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1.
Medicina (Kaunas) ; 60(8)2024 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-39202619

RESUMO

Background and Objectives: Minimally invasive trauma management, including interventional radiology and non-operative approaches, has proven effective. Consequently, our hospital established a trauma IVR protocol called "Ohta Nishinouchi Hospital trauma protocol (ONH trauma protocol) in 2013, mainly for trunk trauma. However, the efficacy of the ONH trauma protocol has remained unverified. We aimed to assess the protocol's impact using interrupted time-series analysis (ITSA). Materials and Methods: This retrospective cohort study was conducted at Ohta Nishinouchi hospital, a tertiary emergency hospital, from January 2004 to December 2019. We included patients aged ≥ 18 years who presented to our institution due to severe trauma characterized by an Abbreviated Injury Scale of ≥3 in any region. The primary outcome was the incidence of in-hospital deaths per 100 transported patients with trauma. Multivariable logistic regression analysis was conducted with in-hospital mortality as the outcome, with no exposure before protocol implementation and with exposure after protocol implementation. Results: Overall, 4558 patients were included in the analysis. The ITSA showed no significant change in in-hospital deaths after protocol induction (level change -1.49, 95% confidence interval (CI) -4.82 to 1.84, p = 0.39; trend change -0.044, 95% CI -0.22 to 0.14, p = 0.63). However, the logistic regression analysis revealed a reduced mortality effect following protocol induction (odds ratio: 0.50, 95% CI: 0.37 to 0.66, p < 0.01, average marginal effects: -3.2%, 95% CI: -4.5 to -2.0, p < 0.01). Conclusions: The ITSA showed no association between the protocol and mortality. However, before-and-after testing revealed a positive impact on mortality. A comprehensive analysis, including ITSA, is recommended over before-and-after comparisons to assess the impact of the protocol.


Assuntos
Mortalidade Hospitalar , Análise de Séries Temporais Interrompida , Humanos , Feminino , Estudos Retrospectivos , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Protocolos Clínicos , Estudos de Coortes , Pelve/lesões , Modelos Logísticos , Japão/epidemiologia , Tronco/lesões
2.
Ann Vasc Surg ; 88: 291-299, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35817382

RESUMO

BACKGROUND: Nonoperative management (NOM) has become a standard strategy for hemodynamically stable patients with blunt splenic injury; however, delayed rupture of splenic pseudoaneurysm (SPA) is a serious complication of NOM. In medical literature, data regarding the long-term incidence of SPA are scarce, and the appropriate timing for performing follow-up contrast-enhanced computed tomography (CT) has not yet been reported. This study aimed to elucidate the long-term incidence and timing of SPA formation after blunt splenic injury in patients treated with NOM. METHODS: This descriptive study was conducted at a tertiary medical center in Japan. Patients with blunt splenic injury who were treated with NOM between April 2014 and August 2020 were included in the analysis. Included patients underwent repeated contrast-enhanced CT to detect SPA formation. The primary outcome was the cumulative incidence of delayed formation of SPA. We also evaluated differences in SPA formation between patients who received transcatheter arterial embolization (TAE; TAE group) and those who did not receive it (non-TAE group) on admission day. RESULTS: Among 49 patients with blunt splenic injury who were treated with NOM, 5 patients (10.2%) had delayed formation of SPA. All cases of SPA formation occurred within 15 days of injury. The incidence of SPA formation was not significantly different between the TAE and non-TAE groups (1/19 vs. 4/30, P = 0.67). CONCLUSIONS: SPA developed in 10% of patients within approximately 2 weeks after blunt splenic injury. Therefore, performing follow-up contrast-enhanced CT in this period after injury may be useful to evaluate delayed formation of SPA. Although our findings are novel, they should be confirmed through future studies with larger sample sizes.


