Hiromichi Osaka

Analysis of patients with decompression illness transported via physician-staffed emergency helicopters

Context: There have been few reports investigating the effects of air transportation on patients with decompression illness (DCI). Aims: To investigate the influence of air transportation on patients with DCI transported via physician-staffed emergency helicopters (HEMS: Emergency medical system of physician-staffed emergency helicopters). Settings and Design: A retrospective medical chart review in a single hospital. Materials and Methods: A medical chart review was retrospectively performed in all patients with DCI transported via HEMS between July 2009 and June 2013. The exclusion criteria included cardiopulmonary arrest on surfacing. Statistical analysis used: The paired Students t-test. Results: A total of 28 patients were treated as subjects. Male and middle-aged subjects were predominant. The number of patients who suddenly surfaced was 15/28. All patients underwent oxygen therapy during flight, and all but one patient received the administration of lactate Ringer fluid. The subjective symptoms of eight of 28 subjects improved after the flight. The range of all flights under 300 m above sea level. There were no significant differences between the values obtained before and after the flight for Glasgow coma scale, blood pressure, and heart rate. Concerning the SpO2, statistically significant improvements were noted after the flight (96.2 ± 0.9% versus 97.3 ± 0.7%). There were no relationships between an improvement in subjective symptoms and the SpO2. Conclusion: Improvements in the subjective symptoms and/or SpO2 of patients with DCI may be observed when the patient is transported via HEMS under flights less than 300 m in height with the administration of oxygen and fluids.

Shizuoka Prefecture Disaster Drill Involving the Japanese and US Military.

Izu peninsula is in Shizuoka prefecture, which is approximately 130 km from Tokyo. According to a report from the National Research Institute for Earth Science and Disaster Prevention, Izu peninsula is located just on the border between the Philippine Sea and the Eurasian plate. In this area, huge earthquakes, called Tokai earthquakes, have occurred repeatedly every 100 to 150 years. The next earthquake is expected to have at least a magnitude of 8 and could cause thousands of deaths, hundreds of thousands of injuries, and millions of damaged buildings, leaving cities that include Shizuoka devastated.

Difference in First Aid Activity During Mass Casualty Training Based on Having Taken an Educational Course

BACKGROUND The Japanese Association for Disaster Medicine developed a mass casualty life support (MCLS) course to improve cooperation among medical practitioners during a disaster, which is essential for reducing the rates of preventable disaster death. We investigated whether there was difference in first aid activity among members of the ambulance service during mass casualty training based on having taken the MCLS course. METHODS Mass casualty training was held at the fire department of Numazu City. Twenty-one ambulance service parties participated in this training. They first evaluated the mass casualty situation, performed the appropriate services at the scene during the initial period, and then provided START triage for mock wounded patients. Throughout the training, 5 examiners evaluated their performance. RESULTS Regarding the difference in first aid activity based on MCLS course attendance among the ambulance service members, the cooperative management (scored on a scale of 1 to 5) among the members who had taken the MCLS course was significantly better than that among those who had not taken the course (median [interquartile range]: 5 [0.5] vs. 4 [1.75], P<0.05). CONCLUSION Attending an MCLS course may help to improve outcomes in the face of an actual mass casualty incident. (Disaster Med Public Health Preparedness. 2018;12:437-440).

A patient with refractory shock induced by several factors, including obstruction because of a posterior mediastinal hematoma

A 44-year-old man who drove a motorcycle experienced a collision with the side of another motorcycle. Because he had sustained a high-energy injury to the spinal cord, he was transferred to our hospital. His circulation was unstable, and received tracheal intubation in addition to thoracostomy for the hemothorax. Whole-body computed tomography (CT) revealed multiple fractures, right hemopneumothorax with pulmonary contusion, and minor liver injury. After infusing 5000 mL of lactated Ringers solution and 10 units of blood, his circulation remained unstable. On a repeat CT examination, the left atrium was found to be compressed by a posterior mediastinal hematoma induced by the fracture of the thoracic spine, and a diagnosis of shock induced by multiple factors, including hemorrhagic, neurogenic, and obstructive mechanisms, was made. After obtaining stable circulation and respirations, internal fixation of the extremities and extubation were performed on the 12th hospital day. Chest CT performed on the 27th day showed the disappearance of compression of the left atrium by the hematoma.

Hypoxic cardiopulmonary arrest with full recovery after induced hypothermic therapy

The patients chart was reviewed, summarized, and presented.

A case of thalamic hemorrhage with takotsubo cardiomyopathy

A 76‐year‐old woman was found unconscious by her family. She had suffered a fall and was soaked in kerosene. On arrival at our emergency department, she was unconscious, normotensive, with right hemiplegia and chemical burns. A computed tomographic scan of her head indicated left thalamic hemorrhage. An electrocardiogram showed ST elevation at the precardial leads. An echocardiogram revealed characteristic of takotsubo cardiomyopathy.