Japanese Journal of Reanimatology

Against the Bureaucratization of the Medical Ethics

Osamu Kanamori

2013 Volume 32 Issue 1 Pages 1-6
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.1

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At the beginning of the 19^th century when the term“medical ethics"appeared for the first time, the main object of this concept was to secure some ethical norms between the doctors. In the course of time, the“objects"of the protection by ethical norms in medical practices are broadened to the extent that they cover the doctors, the patients, and the State. As is well known, the medical ethics is institutionalized about in the 1970's, and is still growing to firmly establish itself in the domain of medicine. With its aid, the difficult problems such as euthanasia, physician-assisted suicide, or palliative care etc. are sophisticatedly discussed in the society. But, at the same time, the medical ethics has a propensity to become more bureaucratized so as to be confused with just routine works inside the medical practices. Theoretically it must be a meta-medicine, but it becomes closer to be just a para-medicine or a sub-medicine. In order to avoid its bureaucratization, we have to remember the importance of some philosophical reflections whenever we treat medical problems and try to resolve them.

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Examination of several factors associated with the prognosis in burn patients

Takahiro Sakuma, Toru Kaneda, Kei-ichiro Saito, Toshiyasu Suzuki

2013 Volume 32 Issue 1 Pages 7-10
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.7

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In many cases, severe burn patients may have poor prognosis. Furthermore, treatment strategy for the patient just after burn injury may affect the vital prognosis so much. The prognostic burn index (PBI) is one of the factors associated with the prognosis, but there may be several another factors in clinically. Therefore, we investigated the influences for the factors associated with the prognosis including PBI to decided the therapeutic strategy for severe burn patient retrospectively. 69 patients (6 months to 95 years old) who were transported by ambulance to the medical emergency center in our hospital were designed. Regarding the analysis, a multivariate logistic analysis was conducted with vital prognosis as the objective variable, and explanatory variables were age, gender, source of injury, self-injury / external wound, number of surgeries and PBI. Furthermore, a ROC curve (Receiver Operating Characteristic curve) was obtained from the vital prognosis and PBI values. As a result, PBI was the only factor to affect the vital prognosis significantly (odds ratio : 1.33, p < 0.05). The mortality rate was 100% when PBI was 93.675 or greater. It may be thought that PBI is very important factor to select either early surgical excision or conventional therapy for severe burn patient.

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Comparisons of chest compressions by manual manipulation and an automated load-distributing band chest compression device.

Kazuhito Tamehiro, Kenji Taki, Kazumi Yano, Kunihiro Yoshida, Yasushi ...

2013 Volume 32 Issue 1 Pages 11-15
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.11

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In emergency transport of cardiopulmonary arrest patients, the mean depth and standard deviation of chest compressions using a resuscitation training dummy were compared statistically when chest compressions was performed manually by 30 volunteers and other chest compression using an automated load- distributing band chest compression device. 60% of volunteers performed manual chest compressions over 5.0 cm of depth at the patient's house, which is the highest proportion. Conversely, the vast majority of depths did not exceed 5.0 cm in manual chest compression while dummy patient was transporting. The mean percentage of chest compression depths over 5.0 cm was only 1.3%. Since variability in depth was seen to be large, chest compressions became unstable, that means reducing the quality of CPR. By comparison, chest compressions with the automated chest compression device maintained high-quality stability during the entire route, as the positional relationship between the backboard and chest compression belt remained constant. Manual chest compressions in pre-hospital first aid are currently unstable, and use of an automated chest compression device may prove beneficial.

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High-dose insulin injection leading to peculiar changes in blood glucose levels during cardiopulmonary resuscitation in a suicide case

Keiji Nagata, Yasuki Isa, Shun-ichi Nihei, Nobuya Harayama, Keiji Aiba ...

