Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 33
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
BMJ Open ; 9(12): e030421, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31843822

RESUMO

OBJECTIVE: Early prediction of bacteraemia in the elederly is needed in the emergency department (ED). DESIGN, SETTING AND PARTICIPANTS: A prospective study in Japan; single-centre trial in patients who satisfied the sepsis criteria was conducted between September 2014 and March 2016. Forty-six elderly patients aged ≥70 years were included. The study protocol was approved by the ethics committee of Osaka Medical College. Ethics Committee approval number was 1585. INTERVENTIONS: Blood sampling to evaluate C-reactive protein (CRP), procalcitonin (PCT) and presepsin plasma levels; two sets of blood sampling for bacterial cultures; and evaluations of the Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation scores were performed on arrival at the ED. The results were compared between patients with bacteraemia and those without bacteraemia. MAIN OUTCOME MEASURE: The accuracy of detecting bacteraemia. RESULTS: The presepsin value was significantly higher in the bacteraemia group than in the non-bacteraemia group (866.6±184.6 vs 639.9±137.1 pg/mL, p=0.03). The PCT and CRP did not significantly differ between the groups. The area under the receiver operating characteristic curve values were not significantly different among presepsin (0.69), PCT (0.61) and CRP (0.53). Multivariate analysis showed that presepsin was independently associated with bacteraemia (OR 8.84; 95% CI 0.95 to 81.79; p=0.02). CONCLUSION: Presepsin could be a good biomarker to predict bacteraemia in elderly patients with sepsis criteria admitted to the ED.

2.
BMC Infect Dis ; 19(1): 719, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416426

RESUMO

BACKGROUND: Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. C. perfringens septicemia is rare, but is a known cause of hemolysis by damaging red blood cell, and often proves rapidly fatal in emergency department (ED) situations. CASE PRESENTATION: A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Laboratory examination revealed a large discrepancy between the red blood cell count of 1.91 × 106/mm3 and the hemoglobin level of 10.3 g/dL, suggesting massive intravascular hemolysis. Computed tomography revealed liver abscesses with gas. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Blood cultures finally identified C. perfringens. CONCLUSION: Intravascular hemolysis and red blood cell (RBC) / hemoglobin (Hb) discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to provide appropriate treatment.


Assuntos
Infecções por Clostridium/diagnóstico , Clostridium perfringens/patogenicidade , Gangrena Gasosa/diagnóstico , Hemoglobinas/análise , Abscesso Hepático/microbiologia , Idoso , Bacteriemia/microbiologia , Hemocultura , Infecções por Clostridium/etiologia , Gangrena Gasosa/etiologia , Parada Cardíaca , Hemólise , Humanos , Abscesso Hepático/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
3.
JAMA Netw Open ; 2(5): e195111, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31150086

RESUMO

Importance: Bystander interventions are a factor for improving survival of out-of-hospital cardiac arrest (OHCA), but it is hypothesized that girls and women experiencing OHCA may be less likely to receive bystander interventions than boys and men. Objective: To investigate sex disparities in receiving public-access automated external defibrillator (AED) pad application and bystander-initiated cardiopulmonary resuscitation (CPR) among students who experienced OHCA in school settings. Design, Setting, and Participants: This nationwide cohort study used the Stop and Prevent Cardiac Arrest, Injury, and Trauma in Schools (SPIRITS) database to link databases from 2 nationally representative registries-the Injury and Accident Mutual Aid Benefit System of the Japan Sport Council and the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Students from elementary schools (ages 6-12 years), junior high schools (ages 12-15 years), high schools (ages 15-21 years), and technical colleges (ages 15-21 years) who experienced nontraumatic OHCA involving attempted resuscitation by emergency medical service personnel or bystanders in school settings from April 1, 2008, to December 31, 2015, were included. Data analysis was performed from January 5, 2019, to April 11, 2019. Exposures: Sex and school level. Main Outcomes and Measures: Application of public-access AED pads or initiation of CPR by a bystander. Results: A total of 232 students who experienced OHCA with nontraumatic causes in school settings (mean [SD] age, 14.5 [2.9] years; 175 [75.4%] male) were included. In multivariable analysis of the full cohort of students who experienced OHCA, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (36 of 57 female students [63.2%] received AED pad application vs 141 of 175 male students [80.6%]; adjusted odds ratio [OR], 0.44; 95% CI, 0.20-0.97; P = .04). In the subgroup analysis of students who experienced OHCA in high schools or technical schools, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (10 of 18 female students [55.6%] vs 84 of 101 male students [83.2%]; adjusted OR, 0.26; 95% CI, 0.08-0.87; P = .03). Among the full cohort, 48 of 57 female students (84.2%) and 151 of 175 male students (86.3%) received CPR from bystanders (adjusted OR, 0.81; 95% CI, 0.30-2.22), and there were no significant differences in receiving bystander-initiated CPR between sexes, irrespective of school level. Conclusions and Relevance: Among students who experienced OHCA in schools in Japan, female sex was associated with lower odds of receiving public-access AED pad application compared with male sex.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Desfibriladores/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Feminino , Humanos , Japão/epidemiologia , Masculino , Parada Cardíaca Extra-Hospitalar/epidemiologia , Estudos Prospectivos , Instituições Acadêmicas , Distribuição por Sexo , Estudantes/estatística & dados numéricos
4.
Resuscitation ; 140: 150-158, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31075289

