Acute Medicine & Surgery最新文献

{"title":"Inadvertent insertion of dialysis catheter into subclavian artery treated with a covered stent: A case report","authors":"Yohei Takenobu,&nbsp;Akihiro Furuta,&nbsp;Sumire Haga,&nbsp;Hiroshi Yukawa,&nbsp;Noriko Nomura,&nbsp;Mizuha Toyama,&nbsp;Akihiro Okada,&nbsp;Takeshi Kawauchi,&nbsp;Yukinori Terada,&nbsp;Manabu Inoue,&nbsp;Kenji Hashimoto","doi":"10.1002/ams2.70038","DOIUrl":"10.1002/ams2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>When inserting central venous catheters, inadvertent injury of major vessels is a rare yet critical complication. Direct surgery is sometimes overly invasive. This report describes a subclavian artery injury caused by inadvertent cannulation of a dialysis catheter, successfully treated with a covered stent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 82-year-old woman with acute renal failure due to sepsis required emergency dialysis. During the insertion of a 12-Fr dialysis catheter into the right jugular vein, pulsatile reflux was noted. Computed tomography revealed catheter misplacement in the subclavian artery. Considering the patient's fragility, endovascular repair was performed. After embolization of side branches, a GORE VIABAHN stentgraft was delivered using a pull-through technique and deployed to seal the injury site. The patient was discharged without neurological or vascular complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Covered stents offer an effective solution for major vessel injuries requiring immediate hemostasis, particularly when direct surgery is complicated by underlying medical or anatomical conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11738960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998258","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":"Crayon ingestion","authors":"Kisho Noda,&nbsp;Tomoki Wada,&nbsp;Ryohei Horie,&nbsp;Toshifumi Asada,&nbsp;Ryota Inokuchi,&nbsp;Kent Doi","doi":"10.1002/ams2.70030","DOIUrl":"10.1002/ams2.70030","url":null,"abstract":"<p>A 24-year-old male with autism presented to the emergency department with recurrent vomiting. His mother found crayon fragments in the vomitus. Computed tomography revealed multiple high-density cylindrical objects in the lower esophagus, stomach, and isolated in the ileum (Figure 1A,B). Urgent upper gastrointestinal endoscopy was performed under general anesthesia and 24 crayon fragments were successfully retrieved from the stomach (Figure 1C,D). The crayons in the ileum were defecated without complications.</p><p>Although methemoglobinemia induced by colored crayons has been reported previously,<span>^{1, 2}</span> current crayon formulations consist largely of nontoxic wax with an extremely low risk of acute toxicity. Because crayons are not readily digestible enzymatically or thermally in the gastrointestinal tract owing to a melting point of approximately 60°C, they can readily cause complications such as gastrointestinal obstruction or choking on aspirated vomit. Guidelines for the management of foreign bodies in the stomach recommend urgent removal of sharp or long (≧6 cm in length) objects by urgent endoscopy.<span>³</span> In this case, the crayon fragments were blunt and &lt;6 cm each, but urgent endoscopy under general anesthesia was performed because the patient with autism was concerned about being unable to express discomfort or pain when complications occurred.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Written informed consent was obtained from the patient's family for the publication of this case report and accompanying images.</p><p>Registry and registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11712129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942481","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":"Warfarin overdose successfully treated using prophylactic vitamin K infusion without severe coagulopathy: A case report","authors":"Ryosuke Omoto,&nbsp;Yutaka Umemura,&nbsp;Yuki Kokubu,&nbsp;Takeyuki Kiguchi,&nbsp;Satoshi Fujimi","doi":"10.1002/ams2.70036","DOIUrl":"10.1002/ams2.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Warfarin, a vitamin K antagonist, is widely used for preventing and treating thromboembolic diseases. While guidelines exist for managing elevated prothrombin time-international normalized ratio (INR) in patients on warfarin, the treatment for warfarin overdose in these patients is yet to be standardized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 41-year-old woman ingested 230 mg of warfarin with suicidal intent, along with other medications. Initially unconscious, her INR was 1.0, and laboratory results were normal. Prophylactic continuous menaquinone-4, vitamin K2, injections were administered before the INR increased. After stopping vitamin K2 72 h later, her INR rose to 1.8, but she recovered without severe coagulopathy or bleeding, despite a high initial warfarin concentration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first case of warfarin overdose managed with prophylactic vitamin K2 injections before INR elevation, successfully preventing severe complications. Prophylactic vitamin K infusion may be a practical approach for warfarin overdose treatment in non-dependent patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11712172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942574","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":"Hypothermia-associated acute pancreatitis: A multicenter prospective observational study","authors":"Masaki Takahashi,&nbsp;Shuhei Takauji,&nbsp;Mineji Hayakawa","doi":"10.1002/ams2.70033","DOIUrl":"10.1002/ams2.