2013 Volume 32 Issue 1 Pages 16-19
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.16

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A 49-year-old man attempted suicide by self-injecting high-dose insulin at home. He was found to be unconscious with 4 ampules of insulin beside him, and he had cardiopulmonary arrest (CPA). He was transferred to the emergency department of our hospital and cardiopulmonary resuscitation (CPR) was performed. Because a severe hypoglycemic state was suspected, a bolus injection of 20 ml of 50% glucose solution was administered via the cubital vein. The glucose level in the blood sample drawn from the femoral site immediately after glucose injection was 1262 mg/dl. However, the level in the next sample, obtained 4 min after the first one, was 33 mg/dl and that of the third sample, obtained 5 min after the second sample, was 305 mg/dl. These changes in blood glucose levels were unpredictable. Spontaneous circulation was not resumed. Based on his rectal temperature and blood chemistry data, we speculated that a long time had passed after the CPA. We concluded that one of the causes of these peculiar changes in blood glucose levels was the arterio-venous difference in blood glucose concentration due to the prolonged circulation time during CPR.

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The case of severe Bradycardia in the patient with pharyngeal tumor undergoing tracheotomy at the positioning of neck extension.

Akiko Furutani, Yasuhiko Iida, Keiko Setoyama, Takao Hirata, Mishiya M ...

2013 Volume 32 Issue 1 Pages 20-22
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.20

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53-year-old woman, complicated with hypertension and uncontrolled diabetes mellitus, received chemotherapy and radiotherapy for pharyngeal tumor. She was scheduled for emergency tracheotomy due to dyspnea because of narrowing upper airway by large pharyngeal tumor. We induced general anesthesia with propofol-fentanyl, and intubated the patient with bronchofiberscope. When her neck was extended, severe bradycardia was recognized. We immediately started sternum compression and injected atropine intravenously. After fifteen seconds, her heart rate gradually recovered. We speculate that main cause of severe bradycardia observed in this case was the vagal reflex of carotid sinus syndrome induced by the direct invasion of tumor to carotid artery. Both dysautonomia, one of the complication of DM and general anaesthetics, propofol and fentanyl also contributed to severe bradycardia.

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The cases transported to our medical facilities with East Japan Earthquake.

Yoshihiro Inoue, Satoshi Kikuchi, Makoto Onodera, Yasuhisa Fujino, Shi ...

2013 Volume 32 Issue 1 Pages 23-28
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.23

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We encountered from 11 to 31, March 23 cases of patients with Great East Japan Earthquake occurred at 11, March 2011. There were 3 cases of respiratory failure by drowning (tsunami lung), two cases of pulmonary thrombosis, congestive heart failure, multiple external injuries, one case of crush syndrome, burn injury, tetanus and 7 cases of simple external injury. All cases survived except for three cases of drowning. There are multiple (biological such as uncommon bacteria, physical such as sand and mud and chemical such as oil) factors of respiratory failure in tsunami lung

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Fluid management using stroke volume variation (SVV) and extravascular lung water (EVLW)

Hiroaki Watanabe

2013 Volume 32 Issue 1 Pages 29-35
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.29

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It is extremely important and difficult to evaluate pre-load accurately in critically ill patients. Recently, a number of studies have reported that dynamic indicators help predict the hemodynamic responses to a fluid challenge better than static indicators. Further, high accuracy of these indicators have attracted considerable attention. Stroke volume variation (SVV), which is one of the dynamic indicators, is a reliable predictor of fluid responsiveness, and hemodynamic management with SVV possibly prevents over-load of volume fluid challenge and makes adequate administration of fluid therapy possible. It is extremely difficult to treat severe acute respiratory distress syndrome (ARDS) that develops during fluid resuscitation in the treatment of various conditions such as sepsis. Recently, extravascular lung water (EVLW) has been shown to be a prognostic indicator in patients with ARDS, and fluid management after measuring EVLW may possibly be beneficial in the treatment of ARDS. Herein, we discuss the possibility of developing goal-directed fluid therapy with both SVV and EVLW measurements for treating severe ARDS.

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[title in Japanese]

[in Japanese]

2013 Volume 32 Issue 1 Pages 36-41
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.36

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Tracheal intubation using the Airway Scope under specific circumstances

Yasuhiko Imashuku

2013 Volume 32 Issue 1 Pages 42-44
Published: March 28, 2013
Released on J-STAGE: May 02, 2013

DOIhttps://doi.org/10.11414/jjreanimatology.32.42

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Airway Scope (AWS) has been reported to be useful in cases of intubation difficulty and has come to be used widely in clinical practice. AWS is also used for awake tracheal intubation. In cases in which AWS is used for patients with large amounts of secretions, special attention is needed. AWS has been used under other specific circumstances and is considered to be an item that will further develop its applications.

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