Patients with type A acute aortic dissection with left coronary malperfusion have extremely poor prognosis because of hemodynamics instability. A 75-year-old man was transported to our emergency room with chest and back pain. He was in shock and developed cardiac arrest. Aortic dissection was diagnosed on computed tomography findings. Percutaneous cardiopulmonary support was initiated and left main trunk stenting was performed. The bleeding could not be controlled even after surgery. Preoperative percutaneous coronary intervention should be considered for treating type A acute aortic dissection because it could improve hemodynamics and minimize myocardial injury.

A woman in her 80s was transported to our emergency room after drinking kerosene. Physical examination revealed kerosene dermatitis on her back, and computed tomography showed chemical pneumonia. She became unconscious. Her left lung had developed a multifocal abscess and appeared to have completely lost its function. However, administration of sivelestat sodium hydrate, methylprednisolone, and antibacterial agents improved lung function. Application of ointment to skin areas affected by kerosene dermatitis led to epithelialization. Chemical pneumonitis caused by even small amounts of kerosene is fatal. However, in this case, all symptoms were treated conservatively and the patient had a good outcome.

We experienced a case of high serum neuron specific enolase (NSE) level with good outcome after cardiopulmonary arrest. The patient was a 43-year-old man. He had a heat stroke in a hot environment and resumed heartbeat by a bystander’s first aid. However, on arrival at our hospital, he presented coma, he improved to GCS E4V4M6 on the 28th hospital days. His serum NSE level was 47 ng/mL, which indicate a poor neurological prognosis, but this case had a good outcome. One possible reason for this is that the complication of heat stroke may have affected the serum NSE level.

A woman in her 30's visited our emergency room for her sudden right axillary pain. Examinations, including the computed tomography and a blood test, were unable to provide sufficient data for a diagnosis, and the patient was therefore hospitalized for follow-up. After four days of the hospitalization, the pain increased dramatically, and Streptococcus pyogenes was detected in a blood culture. Based on these findings, necrotizing fasciitis was diagnosed, and emergency debridement was performed. However, the area of pain and erythema spread subsequently, requiring emergency debridement to be done four times in total to save the patient.