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Hypothermia-associated pancreatitis lacks comprehensive understanding owing to limited studies exploring its mechanism, epidemiology, risk factors, and outcomes. We aimed to investigate the frequency, characteristics, and predictive factors associated with the development of acute pancreatitis in patients with accidental hypothermia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study comprised a post hoc analysis of data from a multicenter prospective observational study (ICE-CRASH study) conducted in 36 tertiary emergency hospitals in Japan. Patients aged ≥18 years with core body temperatures ≤32°C admitted to emergency departments between 2019 and 2022 were enrolled. We identified patients who developed acute pancreatitis within 1 week of admission and described their characteristics. Age, vital signs, and blood gas analysis data were analyzed as potential predictors of acute pancreatitis using receiver operating characteristic (ROC) curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 421 eligible patients with accidental hypothermia, 16 (3.8%) developed acute pancreatitis within 1 week. The age distribution of patients with acute pancreatitis showed bimodal peaks around 50–80 years. Patients with acute pancreatitis had a higher proportion of alcohol consumption than those without acute pancreatitis. ROC curve analysis showed age and pH as significant factors; however, their predictive power was not high.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence of acute pancreatitis was 3.8% in patients with accidental hypothermia with core body temperatures ≤32°C. An association was found between the development of acute pancreatitis and alcohol consumption. No strong predictors of acute pancreatitis were identified.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942490","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 subarachnoid hemorrhage from vertebral artery dissection: A comparative study with other non-traumatic etiologies","authors":"Shu Oshita,&nbsp;Tetsuya Yumoto,&nbsp;Shunta Jinno,&nbsp;Ippei Matsuo,&nbsp;Takashi Hongo,&nbsp;Hiromichi Naito,&nbsp;Masafumi Hiramatsu,&nbsp;Jun Haruma,&nbsp;Kenji Sugiu,&nbsp;Shota Tanaka,&nbsp;Atsunori Nakao","doi":"10.1002/ams2.70031","DOIUrl":"10.1002/ams2.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Vertebral artery dissection (VAD) is a rare cause of non-traumatic subarachnoid hemorrhage (SAH) with significant clinical implications. This study compared the clinical characteristics and outcomes of SAH from intracranial VAD rupture to those from other etiologies, primarily aneurysmal rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study at Okayama University Hospital included patients with non-traumatic SAH diagnosed between 2019 and 2023. Patients were categorized into “VAD rupture” and “other etiologies” groups. The main outcome was clinical presentation and symptoms. Additional outcomes included ICU mortality, in-hospital mortality, and unfavorable outcomes at discharge and 6 months, defined as a modified Rankin Scale score of 3–6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 66 patients were included, with 14 in the VAD rupture group and 52 in the other etiologies group. The VAD rupture group was younger (median age 49 vs. 64 years, <i>p</i> = 0.003) and had a higher incidence of out-of-hospital cardiac arrest (42.9% vs. 9.6%, <i>p</i> = 0.011). Preceding headache was more common in the VAD rupture group (78.6% vs. 11.5%, <i>p</i> &lt; 0.001), with a median duration of 36 h before presentation. ICU and in-hospital mortality was higher in the VAD rupture group (both 50.0% vs. 19.3%, <i>p</i> = 0.019). No significant differences were found in unfavorable neurological outcomes at hospital discharge and 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VAD-related SAH often presents with prodromal headaches, severe symptoms like out-of-hospital cardiac arrest, and higher ICU and in-hospital mortality than other SAH causes, though long-term outcomes are similar. Larger, prospective studies are needed to refine interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891336","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":"Letter to “Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient: A multicenter observational study”","authors":"Benjamin Tangkamolsuk,&nbsp;Quang La,&nbsp;David F. Lo","doi":"10.1002/ams2.70029","DOIUrl":"10.1002/ams2.70029","url":null,"abstract":"<p>We enjoyed reading the article by Kohri et al., titled “Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patients: A multicenter observational study” and would like to offer additional commentary on the article.<span>¹</span> We hope these perspectives may provide insight into areas that may require further research and improvement.</p><p>Kohri et al. reported on the association between early DNR orders and neurological outcomes in OHCA patients, highlighting any possible trends between early DNR orders and OHCA patients. They found that those with a DNR order placed received less therapeutic care intervention and had worse neurological outcomes after the same time period, compared to non-DNR patient counterparts. The paper calls for the reconsideration of the implementation of DNR shortly after cardiac arrest in acute care settings.</p><p>Kohri et al. had studied the DNR orders and their associated outcomes; however, it lacks the comprehensive assessment of the patient's symptoms leading to the DNR orders, which presents several limitations in the observational study. As a result of this, the conclusion may be misleading as the DNR decision-making may have been impacted by other factors, such as pain management.