Febrile neutropenia (FN) is treated by a broad-spectrum antimicrobial. Subsequent antimicrobial therapy depends on identifying the source of the infection. Although urinary tract infections (UTIs) are common and urine culture (UC) is a valuable diagnostic tool, uncertainties remain about the specific indications for conducting UC in FN. This study examined whether performing routine UC would affect the subsequent antimicrobial therapy in FN.
Methods
All emergency department patients who received chemotherapy for malignancy and met the definition of FN (neutrophil count <0.5 × 109/L and fever >37.5°C) were included. The patient's demographic data, clinical symptoms, urinalysis results, urine and blood culture results, antibiotic therapy and duration, and patient outcomes were extracted from electronic medical records. UC was defined as positive if >105 colony-forming units/L were detected.
Results
In total, 115 of the initial 124 cases were included in the analysis. Thirty-one cases met the Infectious Diseases Society of America guideline definition for recommending UC (recommended group) and 84 cases did not (non-recommended group). In the recommended group, 16 of 31 cases had a positive UC, and antibiotics were changed for nine, based on UC results. In the non-recommended group, 15 of 84 cases had a positive UC, and antibiotics were changed for two. The same organism were identified in blood cultures. Seven of 115 cases were detected for the same pathogen in blood and urine cultures.
Conclusion
Performing UC regardless of symptoms could diagnose several asymptomatic UTIs in FN, but seldom impact an antimicrobial treatment strategy.
{"title":"Impact of urinary culture on diagnosis and treatment strategy after empiric therapy in febrile neutropenic patients","authors":"Natsumi Hata, Takateru Ihara","doi":"10.1002/ams2.70012","DOIUrl":"10.1002/ams2.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Febrile neutropenia (FN) is treated by a broad-spectrum antimicrobial. Subsequent antimicrobial therapy depends on identifying the source of the infection. Although urinary tract infections (UTIs) are common and urine culture (UC) is a valuable diagnostic tool, uncertainties remain about the specific indications for conducting UC in FN. This study examined whether performing routine UC would affect the subsequent antimicrobial therapy in FN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All emergency department patients who received chemotherapy for malignancy and met the definition of FN (neutrophil count <0.5 × 10<sup>9</sup>/L and fever >37.5°C) were included. The patient's demographic data, clinical symptoms, urinalysis results, urine and blood culture results, antibiotic therapy and duration, and patient outcomes were extracted from electronic medical records. UC was defined as positive if >10<sup>5</sup> colony-forming units/L were detected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 115 of the initial 124 cases were included in the analysis. Thirty-one cases met the Infectious Diseases Society of America guideline definition for recommending UC (recommended group) and 84 cases did not (non-recommended group). In the recommended group, 16 of 31 cases had a positive UC, and antibiotics were changed for nine, based on UC results. In the non-recommended group, 15 of 84 cases had a positive UC, and antibiotics were changed for two. The same organism were identified in blood cultures. Seven of 115 cases were detected for the same pathogen in blood and urine cultures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Performing UC regardless of symptoms could diagnose several asymptomatic UTIs in FN, but seldom impact an antimicrobial treatment strategy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A balanced transfusion strategy has been a standard resuscitation method for trauma patients, and adherence to a massive transfusion protocol incorporating balanced transfusion is reported to reduce mortality. This study aimed to assess adherence to balanced transfusion among severely injured patients in Japan.
Methods
This study analyzes RESTRIC (restrictive transfusion strategy for critically injured patients) trial patients who were cluster-randomized based on restrictive or liberal transfusion strategy. We defined two transfusion groups: massive transfusion group 1, which includes RBC transfusions of at least eight units within 6 h; and massive transfusion group 2, which includes RBC transfusions of at least 20 units within 24 h. Adherence to balanced transfusion was assessed as the ratios of fresh frozen plasma (FFP) to red blood cells (RBC) and platelet concentrate (PC) to RBC ratio >0.5.
