Bladder deformity accompanied by pelvic fracture indirectly indicates clinical severity.

BACKGROUND: That the bladder can be compressed by extraperitoneal hematoma induced by obstetrics and gynecologic diseases, is well known. However, there have been no reports on the clinical significance of compressed bladder induced by pelvic fracture (PF). We therefore retrospectively investigated the clinical features of compressed bladder induced by the PF. METHODS: From January 2018 to December 2021, we performed a retrospective review of the hospital medical charts of all emergency outpatients who were treated by emergency physicians at the department of acute critical care medicine in our hospital, and who were diagnosed with PF based on computed tomography (CT) on arrival. The subjects were divided into two groups: the Deformity group, in which the bladder was compressed by extraperitoneal hematoma, and the Normal group. Variables were compared between the two groups. RESULTS: During the investigation period, 147 patients with PF were enrolled as subjects. There were 44 patients in the Deformity group and 103 in the Normal group. There were no significant differences between the two groups with regard to sex, age, GCS, heart rate or final outcome. However, the average systolic blood pressure in the Deformity group was significantly lower, and the average respiratory rate, injury severity score, rate of unstable circulation, rate of transfusion and duration of hospitalization in the Deformity group were significantly greater in comparison to the Normal group. CONCLUSIONS: The present study showed that bladder deformity induced by PF tended to be a poor physiological sign that was associated with severe anatomical abnormality, unstable circulation requiring transfusion, and long hospitalization. Accordingly, physicians should evaluate shape of bladder when treating PF.

A Comparison of Tube Thoracostomy for Chest Trauma Between Prehospital and Inhospital Settings.

OBJECTIVE: We compared the outcomes of patients with tube thoracostomy for chest trauma between the prehospital and inhospital settings. METHODS: The subjects were then divided into 2 groups: the prehospital group, which included subjects who underwent tube thoracostomy in the prehospital setting, and the inhospital group, which included subjects who underwent tube thoracostomy in the inhospital setting. The variables were compared between the 2 groups. RESULTS: There were no significant differences between the 2 groups with regard to gender, age, history, mechanism of injury, infusion of antibiotics, white blood cell count, duration of insertion of a chest drain, mechanical ventilation, complication of drain infection, duration of admission, or final outcome. However, the Injury Severity Score, maximum C-reactive protein level, and maximum temperature during hospitalization in the prehospital group (n = 15) were significantly greater than those in the inhospital group (n = 119). CONCLUSION: The present study suggested that thoracostomy performed by physicians in the prehospital setting was safe and did not have an increased risk of infection. In addition, thoracostomy for chest injury in the prehospital setting suggested an improvement in the likelihood of a survival outcome.

An analysis of patients with a chief complaint of difficulty moving.

Objective: There have been few reports in English medical journals analyzing patients with difficulty moving. Herein, we conducted a retrospective survey of emergency patients admitted to our hospital with the chief complaint of difficulty moving, to clarify the clinical characteristics of the frequency, causative disease, and outcome in these patients. Patients and Methods: Between August 2017 and October 2021, we surveyed the patient database maintained by our department, covering cases in which the main complaint at the time of patient transport by ambulance to our hospital was difficulty moving. Results: In 111 cases, the patient's primary complaint was difficulty moving or adynamia. Patients included 59 males and 52 females, with a mean age of 76.3 years old. The most frequent diagnosis in these patients was rhabdomyolysis, followed by infection, body temperature abnormalities, electrolyte disorder, blood glucose abnormality, hypoxia, and renal failure. Trauma and various other diseases, such as stroke and malignancy, were also found to be causative diseases. After discharge from the hospital, the number of patients with a dependent status was greater than those with an independent status. Conclusion: Patients with difficulty moving were primarily elderly, and had a variety of causative diseases. Therefore, multiple approaches are required to manage these patients.

Preliminary study of prehospital use of smart glasses.

Background: A smart glasses system is a computerized communicator with a transparent screen and video camera that can be worn as a pair of glasses. There have been no reports on the use of smart glasses in the prehospital setting. Purpose: To conduct a preliminary investigation on whether smart glasses were smoothly used bidirectionally between the prehospital setting and the receiving hospital. Methods: From March 1, 2022, to March 31, 2022, one smart glasses unit was installed in an ambulance at one branch of the fire department near our hospital. The physician on the computer, who received video and voice transmission from the smart glasses when the ambulance was dispatched, evaluated the transmission status with regard to video reception, voice reception, and voice transmission. In addition, the activity time was compared between cases in which the smart glasses system was used (patient) and not used (control). Results: During the investigating period, 12 cases were analyzed as patients. The rate of good video reception was 75%, the rate of good voice reception was 50%, and the rate of good voice transmission was 25%. There was no significant change in the activity time between the patient and control groups. Conclusion: We performed a preliminary investigation on the usability of smart glasses in the prehospital setting. Using smart glasses, patient information was shared by video and voice before arrival at the hospital, and did not affect the activity time. However, the instability of the communication status should be recognized.

