Acute Medicine & Surgery最新文献

{"title":"Cerebral air embolism followed by endoscopic balloon dilatation for esophageal strictures","authors":"Ryoichi Shoji,&nbsp;Naruaki Otake,&nbsp;Takeo Nagura,&nbsp;Jushi Numata,&nbsp;Junya Tsurukiri","doi":"10.1002/ams2.971","DOIUrl":"https://doi.org/10.1002/ams2.971","url":null,"abstract":"<p>A 59-year-old male patient underwent esophageal endoscopic balloon dilatation (BD) under sedation for esophageal strictures at another hospital. He suddenly became unresponsive post-procedure, resulting in coma and undergoing mechanical ventilation. Head computed tomography (CT) revealed multiple air emboli within the parenchyma, and cerebral air embolism (CAE) was diagnosed. Additionally, abdominal CT revealed air in the portal venous system. Diffusion-weighted magnetic resonance imaging after 2 days confirmed areas of acute ischemia involving the right frontal, temporal, and occipital lobes (Figure 1). Microbubble-enhanced echocardiography revealed no evidence of a cardiac shunt. His consciousness gradually improved over several days without undergoing hyperbaric oxygen therapy, and he was discharged for rehabilitation in left hemiplegia after 30 days.</p><p>CAE is a rare, potentially catastrophic iatrogenic complication.<span>¹</span> Four reports on esophageal endoscopic BD-induced CAE were retrieved from PubMed, but the pathogenesis without obtaining whole-body imaging remains unclear.<span>^2-5</span> The venous air embolism, including the portal vein and the cerebrum, explained the present case. This is the first report on the pathogenesis visualized as supporting evidence of CAE during endoscopic procedures. The mechanism includes air transgression from the esophageal mucosa to the vasculature and flowing into the portal venous system through portal–esophageal vein radicles transected during the procedure.</p><p>All authors declare that they have no conflict of interest, and the manuscript has not been previously published; the manuscript is not under consideration for publication elsewhere.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Written informed consent was obtained from the patient for publication of this case report and accompanying images.</p><p>Registry and the registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.971","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141326697","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":"A well-managed case of discontinuous anorectal injury caused by a personal watercraft treated by combining surgery and colonoscopy","authors":"Hiraaki Okuzawa,&nbsp;Akira Endo,&nbsp;Tomohiro Akutsu,&nbsp;Keisuke Suzuki,&nbsp;Hiromasa Hoshi,&nbsp;Shunichiro Kato,&nbsp;Koji Ito,&nbsp;Yasuhiro Otomo,&nbsp;Koji Morishita","doi":"10.1002/ams2.972","DOIUrl":"https://doi.org/10.1002/ams2.972","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anorectal injury caused by personal watercraft (PWC)-related trauma is rare. However, PWC accidents have increased recently, and since patients tend to be younger, treatment strategies should consider anal function preservation in addition to saving lives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 30-year-old female patient who fell into the water when a PWC suddenly accelerated and injured her perineum with a forceful water jet was transported to our hospital. On examination, she was diagnosed with a traumatic rectal perforation with intraperitoneal findings and an anorectal injury. Emergency surgery, which involved direct suturing, temporary colostomy with intraoperative endoscopy for the rectal perforation, and anorectal reconstruction, was performed. The patient was discharged on postoperative day 19 without complications, and the colostomy was closed 5 months postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We encountered a case of multiple noncontinuous anorectal injuries due to a PWC accident that was successfully treated using a combination of surgery and intraoperative endoscopy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.972","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141326704","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":"Do-not-attempt-resuscitation orders, end-of-life care discussions, and advance care planning for deteriorating patients in Japan","authors":"Tatsuya Tsuji,&nbsp;Yoshiki Sento,&nbsp;Kazuya Sobue","doi":"10.1002/ams2.975","DOIUrl":"https://doi.org/10.1002/ams2.975","url":null,"abstract":"&lt;p&gt;We appreciate the interest and comments of Ogata et al. on our recently published article in &lt;i&gt;Acute Medicine and Surgery&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; We share the view of Ogata et al. that advance care planning (ACP) should be promoted in acute care hospitals. However, because data on patients with clinical deterioration are still lacking in Japan, we hope that similar research will continue to be shared among medical facilities. Therefore, we would like to highlight several issues that need to be addressed in future studies.