RESUMO

BACKGROUND: Our objective was to assess the characteristics such as public-access defibrillation (PAD) by laypersons and the outcomes after pediatric out-of-hospital cardiac arrest by location in the PAD era. METHODS: From a nationwide, prospective, population-based registry of out-of-hospital cardiac arrest patients in Japan, we enrolled consecutive pediatric patients aged ≤17 years before emergency medical service (EMS) arrival between 2013 and 2015. The primary outcome measure was 1-month survival, with favorable neurologic outcome defined as cerebral performance category 1 or 2. Factors associated with favorable neurologic outcome were assessed using multivariable logistic regression analysis. RESULTS: Among 3991 eligible pediatric out-of-hospital cardiac arrests, the proportion of PAD was 0.2% (5/2888) at residence, 1.6% (2/125) in public areas, 0.9% (3/321) on streets/highways, 21.6% (11/51) at recreation/sports event areas, 46.1% (82/178) at education institutions, and 1.2% (5/428) in others. In the multivariable analysis, arrest witnessed by family members (adjusted odds ratio [AOR], 5.25; 95% confidence interval [CI], 3.22-8.58) and nonfamily members (AOR, 2.45; 95% CI, 1.26-4.77), first documented ventricular fibrillation (AOR, 12.29; 95% CI, 7.08-21.35), PAD (AOR, 2.63; 95% CI, 1.23-5.62), and earlier EMS response time (AOR for 1-min increment, 0.88; 95% CI, 0.81-0.94) were associated with improving outcome. As for locations, recreation/sports event areas (AOR, 3.43; 95% CI, 1.17-10.07) and education institutions (AOR, 3.03; 95% CI, 1.39-6.63) were also associated with favorable neurologic outcome. CONCLUSIONS: In Japan, where public-access automated external defibrillators are well disseminated, characteristics such as PAD and outcomes for pediatric out-of-hospital cardiac arrest before EMS arrival differed substantially by location.

5.
Resuscitation ; 139: 33-40, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30953710

RESUMO

BACKGROUND: Sudden cardiac death during exercise or sports is an important problem among young athletes and non-athletes. An understanding of the epidemiological features of sports-related out-of-hospital cardiac arrest (OHCA) among children is crucial for planning approaches for prevention and better outcomes of paediatric OHCAs. We assessed the characteristics and outcomes of sports-related OHCA among children at schools in Japan to prevent sports-related paediatric OHCA at schools. METHODS: The Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a nationwide, prospective, observational study linking databases of two nationally representative registries. Data on the characteristics and outcomes of sports-related paediatric OHCA at schools in Japan were obtained from these databases. RESULTS: Between 2008 and 2015, 188 sports-related paediatric OHCAs due to presumed cardiac origin occurred. The greatest proportion of OHCA during or after sports was due to long-distance running (21.8%), followed by soccer/futsal (13.3%), basketball (12.2%), and baseball/rubber-ball baseball (11.2%). We also assessed the association between prehospital factors and one-month survival with favourable neurological outcome after sports-related OHCA. The proportions of ventricular fibrillation as the first documented rhythm, bystander cardiopulmonary resuscitation (CPR), and public-access defibrillation (PAD) were 87.8%, 87.2%, and 63.3%, respectively. Compared with the non-PAD group, the adjusted odds ratio (95% confidence interval) of the PAD group was 3.64 (1.78-7.45). CONCLUSIONS: In Japan, 188 schoolchildren experienced OHCAs of cardiac origin occurring during or after sports activity at schools during the 8-year period. Increasing PAD is essential to enhance better neurological outcome after sports-related OHCA among students.