Results
Among 220 eligible patients, 98 (44.5%) were grouped as massive transfusion group 1 and 38 (17.3%) as massive transfusion group 2. The balanced transfusion in terms of the FFP to RBC ratio was nearly 100% for groups 1 and 2 over all periods. However, the balanced transfusion in terms of the PC to RBC ratio within 6 h were 51.0% for group 1 and 68.4% for group 2.
Conclusion
This study revealed that while the ratio of FFP to RBC was balanced among patients from the early phase, the ratio of PC to RBC was not fully balanced, particularly in the early phase.
{"title":"Adherence to balanced transfusion among severely injured patients: A post hoc analysis of the RESTRIC trial","authors":"Makoto Aoki, Kazunori Fukushima, Mineji Hayakawa, Daisuke Kudo, Takashi Tagami, Kiyohiro Oshima, Shigeki Kushimoto","doi":"10.1002/ams2.70016","DOIUrl":"https://doi.org/10.1002/ams2.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>A balanced transfusion strategy has been a standard resuscitation method for trauma patients, and adherence to a massive transfusion protocol incorporating balanced transfusion is reported to reduce mortality. This study aimed to assess adherence to balanced transfusion among severely injured patients in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analyzes RESTRIC (restrictive transfusion strategy for critically injured patients) trial patients who were cluster-randomized based on restrictive or liberal transfusion strategy. We defined two transfusion groups: massive transfusion group 1, which includes RBC transfusions of at least eight units within 6 h; and massive transfusion group 2, which includes RBC transfusions of at least 20 units within 24 h. Adherence to balanced transfusion was assessed as the ratios of fresh frozen plasma (FFP) to red blood cells (RBC) and platelet concentrate (PC) to RBC ratio >0.5.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 220 eligible patients, 98 (44.5%) were grouped as massive transfusion group 1 and 38 (17.3%) as massive transfusion group 2. The balanced transfusion in terms of the FFP to RBC ratio was nearly 100% for groups 1 and 2 over all periods. However, the balanced transfusion in terms of the PC to RBC ratio within 6 h were 51.0% for group 1 and 68.4% for group 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study revealed that while the ratio of FFP to RBC was balanced among patients from the early phase, the ratio of PC to RBC was not fully balanced, particularly in the early phase.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142579578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated the correlation between the number of emergency medical service (EMS) dispatches and response time extension. In addition, we conducted a simulation to assess the potential for reducing response times by relocating the ambulance based on the number of dispatches.
Methods
This retrospective observational study analyzed data on patients treated with EMS between May 1 and June 25, 2021, in an urban area (Chiba City, Japan). Spearman's rank correlation tests were used to analyze the correlations among the number of dispatches, response time extension, and ambulance distance. We created a heat map to visualize the number of dispatches and distribution of emergency case occurrences, and simulated the relocation of the EMS team with the lowest number of dispatches to the closest EMS team with the highest number of dispatches.
Results
In total, 7915 emergency cases were included. The median response time across all dispatches was 9 min, whereas that for the response time extension cases was 12 min. There was a significant positive correlation between the increased number of dispatches, response time extension (r = 0.94, p < 0.0001), and ambulance distance (r = 0.95, p < 0.0001). The relocation simulation significantly shortened the average response time from 13 min and 30 s to 12 min and 11 s (9.9% decrease, p < 0.0001).
Conclusion
An increased number of dispatches significantly increased the response time extension cases and ambulance distance. Our simulation suggests that EMS relocation can potentially shorten the response time. While increased dispatches influence the response time extension, optimal EMS allocation may improve response times.
