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Introduction: We retrospectively analyzed convulsive patient outcomes transported by a physician-staffed Helicopter Emergency Medical Service (doctor helicopter [DH]) using the keyword-triggered dispatch with data from the Japan DH Registry System (JDRS). Upon receiving an emergency call containing critical keywords, such as an ongoing convulsion at the firefighting central command room, immediate dispatch of the DH is requested, in addition to dispatching an ambulance. The keyword-triggered dispatch relied on data obtained from the JDRS. Methods: Details from the JDRS database included patient age, sex, cardiac arrest presence upon DH contact, vital signs, DH dispatch timing (keyword-triggered dispatch/emergency medical technician [EMT]-triggered dispatch), medical intervention details, and 1-month outcomes (cerebral performance category [CPC]; CPC1, 2: Good; CPC 3–5: Poor). Subjects were divided into keyword (keyword-triggered dispatch) and control (EMT-triggered dispatch) groups for comparison. Results: Of 1201 patients, all evacuated from the scene, 617 were in the keyword group, and 584 in the control group. No significant differences existed between groups for cardiac arrest, respiratory and heart rates, CPC, or mortality. The keyword group had lower average age, systolic blood pressure, and medical intervention ratio but a higher median Glasgow Coma Scale and good outcome ratio. Conclusion: This first report on the keyword-triggered dispatch as a prognostic factor for convulsive patients evacuated by DH using the JDRS.

Abstract Steam recovery from the spent gases from flues could be a key step in addressing the water shortage issue while additionally benefiting energy saving. Herein, we propose a system that uses organosilica membranes consisting of a developed layered structure to recover steam and latent heat from waste. Proof-of-concept testing is conducted in a running incinerator plant. The proposed system eliminates the need for a water supply while simultaneously recovering latent heat from the waste stream. First, the long-term stability of an organosilica membrane is confirmed over the course of six months on a laboratory-scale under a simulated waste stream. Second, steam recovery is demonstrated in a running waste incinerator plant (bench-scale), which confirms the steady operation of this steam recovery system with a steam recovery rate comparable to that recorded in the laboratory-scale test. Third, process simulation reveals that this system enables water-self-reliance with energy recovery that approximates 70% of waste combustion energy.

Abstract Background Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS. Methods The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians’ interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed. Results Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11–5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16–6.64) may have increased the return of spontaneous circulation (ROSC) rate. Conclusions The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.

Introduction: Retrospectively investigated this relationship using data from Shimoda Fire Department. Methods: We investigated patients who were transported by Shimoda Fire Department from January 2019 to December 2021. The participants were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [−]). We compared the variables mentioned above between these groups. Results: There were 499 cases with incontinence and 8241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the incontinence (+) group were significantly greater in comparison to the incontinence (−) group, whereas the average temperature in the incontinence (+) group was significantly lower than that in the incontinence (−) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation, and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions. Conclusions: This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.

Abstract Background Hemodynamic stabilization is a core component in the resuscitation of septic shock. However, the optimal target blood pressure remains debatable. Previous randomized controlled trials suggested that uniformly adopting a target mean arterial pressure (MAP) higher than 65 mmHg for all adult septic shock patients would not be beneficial; however, it has also been proposed that higher target MAP may be beneficial for elderly patients, especially those with arteriosclerosis. Methods A multicenter, pragmatic single-blind randomized controlled trial will be conducted to compare target MAP of 80–85 mmHg (high-target) and 65–70 mmHg (control) in the resuscitation of septic shock patients admitted to 28 hospitals in Japan. Patients with septic shock aged ≥65 years are randomly assigned to the high-target or control groups. The target MAP shall be maintained for 72 h after randomization or until vasopressors are no longer needed to improve patients’ condition. To minimize the adverse effects related to catecholamines, if norepinephrine dose of ≥ 0.1 μg/kg/min is needed to maintain the target MAP, vasopressin will be initiated. Other therapeutic approaches, including fluid administration, hydrocortisone use, and antibiotic choice, will be determined by the physician in charge based on the latest clinical guidelines. The primary outcome is all-cause mortality at 90 days after randomization. Discussion The result of this trial will provide great insight on the resuscitation strategy for septic shock in the era of global aged society. Also, it will provide the better understanding on the importance of individualized treatment strategy in hemodynamic management in critically ill patients. Trial registration UMIN Clinical Trials Registry; UMIN000041775. Registered 13 September 2020.

