Acute Medicine & Surgery最新文献

Natural disasters, such as earthquakes, pose significant global threats. On January 1, 2024, a devastating 7.6 magnitude earthquake struck Japan's Noto Peninsula, causing widespread destruction and loss of life. The quake resulted in at least 241 deaths, 1536 injuries, and extensive damage to buildings, leading to 34,694 people seeking refuge in shelters.¹ The survival of a 93-year-old woman trapped for over 5 days sheds light on human resilience and medical management during disasters. This letter describes a rare extrication scenario in a disaster setting, focusing on a successful multidisciplinary approach used to manage crush injuries.

On January 6, 2024, amidst the chaos following the earthquake, a critical rescue operation was undertaken in Suzu City to save a 93-year-old woman trapped under debris. A team comprising police, firefighters, and medical personnel, including a doctor and two nurses from a medical non-governmental organization, collaborated on the rescue efforts. The patient, found with her thighs pinned under heavy beams, displayed signs of subsequent crush injury. Her initial medical assessment revealed unstable vital signs with low blood pressure. The administration of 2500 mL of lactated Ringer's solution, 40 mL of sodium bicarbonate, and 10 mL of calcium gluconate, along with the use of hot bags for warming, was instrumental in stabilizing the patient's condition before extrication (Figure 1). The medical team worked in the hot zone (collapsed home confined space) for 15 min. In addition to these medical interventions, we used hot water-filled plastic bags placed against her torso to counteract potential hypothermia. Additionally, continuous verbal reassurance was provided by the rescue team, an essential part of maintaining her consciousness and morale during the entrapment. Decompression occurred 150 min after the initial intervention, and the patient was extracted 240 min after first contact (124 h after onset). Post-extraction, the patient's Glasgow Coma Scale score improved from E3V2M6 to E3V4M6, with sensory disturbances noted in her left lower limb. She was admitted to a nearby tertiary hospital. Laboratory tests showed creatine kinase of 13,475 U/L, potassium of 5.5.mmol/L and creatinine of 1.74 mg/dL confirming crush syndrome and compartment syndrome in the left leg, necessitating a fasciotomy. She was treated with fluid therapy; dialysis was unnecessary. The patient continued her recovery.

Crush syndrome, a significant concern in earthquake disasters, is known to be one of the leading causes of mortality, even after successful rescues.^{2, 3} This was evident in the 2024 Noto Peninsula earthquake, where at least six fatalities were reported due to crush syndrome, underscoring the severity of the condition in post-disaster medical challenges. Comparatively, the 2023 Kahramanmaras earthquake in Turkey also caused a considerable number of crush injuries, 7.7

This review underscores the crucial role of interdisciplinary collaboration in managing obstetric emergencies such as crisis bleeding. Prompt clinical judgment and coordinated interventions involving various departments are emphasized for the well-being of both the mother and newborn. The review explores the importance of emergency response infrastructure in obstetric facilities and delves into the 2022 Obstetric Crisis Bleeding Guidelines, emphasizing the relevance of a DIC score for severity assessment. The collaborative efforts within the operating room, involving different healthcare professionals, are detailed, stressing meticulous coordination during emergencies like massive bleeding. The necessity of interprofessional collaboration for building a responsive perioperative management team is discussed, with a focus on leadership, followership, and effective communication. The abstract also proposes simulation-based education for inter-departmental training, emphasizing a modified non-technical skill evaluation tool tailored to the unique characteristics of obstetric crisis management in the operating room. Continuous formative assessment of these factors is deemed essential for effective training in various obstetric emergency situations.