Hiroki Nagasawa

Bite Wounds Caused by a Wild Boar: A Case Report

A 74-year-old man was attacked by a wild boar while on his way home from his farm in the daytime in winter 2017 on the rural Izu peninsula. He did not provoke the boar; however, hunters were hunting animals in the mountains near the farm around the same time. The boar bit his left leg, and the man fell to the ground. The boar continued biting the mans left leg, and the man delivered a few kicks to the boars face with his right leg. The boar then bit his right foot and ran away. The man was taken to a hospital, and a physical examination revealed 3 bite wounds on his left leg and right foot. The wounds were irrigated with sterilized saline and closed with sutures under local anesthesia. He received antibiotics and a tetanus toxoid booster. The next day, his wounds were found to be infected, and pus was drained from them. After these treatments, his wounds healed successfully. Animal bite wounds are frequently contaminated. Accordingly, in addition to early proper wound treatment, close observation of the wound is required for both the early detection of any signs of infection and early medical intervention, including appropriate drainage of pus and irrigation as necessary.

Traumatic pulmonary artery injury: a review of the recent literature

Pulmonary artery injury (PAI) is rare, lethal clinical entity. Traumatic PAI is anatomically classified into transection/ rupture/laceration, pseudoaneurysm, dissection and fistula. In addition, traumatic PAI is clinically classified into two major categories: iatrogenic and non-iatrogenic, depending on the mechanism of the trauma. The frequency, clinical symptoms and treatment differ between the two clinical categories. If PAI can be managed appropriately and promptly in patients without cardiac arrest, the patient may be saved, as PAI can be easily controlled with appropriate procedures due to the low pressure in the PA circulation.

Massive intraperitoneal free air induced by pneumothorax and pneumomediastinum

Highlights • Intraperitoneal free air can be induced by pneumothorax and pneumomediastinum.• This is the massive intraperitoneal free air by pneumothorax and pneumomediastinum.• Air dissects its way downwards along the esophagus and aorta into the retroperitoneal tissues.• Deterioration of traumatic pneumothorax and/or occurrence of pneumomediastinum after mechanically ventilation is the most considerable reason of the PP in the present case.

A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection

A 35-year-old man (height, 169 cm; body weight, 240 kg; BMI, 84) visited the Department of Dermatology due to left leg pain and swelling. Focused enhanced computed tomography (CT) of the left leg ruled out complications of deep venous thrombosis. Surgical exploration of the left leg resulted in a diagnosis of necrotic soft tissue infection, but amputation was ruled out due to his weight. The patient ultimately died of multiple organ failure on the fourth day of hospitalization. A culture of the surgical material revealed Streptococcus dysgalactiae. The present case suggests that super-obese patients should be aggressively treated before lethal complications occur.

Management of Multiple Burned Patients with Inhalation Injuries

The fire department in Atami received an emergency call at 6:17 am, with notification of 4 or 5 casualties because of a fire. Because there was only 1 ambulance (O) at the station, an additional ambulance (P) was also requested. Ambulance O transported 2 patients (A and B), and ambulance P transported 2 patients (C and D). These 4 patients were judged to have severe inhalation injuries at the scene and were transported to 2 local hospitals (X and Y). After patients C and D arrived at hospital Y, the medical staff decided to transfer them to the emergency medical service center. Patient C was transported by an emergency medical helicopter (doctor helicopter), and patient D was transported to our hospital by ambulance P. After tracheal intubation, both patients (C and D) required intensive care and mechanical ventilation. Patient A at hospital X was also intubated and transported to another hospital by the doctor helicopter. Fortunately, all patients survived. After a review among the parties involved in the incident, initiating an early request for additional human resources, vehicles, and medical support was recognized as contributing a key role in achieving a successful outcome.

An Analysis of Intoxicated Patients Transported by a Doctor Helicopter

OBJECTIVEnWe retrospectively investigated all of the intoxicated patients who were transported by a doctor helicopter (DH) in eastern Shizuoka between April 2004 and December 2015 to determine when air medical transport was used in cases of toxic exposure.nnnMETHODSnSubjects were divided into 2 groups: an outpatient group of subjects who went home after receiving a medical evaluation and treatment and an admission group.nnnRESULTSnThe outpatient and admission groups included 17 and 31 subjects, respectively. The ratio of dispatching the DH to the scene and the median Glasgow Coma Scale score in the outpatient group were greater, and the shock index in the outpatient group was significantly smaller than in the admission group. The duration from exposure of intoxicated agents to contact by staffs of the DH in the outpatient group was also smaller than in the admission group.nnnCONCLUSIONnThe level of consciousness and shock index may be important factors dictating whether or not to dispatch the DH in order to prevent secondary damage induced by unstable circulation.