Abstract Although the regular administration of antihypertensive drugs is a risk factor for falls in older adults, whether their anti-inflammatory effects confer a survival benefit in older adults remains unknown. This single-center retrospective cohort study examined patients with trauma aged ≥ 65 admitted to our hospital between January 2018 and December 2020. Patients who had not received antihypertensive drugs before admission (i.e., AHT(−) group) and those who had received the drugs (i.e., AHT(+) group) were compared using a 1:1 propensity score-matched analysis. The primary outcome was 28-day mortality, and the secondary outcomes were in-hospital mortality and the incidence of complications during the hospital stay. In total, 637 patients were analyzed. After propensity score matching, each study group had 223 patients. No significant difference was observed in the primary outcome (28-day mortality: AHT(−) group, 3.6% vs. AHT(+) group, 3.6%; adjusted relative risk: 1.00, 95% confidence interval (CI): 0.38–2.62); only the in-hospital incidence of delirium was significantly low in the AHT(+) group (25.1% vs. 13.9%; adjusted relative risk: 0.55, 95% CI: 0.37–0.82). Overall, the regular use of antihypertensive drugs did not affect outcomes in geriatric trauma patients; however, the incidence of delirium was reduced in those regularly receiving antihypertensive drugs.

Developing silica membranes that are highly selective for CO2 has always been a challenge due to the small sizes of the pores and less amount of CO2 philic sites in a typical silica network structure. Herein, we describe the fabrication of silica (tetraethoxysilane) membranes functionalized with 3-aminopropyltriethoxysilyl (APTES) and trifluoroacetic acid (TFA). An interaction generated among primary (NH2) amines and TFA was identified, which was then also revealed by the reversible nature of CO2 adsorption/desorption — an opposite trend from observations when using another catalyst (HCl). The resultant TEOS-APTES (TFA) membranes demonstrated CO2 permeance of 3.8 × 10−7 mol m − 2 s − 1 Pa−1 and CO2/N2 selectivity of 35 at 50 ⁰C via the effect of surface diffusion. This is attributed to the increased microporosity and structural variations affected by TFA, which enhanced molecular sieving and controls the CO2-philic sites (-NHCOCF3) via interaction with amines. This novel approach would be effective for the energy-efficient fabrication of highly CO2-permeable membranes.

A 40 cm length Bis(triethoxysilyl)ethane (BTESE) membrane having different pore sizes was successfully prepared by changing the number of coating times for gas permeation (GP) and organic solvent reverse osmosis (OSRO) separation study. It was found that BTESE-6 membranes prepared through six-time coating consisted of small-sized pores in the range 0.56 to 0.64 nm estimated using modified Gas Translation (mGT) method and 0.59 to 0.67 nm estimated by nanopermporometry (NPP) method, respectively. These membranes demonstrated a high DMF rejection, RDMF > 95% with total flux, Jv total > 5 kg m−2 h−1 at operating condition feed pressure, Pf: 8 MPa; feed temperature, Tf : 50 °C; and feed flowrate, Qf : 30 mL/min; and they exhibited a high degree selectivity of He/SF6 in the range of ~ 260–3400 at a permeation temperature 200 °C. On the other hand, the larger pore sizes of the BTESE-4 membranes (pore size estimates > 0.76 nm to 1.02 nm) exhibited low DMF rejection and a low degree selectivity of He/SF6 around ~30% and 25, respectively, at the same operating condition as BTESE-6. Both GT and NPP methods can be considered as an indicator of the measurement membrane pore size. From this study, it was found that He and SF6 gases can be some of the potential predictors for water and DMF permeance. Furthermore, by comparing our OSRO membrane with other PV membranes for DMF/H2O separation, our BTESE-6 membranes still exhibited high flux in the range of 3–6 kg m−2 h−1 with a separation factor H2O/DMF in the range of 80–120.

