【Background】A fully automatic external defibrillator(FAED) without pressing an electric shock button was introduced in Japan in 2021 July. However, no study has been conducted to determine whether FAEDs deliver electric shocks in a shorter time than semi-AEDs. 【Objective】We compared the operation time of FAED and semi-AED. 【Method】A Crossover randomized controlled trial (n=39) of FAED and semi-AED in first responders to compare operation times (i.e., AED arrival-to-shock). 【Results】The operation time of a FAED was 5.8 seconds faster than that of a semi-AED (77.1±10.9 seconds vs. 82.9±10.6). 【Conclusion】The FAED can be operated quickly, even by first responders.

Weexperienced a rare case of empyema by ruptured spleen with malignant lymphomain stomach. A 71 year-old man was admitted to our hospital diagnosed as asevere pneumonia. Chest X-ray and CT suggested pleural effusion. Only 2 mL ofpurulent fluid was removed from the chest by centesis. Surgical drainage wasscheduled. During surgery, pus and food debris were found in the chest.Perforated stomach by spleen tumor ruptured into the chest. Adhesiotomy,splenectomy, partial gastrectomy, lung lower partial lobectomy, and suture ofdiaphragm were performed. Weaning from ventilator was performed on the 4thpostoperative day. He was discharged from intensive care unit on the 7thpostoperative day successfully. His spleen tumor was diagnosed as B cellmalignant lymphoma. Intraoperative judgement and postoperative care saved thisrare case.

In pediatric patients, sedation may be accompanied by the need for mechanical ventilation. However, with prolonged sedation, tolerance tosedative drugs may arise, complicating the case with withdrawal syndrome.

　In this report, we present a case of 11-year-old boy diagnosed as acute lymphoblastic leukemia who was admitted to the intensive care unit (ICU) for continuous hemodiafiltration and plasma exchange. The patient was placed under sedation and mechanical ventilation was initiated. On day 57, the patient was weaned from continuous hemodiafiltration, and the sedative drugs were tapered. The trachea of the patient was extubated, but the patient required reintubation followed by tracheostomy. On day 75, the patient was transferred to the general ward, but he suffered from severe hypoxia presumably due to negative pressure pulmonary edema (NPPE) and was admitted to the ICU. We experienced a case of NPPE due to withdrawal syndrome in a pediatric patient under prolonged sedation. Possible mechanisms included physical obstruction due to airway secretions and functional obstruction due to ventilator desynchronization and increased inspiratory effort. Even in patients with tracheostomy, occurrenceof NPPE should be considered.

Apatient of anti-HIV and diabetic medications was admitted to the ICU withdecreased consciousness and blood pressure, complaining of chest discomfort andvomiting during hospital treatment for leg ulcer. We suspected septic shock andstarted rapid massive infusion of fluids, noradrenaline, and antibiotics, butthe patient's circulatory dynamics had not been improved, and high-flow CRRTwas also started. Suspecting the presence of B-type lactic acidosis due toanti-HIV drugs, diabetes drugs, and vitamin B1 (VB1) deficiency, we suspendedthe drugs and administered VB1 intravenously. As a result, marked improvementof lactic acidosis, securing of urine volume, and stabilization of hemodynamicswere observed. We experienced a case of fatal lactic acidosis due to infectionbased on VB1 deficiency during use of anti-HIV and diabetic drugs. Multimodaltreatments were successful to rescue this patient.