Assuntos
Falso Aneurisma , Embolização Terapêutica , Ferimentos não Penetrantes , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/epidemiologia , Falso Aneurisma/etiologia , Incidência , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/terapia , Baço/diagnóstico por imagem , Baço/lesões , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Escala de Gravidade do Ferimento , Estudos Retrospectivos
3.
BMC Emerg Med ; 20(1): 34, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375651

RESUMO

BACKGROUND: Applying excessive force during endotracheal intubation (ETI) is associated with several complications, including dental trauma and hemodynamic alterations. A gum-elastic bougie (GEB), a type of tracheal tube introducer, is a useful airway adjunct for patients with poor laryngoscopic views. However, how the use of a GEB affects the force applied during laryngoscopy is unclear. We compared the force applied on the oral structures during ETI performed by novices using the GEB versus an endotracheal tube + stylet. METHODS: This prospective crossover study was conducted from April 2017 to March 2019 in a public medical university in Japan. In total, 209 medical students (4th and 5th grade, mean age of 23.7 ± 2.0 years) without clinical ETI experience were recruited. The participants used either a Macintosh direct laryngoscope (DL) or C-MAC video laryngoscope (VL) in combination with a GEB or stylet to perform ETI on a high-fidelity airway management simulator. The order of the first ETI method was randomized to minimize the learning curve effect. The outcomes of interest were the maximum forces applied on the maxillary incisors and tongue during laryngoscopy. The implanted sensors in the simulator quantified these forces automatically. RESULTS: The maximum force applied on the maxillary incisors was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (39.0 ± 23.3 vs. 47.4 ± 32.6 N, P < 0.001) and C-MAC VL (38.9 ± 18.6 vs. 42.0 ± 22.1 N, P < 0.001). Similarly, the force applied on the tongue was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (31.9 ± 20.8 vs. 37.8 ± 22.2 N, P < 0.001) and C-MAC VL (35.2 ± 17.5 vs. 38.4 ± 17.5 N, P < 0.001). CONCLUSIONS: Compared with the use of an endotracheal tube + stylet, the use of a GEB was associated with lower maximum forces on the oral structures during both direct and indirect laryngoscopy performed by novices. Our results suggest the expanded role of a GEB beyond an airway adjunct for difficult airways.


Assuntos
Competência Clínica , Educação de Graduação em Medicina , Intubação Intratraqueal/instrumentação , Laringoscopia/métodos , Língua/lesões , Traumatismos Dentários/etiologia , Estudos Cross-Over , Feminino , Humanos , Japão , Laringoscópios , Curva de Aprendizado , Masculino , Manequins , Estudos Prospectivos , Gravação em Vídeo , Adulto Jovem
4.
Wilderness Environ Med ; 29(3): 375-379, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29731409

RESUMO

Wild boar attacks have rarely been reported in the medical literature. This is the case of an 83-year-old male farmer who was assaulted from behind by an injured adult wild boar. He presented with hemorrhagic shock after sustaining injuries to the right profunda femoris artery and right sciatic nerve as well as significant soft-tissue injuries, bilateral iliac wing fractures, an open pneumothorax, and an anorectal injury. The anorectal injury was treated with fecal diversion but was complicated by soft-tissue infection in the surrounding dead space. The patient needed multiple operations, including removal of the distal rectum and creation of a permanent colostomy. In this report, we highlighted the characteristics of anorectal trauma caused by a wild boar attack. We conclude that penetrating anorectal injuries caused by this type of attack can be associated with extensive soft-tissue damage despite externally appearing to be simple puncture wounds. Anorectal combat injuries have demonstrated similar extensive surrounding soft-tissue injuries and propensity for infection; therefore, this case supports adopting a similar treatment strategy, that of serial and radical debridement, to treat certain wild boar injuries.


Assuntos
Canal Anal/lesões , Reto/lesões , Lesões dos Tecidos Moles/etiologia , Sus scrofa , Ferimentos Penetrantes/etiologia , Idoso de 80 Anos ou mais , Animais , Colostomia , Fazendeiros , Humanos , Japão , Masculino , Reto/cirurgia , Choque Hemorrágico/complicações , Choque Hemorrágico/terapia , Lesões dos Tecidos Moles/terapia , Resultado do Tratamento , Ferimentos Penetrantes/terapia
6.
J Anesth ; 30(2): 205-14, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26715428

