神経難病における救急医療

抄録

Currently, in Japan, the number of patients with intractable neurological diseases (INDs) is increasing due to the aging of the population. Accordingly, it is expected that the number of the patients who receive emergency medical care will also increase. In our hospital, the number of emergency medical department consultations for patients with INDs in 2021 was 147, with 84 for Parkinson disease, 10 for amyotrophic lateral sclerosis, 10 for myasthenia gravis, and 7 for progressive supranuclear palsy, 7 for spinocerebellar degeneration, and 7 for multiple system atrophy. Regarding the symptoms at the time of consultation, the percentage of patients who visited the hospital due to exacerbation of symptoms of neurological disease was relatively small, and the percentage of systemic complications including falls was high. Therefore, it should be noted that emergency care for patients with INDs, many of whom are elderly, has a high risk of complications such as falls, head injuries, infections such as aspiration pneumonia and urinary tract infections, and dehydration. INDs are progressive diseases. Some diseases, such as ALS, progress rapidly and end life in a few years. It is important for attending physicians of emergency medical department to understand how patients with INDs think about how they will spend their recuperative life and how they will face death before providing medical care. Using a tool called ACP (Advanced Care Planning), the patient's life and death views and values are mutually understood by the family and the medical team, and the patient's treatment plan should be shared by the neurologists, the emergency medical doctors, and all other medical staff.