&lt;/p&gt;&lt;p&gt;First, while our study provided a quantitative evaluation of the existence of DNAR orders for deteriorating patients, the quality of EOLC and the process of shared decision-making (SDM) could not be evaluated. Therefore, we could not provide deeper interpretations of the content of SDM with patients and their families regarding DNAR orders, EOLC, limitations of medical treatment, time-limited trials, or ACP.&lt;/p&gt;&lt;p&gt;Second, DNAR orders can change depending on the situation; perspectives; and values of patients, their families, and healthcare providers. We would like to highlight that an RRS resulted in not only new DNAR orders for patients without pre-existing DNAR orders but also the withdrawal of pre-existing DNAR orders.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, the current database includes outcomes at the point of deterioration or 1 month later and does not allow for long-term follow-up. As Ogata et al. pointed out,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; the appropriate timing of SDM among patients and their families and the interpretation and handover of SDM among facilities are key considerations.&lt;/p&gt;&lt;p&gt;Third, we investigated the limitations of the medical treatment for pediatric patients with clinical deterioration in Japan.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Although cases in children were fewer than those in adults, we have demonstrated that the limitation of medical treatment was present in 6% of deteriorating children. This pediatric study underlines the potential utility of including healthcare providers in treatment teams as targets for training in pediatric ACP.&lt;/p&gt;&lt;p&gt;Fourth, the 2023 guidelines published by the Society of Critical Care Medicine recommend that responding healthcare providers should have expertise in facilitating the achievement of patients' goals of care and establishing treatment plans that best reflect their wishes and prognoses.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In the field of acute care medicine in Japan, many statements and guidelines have been published regarding EOLC, DNAR orders, and ACP, including the “Advice on Do Not Attempt Resuscitation (DNAR) order” by the “Japanese Society of Intensive Care Medicine in 2017 and the Guidelines for decision making with end-of-life care” by the Ministry of Health, Labour and Welfare in 2018. However, the contents of these guidelines have not been fully disseminated to the medical field and also proven to be clinically effective in encouraging SDM. Therefore, the outcomes bef","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.975","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141315390","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":"Triangular pyramidal configuration of three treads for ring removal","authors":"Katsuma Horio,&nbsp;Takeji Saitoh,&nbsp;Aiko Naruse,&nbsp;Hideyuki Arima,&nbsp;Atsuto Yoshino,&nbsp;Katsumasa Nakamura","doi":"10.1002/ams2.973","DOIUrl":"https://doi.org/10.1002/ams2.973","url":null,"abstract":"<p>A 40-year-old woman arrived at our emergency department with her wedding ring firmly stuck on her 4th digit after wearing it for a decade. Despite her attempts to remove it, the swollen finger tightly incarcerated the ring. First, we tried to get rid of the ring by simply pulling it off with lubricants. Several attempts were made to remove the ring without success. Subsequently, an elastic tape was tightly wrapped around the finger from its top to the ring, before we try to unwound proximal to the ring and pull it off. But the patient, allergic to lidocaine, felt itchy, and finally we abandoned these methods.</p><p>She rejected to cut the ring off. Consequently, three 1–0 silk threads, arranged like a triangular pyramid (Figure 1A), were threaded through the ring using a mosquito forceps. As one medical staff kept pulling two threads (the black arrows), another simultaneously pulled the remaining thread with one hand (the white arrow) while gently manipulating the ring and rubbing the finger from distal to proximal with the other hand. Eventually, the ring slowly slipped off, marking the first reported use of this three-string method for ring removal.