Japanese Journal of Reanimatology

The criteria for the determination of brain death in children.

Takefumi Sakabe

2011 Volume 30 Issue 1 Pages 1-7
Published: March 25, 2011
Released on J-STAGE: September 12, 2011

DOIhttps://doi.org/10.11414/jjreanimatology.30.1

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The law for organ transplantation in Japan was partly amended on July 17, 2009 and organ transplantation from brain-dead children became possible from July 17, 2010. Major revision of the law consist of, 1) consent given before death (opt-in) is not necessary, 2) children under 15 years of age can be an organ donor, 3) organs can be donated to the relatives if donor gives written preference before death, 4) exclude abused children as an organ donor. In this article, the criteria for the determination of brain death in children, in particular, for those under 6 years of age is described with the process of its establishment.

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International disaster management : Strategy of Red Cross Movement for social resuscitation and recovery after disaster

Takamura Seishi, Saitoh Yukiya, Nakata Akira

2011 Volume 30 Issue 1 Pages 8-14
Published: March 25, 2011
Released on J-STAGE: September 12, 2011

DOIhttps://doi.org/10.11414/jjreanimatology.30.8

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Disaster management is one of the core mandates of the Japanese Red Cross Society (JRCS). Its first domestic disaster relief operation was conducted in 1888. Large experience on disasters and complex emergencies urge the JRCS to develop more rapid and efficient coping mechanisms. In early post-disaster phase, JRCS deploys ERU (Emergency Response Unit) to provide health services for victims. The most common diseases for several days after the disaster are disaster-related injuries (Phase 1). Then the number of chronically ill patients increases gradually in the following several weeks (Phase 2). Rapid and accurate needs assessment in each post-disaster phase is indispensable to provide the victims with appropriate services such as emergency medicine, treatment of chronic diseases, public health activity and mental health care.
Eventually, JRCS assess the needs of affected people and plan long-term rehabilitation program for several years, along with the scope of disaster preparedness in collaboration with national societies. Red Cross mandate is to alleviate the suffering of the most vulnerable. JRCS continue to help national societies and communities to become aware of the risk they have, how to reduce their vulnerability, and how to cope when disaster strikes.

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The emergency medical technicians performed defibrillation appropriately for patients with out-of-hospital cardiac arrest, or not?

Hiroyuki Tanaka

2011 Volume 30 Issue 1 Pages 15-19
Published: March 25, 2011
Released on J-STAGE: September 12, 2011

DOIhttps://doi.org/10.11414/jjreanimatology.30.15

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Purpose : We investigated whether or not the emergency medical technicians performed defibrillation immediately for patients with out-of-hospital cardiac arrest (OHCA). When defibrillation was not performed, we also investigated the reason why not.
Method : There were 104 patients with OHCA occurring within Inashiki district of Ibaraki prefecture, Japan between April and September 2007.
Results : In 78 of these 104 patients, we could identify ECG records with a total of 732 analyses. Of these 732 analyses, defibrillation was indicated in 81 times. However, defibrillation was performed on only 29 occasions, and the resumed analyses were interrupted in the remaining 52. Of these 52, the automated external defibrillator (AED) shifted to a message of no shock advice in 15, and a new analysis restarted in 36.
Discussion : Either another message from AED or restart of a new analysis induced a low ratio of defibrillation being performed. We suggested that analysis in situations under vibration during transport by ambulance without a stopping during analysis might lead to this low ratio. Simultaneously, the phenomena observed in this study resulted in serious elongation in the interruption of “continuous” chest compression. Therefore, some countermeasures against these phenomena are needed.