<span>²</span></p><p>Although the article has a limited level of balancing and confounding through elements such as propensity score analysis, it does not account for subjectivity and biases on the personal level. The clinical judgment or personal biases may vary from individual to individual, and different institutions and hospitals may have their own policies and clinical expertise, resulting in a reduction in the robustness of the conclusion.<span>³</span></p><p>Lastly, the methodology used in the article is quite simplistic and does not capture the overwhelmingly complex reality of healthcare, in which there are a number of different variables that could affect it, such as religion, belief, or socio-economic factors of the family outside the clinical field.<span>⁴</span></p><p>Ultimately, this paper presents a timely and relevant investigation into the correlation between DNR decisions and the neurological outcomes of OHCA patients. By addressing these issues, we can help strengthen the conclusions of essential studies used to improve healthcare globally. We applaud the authors for not only emphasizing the importance of the stress of issuing DNR orders early into care inside an acute care setting. We look forward to reading about future studies that provide insight into these factors.</p><p>No funding was received for this study/paper.</p><p>The authors declare no conflicts of interest.</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":1.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891338","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 PaCO2 and outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest","authors":"Ayumi Kawakami,&nbsp;Keita Shibahashi,&nbsp;Kazuhiro Sugiyama,&nbsp;Toru Hifumi,&nbsp;Akihiko Inoue,&nbsp;Tetsuya Sakamoto,&nbsp;Yasuhiro Kuroda,&nbsp;the SAVE-J II Study Group","doi":"10.1002/ams2.70021","DOIUrl":"https://doi.org/10.1002/ams2.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The optimal arterial partial pressure of carbon dioxide (PaCO₂) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to investigate the association between post-resuscitation PaCO₂ and neurological outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, a multicenter registry study across 36 hospitals in Japan, including patients with out-of-hospital cardiac arrest (OHCA) admitted to intensive care units (ICU) after ECPR between 2013 and 2018. Good PaCO₂ management status was defined as a PaCO₂ value of 35–45 mmHg. We classified patients into four groups (poor–poor, poor–good, good–poor, and good–good) according to their PaCO₂ management status upon admission at the ICU and the following day. The primary outcome was a favorable neurological outcome, defined as cerebral performance category 1 or 2, 30 days after cardiac arrest. The secondary outcome was survival 30 days after cardiac arrest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We classified 885 eligible patients into poor–poor (<i>n</i> = 361), poor–good (<i>n</i> = 231), good–poor (<i>n</i> = 155), and good–good (<i>n</i> = 138) groups. No significant association was observed between PaCO₂ management and favorable 30-day neurological outcomes. Compared with the poor–poor group, the poor–good, good–poor, and good–good groups had adjusted odds ratios of 0.87 (95% confidence interval, 0.52–1.44), 1.17 (0.65–2.05), and 0.95 (0.51–1.73), respectively. The 30-day survival rates among the four groups did not differ significantly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PaCO₂ values were not significantly associated with 30-day neurological outcomes or survival of patients with OHCA after ECPR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142861877","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":"External validation of the sICOP score for early mortality in mechanically ventilated patients with COVID-19","authors":"Mitsuaki Nishikimi,&nbsp;Kei Hayashida,&nbsp;Takashi Tagami,&nbsp;Shinichiro Ohshimo,&nbsp;Nobuaki Shime,&nbsp;Kazuma Yamakawa","doi":"10.1002/ams2.978","DOIUrl":"10.1002/ams2.978","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>The aim of this study was to externally validate the prognostic score for mechanically ventilated patients with novel coronavirus disease-2019 (COVID-19), the simplified intubated COVID-19 predictive (sICOP) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective, multicenter, observational study conducted using the database registry of patients with moderate-to-severe COVID-19 at 66 hospitals in Japan. The data of 146 mechanically ventilated COVID-19 patients were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The areas under the curve (AUC) of the sICOP score for predicting the 28-day mortality and in-hospital mortality were 0.81 (0.73–0.89) and 0.74 (0.65–0.83), respectively. The AUC of the score was statistically significantly higher than that of the SOFA score for 28-day mortality and in-hospital mortality (28-day mortality; 0.82 [0.73–0.90] vs. 0.58 [0.46–0.70], <i>p</i> &lt; 0.001, in-hospital mortality; 0.75 [0.66–0.84] vs 0.55 [0.44–0.66], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that the sICOP score was useful for predicting the 28-day mortality with excellent accuracy in mechanically ventilated COVID-19 patients in the era prior to the widespread availability of vaccines and effective antivirals. Validation of the score would be needed by using data from recent waves.