A Case of Blue Rubber Bleb Nevus Syndrome With Kasabach-Merritt Syndrome and Heart Failure.

A 48-year-old Mongolian man developed bilateral leg edema after suffering from a fever for three months. He lost his appetite, and the edema gradually spread from the legs, becoming systemic. In addition, he had difficulty in moving. He had a history of being diagnosed with numerous venous malformations and Kasabach-Merritt syndrome when he was a child. On arrival, he had numerous venous malformations over pale skin, edema at each extremity, and anemic conjunctiva. Chest roentgen showed bilateral pleural effusion, and cardiac echography findings showed a left ventricular ejection fraction of 30% with diffuse hypokinesis. The results of a blood analysis showed coagulopathy, which was compatible with disseminated intravascular coagulation and pancytopenia. He was diagnosed with blue rubber bleb nevus syndrome with Kasabach-Merritt syndrome and heart failure. Use of diuretics, thiamine, iron, phytonadione, carbazochrome, and tranexamic acid, in addition to intermittent transfusion resulted in the improvement of his Kasabach-Merritt syndrome. Radical management of blue rubber bleb nevus syndrome was deemed impossible by dermatologists due to the large amount of venous malformations. We encountered an extremely rare case of blue rubber bleb nevus syndrome with Kasabach-Merritt and heart failure. Multimodal therapy might help manage Kasabach-Merritt syndrome following improvement in coagulopathy and pancytopenia.

Analysis of the Activities of a Physician-Staffed Helicopter in the Coronavirus Disease 2019 Pandemic Phase.

OBJECTIVE: The purpose of this study was to investigate changes in the duration of activity of a physician-staffed helicopter emergency medical service (HEMS) in Eastern Shizuoka Prefecture before and during the coronavirus disease 2019 pandemic. METHODS: We retrospectively investigated the duration of dispatch activities from February 2020 to June 2021 (pandemic group, n = 1,032) and from April 2016 to January 2020 (control group, n = 3,054). RESULTS: There were no significant differences in the average age, percentage of male patients, interval from the request of HEMS dispatch to arrival, interval from arrival at the scene to leaving the scene, interval from leaving the scene to arrival at the hospital, or the ratio of requests for HEMS dispatch from the local fire department between the control and pandemic groups. In contrast, the interval from the first call to HEMS dispatch in the control group was significantly shorter than that in the pandemic group, and the ratio of requests for HEMS dispatch before contacting patients in the control group was significantly greater than that in the pandemic group. CONCLUSION: The interval from the first call to HEMS dispatch was prolonged in the COVID-19 pandemic period. However, the actual activity time of the HEMS was not affected.

The Usefulness of Physician-Staffed Helicopters for Managing Severe Abdominal Trauma Patients.

Introduction: We retrospectively investigated prognostic factors for severe abdominal trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). Methods: The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of outcome: the Mortality group, which included patients who ultimately died, and the Survival group, which included patients who obtained a survival outcome. Results: There were 2457 in the Mortality group and 11,326 in the Survival group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the following variables were identified as significant positive predictors of a fatal outcome: evacuation from the scene, blunt injury, injury severity score, and age; significant negative predictors of a fatal outcome were transportation by the HEMS and revised trauma score. Conclusions: The present study described the usefulness of the HEMS for severe abdominal trauma patients in comparison with ground ambulance transportation using the JTDB.

A Report Concerning Collaboration Between a Physician-Staffed Helicopter (Doctor Helicopter) and Police Helicopter.

A 35-year-old man injured his right foot by slipping down 200 m into a crater on top of Mount Fuji, where some snow still remained. The next day the patient climbed up from the crater with his friend's assistance and began to descend the mountain; he met the Shizuoka police mountain distress rescue team at the 9th station. The Shizuoka police mountain distress rescue team transported the patient on foot to the snowless 7th station. The Shizuoka police aviation unit, flying a helicopter, then collected the patient. They transported the patient to the nearby Fujinomiya fire department station. The eastern Shizuoka physician-staffed helicopter emergency medical service landed there, and the patient was transported to Juntendo Shizuoka Hospital. On arrival, he had stable vital signs, but his right foot showed a dislocated fracture with frostbite. This is the first case report of collaboration between a helicopter emergency medical service and a police helicopter to rescue a victim from Mount Fuji. When managing victims in high-altitude settings, such as Mount Fuji, collaboration between multiple organizations is necessary.