RESUMO

PURPOSE: Immediate access to the equipment required for difficult airway management (DAM) is vital. However, in Japan, data are scarce regarding the availability of DAM resources in prehospital settings. The purpose of this study was to determine whether Japanese helicopter emergency medical services (HEMS) are adequately equipped to comply with the DAM algorithms of Japanese and American professional anesthesiology societies. METHODS: This nationwide cross-sectional study was conducted in May 2015. Base hospitals of HEMS were mailed a questionnaire about their airway management equipment and back-up personnel. Outcome measures were (1) call for help, (2) supraglottic airway device (SGA) insertion, (3) verification of tube placement using capnometry, and (4) the establishment of surgical airways, all of which have been endorsed in various airway management guidelines. The criteria defining feasibility were the availability of (1) more than one physician, (2) SGA, (3) capnometry, and (4) a surgical airway device in the prehospital setting. RESULTS: Of the 45 HEMS base hospitals questioned, 42 (93.3 %) returned completed questionnaires. A surgical airway was practicable by all HEMS. However, in the prehospital setting, back-up assistance was available in 14.3 %, SGA in 16.7 %, and capnometry in 66.7 %. No HEMS was capable of all four steps. CONCLUSION: In Japan, compliance with standard airway management algorithms in prehospital settings remains difficult because of the limited availability of alternative ventilation equipment and back-up personnel. Prehospital health care providers need to consider the risks and benefits of performing endotracheal intubation in environments not conducive to the success of this procedure.


Assuntos
Aeronaves , Manuseio das Vias Aéreas/métodos , Serviços Médicos de Emergência/métodos , Intubação Intratraqueal/métodos , Algoritmos , Capnografia/métodos , Estudos Transversais , Humanos , Japão , Médicos , Inquéritos e Questionários
7.
J Anesth ; 30(4): 644-52, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27130212

RESUMO

PURPOSE: The availability of difficult airway management (DAM) resources and the extent of capnometry use in Japanese intensive care units (ICUs) remained unclear. The purpose of this study was to clarify whether: (1) DAM resources were adequate, and (2) capnometry was routinely applied in Japanese ICUs. METHODS: This nationwide cross-sectional study was conducted from September 2015 to February 2016. All ICUs received a mailed questionnaire about their DAM resources and use of capnometry. Outcome measures were availability of: (1) 24-h in-house backup coverage; (2) a supraglottic airway device (SGA); (3) a dedicated DAM cart; and (4) surgical airway devices, and (5) routine use of capnometry to verify tube placement and for continuous monitoring of ventilator-dependent patients. The association between these outcomes and ICU type (academic, high-volume, closed, surgical) was also analyzed. RESULTS: Of the 289 ICUs, 196 (67.8 %) returned completed questionnaires. In-house backup coverage and surgical airway devices were highly available (89.3 and 95.9 %), but SGAs and dedicated DAM carts were not (60.2 and 60.7 %). The routine use of capnometry to confirm tube placement was reported by 55.6 % of the ICUs and was highest in closed ICUs (67.2 %, p = 0.03). The rate of continuous capnography monitoring was also 55.6 % and was highest in academic ICUs (64.5 %, p = 0.04). CONCLUSION: In Japanese ICUs, SGAs and dedicated DAM carts were less available, and capnometry was not universally applied either to confirm tube placement, or for continuous monitoring of ventilated patients. Our study revealed areas in need of improvement.


Assuntos
Manuseio das Vias Aéreas/métodos , Unidades de Terapia Intensiva , Intubação Intratraqueal/métodos , Capnografia , Estudos Transversais , Feminino , Humanos , Monitorização Fisiológica , Inquéritos e Questionários
8.
J Anesth ; 29(5): 678-85, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25801541