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805966","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 case of lung injury due to a hydrogen explosion caused by the simultaneous use of two home folk remedies devices","authors":"Masato Tsuchikane,&nbsp;Takeshi Yamagiwa,&nbsp;Tadaaki Takada,&nbsp;Shinjiro Wakai,&nbsp;Sadaki Inokuchi","doi":"10.1002/ams2.70019","DOIUrl":"https://doi.org/10.1002/ams2.70019","url":null,"abstract":"<p>A 62-year-old woman was diagnosed with postoperative breast cancer recurrence. While inhaling hydrogen gas through a nasal cannula at home, she used a heat-therapy machine that emitted electromagnetic waves to the breast cancer site. She suddenly experienced explosive sounds in her chest and smelled burning. Subsequently, she experienced several overlapping hemoptysis episodes and was referred to our hospital for further evaluation. Computed tomography revealed an alveolar-centered pulmonary contusion (Figure 1), and the patient was admitted to the hospital with a diagnosis of inhalation combustion lung injury. Arterial blood gas analysis showed no deterioration, and computed tomography revealed no worsening of pulmonary findings or oxygen demand. The hemoptysis resolved spontaneously, and re-evaluation on day 9 confirmed the disappearance of the pulmonary contusion.</p><p>Blast lung injuries typically occur during wars or bombing incidents but rarely occur in the home environment.<span>¹</span> Although the medical efficacy of hydrogen gas remains controversial, several studies have reported the risk of associated explosions.<span>²</span> Our patient was exposed to a small explosion that caused no abnormalities in blood test results, including coagulation function parameters. This case demonstrates that lung injuries caused by the inhalation of combustible gases associated with folk remedies can occur even at home.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Informed consent was obtained from the patient.</p><p>Registry and 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":1.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764309","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":"Letter to “Refractory cardiogenic shock due to atomoxetine overdose rescued by venoarterial extracorporeal membrane oxygenation: A case report”","authors":"Ju-Tae Sohn","doi":"10.1002/ams2.70028","DOIUrl":"https://doi.org/10.1002/ams2.70028","url":null,"abstract":"&lt;p&gt;I commend Komoriya et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; for their successful treatment described in the case report titled “Refractory cardiogenic shock due to atomoxetine overdose rescued by venoarterial extracorporeal membrane oxygenation: A case report,” recently published in &lt;i&gt;Acute Medicine &amp; Surgery&lt;/i&gt;. Lipid emulsions are commonly used to manage local anesthetic systemic toxicity (LAST) and as an effective adjuvant therapy for mitigating severe cardiovascular depression caused by toxic doses of non-local anesthetic drugs with high lipid solubility (log P = log [octanol/water] partition coefficient: &gt;2).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Moreover, lipid emulsion improves the condition of patients with seizure caused by norepinephrine reuptake inhibitor atomoxetine toxicity, which is unresponsive to intravenous benzodiazepine, suggesting lipid sink.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; To help the readers better understand this case report, I would like to explain the possible mechanisms of lipid emulsion treatment for drug toxicity. The mechanism comprises indirect and direct effects.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The widely accepted lipid shuttle mechanism suggests that lipid emulsions absorb highly lipophilic drugs, such as bupivacaine (log P: 3.41), from tissues such as the brain and heart.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Once absorbed, they transport these drugs to the liver, muscles, and adipose tissue, where the drugs are detoxified and stored.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; QT prolongation induced by bupivacaine, which produces Torsades de Pointes, is due to the inhibition of rapidly activating delayed rectifier potassium channels encoded by human ether-à-go-go-related gene (hERG).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Bupivacaine inhibits hERG potassium channels, which contributes to QT prolongation and cardiac arrest induced by LAST.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; However, lipid emulsions reduce the bupivacaine-induced increase in the T-peak to T-end interval and restore the sinus rhythm.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Similar to local anesthetics, an overdose of atomoxetine in an 11-year-old patient produces life-threatening QT prolongation, which may be due to inhibition of hERG.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The direct effects of lipid emulsions include a positive inotropic effect, supplying fatty acids, and reducing mitochondrial dysfunction.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Considering previous reports,&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; scavenging lipid soluble atomoxetine (log P: 3.9) and the positive inotropic effect induced by lipid emulsions may have contributed to the early removal of the venoarterial extracorporeal membrane oxygenation (ECMO) in this patient. The authors stated that the potential side effects of lipid emulsions in the concomitant use of lipid emulsions and ECMO include layering, agglutination in the tube, and cracking of the stopcock.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; A high dose of lipid emulsion (20 mL/kg, 4 g/kg) as an adjuvant drug to treat toxicity produces layering of the blood and ","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762436","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}