Introduction: We retrospectively investigated prognostic factors for severe abdominal trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). Methods: The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of outcome: the Mortality group, which included patients who ultimately died, and the Survival group, which included patients who obtained a survival outcome. Results: There were 2457 in the Mortality group and 11,326 in the Survival group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the following variables were identified as significant positive predictors of a fatal outcome: evacuation from the scene, blunt injury, injury severity score, and age; significant negative predictors of a fatal outcome were transportation by the HEMS and revised trauma score. Conclusions: The present study described the usefulness of the HEMS for severe abdominal trauma patients in comparison with ground ambulance transportation using the JTDB.

Abstract Aim We retrospectively investigated the current status of poisoned patients who had been transported by a physician‐staffed helicopter emergency medical service and their final outcomes using data from the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM. Methods The following details of dispatch activity were collected from the database of the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM: patient age and sex, timing of dispatch request, presence of cardiac arrest, vital signs, medical intervention, main etiology of intoxication, and final outcome. The patients were divided into two groups: those with a good outcome and those with a poor outcome. The variables were compared between the two groups. Results A total of 336 patients were intoxicated. Psychotropic drug overdose was the dominant cause, followed by carbon monoxide and ethanol. The median Glasgow Coma Scale score was significantly higher in the good outcome group than in the poor outcome group. The rates of cardiac arrest, interventions to secure an airway and/or assist with ventilation, and drug administration were significantly lower in the good outcome group than in the poor outcome group. There were no records concerning the decontamination of the intoxicating substance at the scene or during air evacuation. Conclusion The study suggests that various factors may influence the outcomes of patients with different types of intoxication. These findings offer valuable insights that could help to establish effective treatment strategies and the operation of doctor helicopters for intoxicated patients.

Abstract We performed a narrative minireview for a PubMed search on March 31, 2023, using the keywords “pregnant” and “hyperbaric oxygen” to identify any related articles. Most reports have described pregnant women with carbon monoxide (CO) poisoning being treated by hyperbaric oxygen therapy (HBOT). HBOT helped improve the maternal condition and ensure normal fetal development. Some pregnant women with CO poisoning treated by HBOT suffered abortions or gave premature birth to low‐weight babies or with congenital malformations. However, these results were considered sequelae of CO poisoning, not HBOT. We hypothesized that for pregnant women facing a life‐threatening situation, for which the effectiveness of HBOT has previously been suggested, prioritizing the stabilization of the mother may also be beneficial for normal fetal development.

Graphene oxide (GO) has attracted attention as an excellent membrane material for water treatment and desalination owing to its high mechanical strength, hydrophilicity, and permeability. In this study, composite membranes were prepared by coating GO on various polymeric porous substrates (polyethersulfone, cellulose ester, and polytetrafluoroethylene) using suction filtration and casting methods. The composite membranes were used for dehumidification, that is, water vapor separation in the gas phase. GO layers were successfully prepared via filtration rather than casting, irrespective of the type of polymeric substrate used. The dehumidification composite membranes with a GO layer thickness of less than 100 nm showed a water permeance greater than 1.0 × 10−6 mol/(m2 s Pa) and a H2O/N2 separation factor higher than 104 at 25 °C and 90–100% humidity. The GO composite membranes were fabricated in a reproducible manner and showed stable performance as a function of time. Furthermore, the membranes maintained high permeance and selectivity at 80°C, indicating that it is useful as a water vapor separation membrane.

Abstract Background The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. Case presentation A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. Conclusion This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication of tetanus should be considered before and during the administration of anticoagulation therapy.