RESUMO

PURPOSE: Airway management in severe bronchial asthma exacerbation (BAE) carries very high risk and should be performed by experienced providers. However, no objective data are available on the association between the laryngoscopist's specialty and endotracheal intubation (ETI)-related adverse events in patients with severe bronchial asthma. In this paper, we compare emergency ETI-related adverse events in patients with severe BAE between anesthesiologists and other specialists. METHODS: This historical cohort study was conducted at a Japanese teaching hospital. We analyzed all BAE patients who underwent ETI in our emergency department from January 2002 to January 2014. Primary exposure was the specialty of the first laryngoscopist (anesthesiologist vs. other specialist). The primary outcome measure was the occurrence of an ETI-related adverse event, including severe bronchospasm after laryngoscopy, hypoxemia, regurgitation, unrecognized esophageal intubation, and ventricular tachycardia. RESULTS: Of 39 patients, 21 (53.8 %) were intubated by an anesthesiologist and 18 (46.2 %) by other specialists. Crude analysis revealed that ETI performed by an anesthesiologist was significantly associated with attenuated risk of ETI-related adverse events [odds ratio (OR) 0.090, 95 % confidence interval (CI) 0.020-0.41, p = 0.001]. The benefit of attenuated risk remained significant after adjusting for potential confounders, including Glasgow Coma Score, age, and use of a neuromuscular blocking agent (OR 0.058, 95 % CI 0.010-0.35, p = 0.0020). CONCLUSIONS: Anesthesiologist as first exposure was independently associated with attenuated risk of ETI-related adverse events in patients with severe BAE. The skill and knowledge of anesthesiologists should be applied to high-risk airway management whenever possible.


Assuntos
Manuseio das Vias Aéreas/métodos , Asma/terapia , Intubação Intratraqueal/efeitos adversos , Laringoscopia/métodos , Adulto , Idoso , Manuseio das Vias Aéreas/efeitos adversos , Estudos de Coortes , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco
9.
J Anesth ; 29(4): 622-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25784502

RESUMO

Multiple endotracheal intubation (ETI) attempts increase the risk of airway-related adverse events. However, little is known about autopsy findings after severe ETI-related complications. We present the detailed pathological findings in a patient with severe ETI-related complications. A 77-year-old obese male suffered cardiopulmonary arrest after choking at a rehabilitation facility. Spontaneous circulation returned after chest compressions and foreign-body removal. After multiple failed direct laryngoscopies, the patient was transferred to our hospital. He had massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum on admission, and died from hypoxic brain injury 15 h later. Autopsy revealed severe oropharyngeal, laryngeal, and left lung lower lobe injury. The likely mechanisms of diffuse emphysema were (1) oropharyngeal injury associated with multiple ETI attempts and excessive ventilation pressures and (2) left lung lower lobe injury associated with chest compressions and other resuscitative procedures. Multiple laryngoscopies can cause severe upper-airway injury, worsen respiratory status, and make ETI more difficult-a vicious circle that can be prevented by limiting ETI attempts. This is particularly important in unfavorable environments, in which backup devices and personnel are not easily obtained. The pathological findings in our patient caution against repeated attempts at ETI during resuscitation.


Assuntos
Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Idoso , Obstrução das Vias Respiratórias/complicações , Autopsia , Humanos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Pulmão/patologia , Masculino , Enfisema Mediastínico/etiologia , Pneumoperitônio/etiologia , Pneumotórax/etiologia , Retropneumoperitônio/etiologia , Enfisema Subcutâneo/etiologia
10.
Am J Emerg Med ; 32(7): 725-30, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24792932

RESUMO

BACKGROUND: Although electronic health record systems (EHRs) and emergency department information systems (EDISs) enable safe, efficient, and high-quality care, these systems have not yet been studied well. Here, we assessed (1) the prevalence of EHRs and EDISs, (2) changes in efficiency in emergency medical practices after introducing EHR and EDIS, and (3) barriers to and expectations from the EHR-EDIS transition in EDs of medical facilities with EHRs in Japan. MATERIALS AND METHODS: A survey regarding EHR (basic or comprehensive) and EDIS implementation was mailed to 466 hospitals. We examined the efficiency after EHR implementation and perceived barriers and expectations regarding the use of EDIS with existing EHRs. The survey was completed anonymously. RESULTS: Totally, 215 hospitals completed the survey (response rate, 46.1%), of which, 76.3% had basic EHRs, 4.2% had comprehensive EHRs, and 1.9% had EDISs. After introducing EHRs and EDISs, a reduction in the time required to access previous patient information and share patient information was noted, but no change was observed in the time required to produce medical records and the overall time for each medical care. For hospitals with EHRs, the most commonly cited barriers to EDIS implementation were inadequate funding for adoption and maintenance and potential adverse effects on workflow. The most desired function in the EHR-EDIS transition was establishing appropriate clinical guidelines for residents within their system. CONCLUSION: To attract EDs to EDIS from EHR, systems focusing on decreasing the time required to produce medical records and establishing appropriate clinical guidelines for residents are required.