</p><p>Conventional methods to remove a ring mainly consist of simple pulling with lubricants, binding a string or an elastic tape in the distal part of the finger,<span>^{1, 2}</span> exsanguinating a finger with a distal intravenous tourniquet,<span>³</span> and cutting a ring. The challenge lies in applying sufficient peripheral force without causing harm. The power to pull peripherally is important; however, clinicians cannot often give the proper power to a ring. The three-thread method stands out for its simplicity and effectiveness, likely becoming a common choice among clinicians. This method, especially when combined with finger-binding, offers a viable option for challenging cases. Based on this approach, we developed a device (Figure 1B) featuring a 3 mm wooden board with three attached nuts and screws. The threads are secured within the screws, and the device includes magnets to enhance pulling power with a metal wall. This innovation enables a single clinician to effortlessly remove a ring. The device holds promise as one of the evolving options for ring removal, offering a sleek and effective solution for challenging cases in the future.</p><p>None.</p><p>Approval of the research protocol: N/A.</p><p>Informed Consent: N/A.</p><p>Registry and the Registration No. of the study/Trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141298623","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":"Safety of cannabidiol products as a social issue: A case series","authors":"Yukari Maki,&nbsp;Asuka Tsuchiya,&nbsp;Rie Yamamoto,&nbsp;Takeshi Saito,&nbsp;Seiji Morita,&nbsp;Yoshihide Nakagawa","doi":"10.1002/ams2.965","DOIUrl":"10.1002/ams2.965","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cannabidiol (CBD) products have increased in popularity in Japan in recent years, particularly among young people. Some CBD products contain tetrahydrocannabinol (THC), the main ingredient of cannabis, and its analogs, which are illegal in Japan and have become a social issue. This report discusses the safety of CBD products.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>Five patients with symptoms of CBD ingestion, including nausea, presented to our hospital. Three of the products these patients ingested contained THC. Metabolites of THC were detected in the blood and urine of all three patients, although there were some discrepancies in the urine drug screening test (DS10®). These examination results differed even when the same product was consumed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CBD products are unsafe and may unintentionally contain THC. It is also important to understand that CBD can turn into THC, and the effective time needed to conduct urine drug screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11142928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199243","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":"Injury to a cardiopulmonary resuscitation provider by sternal wire","authors":"Mayo Ohkawa,&nbsp;Asuka Tsuchiya,&nbsp;Seiji Morita,&nbsp;Yoshihide Nakagawa","doi":"10.1002/ams2.969","DOIUrl":"https://doi.org/10.1002/ams2.969","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Median sternotomy is a common surgical procedure during cardiac and pulmonary surgeries. There are many reports of patient injury associated with wire breakage. However, there are only a few reports of healthcare worker injuries by sternal wire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A patient in his 70s, having a history of thoracic aorta replacement, collapsed suddenly and paramedics started mechanical chest compression. On hospital arrival, the emergency department nurse attempted to initiate manual chest compression but was injured by a sternal wire protrusion on the patient's chest. The emergency physician placed gauze on the sternal wire and continued manual chest compression, but the patient died.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To prevent this injury, cardiopulmonary resuscitation (CPR) providers should consciously check the patient's chest. If they observe wire exposure, they should immediately place a gauze, pad or consider performing mechanical chest compression. Safety measures such as the installing rubber pads in the AED should be considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.969","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141073785","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":"Pneumocephalus resulting from traumatic pneumothorax and brachial plexus avulsion","authors":"Naoki Date,&nbsp;Hiroshi Hamakawa,&nbsp;Ichiro Sakanoue,&nbsp;Tomoki Saito,&nbsp;Yutaka Takahashi","doi":"10.1002/ams2.956","DOIUrl":"https://doi.org/10.1002/ams2.956","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traumatic pneumocephalus is commonly encountered after basal skull fractures and rarely associated with blunt chest trauma. Here, we report a case of pneumocephalus caused by traumatic pneumothorax and brachial plexus avulsion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 