{"title":"Increased number of dispatches in emergency medical services correlates to response time extension","authors":"Natsuko Ishikawa, Keisuke Tomita, Takashi Shimazui, Yoko Tochigi, Taka-aki Nakada","doi":"10.1002/ams2.70017","DOIUrl":"https://doi.org/10.1002/ams2.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study investigated the correlation between the number of emergency medical service (EMS) dispatches and response time extension. In addition, we conducted a simulation to assess the potential for reducing response times by relocating the ambulance based on the number of dispatches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study analyzed data on patients treated with EMS between May 1 and June 25, 2021, in an urban area (Chiba City, Japan). Spearman's rank correlation tests were used to analyze the correlations among the number of dispatches, response time extension, and ambulance distance. We created a heat map to visualize the number of dispatches and distribution of emergency case occurrences, and simulated the relocation of the EMS team with the lowest number of dispatches to the closest EMS team with the highest number of dispatches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 7915 emergency cases were included. The median response time across all dispatches was 9 min, whereas that for the response time extension cases was 12 min. There was a significant positive correlation between the increased number of dispatches, response time extension (<i>r</i> = 0.94, <i>p</i> < 0.0001), and ambulance distance (<i>r</i> = 0.95, <i>p</i> < 0.0001). The relocation simulation significantly shortened the average response time from 13 min and 30 s to 12 min and 11 s (9.9% decrease, <i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An increased number of dispatches significantly increased the response time extension cases and ambulance distance. Our simulation suggests that EMS relocation can potentially shorten the response time. While increased dispatches influence the response time extension, optimal EMS allocation may improve response times.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142579618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In patients with coronavirus disease pneumonia, strong spontaneous breathing increases pulmonary vascular permeability and induces self-inflicted lung injury, prolonging the intensive care unit stay and worsening prognosis. Therefore, spontaneous respiration must be strictly controlled.
Case Presentation
A 48-year-old man was admitted for respiratory management of severe coronavirus disease pneumonia. Despite immediate ventilatory management, ventilatory failure and air leak syndrome developed, necessitating venovenous extracorporeal membrane oxygenation, intravenous sedation, and muscle relaxation. Over time, the patient's inspiratory effort worsened and the requirement for transvenous anesthesia increased. Therefore, management was switched to inhalation anesthesia after discontinuation of all transvenous anesthetics, maintaining morphine-only analgesia. Subsequent management enabled effective control of spontaneous respiration, allowing eventual discontinuation of inhalation anesthesia, venovenous extracorporeal membrane oxygenation, and ventilation.
Conclusion
Management of spontaneous respiration in coronavirus disease pneumonia can be complicated by resistance to transvenous anesthesia; however, the use of an inhaled anesthetic may present a valuable alternative.
{"title":"Successful transition from intravenous to inhalation anesthesia for respiratory management of coronavirus disease pneumonia: A case report","authors":"Reijiro Kato, Yuhei Irie, Yoshito Izutani, Hiroyasu Ishikura","doi":"10.1002/ams2.70010","DOIUrl":"https://doi.org/10.1002/ams2.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with coronavirus disease pneumonia, strong spontaneous breathing increases pulmonary vascular permeability and induces self-inflicted lung injury, prolonging the intensive care unit stay and worsening prognosis. Therefore, spontaneous respiration must be strictly controlled.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 48-year-old man was admitted for respiratory management of severe coronavirus disease pneumonia. Despite immediate ventilatory management, ventilatory failure and air leak syndrome developed, necessitating venovenous extracorporeal membrane oxygenation, intravenous sedation, and muscle relaxation. Over time, the patient's inspiratory effort worsened and the requirement for transvenous anesthesia increased. Therefore, management was switched to inhalation anesthesia after discontinuation of all transvenous anesthetics, maintaining morphine-only analgesia. Subsequent management enabled effective control of spontaneous respiration, allowing eventual discontinuation of inhalation anesthesia, venovenous extracorporeal membrane oxygenation, and ventilation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Management of spontaneous respiration in coronavirus disease pneumonia can be complicated by resistance to transvenous anesthesia; however, the use of an inhaled anesthetic may present a valuable alternative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To explore the association between Do-Not-Attempt Resuscitation (DNAR) orders issued within 6 h of admission and neurological outcomes in older patients with out-of-hospital cardiac arrest (OHCA).
