Hiroshi Henmi

Blunt traumatic rupture of the heart: an experience in Tokyo

The present study was planned to clarify the characteristics of blunt traumatic cardiac rupture. We performed a retrospective analysis of 63 patients with blunt traumatic cardiac rupture during the period from April 1975 through February 1993. Six of nine patients arrived with recordable blood pressure, and injuries were detected by ultrasonography. Three patients underwent pericardiocentesis before surgery. Seven patients survived overall. The hemodynamics in all seven survivors were stabilized within 3 days after cardiac repair. The survival rate among the patients who arrived with blood pressure was 54%. A patient who fell from higher than 6 meters or a pedestrian hit by car and thrown as short a distance as 6.5 meters may have cardiac rupture. Ultrasonography is a useful, quick, and sensitive way to detect the presence of pericardial fluid. We prefer to do pericardiocentesis with a large-bore catheter under ultrasonographic guidance for continuous pericardial drainage rather than to create a subxyphoid pericardial window for cardiac tamponade.

NEW DIAGNOSTIC PERITONEAL LAVAGE CRITERIA FOR DIAGNOSIS OF INTESTINAL INJURY

BACKGROUND Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as an indicator for emergency celiotomy. Therefore, since the development of ultrasonography and advanced computed tomographic scanners, the role of DPL has been markedly reduced. Despite such remarkable advances, however, radiologic diagnosis of intestinal injury cannot always provide definitive results, and DPL may still be valuable in such instances. We have developed a new DPL criteria specifically designed to aid in the diagnosis of intestinal injury and have evaluated its effectiveness. METHODS From August 1988 to December 1995, we performed DPL in 250 patients with blunt abdominal trauma and analyzed the diagnostic accuracy of our new criteria. We used the standard quantitative white blood cell (WBC) criterion for detection of intestinal injury supplemented by a positive-negative borderline adjusted to WBC > or = red blood cell (RBC)/150, where RBC > or = 10 x 10(4)/mm3. RESULTS Our criteria had a diagnostic sensitivity of 96.6% and a specificity of 99.4% for intestinal injury after exclusion of 57 patients in whom DPL was performed within 3 hours or after 18 hours from the time of injury. In 133 patients with hemoperitoneum, emergency celiotomy was performed in only 48; the remaining 85 patients with negative DPL based on the WBC criterion avoided surgery, and conservative management resulted in no complications. CONCLUSION With the proposed criteria, DPL can be used to diagnose or exclude intestinal injury even in the presence of hemoperitoneum.

Analysis of patient load data from the 2002 FIFA World Cup Korea/Japan.

INTRODUCTION Past history of mass casualties related to international football games brought the importance of practical planning, preparedness, simulation training, and analysis of potential patient presentations to the forefront of emergency research. METHODS The Japanese Ministry of Health, Labor, and Welfare established the Health Research Team (HRT-MHLW) for the 2002 FIFA World Cup game (FIFAWC). The HRT-MHLW collected patient data related to the games and analyzed the related factors regarding patient presentations. RESULTS A total of 1661 patients presented for evaluation and care from all 32 games in Japan. The patient presentation rate per 1000 spectators per game was 1.21 and the transport-to-hospital rate was 0.05. The step-wise regression analysis identified that the patient presentations rate increased where access was difficult. As the number of total spectators increased, the patient presentation rate decreased. (p < 0.0001, r = 0.823, r2 = 0.677). CONCLUSION In order to develop mass-gathering medical-care plans in accordance with the types and sizes of mass gatherings, it is necessary to collect data and examine risk factors for patient presentations for a variety of events.

Gluteal Soft Tissue Necrosis After Transcatheter Angiographic Embolization for Pelvic Fracture: a Report of Two Cases

In this paper, two cases of the gluteal soft tissue necrosis after pelvic fractures will be discussed. In the case of a 29-year-old man, a localized area of skin necrosis on the buttock appeared after transcatheter arterial embolization (TAE) of the right internal iliac artery (IIA). In the second case, a 52-year-old man, who was treated using TAE of the bilateral IIAs, developed an extensive area of necrosis in the gluteus maximus muscle with subsequent severe infection. In both cases, complete excision of the necrotic tissue and reconstructive flap surgery were imperative. Gluteal soft tissue necrosis is clinically important as one of the serious complications of TAE.