6.
Acute Med Surg ; 6(1): 12-24, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30651993

RESUMO

Aim: To describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in-hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan. Methods: The Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on-scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data. Results: From January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system. Conclusion: Using the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.

7.
Europace ; 21(3): 451-458, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30500911

RESUMO

AIMS: We aimed to reveal the effects of application of public-access automated external defibrillators (AEDs) and bystander-initiated cardiopulmonary resuscitation (CPR) on survival of paediatric patients with out-of-hospital cardiac arrest (OHCA) occurring on school campuses in Japan. METHODS AND RESULTS: Data were obtained from a nationwide prospective observational study of paediatric OHCAs in school settings in Japan, termed Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS). Non-traumatic OHCA patients from elementary school, junior high school, and high school/technical college between April 2008 and December 2015 were enrolled. A multivariable logistic regression analysis was conducted to assess the effect of bystander interventions (i.e. public-access AED application and bystander-CPR) on 30-day survival with favourable neurological outcome. In total, 232 OHCA cases were analysed. The proportion of 30-day survival with favourable neurological outcome was significantly higher among the patients receiving both public-access AED application and bystander-CPR than those without any bystander intervention (50.9% vs. 20.0%, adjusted odds ratio 4.08, 95% confidence interval 1.25-13.31; P = 0.020). During the study period, the proportion of patients to whom public-access AEDs were applied increased significantly (from 61.9% in 2008 to 87.0% in 2015, P-for trend = 0.014). Accordingly, the proportion of 30-day survival with favourable neurological outcome improved significantly (from 38.1% in 2005 to 56.5% in 2015, P-for trend = 0.026). CONCLUSION: The combination of public-access AED application and bystander-CPR increased the chance of survival approximately four-fold in schools. The nationwide efforts towards disseminating public-access defibrillation systems in school settings may reduce the risk of sudden cardiac death among school children.

8.
Am J Cardiol ; 122(5): 890-897, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30057229

RESUMO

The effectiveness of dissemination of public-access automated external defibrillators (AEDs) has been well established for adults, but not for children at the population level. We obtained out-of-hospital cardiac arrest (OHCA) data between January 2005 and December 2014 from a nationwide OHCA registry of Japan. Our study subjects were OHCA cases aged 6 to 17, involving attempted resuscitation by emergency medical service personnel or by bystanders. The primary outcome measure was 1-month survival with favorable neurological outcome after OHCA. We evaluated trends in the proportion of OHCA cases receiving shocks by a public-access AED and outcomes after OHCA over the 10-year study period. Prehospital factors associated with 1-month survival with favorable neurological outcome were also evaluated. During the 10-year study period, a total of 5,899 OHCAs occurred in school-age children, and 1,452 (24.6%) were of cardiac origin. The overall OHCA incidence rate in school-age children was 4.2 per 100,000 people per year. The proportion of patients with OHCA who received shocks by a public-access AED increased significantly during the study period (0.1% in 2005 and 6.4% in 2014, p for-trend <0.001). Accordingly, the 1-month survival with favorable neurological outcome improved significantly (5.3% in 2005 and 9.0% in 2014, p for-trend <0.001). In multivariable analysis, receiving shocks by a public-access AED was significantly associated with improved outcomes (adjusted odds ratio 2.13, 95% confidence interval 1.43 to 4.15; p <0.001). In conclusion, the significant increase in receiving shocks by a public-access AED was followed by a substantial improvement in patient outcomes after OHCA in school-age children in Japan.


Assuntos
Desfibriladores , Acesso aos Serviços de Saúde , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Criança , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Parada Cardíaca Extra-Hospitalar/epidemiologia , Sistema de Registros , Taxa de Sobrevida
9.
J Gen Fam Med ; 19(4): 133-135, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29998043

RESUMO

Atypical pneumonia has been thought to account for 7%-20% of community-acquired pneumonia (CAP). The treatment for the pathogens that cause atypical pneumonia is different from that of other bacterial pneumonia. Therefore, identification of the causative pathogen in a primary care situation is crucial for adequate treatment of CAP. Mycoplasma infection is prevalent in the general population, but Mycoplasma pneumoniae with extrapulmonary symptoms is relatively rare. Herein, we report a case of CAP because of M. pneumoniae that presented with a wide variety of extrapulmonary diseases. Delayed administration of appropriate antibiotics may contribute to development of extrapulmonary manifestations.