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A case report : Spontaneous rupture of the esophagus that was diagnosed at thirteen days after the onset

Gennya Urimoto, Toru Kaneda, Toshiyasu Suzuki

2011 Volume 30 Issue 1 Pages 20-22
Published: March 25, 2011
Released on J-STAGE: September 12, 2011

DOIhttps://doi.org/10.11414/jjreanimatology.30.20

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Spontaneous rupture of the esophagus can be fatal when the diagnosis is delayed more than 24 hours after the onset. Therefore, the early diagnosis is important. We experienced a case with good recovery from delayed diagnosed spontaneous rupture of the esophagus. The patient was a-65-year-old woman. She vomited blood after drinking and was managed as Mallory Weiss syndrome. She also had intractable left pleural effusion. On the thirteen days after the onset, spontaneous rupture of the esophagus was diagnosed because food residue was found in the drainage fluid from the pleural effusion. Primary and fundiac patch closure of lacerated foramen were performed with left thoracotomy. Blood pressure and heart rate were stable after surgery. Although she was mechanically ventilated for eleven days, she was discharged on the 28th postoperative day. Careful perioperative management to prevent leakage from the anastomosis seemed to contribute to good recovery.

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An obstetric DIC caused with prolonged bleeding due to uterine inversion

Kouichi Mogi, Masaaki Sato, Norimasa Seo

2011 Volume 30 Issue 1 Pages 23-26
Published: March 25, 2011
Released on J-STAGE: September 12, 2011

DOIhttps://doi.org/10.11414/jjreanimatology.30.23

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A 25-year-old, 44-kg, 157-cm premigravia delivered her baby on the 39^th weeks and first day. She was transferred to our hospital because of uterine inversion and uncontrollable bleeding. Her systolic blood pressure was 80-90 mmHg ; SpO2 was 100% and heart rate was 95-105 bpm. Preoperative laboratory data showed Hb 4.3g/dl, Hct 13.2 % and plt 18.3X10⁴/mm³. The preoperative assessment indicated she was in hypovolemic shock. Awake intubation and general anesthesia was planned. Awake intubation was gently performed with topical anesthesia and general anesthesia followed with sevoflurane, fentanyl and rocuronium under 100 % oxygen. During the operation, the score of DIC was up to 15 induced with prolonged bleeding from afunctional uterine. The total of MAP 20 units, FFP 20 units and Platlet 10 units were transfused. By total hysterectomy of atonic uterine, the surgery was successfully finished. After the operation, her vital signs and DIC score were soon restored in the ICU. The patient had uneventful postoperative recovery. Although uterine inversion rarely lead to obstetric DIC, this case indicated that the clinical assessment with obstetric DIC in mind and the communication with obstetricians are the core for obstetric anesthesia.

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Japanese Neonatal Cardio-Pulmonary Resuscitation (NCPR) Program and the project for NCPR guidelines based on CoSTR2010

Masanori Tamura

2011 Volume 30 Issue 1 Pages 27-32
Published: March 25, 2011
Released on J-STAGE: September 12, 2011

DOIhttps://doi.org/10.11414/jjreanimatology.30.27

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Japan Society of Perinatal and Neonatal Medicine has started Neonatal Cardio-Pulmonary Resuscitation (NCPR) Program since July 2007 based on Japanese guidelines for neonatal resuscitation following CoSTR2005. For the last three years 1,246 instructors were brought up, and 18,786 health care providers attended training course of NCPR in Japan. There are two big problems in this project. First is the regional imbalance of students attending training course around Tokyo and Osaka, which are the training sites for instructors. Secondly, there is a large difference in activity between instructors. Especially instructors with background of obstetrics are not so active as those of pediatrics. We have the plan to expand the two training sites to 7 in 2010 and to 10 by 2012. We are now preparing ring for NCPR guidelines 2010 based on CoSTR2010.

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The innovation in Mazda Hospital that has succeeded in reducing a job separation rate to zero : the analysis based on situated learning theory.

Shuta Kagawa, Hitomi Yoshimura

2011 Volume 30 Issue 1 Pages 33-38
Published: March 25, 2011
Released on J-STAGE: September 12, 2011

DOIhttps://doi.org/10.11414/jjreanimatology.30.33

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We aimed to discuss an organizational change that Mazda hospital has executed to reduce a job separation rate to zero. We classified the process of the innovation into five points : human relations in the workplace, relations between the hospital and educational institutions, employment of newcomers, relations between the nurse division and the personal division, and the education of newcomers. Then we considered those with a situated learning theory. Especially, we proposed that how they could break through the boundary among different organizations or positions, since “boundary crossing” is the key points to solve a job separate problem.

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