A fully automatic AED, which automatically delivers an electric shock without the need to press the shock button, has been approved by the Japanese government. Current CPR education assumes that the rescuer will use a conventional AED, i.e., an AED that delivers an electric shock when the rescuer presses the shock button. Consequently, concerns may arise that rescuers who use a fully automatic AED may waste time by looking for a non-existent shock button or cause inadvertent electrocution. This paper describes the characteristics of fully automatic AEDs, the introductory process, and the precautions to be taken while emphasizing the importance of following the AED's voice messages and other instructions.

Stress reductionof medical professionals might improve the quality of healthcare. Although itis thought that comfortable environment is effective to reduce stress, variousunpleasant sensations are created in intensive care unit, and cause a greatdeal of stress to the medical staff. In our hospital, we decorated one room inthe intensive care unit based on Effective Medical Creation (EMC). We evaluatedwhether the decorated rooms reduce stress of nurses (total of 120 nurses) whoworked in the intensive care unit compared to the regular rooms. However, it isno significant differences in value of amylase, VAS, and NRS. In the future, weshould consider the timing of measurements and the need to improve room basedon EMC.

One-year-and eight month-old female child with Treacher Collins Syndrome who received cleft palate repair suffered from severe hypoxia due to the airway obstruction after extubation for 20min. Targeted temperature management (TTM) started with amplitude integrated EEG (aEEG) in order to prevent secondary hyoxic brain damage immediately. Four years after TTM, patient recovered without severe complication. We explored the usefulness of TTM with aEEG for neurocritical care management in the pediatric case with severe hypoxia.

The patient was a 78-year-old man, who was diagnosed with C4-7 traumatic spinal cord injury due to a fall and underwent emergency posterior fusion. Postoperatively, transient hypotension was observed during repositioning and other activities. Because of repeated cardiac arrest 3, 15, 16, and 17 days after the surgery, a pacemaker was indicated, and a leadless pacemaker was implanted in consideration of the risk of artificial respiration management and infection. After that, no cardiac arrest occurred, and the patient was transferred to the hospital on the 34th postoperative day. By implanting a leadless pacemaker, the patient could be transferred to the hospital without any additional events.

Circulatory failure can occur in non-responders to standard treatment for septic shock. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in such cases is, however, controversial. Here, we report a patient who was rescued by VA-ECMO for repeated cardiac arrest following admission to the ICU for suspected septic shock due to a prostatic abscess.

　The septic shock was treated with endotoxin adsorption therapy (PMX-DHP) and continuous hemodiafiltration. Circulation was maintained by VA-ECMO. An increase in arterial pulse pressure and an improvement in cardiac contractility that were observed on an echocardiogram obtained on the 2nd day of VA-ECMO. Therefore, low-dose dobutamine was commenced. The VA-ECMO was terminated on day 5.

　In the present case, severe myocardial injury arose as a result of septic shock due to a urinary tract infection, leading to cardiac arrest. Stable circulation was restored by VA-ECMO that allows to treat the underlying infection effectively. Depending on the course of septic shock, infected foci, and underlying diseases, VA-ECMO may be considered an effective option for the treatment of severe circulatory failure.

We experienced a case of subarachnoid hemorrhage (SAH) and Takotsubo syndrome after living donor renal transplantation in a patient with systemic lupus erythematosus (SLE) and lupus nephritis. The patient, a woman in her 50s, was diagnosed with SLE and lupus nephritis and underwent hemodialysis followed by living donor renal transplantation. On postoperative day 9, the patient developed SAH and Takotsubo syndrome. The patient was discharged from the hospital with no neurological sequelae by using renal replacement therapy and strictly controlling the circulating blood volume. The incidence of SAH in SLE is higher than in the general population, and the prognosis is poor when it occurs. In the case of renal transplantation in SLE patients, it is desirable to explain to patients and their families that the risk of developing cerebrovascular disease is higher than usual, and to perform a preoperative cerebrovascular examination.

[Aim] This study aimed to develop a training tool for EMTs on communication with a base hospital contact and to verify its effectiveness. [Methods] A web application (app) called "Byoin Renraku (hospital contact) Training" was developed for this study to provide the participants with simulated experiences of on-site emergencies, clinical reasoning, and hospital contact. The subjects were 52 third-year university students preparing to be certified as emergency life-saving technicians. [Results]: Most participants felt that the app was better at helping them acquire knowledge than improve communication skills. Many also said that feedback from the facilitators and undergoing repeated training on sequential communicating such as I-SBAR-C or MIST greatly impacted their communication skills related to hospital contact. [Conclusion]: The use of this app seemed to impact the subjects' motivation to learn.