An Analysis of Patients with Anaphylaxis Treated by a Physician-Staffed Helicopter

OBJECTIVEnTo determine whether anaphylactic patients treated by the doctor helicopter (DH) staff and transported from the scene obtained a favorable outcome by analyzing changes in vital signs and clinical manifestation before and after treatment during flight.nnnMETHODSnWe retrospectively investigated all of the patients with anaphylaxis who were transported by the DH between March 2004 and February 2017.nnnRESULTSnA total of 68 cases were enrolled in the present study. The average age was 48 years old, and most were men. The most frequent cause of anaphylaxis was a beesting or wasp sting followed by a food allergy. Adrenaline injections were executed at the scene for 48 cases. The condition of 64 (94%) subjects improved or totally subsided (n = 25, 37%) after arriving at the hospital. The Glasgow Coma Scale, peripheral capillary oxygen saturation, and systolic blood pressure after transportation to a hospital were higher than before transportation. All subjects who were treated by the DH staff obtained a survival outcome without sequelae.nnnCONCLUSIONnThe vital signs and clinical conditions of the patients who were treated by the DH staff when they were in an anaphylactic state at the scene showed improvement when they arrived at the hospital.

Prognostic Factors of Cardiopulmonary Arrest Patients by a Physician-Staffed Helicopter

OBJECTIVEnThe aim of this study was to identify the prognostic factors of cardiopulmonary arrest (CPA) patients transported by a physician-staffed helicopter who received cardiopulmonary resuscitation (CPR) using AutoPulse (ZOLL Circulation, Sunnyvale, CA).nnnMETHODSnA total of 110 CPA patients who had CPR performed on them in the helicopter using AutoPulse were enrolled in this retrospective study. We used logistic regression analysis to examine the prognostic factors of CPA patients who were transported by a physician-staffed helicopter.nnnRESULTSnOf these patients, return of spontaneous circulation (ROSC) during transportation was observed in 19 (17.29%); 1 (.9%) survived through hospital discharge without neurologic disability. In multivariate analyses, bystander CPR (P = .023) and the time from the first call to the arrival of a helicopter medical crew (P = .041) were selected as independent factors associated with ROSC.nnnCONCLUSIONnIn our study, factors such as early contact from the first call to the arrival of a helicopter medical crew and the presence of bystander CPR appeared to play an important role in attaining ROSC of CPA patients who were transported by a physician-staffed helicopter using AutoPulse.

A Report Concerning Collaboration Between a Physician-staffed Helicopter (Doctor Helicopter) and Firefighting/Rescue Helicopter

OBJECTIVEnIn Japan, the main helicopters that transport patients are physician-staffed helicopters (known as doctor helicopters [DHs]) and firefighter/rescue helicopters (F/RHs). We report the collaboration between F/RHs and DHs in eastern Shizuoka Prefecture.nnnMETHODSnWe retrospectively investigated all of the patients who were transported by F/RHs in Shizuoka Prefecture between January 2015 and April 2018.nnnRESULTSnNine cases were defined as subjects. Seven subjects had suffered trauma, 1 decompression illness, and 1 intrinsic disease. Seven of the 9 subjects were rescued from the bottom of a cliff or shore reef, and all 7 were transferred from an F/RH to a DH at the rendezvous zone near the rescue scene. One of the 9 subjects was a mass casualty event, and the remaining patient was rescued and directly transported to our hospital by an F/RH. All but 1 who was in cardiac arrest at the scene survived.nnnCONCLUSIONnBecause relatively few subjects were managed via collaboration between an F/RH and a DH in eastern Shizuoka Prefecture, further studies will be required to investigate whether or not such a collaboration is useful for improving the outcome of sick and wounded patients.

A case of real spinal cord injury without radiologic abnormality in a pediatric patient with spinal cord concussion

Introduction:Real spinal cord injury without radiologic abnormality (SCIWORA) is a rare clinical entity.Case presentation:The patient was a 13-year-old girl whose body was overturned anteriorly after crashing her bicycle into a curb. Following the accident, in which her neck and upper back hit the ground, she could not move due to paralysis. On arrival, she had paresis of the bilateral upper extremities and experienced a painful sensation when her upper extremities were touched. Cervical roentgenography and whole-body computed tomography revealed no traumatic lesions in either the intracranium or the cervical bone. Urgent spinal magnetic resonance imaging (MRI) showed no significant spinal cord lesions or spinal canal stenosis. She was put on complete bed rest with a cervical collar. On the 2nd hospital day (24u2009h after the accident), her motor weakness had almost completely subsided, and she felt only mild dysesthesia in both forearms. Roentgenography revealed no instability. Her motor weakness completely recovered on the third day after accident and she was diagnosed with spinal cord concussion.Discussion:The present case study, in which MRI was performed, showed that an immediate improvement was obtained in a patient who experienced real SCIWORA. The importance of not only spinal cord lesions, but also perispinal soft tissue injury on MRI has been emphasized for predicting patient outcomes. Accordingly, immediate MRI is essential for evaluating patients with signs and symptoms of spinal cord injury, even when plain neck roentgenography and cervical CT are negative.