10.
Medicine (Baltimore) ; 97(23): e11058, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29879075

RESUMO

INTRODUCTION: The abrupt onset of sensorimotor deficits is a neurologic emergency that requires immediate management. Acute spontaneous spinal cord infarction (SCI) is rare, but can cause the sudden onset of quadriplegia or quadriparesis. Magnetic resonance imaging (MRI) is an essential imaging modality to diagnose SCI. CASE PRESENTATION: A 75-year-old man with a history of diabetes mellitus type 2, hypertension, and dyslipidemia was transferred to our facility for further workup of the sudden onset of quadriplegia. Diffusion-weighted contrast MRI (DWI) on hospital day 8 revealed hyperintense signals predominantly at the grey matter, and a contrast T2 signal abnormality with a decreased apparent diffusion coefficient (ADC). Steroid pulse therapy was initiated because myelitis could not be completely ruled out, but this did not improve the neurological deficits. Spontaneous SCI was finally diagnosed as an exclusion diagnosis. Symptoms were gradually recovered with rehabilitation, and he was transferred to a rehabilitation facility on hospital day 40. CONCLUSION: MRI with DWI of the spine should be considered for an early diagnosis of SCI. A combination of DWI with ADC maps is recommended to distinguish SCI from other differential disorders.


Assuntos
Infarto/patologia , Quadriplegia/etiologia , Isquemia do Cordão Espinal/patologia , Medula Espinal/patologia , Idoso , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Diagnóstico Precoce , Humanos , Masculino , Quadriplegia/diagnóstico , Medula Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/reabilitação , Resultado do Tratamento
11.
Circ J ; 82(4): 1026-1032, 2018 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-29445066

RESUMO

BACKGROUND: A better understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring in school settings is important to establish an evidence-based strategy for prevention and better prognosis.Methods and Results:The Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a nationwide prospective observational study linking databases from 2 nationally representative registries, the Injury and the Accident Mutual Aid Benefit System of The Japan Sport Council and the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Using these databases, we described the detailed characteristics and outcomes of pediatric OHCAs that occurred in school settings in Japan between 2009 and 2014. During the 6-year study period, 295 OHCA cases were confirmed. Overall incidence rate was 0.4 per 100,000 students per year. The majority of OHCA cases had a cardiac origin (71%), occurred during exercise (65%), were witnessed by bystanders (70%), and received bystander-initiated cardiopulmonary resuscitation (73%). In approximately one-third of cases the student was defibrillated by public-access automated external defibrillator (38%). The proportion of patients with 1-month survival and a favorable neurological outcome was 34% among all OHCAs and 43% among OHCAs of cardiac origin. CONCLUSIONS: In Japan, approximately 50 pediatric cases of OHCA consistently occur yearly in school settings. The majority of students received basic life support from bystanders, and patients with OHCA of cardiac origin had a relatively good prognosis.


Assuntos
Reanimação Cardiopulmonar/métodos , Desfibriladores , Parada Cardíaca Extra-Hospitalar/epidemiologia , Instituições Acadêmicas , Adolescente , Criança , Exercício , Humanos , Incidência , Japão/epidemiologia , Masculino , Parada Cardíaca Extra-Hospitalar/terapia , Prognóstico , Sistema de Registros , Estudantes/estatística & dados numéricos , Resultado do Tratamento
12.
Pediatr Int ; 60(1): 93-95, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29356286

RESUMO

The deployment status of pediatric emergency equipment in ambulances in Japan is unknown. To investigate the status of and issues associated with prehospital emergency medical care for pediatric patients, we conducted a descriptive epidemiological study. We carried out a Web-based survey of 767 fire defense headquarters in Japan, of which 671 responded (valid response rate, 88%). Most of the fire defense headquarters equipped all of their ambulances with oxygen masks (82%), bag-valve masks (for neonates, 83%; for children, 84%), straight laryngoscope blades (for neonates, 47%; for children 68%), blood pressure cuffs for children (91%), oximeter probes (78%), and stiff neck collars (91%); but despite the need for other equipment such as nasopharyngeal and oropharyngeal airways, and Magill forceps, they were insufficiently deployed. In Japan, prehospital emergency medical equipment deployment does not meet the needs of pediatric patients. Minimum equipment standards need to be established for pediatric prehospital care.