Analysis of trends and emergency activities relating to critical victims of the chuetsuoki earthquake

INTRODUCTION When a large-scale disaster occurs, it is necessary to use the available resources in a variety of sites and scenes as efficiently as possible. To conduct such operations efficiently, it is necessary to deploy limited resources to the places where they will be the most effective. In this study, emergency and medical response activities that occurred following the Chuetsuoki Earthquake in Japan were analyzed to assess the most efficient and effective activities. METHODS Records of patient transports by emergency services relating to the Niigata Chuetsuoki Earthquake, a magnitude 6.8 earthquake that struck Japan on 16 July 2007 were analyzed, and interview surveys were conducted. RESULTS The occurrence of serious injuries caused by this earthquake essentially was limited to the day the earthquake struck. A total of 682 patients were treated on the day of the quake, of which about 90 were hospitalized. Of the 17 patients whose conditions were life-threatening, three were rescued and transported to hospital by firefighters, three were transported by ambulance, and 11 were transported to hospital using private means. Sixteen people were subsequently transferred to other hospitals, six of these by helicopter. There was difficulty in meeting all of the requests for emergency services within 4 to 6 hours of the earthquakes occurrence. Most transports of patients whose conditions were life-threatening were between hospitals rather than from the scene of the injury. Transfers of critical patients between hospitals were efficient early on, but this does not necessarily mean that inter-hospital transfers were given higher priority than treatment at emergency scenes. CONCLUSION During the acute emergency period following a disaster-causing event, it is difficult to meet all requests for emergency services. In such cases, it is necessary to conduct efficient activities that target critically injured patients. Since hospital transfers are matters of great urgency, it is necessary to consider assigning resource investment priority to hospital transfers during this acute period, when ambulance services may be insufficient to meet all needs. To deal with such disasters appropriately, it is necessary to ensure effective information exchange and close collaboration between ambulance services, firefighting organizations, disaster medical assistance teams, and medical institutions.

(P2-31) The Situation of the Development of Disaster Medical Assistant Team in Japan

Background After the Great Hanshin-Awaji Earthquake, the disaster countermeasures concerning medical care in Japan changed drastically. In 2005, the Japanese government began to develop a domestic, rapid, medical response system called Disaster Medical Assistance Team (DMAT) for the purpose of rapid medical correspondence in the acute phase. As of 12 July 2010, 393 institutions and 734 teams (3,700 persons) were trained. A DMAT is important not only to the response to large disasters such as earthquakes, but also the response to local disasters. It is important to establish the DMAT system of each prefecture and district. Methods The DMAT system at the local level was described at the 15th World Congress on Disaster and Emergency Medicine. During the present Congress, the development and activities of the DMAT system over the past three years will be reported. Results and Conclusion Eight local districts in the DMAT system have been developed, and progress has been made in the fields of policy, operative plans, and agreement among each province. The system of inter-prefecture mutual aid must be built upon in the near future.

Successful Rapid Helicopter Transportation for a Ruptured Abdominal Aortic Aneurysm Patient

We examined a case of rapid helicopter transportation, which was crucial to the survival of a ruptured abdominal aortic aneurysm (AAA) patient with profound shock. A 70-year-old woman, who presented at home with acute severe back pain, was transferred by helicopter 50km to our hospital. On arrival, she had no detectable blood pressure and soon developed bradycardia with subsequent cardiac arrest, which required an emergency room thoracotomy A @ (ERT). After open cardiac massage and thoracic aortic cross-clamping, her heart beat was recovered. Additional laparotomy revealed about 500ml of blood from intraperitoneal bleeding and a large dilated and ruptured retroperitoneal hematoma. The AAA was reconstructed using a Y-graft. On the 78 hospital day, she was discharged from our hospital without any neurological defects. In this case, all factors such as the intimate cooperation between the ambulance EMTs and aviation team, early call and prompt dispatch of the helicopter, and effective therapy by the receiving hospital were necessary for the survival of this patient. We concluded that we should promptly prepare an emergency helicopter system for improving the outcome of patients in local areas, and that these systems will prove effective in case of natural or civil disaster.

Causes and Treatment of Desaturation in SjO2 Monitoring

To minimize secondary brain damage, which greatly influences prognosis during brain damage, it is necessary to avoid the state of ischemia as much as possible because ischemia is an important factor in secondary brain damage. On the other hand, because ischemia has various causes, gaining an understanding of its pathology and deciding on a course of treatment is certainly not easy. In an attempt to resolve this problem, continuous monitoring of jugular bulb venous oxygen saturation (SjO2) has recently attracted considerable attention. SjO2 reflects the status of total brain oxygen metabolism because its value is determined by the ratio between cerebral blood flow and brain oxygen metabolism.

Continuous Monitoring of Jugular Venous Oxygen Saturation in Neurosurgical Intensive Care Units

It is very important for to evaluate cerebral blood flow and cerebral oxygen metabolism of patients who are suffering from severe head injury or severe cerebrovascular disease. It is well known that jugular bulb saturation shows the ratio of cerebral blood flow and cerebral oxygen metabolism. Thus, many trials were carried out to measure jugular bulb saturation to determine cerebral blood flow and cerebral oxygen metabolism. It has been very difficult, however, to measure and record these parameters continuously at bedside. Recent technology now makes it possible to measure and record these parameters at a bedside monitor.