Importance of a Collaboration Agreement in the Management of Physician-Staffed Helicopters.

OBJECTIVE: The purpose of this study was to present the management of 3 physician-staffed helicopters (helicopter emergency medical service [HEMS]) in 3 different requests in eastern Shizuoka based on a collaboration agreement and to investigate the current state of dispatches based on the agreement. METHODS: We investigated 3 incidents managed simultaneously by HEMS based on the collaboration agreement by inquiry to the bases, which were located in eastern Shizuoka, Yamanashi, and Kanagawa. We also investigated all records on the management of HEMS based on the collaboration agreement since the contract was made in 2014 by inquiry to the Shizuoka prefectural government. RESULTS: Three simultaneous flight requests were successfully completed. The total number of dispatches based on the collaboration agreement was 112 flights for 7 years from 2014 to 2020. The most frequent reason for request was overlapping request (n = 71). The prefecture with the highest number of requests was Shizuoka (n = 79), where medical resources were limited and the most frequent disease was trauma (n = 93). CONCLUSION: The present study reports how 3 HEMS were operated simultaneously for 3 different requests. To use medical resources effectively, including HEMS, the collaboration agreement among neighboring prefectures was very important, especially for areas in which medical resources are limited.

Repeated anaphylactic reaction after walking following an intraarticular injection of diclofenac etalhyaluronate sodium during a 3-day period.

BACKGROUND: There has been no English report of repeated anaphylactic reaction after exercise-induced anaphylaxis due to a single intraarticular injection of diclofenac etalhyaluronate sodium. CASE PRESENTATION: A 60-year-old woman felt dyspnea, generalized itching, and urticaria following hypotension a few minutes after receiving an intraarticular injection of diclofenac etalhyaluronate sodium for the first time. She immediately received intramuscular adrenaline administration and her symptoms subsided. However, she received intermittent injections of adrenaline three times for repeated anaphylactic reactions after walking over a 3-day period, in addition to complication with Kounis syndrome. She was discharged on foot on day 9 without sequelae. CONCLUSION: Physicians should have patients who receive intraarticular injection of diclofenac etalhyaluronate sodium walk for a short period and evaluate their status.

Reaction of Juntendo Shizuoka Hospital at Izu Peninsula to Typhoon Hagibis (2019) and an Analysis of Twitter Concerning Izunokuni City.

OBJECTIVE: This research was carried out to report the activity of the headquarters for disaster control at our hospital, and investigate the usefulness of obtaining information from Twitter when Typhoon Hagibis hit Izu Peninsula. METHODS: First, we recounted the activity of the headquarters for disaster control. We then collected information from Twitter from October 12-14, 2019, using the keyword Izunokuni.' We took into consideration the contents of Twitter user posts as well as the number of reactions ('retweets' and 'likes'). Twitter information was classified into photo (+) and (-) groups, depending on whether or not the post had a photo or video included. The number of reactions between the two groups was then analyzed. RESULTS: We counted 122 Twitter posts containing Hagibis-related information for Izunokuni City. The average number of both 'retweets' and 'likes' in the photo (+) group were significantly greater than those in the photo (-) group. All photos and videos depicted specific places in Izunokuni City and included actual footage of disaster scenes or local warning signs. CONCLUSION: Based on our experience at the headquarters for disaster control during Typhoon Hagibis, Twitter was considered to be a useful tool for obtaining local disaster information based on its timeliness, reality and specificity.

Survey of trauma patients injured by falling or flying objects in Japan based on the Japan Trauma Data Bank.

PURPOSE: We retrospectively investigated patients injured by falling/flying objects using the Japan Trauma Data Bank (JTDB). METHODS: The study collected information of the JTEB from January 2004 to May 2019. The subjects were divided into two groups: the unexpected accident (UA) group included cases in which the patient was injured by an unexpected accident; the labor accident (LA) group included cases in which the patient was injured at work. RESULTS: A total of 1997 patients were enrolled as subjects (UA group, n = 383; LA group, n = 1134). In both groups, head injuries were the most frequent type of injury, followed by chest injuries. The median head abbreviated injury scale of the UA group was significantly higher than that of the LA group. In the UA group, the percentage of female patients, average age, and average TRISS value were significantly greater in comparison to the LA group. The frequency of emergency operations in the UA group was significantly lower in comparison to the LA group. The frequency of head injuries in the UA group was significantly greater than that in the LA group. The frequencies of upper extremity and lower extremity injuries in the UA group were significantly lower than those in the LA group. CONCLUSION: This is the first report to analyze trauma patients injured by falling/flying objects using the JTDB. Public health and emergency providers can use this information to anticipate the health-care needs after falling/flying object injuries.

