Objective: We examined cases of anaphylaxis diagnosed at Emergency and Critical Care Center in Tokyo Medical University Hospital.  Methods: 192 cases were transported to our emergency medical center of our hospital between January 2011 and March 2017. Place of occurrence, severity, treatment and causative antigen were examined. Results: The number of anaphylaxis had increased year by year at 1.69% of the total number of patients. 58% of patients were occurring at outside. Severity was moderate in 76 cases 39%, severe cases were in 103 cases 54%. Food allergy accounted for 89.5%.  25 cases where causal antigens were determined in dermatology were with wheat as the most common causative antigen, followed by Anisakis allergy. Discussion: In this study, the initial cases occur frequently in anaphylactic patients. In order to prevent recurrence, it is important guidance and identification of the causative antigen. Cooperation with another department for anaphylaxis is important. Conclusion: Consider anaphylaxis trends in metropolitan areas, it was found that food allergies often.

A lifesaving introductory course (hereinafter referred to as introductory course) was newly established as a measure to promote the spread of first aid allowance, but there has been no research to investigate its effect on the maintenance of knowledge and technology, and the presentation of appropriate intervals for retraining absent. This time, we examined whether the introductory course attendance at school age would be beneficial if you took the first aid course again later along with the attendance interval. The subjects were first-year junior high school students (296 students) who attended a lifesaving class I, group A (95 students) who had attended an introductory course at the 6th grade, and group B (72 students) who had attended an introductory course at the 5th grade. The group A and B and the group N (129 students) with no history of attendance were divided into 3 groups, and 5 items of cardiopulmonary resuscitation were scored and compared in each group. In group A, the total score and four items of the chest compression technique were higher than the other groups (p<0.05). Introductory course attendance at school age is beneficial for re-enrollment of ordinary lifesaving class I for junior high school students. Furthermore, attendance at 6th grade is highly effective for maintaining knowledge and skills.

Background: At Musashino Red Cross Hospital in Tokyo Japan, there is a system for the early treatment of patients with stroke. When a patient with a suspected stroke is identified by the emergency service or physicians in the region, a pre-arrival alert is directed to the medical stroke specialist. The physician subsequently activates the stroke team. This system is termed Stroke Care Unit Hotline. Although there are no pharmacists in the emergency department, following the activation of Stroke Care Unit Hotline, pharmacists working in the ward of Stroke Care Unit join the stroke treatment team in the emergency department. Purpose: The aim of this study was to determine the role and effects of pharmacists on rtPA therapy for patients with acute ischemic stroke. Methods: The present retrospective study was comparison of the door-to-rtPA time between the pharmacist-present group and pharmacist-absent group at Musashino Red Cross Hospital between March 1, 2016 and March 31, 2019. And the effects of pharmacists’ activities on rtPA therapy were investigated. Results: Among the 447 patients diagnosed with ischemic stroke, 63 patients received rtPA therapy. In total, 16 and 47 patients were included in the pharmacist-present group and pharmacist-absent group, respectively. The median door-to-rtPA time in the presence and absence of a pharmacist was 74 min and 89 min, respectively (p=0.01). At 24 h post-rtPA, the National Institutes of Health Stroke Scale (NIHSS) showed a significant decrease in the pharmacist-present group. Moreover, following patient discharge, the modified Rankin Scale (mRS) was markedly decreased in the pharmacist-present group. Discussion: The interventions of a pharmacist who did not belong to the emergency department shortened the door-to-rtPA time for patients with acute ischemic stroke. This study suggested that the rapid confirmation of medical information by the pharmacist is linked to the early administration of rtPA therapy. Also, the study showed that the early intervention of the pharmacist may improve the quality of life of the patients. The increased intervention of pharmacist who has a specialty of each field may be beneficial to emergency care teams and patient care.

Diphenhydramine is widely used as an anti-allergy medication, cold preparation, and sleeping aid. We report a case in which the blood level of diphenhydramine was measured in the course of treatment and was shown to be 4,990 mg. A 22-year-old woman presented to our emergency department with a disturbance in consciousness, nystagmus, and convulsions. We suspected diphenhydramine poisoning because Restamin U Kowa tablets had been found in her belongings. She was admitted to the critical care unit, where she was mechanically ventilated and underwent hemodialysis. She was extubated on the 4th day, was lucid. She recovered without complications and was discharged from the hospital on the 8th day. The blood diphenhydramine level suggested that diphenhydramine was removed not only by renal excretion but also by hemodialysis, which was normally considered ineffective. Therefore  treatment with hemodialysis may be considered in serious diphenhydramine overdose.