20-year-old male was admitted to our hospital following a motorcycle accident with complete paralysis of the right upper limb. 2 days later, follow-up computed tomography revealed a slight right pneumothorax, pneumomediastinum around the neck, and intracranial air without skull fracture. Air migrates into the subarachnoid space through a dural tear caused by a brachial plexus avulsion. The pneumocephalus immediately improved after the insertion of a chest drain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pneumothorax combined with brachial plexus avulsion could lead to pneumocephalus. Immediate chest drainage might be the best way to stop the migration of air; however, care should be taken to not worsen cerebrospinal fluid leakage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.956","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140952969","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":"Multidisciplinary approach to a 93-year-old survivor with crush syndrome: A 124-h rescue operation after the 2024 Noto Peninsula earthquake","authors":"Mototaka Inaba,&nbsp;Hiromichi Naito,&nbsp;Masaki Hisamura,&nbsp;Kaoru Harada,&nbsp;Atsunori Nakao","doi":"10.1002/ams2.967","DOIUrl":"https://doi.org/10.1002/ams2.967","url":null,"abstract":"&lt;p&gt;Natural disasters, such as earthquakes, pose significant global threats. On January 1, 2024, a devastating 7.6 magnitude earthquake struck Japan's Noto Peninsula, causing widespread destruction and loss of life. The quake resulted in at least 241 deaths, 1536 injuries, and extensive damage to buildings, leading to 34,694 people seeking refuge in shelters.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The survival of a 93-year-old woman trapped for over 5 days sheds light on human resilience and medical management during disasters. This letter describes a rare extrication scenario in a disaster setting, focusing on a successful multidisciplinary approach used to manage crush injuries.&lt;/p&gt;&lt;p&gt;On January 6, 2024, amidst the chaos following the earthquake, a critical rescue operation was undertaken in Suzu City to save a 93-year-old woman trapped under debris. A team comprising police, firefighters, and medical personnel, including a doctor and two nurses from a medical non-governmental organization, collaborated on the rescue efforts. The patient, found with her thighs pinned under heavy beams, displayed signs of subsequent crush injury. Her initial medical assessment revealed unstable vital signs with low blood pressure. The administration of 2500 mL of lactated Ringer's solution, 40 mL of sodium bicarbonate, and 10 mL of calcium gluconate, along with the use of hot bags for warming, was instrumental in stabilizing the patient's condition before extrication (Figure 1). The medical team worked in the hot zone (collapsed home confined space) for 15 min. In addition to these medical interventions, we used hot water-filled plastic bags placed against her torso to counteract potential hypothermia. Additionally, continuous verbal reassurance was provided by the rescue team, an essential part of maintaining her consciousness and morale during the entrapment. Decompression occurred 150 min after the initial intervention, and the patient was extracted 240 min after first contact (124 h after onset). Post-extraction, the patient's Glasgow Coma Scale score improved from E3V2M6 to E3V4M6, with sensory disturbances noted in her left lower limb. She was admitted to a nearby tertiary hospital. Laboratory tests showed creatine kinase of 13,475 U/L, potassium of 5.5.mmol/L and creatinine of 1.74 mg/dL confirming crush syndrome and compartment syndrome in the left leg, necessitating a fasciotomy. She was treated with fluid therapy; dialysis was unnecessary. The patient continued her recovery.&lt;/p&gt;&lt;p&gt;Crush syndrome, a significant concern in earthquake disasters, is known to be one of the leading causes of mortality, even after successful rescues.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; This was evident in the 2024 Noto Peninsula earthquake, where at least six fatalities were reported due to crush syndrome, underscoring the severity of the condition in post-disaster medical challenges. Comparatively, the 2023 Kahramanmaras earthquake in Turkey also caused a considerable number of crush injuries, 7.7","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.967","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140949221","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 the severity of hypothermia and in-hospital mortality in patients with infectious diseases: The J-Point registry","authors":"Tadaharu Shiozumi,&nbsp;Yuki Miyamoto,&nbsp;Sachiko Morita,&nbsp;Naoki Ehara,&nbsp;Nobuhiro Miyamae,&nbsp;Yohei