Assuntos
Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Sistemas de Informação Hospitalar/estatística & dados numéricos , Sistemas de Registro de Ordens Médicas/estatística & dados numéricos , Registros Eletrônicos de Saúde/economia , Serviço Hospitalar de Emergência/economia , Sistemas de Informação Hospitalar/economia , Humanos , Japão , Inquéritos e Questionários , Fatores de Tempo
11.
Soc Psychiatry Psychiatr Epidemiol ; 49(12): 1911-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24907049

RESUMO

PURPOSE: The aim of this study is to assess whether the risk or types of suicide change in Fukushima in the aftermath of a series of disaster, including earthquake, tsunami and nuclear accident in March 2011. METHOD: The clinical records of all patients visited to the medical centre near the nuclear plant from 1 year before to 1 year after the disaster were reviewed (n = 981). Patients with non-fatal suicide attempt were divided into two categories depending on their method of suicide attempt. Standardised mortality ratios were calculated to adjust for changes in demographic profiles. RESULTS: The risk of non-fatal suicide attempts using high-mortality methods was significantly higher for 4 months, by three to four times after the series of disasters, and then decreased. There was no significant increase of non-fatal suicide attempts using low-mortality methods after the disaster. CONCLUSIONS: After such a disaster, immediate psychiatric support may be required because of the increased risk of non-fatal suicide attempts in the immediate aftermath.


Assuntos
Desastres , Terremotos , Acidente Nuclear de Fukushima , Tentativa de Suicídio/estatística & dados numéricos , Sobreviventes/psicologia , Tsunamis , Adulto , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Sobreviventes/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
12.
J Anesth ; 28(3): 381-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24141883

RESUMO

PURPOSE: Early operative control of hemorrhage is the key to saving the lives of severe trauma patients. We investigated whether emergency room (ER) stay time [time from the ER to the operating room (OR)] is associated with trauma severity and unexpected trauma death [Trauma and Injury Severity Score (TRISS) method-based probability of survival (Ps) ≥0.5 but died] of injured patients needing emergency trauma surgery. METHODS: We performed a retrospective review of all trauma patients requiring emergency surgery and all patients with pelvic fractures requiring transcatheter arterial embolization at our hospital from January 2002 to December 2012. We analyzed the relationships among injury severity on ER admission [Injury Severity Score (ISS); Revised Trauma Score (RTS); Ps; Shock Index (SI); American Society of Anesthesiologists Physical Status (ASA-PS)]; mortality rate; unexpected trauma death rate; and ER stay time. RESULTS: ER stay times were significantly shorter for patients with life-threatening conditions [RTS <6.0 (p < 0.01), Ps <0.5 (p < 0.001), SI ≥1.0 (p < 0.01), and ASA-PS ≥4E (p < 0.001)]. In particular, ER stay time was inversely related to injury severity up to 120 min. The risk of unexpected trauma death significantly increased as ER stay time increased over 90 min (p < 0.01). CONCLUSIONS: Our results suggest that all medical staff should work together effectively on high-risk patients in the ER, bringing them immediately to the OR according to their level of risk. If injured patients need emergency trauma surgery, ER stay times should be kept as short as possible to reduce unexpected trauma death.


