Mariko Obinata

Introduction of a Physician-Staffed Helicopter Emergency Medical Service in Eastern Shizuoka Prefecture in Japan

OBJECTIVE To analyze the operating situation of a physician-staffed helicopter emergency medical service in eastern Shizuoka prefecture. METHODS A retrospective analysis was performed using the conveyance records reported by staff members of the physician-staffed helicopter. A comparison between 2007 (n = 619) and 2012 (n = 678) was performed. RESULTS There were no significant differences between the 2 groups with regard to the sex, ratio of cardiopulmonary arrest, and survival ratio. In contrast, the duration from the request of dispatch to arrival at the hospital in 2007 was significantly longer than that in 2012 (53.7 vs 48.2 minutes, P < 0.0001). The average age in 2007 was significantly younger than in 2012 (55.7 vs 59.4 years, P < 0.01). The ratio of trauma case in the 2012 was higher than that in 2007 (47 vs 37%, P < 0.001). The ratio of severe cases in 2007 was higher than in 2012 (45 vs 39%, P < 0.05). CONCLUSION Japan is an aging society. In eastern Shizuoka prefecture, the increase in the number of trauma and minor injury cases may have increased due to the emphasis on the importance of early medical intervention by the fire department.

Management of a Mass Casualty Event Caused by Electrocution Using Doctor Helicopters

OBJECTIVE This is the first report to show the use of doctor helicopters in a mass casualty event induced by electrocution. METHODS We performed a narrative review. RESULTS Two children obtained electrocution burns by breaking an electric fence. Five adults also received electrocution burns. Emergency medical technicians at the scene requested additional dispatch of an ambulance and the doctor helicopter. Two adult men with cardiopulmonary arrest were transported by 2 ambulances to a nearby hospital. One adult woman was in a restless confusional state, intubated, and transferred to another hospital using the doctor helicopter. One boy, who was initially in a coma, and his mother were transferred to our hospital by 1 ambulance. Another boy, who had finger amputation, was transferred to the other hospital by another doctor helicopter. A remaining elderly woman was transported to the other local hospital by ambulance. All the victims, except the 2 fathers who fell into cardiac arrest, survived. CONCLUSION Early confirmation of the safety of the scene, early establishment of command and control, early request for dispatch of other parties and the doctor Helicopter, appropriate triage, appropriate treatment at the scene, selecting appropriate medical facilities, and dispersion transportation were crucial.

Significance of the vacuum phenomenon in patients with trauma evaluated by whole-body computed tomography☆

BACKGROUND Severely traumatized patients undergo whole-body computed tomography (WCT) to detect lethal anatomical injuries. When checking the images, we have sometimes recognized minute gas (the vacuum phenomenon [VP]) near the traumatized lesions. Accordingly, we investigated the significance of the VP in patients with trauma. BASIC PROCEDURES From April to October 2013, a medical record review was retrospectively performed for all patients with trauma. The exclusion criteria included an age more than 60 years, patients who did not receive the WCT, scan and those in cardiopulmonary arrest on arrival. The subjects were divided into 2 groups: a VP group (n=19), which included patients who had the VP, and a control group (n=49). MAIN FINDINGS There were no significant differences between the 2 groups with regard to age, the mechanism of injury, or the survival rate. In contrast, the ratio of women, the Injury Severity Score, and the duration of hospitalization in the VP group were significantly higher than those in the control group. The greatest number of the VP was located at or near rib fractures, followed by joint spaces that experienced a traumatic impact. PRINCIPAL CONCLUSION This study demonstrated that the VP tended to be observed most often in severely traumatized female cases. The VP is observed at locations that experience a traumatic impact, so an analysis of the VP may be useful to elucidate the mechanism of injuries. The presence of traumatic VP itself does not influence the final outcome.

A case of the vacuum phenomenon as a mechanism of gas production in the abdominal wall

A 40-year-old man experienced a collision with a car while driving a motorcycle in which the car was in the opposite lane and made a right turn. The patient was thrown approximately 10 m from the point of collision and, as he exhibited a consciousness disturbance, was transferred to our department. He had a score of 13 on the Glasgow Coma Scale with sinus tachycardia on arrival. He showed guarding of the abdomen. A pan scan disclosed traumatic subarachnoid hemorrhage, intraventricular hemorrhage, fractures of the atlas, thoracic spine, sternum and left femur, and gas in the abdomen located just in front of the stomach. As the gas in the abdomen was initially judged to be free air, the patient underwent emergency laparotomy. However, no signs of perforation or injury were detected throughout the entire digestive tract. The accumulation of minute gas (vacuum phenomenon) occurs as traumatic impact. As representative mimics of free air were not observed during surgery in the present case, we believe that the traumatic impact to the patients abdomen as a result of the collision caused the accumulation of gas in the abdominal wall due to vacuum phenomenon. Physicians should be aware of this clinical entity to accurately recognize the mechanism of gas formation in patients showing negative laparotomy findings for gas in the abdomen. This unique case adds additional information regarding the documented etiologies of mimics of pneumoperitoneum.

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.

A patient with clear consciousness even with a glucose level of 5 mg/dL (0.2 mmol/L) ☆ ☆☆

A 74-year-old man noted dysarthria and right hemiparesis. His history included a gastric ulcer 2 years previously, and he had gradually lost 10 kg over a 2-year period due to appetite loss. He daily consumed 120 mg of alcohol. Upon arrival, he had clear consciousness and stable vital signs. He was malnourished. Neurologic findings included a positive finding of Barre sign in the right hand and dysarthria. A venous blood gas analysis demonstrated the following: pH 7.059; PCO2, 21.5 mm Hg; PO2, 59.1 mm Hg; HCO(3-), 5.8 mmol/L; base excess, -22.7 mmol/L; lactate,17 mmol/L; and glucose, 4 mg/dL. After the administration of an infusion of thiamine and glucose, his abnormal neurologic findings subsided completely. Head magnetic resonance image (MRI; diffusion weighted image) disclosed 3 spotty, high-intensity signals in the brain. The main results of biochemical analyses of the blood collected on arrival were as follows: hemoglobin, 5.5 g/dL; glucose, 5 mg/dL; aspartate aminotransferase, 89 IU/L. He was admitted for further examination and was diagnosed as having alcoholic ketoacidosis with hypoglycemic encephalopathy and anemia due to colon cancer.

Pregnant Woman Bitten by a Japanese Mamushi (Gloydius blomhoffii)

We herein report the fourth case of a pregnant woman bitten by a mamushi. A 33-year-old pregnant woman in the 25th week of gestation was bitten by a mamushi. Her vital signs were stable; however, biochemical analyses of the blood showed mild deterioration of anemia and hypoproteinemia. The effects of envenomation were limited to the extremities, the administration of supportive therapy without antivenom fortunately resulted in a favorable outcome. As there are differences in the maternal medical condition and weeks of gestation, further research is needed to clarify the optimal management strategy for administering antivenom in pregnancy.

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.