Methods
Patients aged ≥65 years who experienced OHCA between September 2019 and March 2021 enrolled in the multicenter observational study in Japan (SOS-KANTO 2017) were included. Data regarding DNAR decisions were prospectively collected and the time required to obtain DNAR orders. Patients who received DNAR orders within 6 h of admission (DNAR group) were compared with those who did not (non-DNAR group) using propensity score analysis with inverse probability treatment weighting (IPTW) to adjust for potential confounders.
Results
Of the 9909 registered individuals in the SOS-KANTO 2017 study across 42 facilities, 685 were selected for analysis, with 361 (52.7%) in the DNAR group. Even after adjusting for the confounding factors, the frequency of post-admission therapeutic interventions was lower, and the proportion of patients with favorable neurological outcomes was significantly lower (2.6% vs. 19.3%, p < 0.001) in the DNAR group. Twenty-six (7.3%) patients in the DNAR group survived for 1 month, of whom six (1.7%) had favorable neurological outcomes.
Conclusions
Older patients with OHCA who had early DNAR had significantly fewer therapeutic interventions after admission and had worse neurological outcomes at 30 days than those without a DNAR order, even after adjusting for demographic and prehospital variables.
{"title":"Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient: A multicenter observational study","authors":"Megumi Kohri, Takashi Tagami, Kensuke Suzuki, Shinnosuke Kitano, Tomohito Amano, Suzuka Hagiwara, Nobuya Kitamura, Satoo Ogawa","doi":"10.1002/ams2.70008","DOIUrl":"https://doi.org/10.1002/ams2.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the association between Do-Not-Attempt Resuscitation (DNAR) orders issued within 6 h of admission and neurological outcomes in older patients with out-of-hospital cardiac arrest (OHCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged ≥65 years who experienced OHCA between September 2019 and March 2021 enrolled in the multicenter observational study in Japan (SOS-KANTO 2017) were included. Data regarding DNAR decisions were prospectively collected and the time required to obtain DNAR orders. Patients who received DNAR orders within 6 h of admission (DNAR group) were compared with those who did not (non-DNAR group) using propensity score analysis with inverse probability treatment weighting (IPTW) to adjust for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 9909 registered individuals in the SOS-KANTO 2017 study across 42 facilities, 685 were selected for analysis, with 361 (52.7%) in the DNAR group. Even after adjusting for the confounding factors, the frequency of post-admission therapeutic interventions was lower, and the proportion of patients with favorable neurological outcomes was significantly lower (2.6% vs. 19.3%, <i>p</i> < 0.001) in the DNAR group. Twenty-six (7.3%) patients in the DNAR group survived for 1 month, of whom six (1.7%) had favorable neurological outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older patients with OHCA who had early DNAR had significantly fewer therapeutic interventions after admission and had worse neurological outcomes at 30 days than those without a DNAR order, even after adjusting for demographic and prehospital variables.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bear-related trauma is a significant concern in Japan. This study identified trauma patterns, outcomes, and therapeutic approaches for bear-related injuries treated.
Methods
This retrospective observational study used medical records from Akita University Hospital, focusing on patients with bear-related trauma in 2023. Demographic data, injury details, treatment procedures, and outcomes were extracted.
Results
The study included 20 patients (median age: 74.5 years, 65% males). Most injuries occurred in human habitats, mainly in autumn, with the face being the most affected area (90%). Three patients required emergency transfusions and tracheal intubation. Emergency surgery was performed in 52.6% of patients, and 42.1% were admitted to the intensive care unit. All patients survived with a median hospital stay of 17 days. However, 15.8% of patients had significant sequelae, such as blindness. Despite prophylactic antibiotics, wound infections occurred in 21.1% of patients, particularly in deep wounds that were not adequately washed under general anesthesia.
Conclusions
Bear-related trauma often results in severe upper-body injuries that require prompt medical intervention. These findings highlight the need for improved preventive measures and strategies for initial treatment and long-term care.
