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69 results on '"Yanagawa, Y."'

1. Convulsive Patients Transported by a Physician-staffed Helicopter in Japan Had Better Outcomes in the Keyword-triggered Dispatch Compared to Postcontact Emergency Medical Technician-triggered Dispatch.

Author

Kawai K, Nagasawa H, Nomura T, Sugita M, and Yanagawa Y

Abstract

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., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Emergencies, Trauma, and Shock.)

Published
2024
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17. Multiple Systemic Embolization Associated with Chest Compression in a Patient with Cardiac Arrest.

Author

Miyatani K, Takeuchi I, Fujita W, and Yanagawa Y

Abstract

The patient was an 80-year-old woman with chronic atrial fibrillation, chronic heart failure, cerebellar infarction, hyperlipidemia, and hypertension, who suddenly collapsed while playing gateball outdoors. The doctor at a nearby clinic doctor found her in a state of cardiopulmonary arrest and started basic life support. Twelve minutes after discovery, spontaneous circulation returned. On arrival, she was in a deep coma state with atrial fibrillation-related tachycardia. A physical examination revealed pulseless right radial and left popliteal arteries with cyanosis. Whole-body-enhanced computed tomography and head magnetic resonance imaging demonstrated multiple ischemic organs. Taken together, it was considered that a massive-free thrombus from the left atrium, which was caused by atrial fibrillation, had first obstructed the left ventricular outflow tract, resulting in cardiac arrest. Then, the thrombus had been scattered throughout the body by chest compression. Her condition was judged to be irreversible and she died on day 3. This is the first reported case of multiple systemic embolization associated with chest compression in a patient with cardiac arrest. This unique case adds one more cause to the list of the documented etiologies of complications caused by chest compression., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Emergencies, Trauma, and Shock.)

Published
2023
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20. Relationship between Incontinence and Disease Severity in Patients Transported by Ambulance.

Author

Hamada M, Takeuchi I, Muramatsu KI, Nagasawa H, Ohsaka H, Ishikawa K, and Yanagawa Y

Abstract

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., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Emergencies, Trauma, and Shock.)

Published
2023
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21. Cardio-Cerebral Infarction in a Patient with Deep Coma: A Diagnostic Challenge.

Author

Sonoda T, Hamada M, and Yanagawa Y

Abstract

The patient was a 69-year-old man who called an ambulance due to dyspnea. When emergency medical technicians found him, he had collapsed into deep coma in front of his house. On arrival, he remained in a deep coma with severe hypoxia. He underwent tracheal intubation. An electrocardiogram showed ST elevation. Chest roentgen showed bilateral butterfly shadow. Cardiac ultrasound revealed diffuse hypokinesis. Head computed tomography (CT) showed early cerebral ischemic signs that had been initially overlooked. Urgent transcutaneous coronary angiography showed obstruction of the right coronary artery that was treated successfully. However, the next day, he was still in coma and demonstrated anisocoria. Repeated head CT showed diffuse cerebral infarction. He died on the 5 th day. We herein report a rare case of cardio-cerebral infarction with a fatal outcome. Patients with acute myocardial infarction and a coma state should be evaluated for cerebral perfusion or occlusion of major cerebral vessels by enhanced CT or an aortogram if percutaneous coronary intervention is performed., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Emergencies, Trauma, and Shock.)

Published
2023
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28. The Usefulness of Physician-Staffed Helicopters for Managing Severe Abdominal Trauma Patients.

Author

Jitsuiki K, Nagasawa H, Muramatsu KI, Takeuchi I, Ohsaka H, Ishikawa K, and Yanagawa Y

Abstract

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., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Emergencies, Trauma, and Shock.)

Published
2022
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33. Electric Shock for a Patient with Ventricular Fibrillation during Air Evacuation Using a Helicopter.

Author

Takeuchi I, Yanagawa Y, Takeuchi M, and Suwa S

Abstract

A 73-year-old male suddenly felt chest pain and nausea in his home. The fire department requested the dispatch of a physician-staffed helicopter. When the medical staff of the helicopter checked him, his 12-lead electrocardiogram showed ST elevation at the II, III, and aVF leads. After being fitted with pads for monitoring and defibrillation, he was transferred to the helicopter. Before landing at the base hospital a few minutes later, his electrocardiogram suddenly demonstrated ventricular fibrillation (VF). The patient received an electric shock. When the helicopter landed on the base hospital, he still showed VF. After being directly transferred to the catheter room, he received advanced cardiac life support with percutaneous cardiopulmonary support. A trans-arterial coronary angiogram revealed total occlusion of the right coronary artery. After recanalization of the occluded artery, he regained spontaneous circulation. He received intensive care, including targeted temperature management, and he regained consciousness and achieved social rehabilitation. We herein report the first case of VF safely treated with an electric shock during air evacuation by a rotary-wing aircraft in the English literature. Preparations in advance are necessary to perform electric shock safely during a flight aboard rotary-wing aircraft., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Emergencies, Trauma, and Shock.)

Published
2020
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35. Increase in Fibrinogen Degradation Product Levels 5 Days after a Traumatic Insult.

Author

Nagasawa H, Omori K, Takeuchi I, and Yanagawa Y

Abstract

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 1 st to 7 th 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 1 st to 4 th hospital day, the average level of FDP significantly diminished day by day. However, from the 5 th hospital day, the average level significantly increased. This trend persisted even after excluding the complications of infection and surgical procedures performed between the 2 nd and 7 th hospital day., Conclusions: Among trauma patients, the average level of FDP significantly diminished day by day from the admission to the 4 th hospital day; however, from the 5 th 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., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Emergencies, Trauma, and Shock.)

Published
2020
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39. An Analysis Using Modified Rapid Ultrasound for Shock and Hypotension for Patients with Endogenous Cardiac Arrest.

Author

Yanagawa Y, Ohsaka H, Nagasawa H, Takeuchi I, Jitsuiki K, and Omori K

Abstract

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., Competing Interests: There are no conflicts of interest.

Published
2019
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40. Impact of Automated External Defibrillator as a Recent Innovation for the Resuscitation of Cardiac Arrest Patients in an Urban City of Japan.

Author

Takeuchi I, Nagasawa H, Jitsuiki K, Kondo A, Ohsaka H, and Yanagawa Y

Abstract

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., Competing Interests: There are no conflicts of interest.

Published
2018
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41. Fatal Acute Myocardial Infarction after Multiple Blunt Injuries Involving the Chest.

Author

Fujiwara K, Ohsaka H, Madokoro S, and Yanagawa Y

Abstract

The patient was a 60-year-old male fell whose head and left chest hit the ground after falling from a height of 2 m. He complained of the left shoulder and chest pain after regaining consciousness. On arrival, he showed left bloody otorrhea, left chest tenderness, and a limited range of motion due to the left shoulder pain. Emergency chest roentgenography revealed multiple left rib fractures, left clavicular fracture with decreased radiolucency in the left lung field, suggesting lung contusion. When the patient was being transported for computed tomography, he suddenly displayed ventricular tachycardia with pulse and subsequently became VF storm, which required percutaneous cardiopulmonary support. The coronary angiogram showed complete obstruction of the branch of the anterior descending artery. Coronary angioplasty resulted in recanalization; however, massive hemorrhage from the left ear was recognized. Computed tomography revealed traumatic subarachnoid hemorrhage and left massive hemothorax requiring thoracostomy. Massive hemorrhage from the left ear and left thoracic cavity continued after the patient was transported to the coronary care unit. He underwent massive transfusion; however, he died on the same day., Competing Interests: There are no conflicts of interest.

Published
2018
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