Assuntos
Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/cirurgia , Adulto , Idoso , Serviços Médicos de Emergência , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos
13.
Injury ; 55(3): 111296, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38184413

RESUMO

INTRODUCTION: Traumatic brain injury (TBI)-associated coagulopathy significantly influences survival outcomes in patients with multiple injuries. Severe TBI can potentially affect systemic hemostasis due to coagulopathy; however, there is limited evidence regarding whether the risk of hemorrhage increases in patients with pelvic fractures complicated with TBI. Therefore, through multivariable analysis, we aimed to examine the association between severe TBI and increased blood transfusion requirements in patients with pelvic fractures. MATERIALS AND METHODS: This retrospective observational study was conducted at a tertiary care facility in Japan. Patients aged 16 years or older with pelvic fractures who were admitted to our intensive care unit between April 2014 and December 2021 were included in the analysis. The patients were categorized into no to mild and severe TBI groups according to whether the Head Abbreviated Injury Scale (AIS) score was 3 or higher. The primary outcome was the number of red blood cell (RBC) units transfused within 24 h after arrival at the hospital. The primary outcome was analyzed using univariable and multivariable linear regression analyses. The covariates used for the multivariable linear regression analysis were age, sex, antithrombotic therapy, mechanism of injury, Pelvic AIS score, and extravasation on contrast-enhanced computed tomography on admission. RESULTS: We identified 315 eligible patients (221 and 94 in the no to mild and severe TBI groups, respectively). In the univariable analysis, the RBC transfusion volume within 24 h after arrival was significantly higher in the severe TBI group than in the no to mild TBI group (2.53-unit increase; 95 % confidence interval [CI]: 0.46-4.61). However, in the multivariable analysis, no statistically significant association was detected between severe TBI and the RBC transfusion volume within 24 h after arrival at the hospital (0.87-unit increase; 95 % CI: -1.11-2.85). CONCLUSIONS: Concomitant severe TBI was not associated with increased RBC transfusion volumes in patients with pelvic fractures on multivariable analysis.


Assuntos
Transtornos da Coagulação Sanguínea , Lesões Encefálicas Traumáticas , Lesões Encefálicas , Fraturas Ósseas , Humanos , Transfusão de Eritrócitos/efeitos adversos , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Transfusão de Sangue , Transtornos da Coagulação Sanguínea/etiologia , Fraturas Ósseas/complicações , Fraturas Ósseas/terapia , Estudos Retrospectivos
14.
Kobe J Med Sci ; 69(4): E151-E158, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38462525

RESUMO

Endotracheal intubation (ETI) is a common and crucial intervention. Whether the performance of ETI differs according to the sex of the laryngoscopist remains unclear. The aim of this study was to assess sex disparities in markers of ETI performance among novices using a high-fidelity simulator. This prospective observational study was conducted from April 2017 to March 2019 in a public medical university. In total, 209 medical students (4th and 5th grade) without clinical ETI experience were recruited. Of the 209 students, 64 (30.6%) were female. The participants used either a Macintosh direct laryngoscope or C-MAC video laryngoscope in combination with a stylet or gum-elastic bougie to perform ETI on a high-fidelity simulator. The primary endpoint was the maximum force applied on the maxillary incisors during laryngoscopy. The secondary endpoint was the time to ETI. The implanted sensors in the simulator automatically quantified the force and time to ETI. The maximum force applied on the maxillary incisors was approximately 30% lower in the male than female group for all laryngoscopes and intubation aids examined (all P < 0.001). Similarly, the time to ETI was approximately 10% faster in the male than female group regardless of the types of laryngoscopes and intubation aids used (all P < 0.05). In this study, male sex was associated with a lower maximum force applied on the maxillary incisors during both direct and indirect laryngoscopy performed by novices. A clinical study focusing on sex differences in ETI performance is needed to validate our findings.


Assuntos
Laringoscópios , Laringoscopia , Humanos , Masculino , Feminino , Incisivo , Intubação Intratraqueal , Estudos Prospectivos
15.
Artigo em Inglês | MEDLINE | ID: mdl-38397612

RESUMO

Suicide is an increasingly important public healthcare concern worldwide. Studies examining the effect of attempted suicide on clinical outcomes among patients with trauma are scarce. We conducted a retrospective cohort study at a community emergency department in Japan. We included all severely injured patients with an Injury Severity Score > 15 from January 2002 to December 2021. The primary outcome measure was in-hospital mortality. The other outcome of interest was hospital length of stay. One-to-one propensity score matching was performed to compare these outcomes between suicide attempt and no suicide attempt groups. Of the 2714 eligible patients, 183 (6.7%) had trauma caused by a suicide attempt. In the propensity score-matched analysis with 139 pairs, the suicide attempt group showed a significant increase in-hospital mortality (20.9% vs. 37.4%; odds ratio 2.27; 95% confidence intervals 1.33-3.87) compared with the no suicide attempt group. Among survivors, the median hospital length of stay was significantly longer in the suicide attempt group than that in the no suicide attempt group (9 days vs. 12 days, p = 0.0076). Because of the unfavorable consequences and potential need for additional healthcare, increased attention should be paid to patients with trauma caused by a suicide attempt.