Context: Few reports have investigated the time course of fibrinogen (or fibrin) degradation product (FDP) levels for trauma patients in the subacute phase. Aims: This study aimed to investigate the time course of the FDP levels among patients with moderate and severe trauma in the subacute phase. Settings and Design: A retrospective medical chart review in a single hospital. Subjects and Methods: From September 2017 to March 2018, a medical chart review was retrospectively performed for all patients with trauma who were admitted to our department, and these patients were included as participants in the present study. We collected the data on each patient's sex, age, presence of head injury, mechanism of injury, Glasgow Coma Scale on arrival, systolic blood pressure, heart rate, type of injury (blunt versus penetrating), injury severity score, complication of infection, surgical procedure, duration of admission, survival rate, and FDP level from the 1st to 7th hospital day. The average level of FDP on each hospital day was compared with that on the previous day. Statistical Analysis Used: The statistical analyses were performed using a paired Student's t-test. P < 0.05 was considered to indicate a statistically significant difference. Results: From the 1st to 4th hospital day, the average level of FDP significantly diminished day by day. However, from the 5th hospital day, the average level significantly increased. This trend persisted even after excluding the complications of infection and surgical procedures performed between the 2nd and 7th hospital day. Conclusions: Among trauma patients, the average level of FDP significantly diminished day by day from the admission to the 4th hospital day; however, from the 5th hospital day, the average level significantly increased. Further studies are needed to determine the time course of FDP or D-dimer levels in the long term and when FDP levels return to normal limits.

Background A smart glasses system is a computerized communicator with a transparent screen and video camera that can be worn as a pair of glasses. There have been no reports on the use of smart glasses in the prehospital setting. Purpose To conduct a preliminary investigation on whether smart glasses were smoothly used bidirectionally between the prehospital setting and the receiving hospital. Methods From March 1, 2022, to March 31, 2022, one smart glasses unit was installed in an ambulance at one branch of the fire department near our hospital. The physician on the computer, who received video and voice transmission from the smart glasses when the ambulance was dispatched, evaluated the transmission status with regard to video reception, voice reception, and voice transmission. In addition, the activity time was compared between cases in which the smart glasses system was used (patient) and not used (control). Results During the investigating period, 12 cases were analyzed as patients. The rate of good video reception was 75%, the rate of good voice reception was 50%, and the rate of good voice transmission was 25%. There was no significant change in the activity time between the patient and control groups. Conclusion We performed a preliminary investigation on the usability of smart glasses in the prehospital setting. Using smart glasses, patient information was shared by video and voice before arrival at the hospital, and did not affect the activity time. However, the instability of the communication status should be recognized.

Abstract Background Gastric emphysema and emphysematous gastritis (EG) are rare diseases involving air being introduced into the stomach wall. Emphysematous gastritis is an infectious disease with a high fatality rate. Case presentation An 83‐year‐old woman had recovered from septic shock, however, an antibiotic‐refractory inflammatory response remained. She was diagnosed with pseudogout and administered a non‐steroidal anti‐inflammatory drug. However, abdominal pain, prominent abdominal distension, and strawberry milk‐like gastric juice were recognized. Computed tomography showed ileus due to fecal impaction and GE. The results of culture of the gastric juice were positive (Pseudomonas aeruginosa and Enterococcus faecalis). Disimpaction, fasting management, and antibacterial treatments resulted in the recovery of her symptoms. Conclusion This is the first case in which ileus associated with fecal impaction caused EG. The present case highlights the importance of promoting regular bowel movements.

This work investigated the long-term hydrothermal performance of composite carbon-SiO2-ZrO2 membranes. A carbon-SiO2-ZrO2 composite was formed from the inert pyrolysis of SiO2-ZrO2-polybenzoxazine resin. The carbon-SiO2-ZrO2 composites prepared at 550 and 750 °C had different surface and microstructural properties. A carbon-SiO2-ZrO2 membrane fabricated at 750 °C exhibited H2 selectivity over CO2, N2, and CH4 of 27, 139, and 1026, respectively, that were higher than those of a membrane fabricated at 550 °C (5, 12, and 11, respectively). In addition to maintaining high H2 permeance and selectivity, the carbon-SiO2-ZrO2 membrane fabricated at 750 °C also showed better stability under hydrothermal conditions at steam partial pressures of 90 (30 mol%) and 150 kPa (50 mol%) compared with the membrane fabricated at 500 °C. This was attributed to the complete pyrolytic and ceramic transformation of the microstructure after pyrolysis at 750 °C. This work thus demonstrates the promise of carbon-SiO2-ZrO2 membranes for H2 separation under severe hydrothermal conditions.

A series of pendant–type alkoxysilane structures with various carbon numbers (C1–C8) were used to fabricate sol–gel derived organosilica membranes to evaluate the effects of the C/Si ratio and fluorine doping. Initially, this investigation was focused on the effect that carbon-linking (pendant–type) units exert on a microporous structure and how this affects the gas-permeation properties of pendant–type organosilica membranes. Gas permeation results were compared with those of bridged–type organosilica membranes (C1–C8). Network pore size evaluation was conducted based on the selectivity of H2/N2 and the activation energy (Ep) of H2 permeation. Consequently, Ep (H2) was increased as the C/Si ratio increased from C1 to C8, which could have been due to the aggregation of pendant side chains that occupied the available micropore channel space and resulted in the reduced pore size. By comparison, these permeation results indicate that pendant–type organosilica membranes showed a somewhat loose network structure in comparison with bridged–type organosilica membranes by following the lower values of activation energies (Ep). Subsequently, we also evaluated the effect that fluorine doping (NH4F) exerts on pendant−type [methytriethoxysilane (MTES), propyltrimethoxysilane (PTMS)] and bridged-type [1,2–bis(triethoxysilyl)methane (BTESM) bis(triethoxysilyl)propane (BTESP)] organosilica structures with similar carbon numbers (C1 and C3). The gas-permeation properties of F–doped pendant network structures revealed values for pore size, H2/N2 selectivity, and Ep (H2) that were comparable to those of pristine organosilica membranes. This could be ascribed to the pendant side chains, which might have hindered the effectiveness of fluorine in pendant–type organosilica structures. The F–doped bridged–type organosilica (BTESM and BTESP) membranes, on the other hand, exhibited a looser network formation as the fluorine concentration increased.

Recently, there have been a number of reports concerning the utility of abdominal computed tomography (CT) for diagnosing overdose (OD). We herein report the summary and results of an analysis of these reports to assess the significance of CT for patients with OD. Searches of Ichushi (Japana Centra Revuo Medicine) and PubMed were carried out to identify articles from 1983 to 2019 using the key words “poisoning” and “abdominal computed tomography”. Forty‐eight cases across 15 articles were defined as subjects in this report. The average age of subjects was 46 years old, and there were 28 women. Forty‐five of the 48 subjects (93.8%) had positive findings of residual drugs on CT. The finding of a high‐density fluid level in the stomach was the most frequent (60.4%), followed by ill‐defined high‐density material in the stomach (12.5%) and high‐density tablets in the stomach (10.4%). One prospective study suggested the merits of decontamination for patients with positive findings on CT even if more than 60 min had elapsed since the ingestion of drugs. Computed tomography could aid in the diagnosis of OD in comatose patients who cannot talk or who present without any other evidence of OD. In addition, a recent study revealed the merits of decontamination for patients with positive findings on the CT even if more than 60 min had elapsed since the ingestion of drugs.

Background Fujifilm (Tokyo, Japan) developed a portable X‐ray system called the CALNEO Xair, which can be carried by a physician. The X‐ray radiation machine weighs 3.5 kg. The dimensions are: height, 144 mm; length, 148 mm; width, 258 mm. Case Presentation When a 33‐year‐old woman driving a car made a right turn at a crossroad, her car hit another car, causing her vehicle to tip onto its side. Staff of the doctor helicopter checked her at the scene, and the findings of chest and pelvic X‐ray were all negative. She received a diagnosis of cervical sprain and pelvic contusion and was transferred to a local hospital by ambulance. Conclusion This is the first report of a case evaluated by a portable X‐ray system at the scene, under transportation by a doctor helicopter. This system could be useful for undertaking prehospital assessment and medical treatment.

Abstract Background Mirtazapine has a good tolerability and safety profile that demonstrates several benefits over other antidepressants and it is associated with few fatalities. Boric acid is an odorless white powder that is generally not recognized as a poisonous substance. We report a case of cardiac arrest induced by the intentional ingestion of mirtazapine, boric acid, and sennosides, by a patient who required percutaneous cardiopulmonary bypass. Case presentation Our patient was a 49-year-old Japanese woman with a history of depression; she was found in an unconscious state after ingesting boric acid (unknown amount), mirtazapine (1950 mg), and sennosides (780 mg). On arrival, she was in a deep coma with marked hypotension induced by atrial fibrillation, tachycardia, and diffuse hypokinetic cardiac motion. She had systemic diffuse erythema. Her serum concentrations of boric acid and mirtazapine on arrival were 560.49 mg/L and 1270 ng/mL, respectively. She experienced repeated cardiac arrest, and was therefore treated with tracheal intubation, mechanical ventilation, percutaneous cardiopulmonary bypass, and continuous hemodialysis filtration. Stable circulation and respiration and a normal kidney function were finally obtained and she was transferred to a local medical facility in a persistent unconscious state. Conclusions This is the first case of a return of spontaneous circulation after cardiac arrest induced by the intentional ingestion of boric acid and mirtazapine, requiring percutaneous cardiopulmonary bypass for survival. To maintain cerebral perfusion during percutaneous cardiopulmonary bypass, even in a prolonged state of cardiac arrest induced by overdose, is medically, ethically, and economically challenging.

Aims: We prospectively investigated whether or not a rapid ultrasound for shock and hypotension (RUSH) examination is useful for managing patients with endogenous cardiac arrest (CA). Settings and Design: A prospective medical chart review in a single hospital. Materials and Methods: From March 2016 to December 2017, we performed a modified RUSH for all patients with out-of-hospital endogenous CA. We investigated the frequency of positive findings on modified RUSH and what kind of diseases could most easily be pinpointed as the cause of CA by the modified RUSH. Results: During the investigation period, 194 participants were enrolled in the present study. They were primarily male, with an average age of 68.8-year-old, and 178/194 (91.7%) died as outpatients. The most frequent cause of CA was cardiogenic, followed by aortic disease, respiratory failure, and stroke except for unknown. There were 14/26 (54%) aortic disease patients who showed positive RUSH findings. Among cases of the aortic disease, only aortic dissections had positive findings. Aside from aortic disease, there were no cases of positive findings of the modified RUSH among the remaining diseases, and all patients with positive findings died. Only pulseless electrical activity (PEA) was a statistically significant factor for positive findings of the modified RUSH in cases of the aortic disease. Conclusions: The present study revealed that, among patients with out-of-hospital endogenous CA, modified RUSH is useful for diagnosing ascending aortic dissection for the detection of hemothorax and/or cardiac tamponade, especially with PEA.

Introduction: The median sacral artery injury is a rare entity, especially in trauma. And the injuries are always with pelvic fractures. We describe a case of the median sacral injury which was induced by blunt trauma without pelvic fractures. Case presentation: A 26-year-old male who suffered L4–5 fracture dislocation and some hemorrhage in pelvic cavity following a motorcycle accident. He had a median sacral artery injury, and we tried to the trans-catheter arterial embolization, however it could not be success. The embolization was performed using of gelatin sponges in bilateral internal iliac artery and left 4th lumber artery. After his admission, a demand of transfusions lasted for 7 days. Conclusion: We successfully treated a case of median sacral avulsion injury by choosing conservative treatment.

Aim We aimed to evaluate effect of prehospital intravenous (IV) access on mortality in traumatic shock using a large nationwide dataset. Methods We used the Japan Trauma Data Bank to identify adults (≥18 years) with a systolic blood pressure 0.1 was considered a significant imbalance. Primary outcome was 72‐h mortality. Results Propensity scores matching generated 479 pairs from 5,857 patients. No significant between group differences occurred in 72‐h mortality (7.8 versus 8.8%; difference, −1.0%; 95% confidence interval [CI]: −2.5–4.5%), 28‐day mortality (11.8 versus 11.3%; 95% CI: −4.6–3.6%), blood transfusion administration within 24 h (55.3 versus 49.1%; 95% CI: −0.1–12.6%), prehospital time (56.3 versus 53.0 min; 95% CI: −1.8–8.4 min), and cardiopulmonary arrest on hospital arrival (1.3 versus 1.3%; 95% CI: −1.4–1.4%). However, significantly higher systolic blood pressure on hospital arrival was found in the IV (+) than in the IV (−) group (104.6 versus 100.1 mm Hg; 95% CI: 0.3‐8.7 mm Hg). Conclusion We found no significant effect of establishing IV access in the prehospital setting on survival outcomes of patients with traumatic shock.