Okada,&nbsp;Takaaki Jo,&nbsp;Yasuyuki Sumida,&nbsp;Nobunaga Okada,&nbsp;Makoto Watanabe,&nbsp;Masahiro Nozawa,&nbsp;Ayumu Tsuruoka,&nbsp;Yoshihiro Fujimoto,&nbsp;Yoshiki Okumura,&nbsp;Tetsuhisa Kitamura,&nbsp;Tasuku Matsuyama","doi":"10.1002/ams2.964","DOIUrl":"https://doi.org/10.1002/ams2.964","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Hypothermia is associated with poor prognosis in patients with sepsis. However, no studies have explored the correlation between the severity of hypothermia and prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the Japanese accidental hypothermia network registry (J-Point registry), we examined adult patients aged ≥18 years with infectious diseases whose initial body temperature was ≤35°C from April 1, 2011 to March 31, 2016, in 12 centers. Patients were divided into three groups according to their body temperature: Tertile 1 (T1) (32.0–35.0°C), Tertile 2 (T2) (28.0–31.9°C), and Tertile 3 (T3) (&lt;28.0°C). In-hospital mortality was employed as a metric to assess outcomes. We conducted a multivariate logistic regression analysis to investigate the relationship between the three categories and the occurrence of in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 572 patients were registered, and 170 eligible patients were identified. Of these patients, 55 were in T1 (32.0–35.0°C), 76 in T2 (28.0–31.9°C), and 39 in T3 (&lt;28.0°C) groups. The overall in-hospital mortality rate in accidental hypothermia (AH) patients with infectious diseases was 34.1%. The in-hospital mortality rates in the T1, T2, and T3 groups were 34.5%, 36.8%, and 28.2%, respectively. The multivariable analysis demonstrated no significant differences regarding in-hospital mortality among the three groups (T2 vs. T1, adjusted odds ratio [OR]: 1.29; 95% confidence interval [CI]: 0.58–2.89 and T3 vs. T1, adjusted OR: 0.83; 95% CI: 0.30–2.31).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this multicenter retrospective observational study, hypothermia severity was not associated with in-hospital mortality in AH patients with infectious diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.964","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140949192","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":"Characteristics and outcomes of out-of-hospital cardiac arrest in a hilly area: Utstein Registry data from the Nagasaki Medical Region, Japan","authors":"Valeryia Zmushka,&nbsp;Goro Tajima,&nbsp;Keita Iyama,&nbsp;Koichi Hayakawa,&nbsp;Kazunori Yamashita,&nbsp;Takamitsu Inokuma,&nbsp;Hiroo Izumino,&nbsp;Takanobu Otaguro,&nbsp;Eri Uemura,&nbsp;Tomohiro Ueki,&nbsp;Shimon Murahashi,&nbsp;Shuhei Yamano,&nbsp;Kensuke Takahashi,&nbsp;Yoshihiro Aoki,&nbsp;Atsuko Tachikawa,&nbsp;Osamu Tasaki","doi":"10.1002/ams2.966","DOIUrl":"https://doi.org/10.1002/ams2.966","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To analyze characteristics and investigate prognostic indicators of out-of-hospital cardiac arrest (OHCA) in a hilly area in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective population-based study was conducted using the Utstein Registry for 4280 OHCA patients in the Nagasaki Medical Region (NMR) registered over the 10-year period from 2011 to 2020. The main outcome measure was a favorable cerebral performance category (CPC 1–2). Sites at which OHCA occurred were classified into “sloped places (SPs)” (not easily accessible by emergency medical services [EMS] personnel due to slopes) and “accessible places (APs)” (EMS personnel could park an ambulance close to the site). The characteristics and prognosis based on CPC were compared between SPs and APs, and multivariable analysis was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant improvement in prognosis occurred in the NMR from 2011 to 2020. Prognosis in SPs was significantly worse than that in APs. However, multivariable analysis did not identify SP as a prognostic indicator. The following factors were associated with survival and CPC 1–2: age group, witness status, first documented rhythm, bystander-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, use of mechanical CPR (m-CPR) device or esophageal obturator airway (EOA), and year. Both m-CPR and EOA use were associated with a poor prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In a hilly area, OHCA patients in SPs had a worse prognosis than those in APs, but SPs was not significantly associated with prognosis by multivariable analysis. Interventions to increase bystander-initiated CPR and AED use could potentially improve outcomes of OHCA in the NMR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.966","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140949191","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}