Benefits and Drawbacks of Using Hotels as Shelters After a Landslide.

OBJECTIVES: On July 3, 2021, a landslide occurred in part of Atami City, Shizuoka, Japan. METHODS: The government of Shizuoka Prefecture requested the dispatch of Shizuoka Disaster Medical Assistance Teams (S-DMATs). RESULTS: On day 2, the evacuees were evacuated into 2 hotels (A and B). Hotel A accommodated over 570 independent and dependent evacuees. Hotel B accommodated 44 dependent aged individuals, who lived in the same long-term health-care facility, together with their 11 caregivers. The evacuees in hotel B returned to the previous facility on day 10 without any specific medical problems. The evacuees in hotel A were managed in the guest rooms as family units. Individuals requiring care in guest rooms in hotel A became isolated because they could not call for help or walk. Furthermore, hotel guest rooms were not barrier-free. The S-DMATs supported the evacuees. CONCLUSIONS: Independent evacuees received the maximum benefits from the use of a hotel as a shelter. In contrast, it was difficult for dependent evacuees to benefit from the hotel as it is as a shelter when living alone in the hotel. Dependent evacuees required appropriate support to eat, walk, use the toilet, and keep themselves clean when using a hotel as a shelter.

Severe COVID-19 Pneumonia Treated by Intensive Immune Suppression Therapy With a Combination of Steroid Pulse and Tocilizumab Followed by a Tapering Dose of Steroid Therapy During the Delta (B.1.617.2) Variant Outbreak: A Successfully Treated Case.

A 55-year-old man developed a low-grade fever (day 1). His wife had already been infected with COVID-19 four days previously and he had been isolated in his house as a close contact. Polymerase chain reaction for COVID-19 was positive. He had untreated diabetes mellitus. On day 7, his percutaneous saturated oxygen fell to <70% and he was transported to a hospital by ambulance. He underwent tracheal intubation, mechanical ventilation, and treatments with half steroid pulse, tocilizumab, remdesivir, and heparin. However, his ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) decreased to 120 under mechanical ventilation and he was transported to our hospital. On arrival, he did not synchronize with mechanical ventilation well. Initially, he was treated using a muscle relaxant and deep sedation to facilitate complete synchronization with mechanical ventilation and his P/F ratio improved to 247; thus, he was treated with mechanical ventilation alone with intermittent placement in the prone position. In addition, he was treated with steroid pulse therapy after steroid tapering therapy for nearly one month, glycyrrhizin, γ-globulin, azithromycin, and heparin. On day 20, the tracheal tube was removed after the improvement of the P/F ratio. We herein present the case of a patient with severe COVID-19 pneumonia who survived following treatment by intensive immune suppression therapy, including the combination of steroid pulse and tocilizumab, followed by a tapering dose of steroid therapy, after an outbreak of COVID-19 Delta variant. Further studies are needed to investigate the usefulness of this regimen.

Significance of medical intervention for non-traumatic hemorrhagic cardiac tamponade.

BACKGROUND: The outcomes of patients with cardiac arrest induced by non-traumatic hemorrhagic cardiac tamponade are poor. PURPOSE: We retrospectively investigated the significance of medical intervention with pericardiocentesis and/or pericardiotomy for non-traumatic hemorrhagic cardiac tamponade. METHODS: From January 2013 to April 2021, we retrospectively reviewed the medical charts of all patients with cardiac arrest in a prehospital setting or emergency room due to cardiac tamponade confirmed by an ultrasound examination with or without an invasive procedure (pericardiocentesis and/or pericardiotomy) and computed tomography findings, including those obtained at autopsy imaging. The subjects were divided into two groups: the Intervention (+) group, which included subjects who underwent pericardiocentesis or pericardiotomy, and the Intervention (-) group, which included subjects who did not undergo pericardiocentesis or pericardiotomy. Variables were then compared between the two groups. RESULTS: There were 68 patients with non-traumatic cardiac tamponade. All three survival cases had witnessed collapse, and the initial rhythm was pulseless electrical activity (PEA).There were no statistically significant differences in the sex, age, means of transportation, bystander chest compression, electric shock, or adrenalineor FDP levels between the two groups.However, the number with witnessed collapse, PEA, rupture of the heart;the ratio of obtaining return of spontaneous circulation; and the survival ratio were significantly greater in the Intervention (+) group than in the Intervention (-) group. CONCLUSION: Based on the results of preliminary study, we hypothesized that invasive medical intervention for patients with cardiac arrest induced by non-traumatic hemorrhagic cardiac tamponade might be useful for obtaining return of spontaneous circulation and a survival outcome, especially for patients with witnessed collapse with PEA as the initial rhythm.