{"title":"Characteristics of black bear-related trauma: A retrospective observational study","authors":"Hideomi Tsuchida, Kasumi Satoh, Nobuhisa Hirasawa, Manabu Okuyama, Hajime Nakae","doi":"10.1002/ams2.70009","DOIUrl":"10.1002/ams2.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Bear-related trauma is a significant concern in Japan. This study identified trauma patterns, outcomes, and therapeutic approaches for bear-related injuries treated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study used medical records from Akita University Hospital, focusing on patients with bear-related trauma in 2023. Demographic data, injury details, treatment procedures, and outcomes were extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 20 patients (median age: 74.5 years, 65% males). Most injuries occurred in human habitats, mainly in autumn, with the face being the most affected area (90%). Three patients required emergency transfusions and tracheal intubation. Emergency surgery was performed in 52.6% of patients, and 42.1% were admitted to the intensive care unit. All patients survived with a median hospital stay of 17 days. However, 15.8% of patients had significant sequelae, such as blindness. Despite prophylactic antibiotics, wound infections occurred in 21.1% of patients, particularly in deep wounds that were not adequately washed under general anesthesia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bear-related trauma often results in severe upper-body injuries that require prompt medical intervention. These findings highlight the need for improved preventive measures and strategies for initial treatment and long-term care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Chiari network mostly causes no symptoms but may occasionally be involved in thrombus formation in the right atrium. We present a case of right atrial thrombus discovered in the postoperative course of blunt cardiac rupture.
Case Presentation
A 19-year-old female injured in a motor vehicle accident was transported to the hospital in a state of shock. Echocardiography revealed pericardial effusion. Cardiopulmonary arrest was imminent, so a clamshell thoracotomy was performed. A laceration at the right atrial junction of the superior vena cava was observed and sutured. Echocardiography on post-injury day 6 showed a floating thrombus in the right atrium. Anticoagulation therapy was started, the thrombus was reduced, and the patient was discharged on day 27 without sequelae. Six months later, echocardiography showed a filamentous structure and the presence of the Chiari network.
Conclusion
Right intra-atrial thrombi are rare and may warrant a search of the Chiari network in conditions where hypercoagulation is anticipated.
{"title":"A case of right atrial thrombus in the Chiari network after blunt cardiac rupture","authors":"Takahiro Oishi, Keisuke Tamagaki, Shuhei Maruyama, Shuji Kanayama, Daiki Wada, Tomoyuki Yoshihara, Fukuki Saito, Kazuhisa Yoshiya, Yasushi Nakamori, Yasuyuki Kuwagata","doi":"10.1002/ams2.70007","DOIUrl":"10.1002/ams2.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Chiari network mostly causes no symptoms but may occasionally be involved in thrombus formation in the right atrium. We present a case of right atrial thrombus discovered in the postoperative course of blunt cardiac rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 19-year-old female injured in a motor vehicle accident was transported to the hospital in a state of shock. Echocardiography revealed pericardial effusion. Cardiopulmonary arrest was imminent, so a clamshell thoracotomy was performed. A laceration at the right atrial junction of the superior vena cava was observed and sutured. Echocardiography on post-injury day 6 showed a floating thrombus in the right atrium. Anticoagulation therapy was started, the thrombus was reduced, and the patient was discharged on day 27 without sequelae. Six months later, echocardiography showed a filamentous structure and the presence of the Chiari network.