Recently, comprehensive medical care is being promoted for when resuscitation is performed on patients in cardiopulmonary arrest on arrival (CPAOA), with an emphasis on not only cardiac resuscitation but also on brain resuscitation. When a patient in CPAOA is transported to hospital, how the arrest occurred and how much time has elapsed from the onset of arrest are frequently unknown. Even in witnessed CPA cases, the time elapsed since CPA is often incorrect, and this information is especially important. In this study, we examined an objective index to enable estimation of the time elapsed from the onset of CPA to the arrival at hospital where emergency management was performed. We studied 225 patients with witnessed intrinsic cardiogenic out-of-hospital CPA (128 male and 97 female) who were transported to our hospital during the period from April 1996 to March 2003. We statistically analyzed the correlation between the blood ammonia level at the time of the initial management and the time elapsed from confirmation of CPA to arrival at the hospital (CPA-arrival time). There was a positive correlation between the blood ammonia level at the time of initial management and the CPA-arrival time. Patients who made a full recovery showed a significantly lower blood ammonia level at the time of initial management than those who did not make a full recovery. Also, many patients whose blood ammonia level was less than 180μg/dl at the time of initial management were able to make a full recovery. Based on these results, we conclude that the blood ammonia level can potentially be used as a useful index for estimating the time elapsed since CPA and the neurological prognosis including brain resuscitation.

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The four basic mechanisms of blast injury are termed primary, secondary, tertiary, and quaternary. Primary blast injuries occur as a result of the blast shock wave. The authors present a rare case of abdominal blast injury with right gastroepiploic artery injury in a 56-years old man resulting from an explosive air shock wave in a metal pipe. Abdominal blast injury should be suspected in anyone exposed to an explosion. An understanding is needed of the complicated mechanisms of these injuries, including abdominal vascular injury and the findings of an acute abdomen.

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Emergency physicians are dispatched to the scene of a disaster by the “doctor helicopter” not only to reduce the time required to transport victims but also to offer them high quality medical service at the scene of an accident. At a recent traffic accident that occurred in the western part of Shizuoka Prefecture, involved a large number of victims, emergency medical service was rendered with the cooperation of the rescue squad. In this instance, the most severely injured were sent to the emergency and critical care center, while appropriate hospitals and methods of transport were selected for the others who suffered from less severe injuries by the flight doctor. These direct medical control activities, starting with the dispatch of an emergency medical team and involving care given at the scene of an accident, transport of the wounded, and medical triage cannot be conducted adequately by the use of a helicopter operated by the rescue squad. It is believed that such a service is very effective in the event of a disaster. Like an earthquake, which has been predicted in the Tokai region in the near future.

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We herein present two cases suspected of having liver compartment syndrome that were successfully managed with transarterial embolization (TAE). The first patient was a 40-year-old female involved in a car accident. Contrast-enhanced computed tomography (CT) showed a large intraparenchymal hematoma and active hemorrhaging in the hematoma. Transarterial embolization was performed. A hepatofugal portal flow was only detected in the right lobe of the liver, and a normal antegrade flow was observed in the left lobe. The second patient was a 73-year-old man who had fallen down a flight of stairs. Contrast-enhanced CT showed a large intraparenchymal hematoma. On angiography, a small hemorrhage was observed and TAE was performed. A hepatofugal portal flow was detected in the right lobe of the liver. Liver compartment syndrome is defined as intraparenchymal hypertension induced by a large subcapsular hematoma in a patient with blunt hepatic injury. Liver compartment syndrome causes a disruption in the normal liver circulation and may result in either hepatic ischemia or Budd-Chiari syndrome. It is important to prevent an enlargement of the hematoma by applying TAE.

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