Assuntos
Serviços Médicos de Emergência/provisão & distribução , Medicina de Emergência/instrumentação , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pediatria/instrumentação , Ambulâncias/estatística & dados numéricos , Criança , Pesquisas sobre Serviços de Saúde , Humanos , Japão , Garantia da Qualidade dos Cuidados de Saúde
13.
Resuscitation ; 118: 147-158, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28728893

RESUMO

BACKGROUND: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. METHODS: An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. RESULTS: The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. CONCLUSIONS: The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations.


Assuntos
Reanimação Cardiopulmonar/normas , Afogamento , Parada Cardíaca/terapia , Consenso , Serviços Médicos de Emergência/normas , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Humanos , Cooperação Internacional
14.
Artigo em Inglês | MEDLINE | ID: mdl-28716971

RESUMO

BACKGROUND: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. METHODS: An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. RESULTS: The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. CONCLUSIONS: The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations.


Assuntos
Pesquisa Biomédica/normas , Reanimação Cardiopulmonar/normas , Afogamento , Parada Cardíaca/terapia , Projetos de Pesquisa/normas , Consenso , Afogamento/mortalidade , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Humanos , Comunicação Interdisciplinar , Cooperação Internacional
15.
Am J Emerg Med ; 35(10): 1584.e5-1584.e7, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28751042

RESUMO

Spontaneous rupture of the urinary bladder (SRUB) is rare and results in a lethal condition, i.e., pan peritonitis. However, early and accurate diagnosis of SRUB is very difficult. A 54-year-old woman was transported to our hospital with suspicion of pan peritonitis after spontaneous return of circulation with pulseless electrical activity. Laboratory investigation seemed to indicate acute renal failure. Namely, her serum urea and creatinine levels were grossly elevated. Exploratory laparotomy showed unexpected rupture of urinary bladder. Her recovery after surgery was relatively smooth. SRUB should be considered in the differential diagnosis of pan peritonitis, because urgent appropriate surgical intervention can rescue patients from this rare lethal disease.


Assuntos
Parada Cardíaca/complicações , Doenças da Bexiga Urinária/etiologia , Bexiga Urinária , Feminino , Humanos , Laparotomia , Pessoa de Meia-Idade , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos
16.
Nagoya J Med Sci ; 79(1): 109-113, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28303069

RESUMO

Strangulated intestinal obstruction is one of the most common types of acute abdomen and requires urgent surgical treatment. Herein, we report a very rare case of strangulated intestinal obstruction caused by an ileo-ileal knot. An 80-year-old woman was admitted to our hospital with suspicion of strangulation ileus and underwent emergency laparotomy after investigation by exploratory single-port laparoscopy. During surgery, a small bowel gangrene caused by an ileo-ileal knot was found. The gangrenous segment was resected, and primary anastomosis was performed. Post-operative recovery was uneventful except for a minor wound infection. Our extensive search of the literature found only 7 case reports of ileo-ileal knot including ours. An ileo-ileal knot should be considered in the differential diagnosis of acute intestinal obstruction, because this rare phenomenon requires urgent surgical treatment; and some complications should be considered during or after surgery.


Assuntos
Obstrução Intestinal/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Gangrena/diagnóstico , Gangrena/etiologia , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia
17.
Medicine (Baltimore) ; 96(48): e8946, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29310390

RESUMO

RATIONAL: Takotsubo cardiomyopathy (TCM) is a transient systolic dysfunction of the left ventricular apex without stenosis of coronary arteries and is induced by various psychological and physical factors. TCM sometimes causes lethal complications such as arrhythmia, thrombogenesis, and even cardiac rupture, and thus it should be diagnosed appropriately and managed carefully. Intensive care unit (ICU) patients are exposed to overstress during the treatment process and therefore can are at potential risk for TCM. PATIENT CONCERNS: The patient was diagnosed as having pneumonia because of influenza A virus mixed with bacteria and underwent intensive care with intubation and mechanical ventilation in the ICU. His respiratory condition soon improved, and so extubation was carried out; however, redeterioration with pulmonary edema occurred at half of a day following extubation. DIAGNOSIS: The chest x-ray revealed pulmonary edema. The electrocardiogram pattern significantly changed with time, and the echocardiogram showed weakness of wall motion around the left ventricular apex. Hence, to confirm the diagnosis, we performed cardiac catheterization immediately, with the results showing a Takotsubo-like form at the systolic phase without significant stenosis of the coronary arteries. INTERVENTION: The patient was reintubated with administration of catecholamine for decreasing blood pressure caused by left ventricular dysfunction. Also, diuretics for pulmonary edema and anticoagulants for prevention of thrombogenesis were administered. OUTCOMES: As the respiratory condition improved with stabilization of cardiovascular hemodynamics, reextubation was done at ICU day 11 and was discharged from the ICU at ICU day 15. The patient was subsequently treated for pneumonia after leaving the ICU but suffered from repetitive aspiration pneumonia and was finally transferred to another hospital at hospital day 111. LESSONS: TCM should be considered especially under the situation of intensive care, and prompt diagnosis should be followed by appropriate management.


