Several simulation-based sedation training course (SEDTC) programs have been developed by critical care doctors, including anesthesiologists for patient and patient safety improvement. In-hospital, interprofessional SEDTC is required for practical safety improvement in each procedural sedation environment.

This study reports on whether prehospital advanced airway management (AAM) is associated with neurological outcomes in out-of-hospital cardiac arrest patients due to asphyxia. Although prehospital AAM was not associated with neurologic prognosis in asphyxial cardiac arrest, considering the time required for emergency medical services (EMS) activity (encompassing the EMS call, time to first contact with EMS, and time to AAM), ithe critical window for improving neurological outcomes may have closed by the time of prehospital AAM, which could explain the lack of improvement in outcomes.

In this network meta-analysis involving 17 studies with 6850 participants across five interventions, lactate or capillary refill time-guided resuscitation showed significantly lower mortality up to 90 days in adults with sepsis or septic shock compared to usual care, whereas ScvO₂-guided therapy had a higher mortality risk than lactate-guided therapy.

In this study, the soft clustering method identified six distinct segments of adult ambulance users with nonurgent medical conditions by using population-based ambulance records.

Visible negative pressure wound therapy for open abdominal management (OAM) allowed us to understand the intra-abdominal cavity and close the abdomen at the appropriate time without worsening the prognosis. Intra-abdominal visualization is an extremely important resource in terms of clear sharing of information when managing patients with OAM as a team.

Aggressive surgery can be a valid strategy for treating life-threatening incisional hernias complicated by necrotizing soft tissue infection.

For the first time in Olympic and Paralympic Games history, visitors were triaged at the emergency department of the polyclinic to enable early treatment of critical illnesses or injury in the emergency room and to identify patients suspected of having COVID-19 as early as possible.

Emergency physicians in Japan face significant barriers such as data entry burdens and limited research time in multicenter research. Collaborative incentives such as networking and sharing research outcomes are potent motivators for participation.

Temperature variation (high or low temperatures) accompanies sepsis and various studies have examined the relationship between these temperature abnormalities and outcomes in patients with sepsis. We provide very granular data on temperature abnormalities in the emergency department and describe patients who present to triage febrile or hypothermic, those who present with normothermia and then become either febrile or hypothermic, and the relationship between these findings and their clinical outcomes. Further, we calculate the patient's temperature burden and describe a novel quantification value for studying temperature alterations in patients with sepsis, namely, a “unit of temperature burden (UTB),” which is defined as >1°C (1.8°F) above or below 37°C (98.6°F) for 1 min.

The present study showed that the marked characteristics of intoxicated patients who suffered a poor outcome and were evacuated by doctor-helpers were the presence of cardiac arrest when emergency medical technicians encountered the patient, loss of consciousness, and the need for frequent medical intervention. These findings might be useful to consider when medical providers manage intoxicated patients in the field.

This manuscript provides a current epidemiology of sepsis using a Japanese administrative database. Following a systematic literature review between 2003 and January 2023, we included 20 studies that defined patients with sepsis as those with an infection and organ dysfunction. The selected studies demonstrated a decreased mortality rate in patients with sepsis, a decreasing trend in the effective cost per survivor, and a lower 28-day mortality in the short-course (≤7 days) group than in the long-course (≥8 days) group from 2010 to 2017.

Rapid rewarming after targeted temperature management at 34°C was associated with a more favorable neurological outcome than slow rewarming, using the data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest Registry, a nationwide multicenter prospective cohort in Japan. However, rapid rewarming was associated with more cases of hypotension and electrolyte abnormalities.

We describe a case of segmental arterial mediolysis with a vessel ruptured on two consecutive days.

Traumatic intrapericardial diaphragmatic hernias are very rare; they occur when the central tendon of the diaphragm ruptures, allowing abdominal viscera to herniate into the pericardial sac, causing life-threatening cardiac tamponade. Computed tomography imaging with multiplanar reconstruction is useful in evaluating such cases.

Anaphylactic shock due to intra-articular injection of diclofenac etalhyaluronate agent can be prolonged and recurrent. Therefore, extended observation is required. In addition, aspiration of joint fluid may be one of the treatment options.

The endothelial glycocalyx covers the lumen of blood vessels throughout the body and plays an important role in endothelial homeostasis. The morphology and thickness of the endothelial glycocalyx differ from organ to organ. The morphology of the glycocalyx damaged by acute inflammation differed from that damaged by chronic inflammation.

In recent years, various home-use health devices have gained popularity. The abdominal roller is one such example. Although there are very few reports of spinal cord injury by this device, we saw two rare cases. We consider there are potentially many accidents caused by this device, and it is necessary to emphasize the appropriate use of such equipment.

The aim of the study was to assess whether cardiopulmonary resuscitation (CPR) instructions given by dispatchers improve outcomes in out-of-hospital cardiac arrest (OHCA) cases. The study concluded that dispatcher-provided CPR instructions did not show a clear clinical benefit on the neurological outcomes of OHCA cases.

The Yokohama MC is pioneering a new approach to address the heart failure pandemic in Japan.

This study showed a Δ wedging ratio (WR) (change of WR from supine to 30° head-elevated position) value of ≥5.1% for acute vertebral compression fractures. WR (supine) = (b–a)/b × 100 (%), WR (30° head-elevated) = (d–c)/d × 100 (%) Δ WR = WR (30° head-elevated) – WR (supine) = (d–c)/d × 100–(b–a)/b × 100 (%).

A 75-year-old man diagnosed with spinal epidural hematoma. He had used a commercial cervical massage tool before going to bed, resulting in transient quadriplegia and hypotension.

We showed that multisystem inflammatory syndrome in adults can occur in 2.5% of critically ill COVID-19 patients requiring mechanical ventilation, and the overall survival rate is 42%.

The figure is our composed package of massive transfusion protocol. This is an experimental report of two precipitous hyperkalemia cases during activation of massive transfusion. Although several other factors might be causing the rise in potassium, we consider the extended preservation periods of red blood cell products to be one cause of these unexpectedly rapid rises in potassium during massive transfusion protocol.

We attempted to present a simulation course online to learn about the initial treatment of minor emergencies, which was held on-site until the COVID-19 pandemic. We reviewed the subjects covered in the course and evaluated whether these were “decision-making” or “technical skills” that had primarily been taught as simulation-based training for each subject, and then supplemented the contents accordingly. As a result, satisfaction levels with the online course (good feedback from 97.6% of the 85 participants) were comparable to those with the on-site course as measured by a postcourse questionnaire, which confirmed success in the onlinization of the simulation course.

We assessed the number of cases with difficulty in hospital acceptance and outcomes during the COVID-19 pandemic in 2020 and 2021 using the ORION database. In this study, the number of patients experiencing difficulty in hospital acceptance during the COVID-19 pandemic in Osaka Prefecture increased, and patient outcomes were worse than before the pandemic.

(A) Intraoperatively, the uterus was lacerated from the cervix to the uterine body (arrow). (B) Postoperative abdominal computed tomography. Gauze was packed in the abdomen and pelvis (arrow).

Splenic rupture because of metastasis from a distant organ is rare, and it becomes much rarer when the primary focus is occult cancer. Meanwhile, it is known that cancer might lead to systemic thrombotic events. Here, we report an 80-year-old male patient who developed a spontaneous splenic rupture because of occult signet-ring cell carcinoma of the stomach and simultaneously manifested systemic thrombotic events including a coincidental bulky splenic vein thrombosis and subsequent major brain infarction.

A 46-year-old man was admitted to the emergency department after ingesting a massive overdose of amlodipine and candesartan, which caused severe refractory shock. Despite receiving various medical therapies, the patient's hemodynamic status deteriorated, and venoarterial extracorporeal membrane oxygenation was initiated. The patient was successfully weaned off extracorporeal membrane oxygenation and discharged on day 18 of hospitalization, suggesting that this therapy could be considered for the management of refractory shock in the context of calcium channel blocker and angiotensin II receptor blocker overdose.

This submission examines the incidence and management of craniomaxillofacial trauma (CMFT) in war-affected nations, highlighting the critical gaps in care due to limited resources, health care infrastructure, and surgical personnel. The study emphasizes the importance of a multidisciplinary approach to CMFT management and calls for international intervention to provide life-saving surgical procedures for those suffering from CMFT in conflict zones. The need for improved data collection and research to develop effective evidence-based treatment methods is also emphasized.

A patient with severe acute respiratory distress syndrome caused by Otsujito was successfully treated with low-dose steroids and specialized intensive care. Otsujito is widely prescribed in Japan, attention should be paid to its severe adverse effects. This case suggests that high-dose steroids are not necessary for treating drug-induced acute respiratory distress syndrome, even though it is recommended in Japanese guidelines for drug-induced lung injury.

Nasogastric tube syndrome (NGTS) is a rare but lethal complication of nasogastric tube placement. Nasogastric tube syndrome can be fatal due to upper airway obstruction caused by vocal cord paresis. We report a woman who was diagnosed with NGTS caused by long-term use of small-bore nasogastric tube.

In this study, we aimed to investigate the association between body mass index (BMI) and prognosis in critical patients with coronavirus disease 2019 (COVID-19) requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective observational single-center study. Participants were patients with COVID-19 who required VV-ECMO. VV-ECMO induction for patients with COVID-19 may lead to earlier indications in patients with BMI >30 kg/m² than in those with BMI ≤30 kg/m².

A 9-year-old boy who fell down the stairs had unmeasurable blood pressure, barely palpable carotid artery, and intra-abdominal hemorrhage noted on ultrasound upon arrival at the hospital.

We report a patient with severe acute pancreatitis who underwent decompressive laparotomy for acute compartment syndrome secondary to a large retroperitoneal hematoma due to ruptured gastroduodenal artery pseudoaneurysms.

The operational efficiency and out-of-hospital cardiac arrest (OHCA) outcomes were compared with the coronavirus disease 2019 (COVID-19) pandemic and nonpandemic period. The COVID-19 pandemic has resulted in the reduced operational efficiency of emergency medical services, thereby resulting in prolonged response times and lower survival rates among patients with OHCA.

This study aimed to assess the association of hypoglycemia at admission with mortality in patients with sepsis according to body mass index (BMI). There was a significant interaction between normal BMI and hypoglycemia affecting in-hospital mortality; however, this effect was not observed for other BMI categories (odds ratio, 2.32; 95% confidence interval, 1.05–5.07; p-value for interaction = 0.0476). Hypoglycemia at admission in sepsis patients was associated with high mortality in patients with normal BMI, but not in those with low or high BMI.

In younger patients, intoxication and psychiatric disorders are the most common causes of severely impaired consciousness. When stroke is the cause, systolic blood pressure is often higher than other final diagnoses.

The classic technique of Gram staining has regained its usefulness through persistent clinical practice in Japan. Gram staining conducted by trained physicians could serve as a valuable means of optimizing antimicrobial treatment in ERs and ICUs.

A 73-year-old man had undergone thoracoscopic subtotal esophagectomy and laparoscopic-assisted gastric tube reconstruction via the retrosternal route for thoracic esophageal cancer 8 years previously. He was diagnosed with gastric tube ulcer perforation penetrating the pericardium. Emergency surgery was performed to remove the gastric tube, followed by immediate reconstruction by right colon interposition.

A 38-year-old man presented with unconsciousness due to diabetic ketoacidosis. The patient showed bilateral pupil dilation, and computed tomography scan showed prominent cerebral edema 9 h after admission. Ventricular drainage was carried out and spinal fluid was drained 12 h after admission.

A 61-year-old man who attempted to commit suicide by disulfiram overdosing that caused a delayed onset of impaired consciousness and ketoacidosis.

The diagnosis and treatment of pheochromocytoma crisis (PCC) is challenging. We report a lifesaving case of PCC, highlighting the usefulness of computed tomography in acute diagnosis and the importance of administering α-blockades even in shock if PCC is suspected.

A novel trauma workflow system called the hybrid emergency room (Hybrid ER) that combines a sliding computed tomography (CT) scanning system with interventional radiology features was first installed in Osaka General Medical Center in 2011. The Hybrid ER system developed by our country colleagues represents a significant step toward the ultimate trauma management system in trauma workflow and non-trauma fields.

We assessed the risk of burnout of Japanese emergency physicians (EPs). We distributed questionnaires to the EPs of 27 emergency departments (EDs); these questionnaires were used to analyze the ED- and EP-level factors and correlate to the Maslach Burnout Inventory-Human Services Survey scores. We found severe degrees of burnout in EPs working in emergency medical service centers, receiving only a 3 to 6 hour-sleep period and those in their twenties.

The aim of this study is to evaluate the ability of modified suPAR with National Early Warning Score (NEWS) for detecting mortality in elderly emergency patients who are older than 70 years. Our single-center study has demonstrated the high utility of modified suPAR with NEWS as a predictive tool of mortality in elderly emergency patients.

The NEWS predicted severe disease with the coronavirus disease 2019 (COVID-19) Delta variant. The NEWS (area under the receiver operating characteristic curves [AUROC] 0.88) was superior to the qSOFA (AUROC 0.74) and Confusion, Respiratory rate, Blood pressure, and Age ≥65 (CRB-65; AUROC 0.67) scores, and there was no significant difference between the NEWS and Kanagawa score (AUROC 0.86).

We experienced a fatal case of Capnocytophaga sepsis caused by dog bite. Splenic hypoplasia could be a risk factor for animal bite infection.

Failure of initial insertion of peripheral intravascular catheter (PIVC) may be a risk factor for adverse events in patients admitted to the intensive care unit from the emergency room. We could potentially provide various interventions to avoid failure of initial PIVC insertion. For example, PIVC insertion could be performed by experienced practitioners.

We undertook a scoping review to map published international literature using the Japan Trauma Data Bank (JTDB). We observed an increase in international publications using the JTDB and highlighted the major topics and knowledge gaps. Our findings could encourage further research using the JTDB to improve trauma care.

The study findings did not support the benefit or the disadvantage of early vasopressor administration with fluid therapy for septic shock. However, early vasopressor administration may help avoid volume overload in the long course of sepsis care.

Three days after mechanical cardiopulmonary resuscitation (CPR) and initiation of venoarterial extracorporeal membrane oxygenation, massive intra-abdominal bleeding was detected, although the initial computed tomography scan did not show abdominal visceral injury. In post-CPR patients, delayed bleeding from visceral injury should be considered, even after a certain time, especially in cases of coagulation abnormalities.

In the aging society, it is important not only to rescue elderly patients, but also to maintain their postoperative activities of daily living and prevent making them bedridden. The present study showed in the field of acute care surgery for elderly patients’ prehospital performance status, prevalence of dementia, perioperative circulatory dynamics, renal dysfunction, and abnormalities in the coagulation-fibrinolytic system can be predictors of bedridden status at discharge, with preoperative circulatory dynamics being the earliest and most sensitive marker. The result suggests that it may be possible to predict not only outcome, but also the occurrence of bedridden patients after treatment, and to provide medical treatment in accordance with the readiness and wishes of the patients and their families. We hope that this study will contribute to the medical treatment of the elderly in the future.

Broad-spectrum antibiotics and empirical therapy are widely used in intensive care unit. Effective clinical response on day 7 group showed the lower infection-related mortality. Improvement on day 7 might predict a favorable outcome.

A 26-year-old man presented to our institution with abdominal pain and nausea after eating food containing Psyllium to lose weight. Since patients undergoing extreme slimming regimens may cause intestinal obstruction if psyllium is taken without adequate fluid intake caution should be taken when eating psyllium.

There is currently no international consensus on whether disseminated intravascular coagulation (DIC) should be a therapeutic target for anticoagulant therapy. This review explores the roots of the large discrepancies on how DIC is perceived between Japan and other countries and discusses relevant treatment concepts.

Intravenous fluid therapy (IVF), which is commonly used in patients with acute alcohol intoxication, did not shorten length of time until awakening in the emergency department. Therefore, IVF should not be routinely used for the treatment of these patients.

Report of solitary left renal vein thrombosis in a patient with nutcracker syndrome after trauma.

Tetanus prevention is largely dependent on adequate vaccination, but it might also be influenced by climate change and not necessarily the level of development of a country. In the future, it will be necessary for not only developing countries but also developed countries that are susceptible to climate change to be on guard against urban flooding–induced tetanus.

This nationwide cross-sectional study examined the use of angioembolization for splenic injury in Japan. Despite adjustment for patient factors, substantial variations were observed in the utilization of splenic angioembolization among hospitals in Japan. Higher accessibility to computed tomography and shorter time to angiography were related to increased utilization of splenic angioembolization.

A 40-year-old woman presented with rapid airway narrowing due to rupture of the occipital artery caused by neurofibromatosis type I. She was treated with surgical airway management. We report a case treated by surgical airway management and embolization and surgery.

Within Japan, diagnosis procedure combination (DPC) data and medical receipt data are being stored in electronic media, and real-world evidence in various fields has started to be reported. We reviewed clinical studies on disseminated intravascular coagulation using DPC data obtained from an insurance database with large numbers of cases and a related commercially available dataset including DPC and laboratory data. Real-world data analysis will be increasingly necessary to complement the evidence gap unfilled by randomized control trials.

We present a comparison of the time spent at the trauma scene stratified by trauma severity. The mean time on the scene was prolonged among the less severe, moderately severe, and severe groups. By contrast, time did not change significantly for the life-threatening group.

The purpose of this study was to examine the treatment methods and prognosis of patients with severe multiple trauma registered in the Japan Trauma Data Bank, and to examine the relevance of resuscitative endovascular balloon occlusion of the aorta (REBOA). The mixed-effect model regression analysis showed a significantly lower odds ratio for in-hospital mortality rate in the REBOA group. REBOA use was associated with decreased mortality compared to aortic cross-clamping in severely injured trauma patients.

This report illustrates an exceedingly rare case of myxedema coma presenting with deep coma and severe hypothermia that led to cardiac arrest immediately after arrival at the emergency department. A careful physical examination and adjunctive data guided us to a prompt diagnosis of myxedema coma. Once suspected, in addition to intensive supportive care, treatment with thyroid hormone as well as glucocorticoids was essential to resolve this critical condition.

This study assessed the demand-supply balance of the disaster medical care system in Osaka city by integrating the data on damage estimation and disaster coping hospitals using a geographic information system (GIS). In the case of a low evacuation rate, greater bed shortage was found along the coast of Osaka Bay, where the probabilities of flooding are high. In the case of a high evacuation rate, however, the number of casualties was much lower.

Hematocolpos due to vaginal agenesis with a functional uterus are particularly rare and are sometimes misdiagnosed in adolescent females because of the diversity in symptoms. Major complaints in cases diagnosed during adolescence are often lower abdominal pain, back pain, cancelation dysfunction, and primary amenorrhea. History-taking, imaging tests, and appropriate collaboration with obstetrician/gynecologist with awareness of secondary sexual characteristics were crucial in this case.

This study explored a case study of a patient with acute paraquat poisoning. We were able to successfully treat this patient using a combination of early continuous hemodiafiltration and later hemodialysis, and after 240 days, he has experienced no common negative sequalae.

A 77-year-old woman with Ellsberg syndrome caused by varicella zoster virus infection presented with preceding urinary retention. Ellsberg syndrome is not well known to many clinicians but should be considered in the differential diagnosis for urinary retention.

We encountered two rare cases of traumatic pancreaticoduodenal artery injury wherein the patients were saved by a multidisciplinary team with a shared goal of clinical success rather than procedural success of angioembolization. The permissive untreated pseudoaneurysm concept can be useful in developing damage control interventional radiology strategies for trauma cases with challenging time limitations, such as traumatic pancreaticoduodenal artery injury with circulatory collapse.

Spontaneous splenic rupture by diffuse large B-cell lymphoma (DLBCL) is extremely rare. A 60-year-old male patient developed a splenic rupture due to aggressive systemic invasions of DLBCL preceded by transverse spinal cord myelitis of unknown cause 2 months before. An autopsy revealed diffuse systemic invasions of lymphoma cells in all major organs without rearrangement of MYC, BCL6, and NUM.

A high preoperative SOFA score and a short length of small intestine remaining after surgery can predict postoperative death in patients with NOMI.

Severe heat stroke cases require a more detailed classification of degree III in the JAAM-HS criteria, and not measuring deep body temperature could have been a factor in the nonperformance of active cooling and worse outcomes.

This case illustrates that patients with lumbar scoliosis could be at higher risk of severe kidney laceration. Protrusion of the lateral edges of a scoliotic lumbar spine into the retroperitoneal space could crush the kidney, even after a minor fall. Clinicians should be cautious when examining patients with lumbar spine scoliosis because even minor trauma, such as a fall, can result in severe kidney injury.

There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of “self-injury (suicide)”, “motor vehicle accident”, “fall from height”, “fall down”, and “fall to the ground”. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019; however, there was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020.

The present study analyzed patients with unplanned admissions via emergency departments (EDs). Mental illness was associated with a higher prevalence of preceding ED visits. Severity of illness may be discounted at initial ED visit in mentally ill patients.

The impact of the coronavirus disease 2019 (COVID-19) infestation on patients transported to emergency rooms was determined in a population-based study. The study results indicate that the spread of COVID-19 affected the survival of all emergency patients regardless of specific disease.

Although the elderly group received lower doses of thiopental, the incidence of hypoxia was significantly higher in this group than in the non-elderly group. However, the overall incidence of adverse event was not significantly different between groups.