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Right intra-atrial thrombi are rare and may warrant a search of the Chiari network in conditions where hypercoagulation is anticipated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142306936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The hybrid ER<span><sup>1-3</sup></span> can significantly reduce time required for initial emergency care, but extensive information gathered during treatment needs to be interpreted and reflected in the treatment strategy within a short period of time. We report on the development of an information sharing system for initial emergency care.</p><p>During initial emergency care, vital signs, blood gas analysis (BGA), and laboratory data are important factors in decision making. When we perform surgery or transcatheter arterial embolization (TAE), knowing the trend of each parameter is important in determining whether vital signs have stabilized or worsened as a result of the therapeutic intervention. Vital sign monitors provide real-time vital signs but no information on their trend. In contrast, information systems commonly used in the intensive care unit or operating room provide trend information, but they update at a minimum of every minute. Updating at a minimum of every minute is too long for initial emergency care in which the critical patient's condition is constantly changing. Our developed system displays trend information on heart rate, blood pressure, and BGA that updates every 5 s and shows their trends over 180 min. Medical staff may not notice sudden changes in vital signs or results of BGA or laboratory data. When vital signs exceed a predetermined threshold, the system alerts them through an audio signal in the ER and in headsets and provides specific values for the medical staff. When updated results of BGA and laboratory tests are received, they are automatically and promptly showed in the monitor and read out as well. The manager could set any items in BGA and laboratory data to be read out by this system to their liking (e.g., calcium ions, CO-Hb). This allows the staff to recognize changes in vital signs and test results with no time lag. Initial emergency care, especially in trauma patients, is always a race against time. The system displays the time since the start of monitoring, surgery, TAE, and aortic blockade in a count-up format and alerts the medical staff via audio of the time that has elapsed. The system has two modes: standard mode and critical care specific (Figure 1 and Videos S1–S5). It responds to requests input through icons on the touch screen or by voice. This interactive utility is used to record various procedures, start and end times of measurements, and reconfirm information. Monitoring the administration of blood transfusion could be difficult in the emergency setting. The system displays administered transfusions (e.g., RBC, FFP, PC and cryoprecipitate) as the icons on the monitor manual input. In this way, the changes in vital signs and laboratory tests due to transfusion could be recognized on the screen. Dynamic monitoring updated every 5 s of vital signs are displayed on a 55-inch monitor so that staff can check the trend at any time and be alerted to changes in the patient's condition. We beli
混合 ER1-3 可以大大缩短初期急救护理所需的时间，但在治疗过程中收集到的大量信息需要在短时间内进行解读并反映在治疗策略中。我们报告了初始急救护理信息共享系统的开发情况。在初始急救护理期间，生命体征、血气分析（BGA）和实验室数据是决策的重要因素。当我们实施手术或经导管动脉栓塞术（TAE）时，了解每个参数的变化趋势对于确定生命体征是否因治疗干预而稳定或恶化非常重要。生命体征监护仪可提供实时生命体征，但无法提供其趋势信息。相比之下，重症监护室或手术室常用的信息系统可提供趋势信息，但至少每分钟更新一次。对于危重病人病情不断变化的初期急救护理来说，至少每分钟更新一次的时间太长了。我们开发的系统可显示心率、血压和 BGA 的趋势信息，每 5 秒更新一次，并显示 180 分钟内的趋势。医务人员可能不会注意到生命体征或 BGA 或实验室数据结果的突然变化。当生命体征超过预定阈值时，系统会通过急诊室和耳麦中的音频信号发出警报，并为医务人员提供具体数值。当收到 BGA 和实验室检测的最新结果时，它们也会自动、及时地显示在监视器中并被读出。管理人员可根据自己的喜好设置 BGA 和实验室数据中的任何项目（如钙离子、一氧化碳-血红蛋白）。这样，医务人员就能及时发现生命体征和化验结果的变化。初期急救护理，尤其是创伤病人的急救护理，总是在与时间赛跑。该系统以倒计时的方式显示自开始监测、手术、TAE 和主动脉阻断以来的时间，并通过音频提醒医务人员已过的时间。该系统有两种模式：标准模式和重症监护专用模式（图 1 和视频 S1-S5）。通过触摸屏上的图标或语音输入请求，系统会做出响应。这种交互式实用程序可用于记录各种程序、测量的开始和结束时间以及重新确认信息。在急诊环境中，监测输血情况可能比较困难。该系统将输血（如红细胞、全血细胞、PC 和低温沉淀）显示为监护仪手动输入的图标。这样，输血引起的生命体征和实验室检测的变化就能在屏幕上被识别出来。每 5 秒更新一次的生命体征动态监测结果显示在 55 英寸的监视器上，工作人员可以随时查看趋势，并对病人的病情变化发出警报。我们相信，这套系统对于提高混合急诊室的功能和抢救率非常有用。Yasushi Nakamori 博士从佳能医疗系统有限公司（Canon Medical Systems Co.Yasuyuki Kuwagata 博士是 Acute Medicine & Surgery 杂志的编辑委员会成员，也是本文的共同作者。为了尽量减少偏见，他没有参与所有与接受发表这篇文章有关的编辑决策：本研究根据《赫尔辛基宣言》的原则进行，并获得了关西医科大学医疗中心机构审查委员会的批准（研究编号：2023283）。知情同意书：不适用。研究/试验的登记和登记号：不适用：动物实验动物研究：不适用。
