independently associated with RBC transfusion. These analyses demonstrated that age ≥ 65 years (OR 4.540, 95% CI 1.272–16.204) and systolic blood pressure &lt; 90 mmHg on arrival (OR 6.124, 95% CI 2.182–17.186) were independently associated with RBC transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Advanced age is independently associated with RBC transfusion in patients with isolated scalp lacerations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexplained Acute Life-Threatening Right Heart Failure During Hip Surgery","authors":"Hiroshi Araki,&nbsp;Motohiro Sekino,&nbsp;Shohei Kaneko,&nbsp;Naoya Iwasaki,&nbsp;Tetsuya Hara","doi":"10.1002/ams2.70165","DOIUrl":"10.1002/ams2.70165","url":null,"abstract":"<p>An 87-year-old woman underwent internal fixation for a right femoral neck fracture under general anesthesia. Intraoperatively, she developed sudden hypoxemia, shock, and severe right ventricular dilatation, necessitating the introduction of venoarterial extracorporeal membrane oxygenation. Pulmonary thromboembolism was excluded by dedicated computed tomography pulmonary angiography (Figure 1A,B).</p><p>Twelve hours postoperatively, conjunctival petechiae appeared (Figure 1C, white arrow). Brain magnetic resonance imaging after 5 weeks revealed diffuse small, low-signal spots (starfield pattern) on susceptibility-weighted imaging (Figure 1D, yellow arrow heads), confirming the clinical diagnosis of fulminant fat embolism syndrome (FES).</p><p>Although the classical FES triad (respiratory distress, neurological abnormalities, and petechial rash) is well recognized, it is frequently incomplete or absent at presentation [<span>1, 2</span>]. Especially, fulminant FES can manifest as sudden cardiovascular collapse, which may precede these classical features [<span>3</span>]. Notably, while FES is classically associated with younger patients, it also peaks in the elderly sustaining proximal femoral fractures [<span>4</span>]. During instrumentation, high intramedullary pressure forces marrow fat into the venous system [<span>1, 3</span>]; in elderly patients with reduced cardiopulmonary reserve, this leads to acute right heart failure [<span>2-4</span>].</p><p>This case highlights that FES should be considered in elderly patients presenting with unexplained acute right heart failure during orthopedic surgery.</p><p>The authors have nothing to report.</p><p>The patient's daughter gave written consent for the publication of this report. Ethics approval for this case report was waived by the Institutional Review Board of our Institution.</p><p>The patient's daughter gave written consent for the publication of this report.</p><p>The authors declare no conflicts of interest.</p><p>Data sharing not applicable to this article as no datasets were generated or analysed during the current study.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}