An overview of the existing data evaluating the overall effectiveness, safety, and feasibility of out-of-hospital endotracheal intubation (ETI) by paramedics/EMS (emergency medical service) was conducted. A specific focus was the question of whether the administration of ETI prior to hospital admittance improves the survival of patients with OHCA. The conclusions are as follows.
1) The provision of CPR with advanced airway management is a significant predictor of poor neurologically favorable survival compared to the use of conventional bag-valve-mask ventilation. Both ETI and the use of  supraglottic airway devices are associated with a decreased likelihood of favorable neurologic outcome.
2) EMS personnel have difficulty gaining and maintaining competency in ETI skills, and the administration of ETI by unskilled practitioners can result in adverse events. In addition, pre-hospital ETI influences patient  outcomes by affecting the execution of simultaneous basic life support procedures, resulting in ineffective chest compression with significant interruptions.
3) Personnel concerned with the Medical Control Affairs in Japan should discuss the need for strategies to improve airway management for individuals who have experienced an OHCA.

BACKGROUND: An emergency medicine clinical pharmacist needs to understand practical procedures for emergency medicine, including the drug administration process in the emergency department.
PURPOSE: To investigate the utility of a novel training method in emergency medicine developed for novice pharmacists using a case map (representation of scenario in tabular format, CM).
METHODS: We developed a sequential emergency training program consisting of four rounds, with lectures and small group discussions (SGD) using CM, for 26 young pharmacists in our hospital. Comprehension levels before and after each training session were compared by pre- and post-tests. Consciousness surveys were also performed before the first and after the last round. These data were analyzed statistically.
RESULTS: The scores from the comprehension tests improved significantly after each of the four rounds (p<0.01). Motivation for acquiring knowledge about emergency medicine increased significantly after the sequential training (p<0.01).
CONCLUSION: Lectures and SGDs using CM can be a useful method for learning practical procedures for initial treatment in emergency medicine for young pharmacists.

PURPOSE: Head computed tomography-angiography (CTA) is useful for the diagnosis of subarachnoid hemorrhage. Adequate cerebrovascular CT value is essential for obtaining a good quality CTA. Low tube-voltage scan is considered useful for CTA; however, reduction in tube voltage increases the image noise. In this study, we verified the utility of low tube-voltage scan for head CTA for diagnosing subarachnoid hemorrhage.
METHODS: We scanned a head phantom (Kyoto Kagaku Corporation, Japan) using a tube voltage of 80, 100, and 120 kv. The tube current used was 450, 360, and 300 mA, respectively. The vascular CT value, contrast to noise ratio (CNR), and Computed Tomography Dose Index volume (CTDIvol) were calculated for each set of parameters. In addition, we measured the CT value, CNR, contrast media arrival time than a clinical images.
RESULTS: The vascular CT value increased with decrease in tube voltage. At equivalent radiation dose, 80kv scan was associated with the highest CNR.
CONCLUSION: Low tube-voltage scan is thus useful for head CTA for detecting subarachnoid hemorrhage that a condition of the patients are severe.

SECONDARY ABSTRACT: It is well-known that spinal epidural hematoma is a rare disease; however, the possibility of this disease should be considered for patients with acute paralysis or paresthesia as the neurological outcome can be improved by rapid diagnosis and treatment. Vertebral hemangioma is the most common type of benign vertebral tumor. There have been only a few reports of spinal epidural hematoma occurring from vertebral hemangioma triggered by minor vertebral fracture.
CASE: A 77-year-old woman developed acute onset of back pain and paralysis in the left leg. Neurological examination showed middle back pain (Numerical Rating Scale: 5/10), paralysis in the left leg (Manual Muscle Testing: MMT 1/5) and paresthesia on the left side under the chest. MRI showed a spinal epidural hematoma at C7-Th3 spinal level and the fracture of vertebral hemangioma at C7. She was diagnosed with spinal epidural hematoma that occurred from vertebral hemangioma triggered by minor vertebral fracture. Laminectomy and removal of the hematoma were immediately performed. Neurological symptoms completely recovered after the surgery.