{"title":"Development of a system to support information sharing for medical staff in the hybrid emergency room","authors":"Shuhei Maruyama, Yasushi Nakamori, Shuji Kanayama, Daiki Wada, Fukuki Saito, Yasuyuki Kuwagata","doi":"10.1002/ams2.70006","DOIUrl":"https://doi.org/10.1002/ams2.70006","url":null,"abstract":"<p>The hybrid ER<span><sup>1-3</sup></span> can significantly reduce time required for initial emergency care, but extensive information gathered during treatment needs to be interpreted and reflected in the treatment strategy within a short period of time. We report on the development of an information sharing system for initial emergency care.</p><p>During initial emergency care, vital signs, blood gas analysis (BGA), and laboratory data are important factors in decision making. When we perform surgery or transcatheter arterial embolization (TAE), knowing the trend of each parameter is important in determining whether vital signs have stabilized or worsened as a result of the therapeutic intervention. Vital sign monitors provide real-time vital signs but no information on their trend. In contrast, information systems commonly used in the intensive care unit or operating room provide trend information, but they update at a minimum of every minute. Updating at a minimum of every minute is too long for initial emergency care in which the critical patient's condition is constantly changing. Our developed system displays trend information on heart rate, blood pressure, and BGA that updates every 5 s and shows their trends over 180 min. Medical staff may not notice sudden changes in vital signs or results of BGA or laboratory data. When vital signs exceed a predetermined threshold, the system alerts them through an audio signal in the ER and in headsets and provides specific values for the medical staff. When updated results of BGA and laboratory tests are received, they are automatically and promptly showed in the monitor and read out as well. The manager could set any items in BGA and laboratory data to be read out by this system to their liking (e.g., calcium ions, CO-Hb). This allows the staff to recognize changes in vital signs and test results with no time lag. Initial emergency care, especially in trauma patients, is always a race against time. The system displays the time since the start of monitoring, surgery, TAE, and aortic blockade in a count-up format and alerts the medical staff via audio of the time that has elapsed. The system has two modes: standard mode and critical care specific (Figure 1 and Videos S1–S5). It responds to requests input through icons on the touch screen or by voice. This interactive utility is used to record various procedures, start and end times of measurements, and reconfirm information. Monitoring the administration of blood transfusion could be difficult in the emergency setting. The system displays administered transfusions (e.g., RBC, FFP, PC and cryoprecipitate) as the icons on the monitor manual input. In this way, the changes in vital signs and laboratory tests due to transfusion could be recognized on the screen. Dynamic monitoring updated every 5 s of vital signs are displayed on a 55-inch monitor so that staff can check the trend at any time and be alerted to changes in the patient's condition. We beli","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Direct reinfusion of pericardial blood during cardiac surgery triggers a systemic inflammatory response. Although various inflammatory mediators have been identified as triggers, the role of damage-associated molecular patterns (DAMPs) remains poorly understood. Despite guidelines recommending against this practice owing to its harmful effects, it is sometimes used in emergencies.
Case Presentation
A 72-year-old man with atrial fibrillation and cerebral infarction developed cardiac tamponade during catheter ablation. He underwent pericardial drainage and direct blood reinfusion. He was transferred to our ICU, where he developed acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). Despite aggressive management, the patient died 41 days after admission.