An 80-year-old man with flu symptoms collapsed at his house and had a backache worsened over time. His family called for an ambulance. On arrival, chest X-ray showed reduced permeability of the right lung field, and truncal computed tomography (CT) suggested right multilobular empyema and right iliopsoas abscess. A blood test showed an acute inflammatory response. The patient underwent right small thoracotomy for empyema and ultrasonic-guided drainage for the right iliopsoas abscess and started the administration of antibiotics. We started the administration of doripenem by intravenous drip and then deescalated to ampicillin based on the culture results. Streptococcus intermedius was cultured from all sites. Following these treatments for three months, his general condition improved. We herein report a unique case of complicated empyema and iliopsoas abscess in which a favorable outcome was obtained by an appropriate diagnosis and treatment. Reports of multiple abscesses have been increasing recently because of the growing geriatric population and aging-related complications. It is important to search the whole body to detect multiple abscesses in cases where an abscess is detected at a single site.

Context/Aims: We retrospectively analyzed the characteristics of prehospital care for cardiopulmonary arrest (CPA) to identify the predictors of a good recovery (GR) among the recent changes in the management of Japanese prehospital care. Settings and Design: This study was a retrospective medical chart review. Subjects and Methods: We reviewed the transportation records written by emergency medical technicians and the characteristics of prehospital management of out-of-hospital (oh) CPA described by the Sunto-Izu Fire Department from April 2016 to March 2017. The cases were divided into two groups: a GR group (cerebral performance category of 1–3 at 1 month after CPA) and a poor recovery (PR) group. Results: During the analysis period, there were 545 cases of CPA. The average age in the GR group (n = 19) was significantly younger than that in the PR group. The proportions of patients with witnessed collapse, automated external defibrillator (AED) executed by a bystander, ventricular fibrillation during prehospital cardiopulmonary resuscitation (CPR), defibrillation-induced cardioversion, cardiogenic arrest, and oh-return of spontaneous circulation (ROSC) were significantly greater in the GR group than in the PR group. The proportions of telephone CPR conducted by operator, instrumentally secured airways, and administration of epinephrine were significantly smaller in the GR group than in the PR group. A multivariate analysis showed that the significant predictors of GR were bystander AED, ROSC, not instrumentally secured airway, and younger age. Conclusions: This study showed that patients with CPA who were younger, underwent AED executed by a bystander, and obtained oh-ROSC had a higher chance of a favorable outcome.

Various types of amine-functionalized silica/organosilica membranes have been developed due to their potentially superior CO2 separation performance. This article reviews the progress made in this field and special attention is paid to elucidating the role of amine type in CO2 separation performance within amine-functionalized silica/organosilica membranes. This review includes a systematic comparison of various organosilica membranes with either unhindered or sterically hindered amines developed in our previous studies. Herein, we thoroughly discuss the structural characterizations and CO2 adsorption/desorption properties of amine-functionalized xerogel powders and CO2 transport/separation performance across the relevant membranes. Future directions for the design and development of high-performance CO2 separation membranes are suggested, and particular attention is paid to the future of activation energies for gas permeation.

There have been few reports concerning simulation drills forthe relocation of severely ill orinjured patients treated in intensive care units (ICUs). We herein report our experience of one such simulation drill. It is a Narrative method. A simulation drill was performed on a weekday 2 weeks prior to the actual relocation. We selected 3 mock patients. The first one was a severely ill and unstable patient, the second had severe stroke, and the third had severe trauma. After the simulation, the average transportation time was 15 minutes. The simulation revealed that mock patients with a percutaneous cardiopulmonary support system and intra-aortic balloon pumping in a standard ICU bed could not be accommodated in the elevator. Furthermore, working the elevator controls resulted in wasted time while transferring the patients. As a result, the number of people, who controlled the elevator, was therefore increased during the actualrelocation. During the actual relocation, all patients were transported safely and more quickly than predicted based on the results of the simulation drill. Most physicians and paramedical staff have little experience with relocating ICUs, so a simulation drill was necessary to ensure the safe and prompt transport of patients. [ABSTRACT FROM AUTHOR]