An outcome study of out-of-hospital cardiac arrest using the Utstein template--a Japanese experience.

Publication of the Utstein style template has made it possible to evaluate and compare national, regional, and hospital based Emergency Medical Services. This research was a national investigation to present outcome data for out-of-hospital cardiac arrest (OHCA) patients in Japan. 3029 OHCA patients who were transported to 10 Emergency and Critical Care Medical Center from November 1997 to April 1999 were recorded according to the Utstein style and the outcome evaluated by logistic regression analysis. Among 3029 OHCA patients, 109 were found dead. The remaining 2920 patients who underwent cardiopulmonary resuscitation (CPR) by emergency medical technicians (EMT) were included in this study. Among these patients, 1294 were considered of primary cardiac origin patients by the EMT and 722 of these patients suffered a witnessed cardiac arrest. Bystander CPR were performed in 28.4% of these witnessed patients and the discharge rate was 3.5% overall and 11.4% in witnessed VF/VT. Outcome analysis showed that a discharge rate in witnessed primary cardiac arrest was 30% in prehospital resuscitation which was 7.5 times higher than in-hospital emergency room resuscitation groups (4.0%). The longer the interval between an emergency telephone call and defibrillation, the lower the 1 month survival rate, which reached almost 0% at 30 min. Follow up evaluation after discharge revealed that the survival rate rapidly decreased from 24 h to 3 months, then became a plateau in primary cardiac patients was rapidly decreased from 24 h to 1 month, then became a near plateau in non-cardiac origin group. To improve the resuscitation rate in the prehospital phase, a prehospital medical control system should be developed with expansion of on scene techniques by Japanese paramedics such as tracheal intubation, administration of emergency drugs and early defibrillation with standing orders. Education and motivation of first responders will be needed and every effort should be concentrated on improving bystander CPR rate.

Preoperative diagnosis of obturator hernia by computed tomography.

A retrospective study of 6 patients with obturator hernia diagnosed before surgery by X-ray and computed tomography (CT) was conducted between 1993 and 2000. The initial CT of the abdomen including the pelvic area revealed incarcerated bowel in the obturator foramen of all 6 patients. All patients underwent laparotomy as soon as possible after CT scans were obtained. Resection of the small bowel was performed in 3 patients, and release of the small bowel was performed in the remaining 3 patients. There were no perioperative deaths. In elderly women who show evidence of small bowel obstruction by abdominal plain x-ray studies, we recommend performing CT scans of the abdomen including the pelvic area for detection of obturator hernia.

[Development of GC/MS library for analyzing pesticides and drugs].

To analyze the root components of compounds causing drug addiction, we have developed our own GC/MS libraries(PESTICID.LIB consisting of 20 pesticides and Herbicides, and DRUG.LIB with 57 drugs). We have usually utilized standardized agents, but gastric contents, gastric specimens, serum and urine samples from patients were also used for the analyses. We were able to add libraries of various difficult to purchase psychotropic drugs and legally restricted agents by extracting them from the patient samples. Comments about the retention time, the base peak of the mass spectrum and 5 typical ion chromatograms in the libraries have been useful for laboratory analysis, and consequently have improved the accuracy of detection and identification. They were also found to be a useful guideline for discrimination of the unchanged materials and the metabolites. We are attempting to improve the accuracy of the library to avoid the effects of GC column conditions such as the column size, column temperature and different inserts by using a retention time index.

[Ethylene glycol poisoning complicated by central nervous system abnormalities].

We report a case of ethylene glycol (EG) poisoning complicated by central nervous system abnormalities. A long-distance truck driver aged 36 year old ingested 200ml of EG in a suicidal attempt. He was referred to our hospital from another hospital because of vomiting and altered mental status. On arrival at our hospital, he had low level of consciousness (Glasgow Coma Scale: E3V4M5), miosis, and external ophthalmoplegia. Laboratory analysis revealed a severe metabolic acidosis with wide anion gap. Many crystals were detected in the urinary sediment. After admission, acute oliguric renal failure required continuous hemodialysis for 6 days. Despite the treatment, the level of consciousness did not improve. The CT scan of the brain obtained on the fourth day revealed low density areas in the bilateral basal ganglia, mid brain and pons. The renal biopsy showed tubular oxalate deposits. After 12 days, the volume of urination increased. At the same time the mental status gradually recovered. He was discharged on 36 days after admission without any sequelae.