Conclusion
This case highlights severe adverse events following direct reinfusion of pericardial blood. These findings suggest a significant role for DAMPs in mediating these inflammatory responses. Direct reinfusion of pericardial drainage blood should be avoided during emergencies to prevent life-threatening complications.
{"title":"Direct reinfusion of pericardial blood complications: A case of acute respiratory distress syndrome and disseminated intravascular coagulation","authors":"Takuto Yasuda, Kasumi Satoh, Nobuhisa Hirasawa, Manabu Okuyama, Hajime Nakae","doi":"10.1002/ams2.70005","DOIUrl":"https://doi.org/10.1002/ams2.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Direct reinfusion of pericardial blood during cardiac surgery triggers a systemic inflammatory response. Although various inflammatory mediators have been identified as triggers, the role of damage-associated molecular patterns (DAMPs) remains poorly understood. Despite guidelines recommending against this practice owing to its harmful effects, it is sometimes used in emergencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 72-year-old man with atrial fibrillation and cerebral infarction developed cardiac tamponade during catheter ablation. He underwent pericardial drainage and direct blood reinfusion. He was transferred to our ICU, where he developed acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). Despite aggressive management, the patient died 41 days after admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights severe adverse events following direct reinfusion of pericardial blood. These findings suggest a significant role for DAMPs in mediating these inflammatory responses. Direct reinfusion of pericardial drainage blood should be avoided during emergencies to prevent life-threatening complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vascular Ehlers-Danlos syndrome has a high mortality rate due to hemorrhagic complications.
Case Presentation
We report a case of vascular-type Ehlers-Danlos syndrome diagnosed due to rupture of multiple celiac aneurysms. The patient was a 25-year-old Japanese man with a history of a sigmoid perforation. He was admitted to a nearby hospital because of abdominal pain. On day 9 of hospitalization, the patient experienced shock. Enhanced abdominal computed tomography revealed a hepatic aneurysm and intra-abdominal bleeding, and the patient was transferred to our hospital. Emergency abdominal angiography revealed multiple aneurysms in the celiac, common, and right hepatic arteries. The right hepatic artery was considered responsible and was embolized. The patient had characteristic physical findings of the syndrome, aiding in confirming the genetic analysis of COL3A1 gene abnormality.
Conclusion
Juvenile-onset colonic perforation and rupture of the celiac arteries are key findings in the suspicion of vascular-type Ehlers-Danlos syndrome.
{"title":"Vascular type Ehlers-Danlos syndrome with intra-abdominal hemorrhage due to ruptured hepatic aneurysm: A case report","authors":"Masaou Tanaka, Kentaro Ueda, Takafumi Yonemitsu, Shinobu Tamura, Akira Ikoma, Tetsuo Sonomura, Shigeaki Inoue","doi":"10.1002/ams2.984","DOIUrl":"https://doi.org/10.1002/ams2.984","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vascular Ehlers-Danlos syndrome has a high mortality rate due to hemorrhagic complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report a case of vascular-type Ehlers-Danlos syndrome diagnosed due to rupture of multiple celiac aneurysms. The patient was a 25-year-old Japanese man with a history of a sigmoid perforation. He was admitted to a nearby hospital because of abdominal pain. On day 9 of hospitalization, the patient experienced shock. Enhanced abdominal computed tomography revealed a hepatic aneurysm and intra-abdominal bleeding, and the patient was transferred to our hospital. Emergency abdominal angiography revealed multiple aneurysms in the celiac, common, and right hepatic arteries. The right hepatic artery was considered responsible and was embolized. The patient had characteristic physical findings of the syndrome, aiding in confirming the genetic analysis of COL3A1 gene abnormality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Juvenile-onset colonic perforation and rupture of the celiac arteries are key findings in the suspicion of vascular-type Ehlers-Danlos syndrome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.984","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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