Assuntos
Tentativa de Suicídio , Humanos , Estudos Retrospectivos , Tempo de Internação , Centros de Atenção Terciária , Pontuação de Propensão , Mortalidade Hospitalar , Japão/epidemiologia , Escala de Gravidade do Ferimento
16.
BMC Infect Dis ; 13: 406, 2013 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-24004824

RESUMO

BACKGROUND: The genus Chromobacterium consists of 7 recognized species. Among those, only C. violaceum, commonly found in the soil and water of tropical and subtropical regions, has been shown to cause human infection. Although human infection is rare, C. violaceum can cause life-threatening sepsis, with metastatic abscesses, most frequently infecting those who are young and healthy. CASE PRESENTATION: We recently identified a case of severe bacteremia caused by Chromobacterium haemolyticum infection in a healthy young patient following trauma and exposure to river water, in Japan. The patient developed necrotizing fasciitis that was successfully treated with a fasciotomy and intravenous ciprofloxacin and gentamicin. CONCLUSIONS: C. haemolyticum should be considered in the differential diagnosis of skin lesions that progressively worsen after trauma involving exposure to river or lake water, even in temperate regions. Second, early blood cultures for the isolation and identification of the causative organism were important for initiating proper antimicrobial therapy.


Assuntos
Bacteriemia/diagnóstico , Chromobacterium/isolamento & purificação , Rios/microbiologia , Adulto , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Diagnóstico Diferencial , Fasciite Necrosante/complicações , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/microbiologia , Fasciite Necrosante/patologia , Humanos , Masculino , Ferimentos e Lesões/complicações
17.
Am J Emerg Med ; 31(10): 1486-9, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24007697

RESUMO

OBJECTIVE: It is known that patients with convulsion often present hyperammonemia. The elevation of ammonia levels in convulsion is considered to occur along with extensive muscle contractions, but the details remain unclear. In emergency pathologies, such as cardiopulmonary arrest or hemorrhagic shock without muscle contraction, red blood cells are known to produce ammonia through acidosis, leading to hyperammonemia. A similar effect would be considered to be involved in idiopathic epileptic seizure patients as well. METHODS: We retrospectively analyzed the cases of epileptic seizure that were transported to the emergency medical care center of Ohta Nishinouchi Hospital and diagnosed by neurologist as idiopathic epileptic seizure or epilepsy due to cerebrovascular disorder. Forty-four patients were idiopathic epilepsy, and 8 had epilepsy due to cerebrovascular disorder. Those with hepatic encephalopathy, metabolic disorder, alcohol consumption, tumor, and patients taking oral valproic acid were excluded. RESULTS: High ammonia levels (>35 µmol/L) were observed in 22 cases. Maximum ammonia level was 506 µmol/L. Significant differences were observed in the pH (r = 0.838, P < .0001) and base excess (BE) (r = 0.863, P < .0001), the values suggesting a strong negative correlation between the ammonia level and pH/BE. CONCLUSION: Idiopathic epileptic seizures can present with prominent hyperammonemia with acidosis. Because high ammonia level in epileptic seizure was strongly correlated with pH and BE, we speculate that hyperammonemia is not only because of extensive muscle contractions but is also related to ammonia production in the red blood cells through acidosis like other emergency conditions.


Assuntos
Epilepsia/complicações , Hiperamonemia/etiologia , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/etiologia , Adulto , Amônia/sangue , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epilepsia/sangue , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Estudos Retrospectivos
18.
Emerg Med J ; 30(11): 914-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23302505

RESUMO

Emergency care services face common challenges worldwide, including the failure to identify emergency illnesses, deviations from standard treatments, deterioration in the quality of medical care, increased costs from unnecessary testing, and insufficient education and training of emergency personnel. These issues are currently being addressed by implementing emergency department information systems (EDIS) and clinical decision support systems (CDSS). Such systems have been shown to increase the efficiency and safety of emergency medical care. In Japan, however, their development is hindered by a shortage of emergency physicians and insufficient funding. In addition, language barriers make it difficult to introduce EDIS and CDSS in Japan that have been created for an English-speaking market. This perspective addresses the key events that motivated a campaign to prioritise these services in Japan and the need to customise EDIS and CDSS for its population.


Assuntos
Sistemas de Apoio a Decisões Clínicas/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Sistemas de Informação Hospitalar/organização & administração , Humanos , Japão
19.
J Anesth ; 27(6): 832-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23686452

RESUMO

PURPOSE: Airway management of trauma patients during emergency surgeries can be very difficult and presents a challenge for anesthesiologists. Difficult airways are associated with emergency surgical airways (ESA), but little is known about ESA in the operating room. We conducted this study to clarify the present use of ESA for trauma patients in emergency surgery settings. METHODS: We performed a retrospective review of all trauma patients requiring emergency surgery under general anesthesia at our hospital from January 2002 to December 2012, focusing on ESA. RESULTS: During the study period, 15,654 trauma patients were treated at our hospital, of whom 554 (3.5 %) required emergency surgery. Four of these patients (0.72 %) received ESA as definitive airway management. Two patients with severe facial injury and distorted upper airways and 1 patient with penetrating neck trauma received open standard tracheostomy (OST). These three patients received OST as the initial approach to intubation. A fourth OST was performed after several unsuccessful attempts at endotracheal intubation. No cases were classified as "cannot ventilate, cannot intubate" (CVCI), and there were no complications associated with ESA. All cases had good outcomes. Statistical analysis revealed that patients with severe facial trauma (Abbreviated Injury Scale ≥3) received ESA at a significantly higher rate than others (p = 0.015, odds ratio 14.1). CONCLUSION: One of the most important functions of anesthesiologists is risk management. We should recognize risks that can cause CVCI situations, and make proper clinical decisions, including providing ESA, to assure patient safety.


Assuntos
Manuseio das Vias Aéreas/métodos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/cirurgia , Adulto , Idoso , Anestesia Geral/métodos , Serviços Médicos de Emergência/métodos , Tratamento de Emergência/métodos , Feminino , Hospitais de Ensino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/métodos
20.
Air Med J ; 32(6): 346-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24182885

RESUMO

INTRODUCTION: Prehospital time is crucial for treating acute disease; therefore, it is important to activate helicopter emergency medical services (HEMS) promptly. We investigated the differences in the activation intervals (the time elapsed from receiving the emergency call to the time of HEMS request) under various conditions to evaluate the current status of HEMS-related prehospital triage in Japan. METHODS: We retrospectively investigated activation intervals under exogenous (trauma, n = 553; intoxication, n = 56; and burns, n = 32) and endogenous conditions (acute coronary syndrome [ACS], n = 47; and stroke, n = 173) between January 31, 2008, and January 31, 2012, by reviewing flight records. RESULTS: Activation intervals were trauma (14.3 ± 11.5 min), intoxication (10.3 ± 8.6 min), burns (15.0 ± 13.1 min), ACS (17.9 ± 14.6 min), and stroke (19.1 ± 13.1 min). One-way analysis of variance showed a significant difference between exogenous and endogenous groups (P < .001). Post-hoc analysis using Tukey's honestly significant difference test showed significant differences between ACS and intoxication (P < .05), stroke and intoxication (P < .001), and stroke and trauma (P < .001). CONCLUSIONS: Endogenous conditions had longer activation intervals, which may reflect a lack of mechanisms assessing their severity. We are considering developing new triage criteria for dispatchers.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência/organização & administração , Feminino , Humanos , Japão , Masculino , Estudos Retrospectivos , Fatores de Tempo
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