Assuntos
Extubação/efeitos adversos , Insuficiência Respiratória/complicações , Cardiomiopatia de Takotsubo/etiologia , Idoso de 80 Anos ou mais , Cuidados Críticos , Humanos , Masculino , Pneumonia/complicações , Pneumonia/terapia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/terapia
18.
BMJ Open ; 6(7): e011419, 2016 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-27381208

RESUMO

OBJECTIVES: To evaluate the incidence and outcomes of self-harm from ambulance records. DESIGN: A retrospective, observational study. SETTING: Osaka City, Japan. PARTICIPANTS: A total of 365 adolescents aged 10-19 years with emergency self-harm such as poisoning by drugs or gas, cutting skin, jumping from heights, hanging and drowning and treated by emergency medical service personnel from January 2010 through December 2012. PRIMARY OUTCOME MEASUREMENTS: Incidence per 100 000 persons and outcome at the scene or hospital arrival by age and gender. Poisson regression models for incidence evaluation were used; reporting relative risks (RRs) and their 95% CIs. RESULTS: During the study period, a total of 425 self-harm events were documented in 365 adolescents. The incidence of self-harm increased significantly between the ages of 11 and 19 years, from 6.3 to 81.0 among boys and the ages of 12 and 19 years from 6.3 to 228.3 among girls, respectively (both p<0.001). Although there was no incidence difference between girls and boys in the group aged 11-14 years (RR 1.20; 95% CI 0.59 to 2.47), the incidence was significantly higher among girls than boys in the group aged 15-19 years (RR 4.18; 95% CI 3.20 to 5.45). The overall proportion of death by self-harm was 4.9%. The proportion of hospital admission and death by self-harm was higher among boys than among girls (38.6% vs 25.2%, p=0.016 and 14.8% vs 2.4%, p<0.001). CONCLUSIONS: The incidence of emergency treatment for self-harm by adolescents increased with age and our findings also demonstrated the gender paradox. It would be necessary to establish active, gender-specific and comprehensive prevention strategies for adolescent self-harm, based on our findings showing the age and gender differences of self-harm among adolescents.


Assuntos
Comportamento do Adolescente/psicologia , Saúde do Adolescente , Serviços Médicos de Emergência/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Adolescente , Distribuição por Idade , Criança , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Registros Médicos/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Estudos Retrospectivos , Fatores de Risco , Comportamento Autodestrutivo/psicologia , Comportamento Autodestrutivo/terapia , Distribuição por Sexo
19.
Acute Med Surg ; 3(4): 356-359, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-29123812

RESUMO

Aim: The use of automated external defibrillators was expanded to include infants according to the 2010 cardiopulmonary resuscitation guidelines in Japan. However, deployment has been slower for pediatric patients in Japan, because there are fewer appropriate pediatric patients for automated external defibrillators than adults. This study aimed to investigate the targeted age range for pediatric defibrillation and device deployment of defibrillators for pediatric patients in prehospital emergency medical care settings in Japan, and present the issues associated with automated external defibrillators. Methods: We administered a web-based survey to the fire defense headquarters in Japan regarding prehospital emergency medical care for pediatric patients in June 2013. We extracted and analyzed some parts of the data related to pediatric defibrillation. Results: Eighty-eight percent of the fire defense headquarters responded to the survey. Sixty-two percent of the fire defense headquarters applied the expanded indication protocol for pediatric defibrillation, which included infants. Forty-three percent of the fire defense headquarters replied that their emergency medical service personnel were using semi-automatic defibrillators without a pediatric mode, whereas 21% of them were using automated external defibrillators that were not equipped with pediatric attenuators. Moreover, many of the semi-automatic defibrillators are not designed for pediatric defibrillation in patients aged <8 years. Conclusions: Pediatric prehospital emergency medical care in Japan is inadequately equipped for pediatric defibrillation. It will be necessary to use age-appropriate defibrillators as the targeted age range for automated external defibrillators rapidly expands to include infants.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA