Objective: To investigate tracheal cuff pressures by inflation of fixed volume of air in an experimental condition using a pig trachea.

Methods: A fresh pig trachea was intubated with a tracheal tube of 7, 7.5, or 8mm inner diameter (ID). Then the cuff of the tube was inflated with fixed volume of air (5mL or 10mL) and cuff pressure was measured using a manometer. In addition, pressure-volume curve of the cuff was obtained by inflation of increasing volume of air.

Results: Cuff pressure (cmH2O) is shown by mean (95% confidence interval). Adult male-sized trachea (17mm ID) inflated with 5mL air: tracheal tube ID 7mm; 11.5 (11-12), ID 7.5mm; 9.4 (8.6-10.3), ID 8mm; 10.8 (10.1-11.5). Adult male-sized trachea inflated with 10mL of air: ID 7mm; 53.8 (51.5-56.1), ID 7.5mm; 59.3 (56.9-61.7), ID 8mm; 60.5 (57.1-63.9). Adult female-sized trachea (ID 14mm) inflated with 5mL of air: ID 7mm; 39.1 (36.4-41.8), ID 7.5mm; 32.9 (31.3-34.5), ID 8mm; 40.2 (37.4-43.1). In adult female-sized trachea inflated with 10mL of air, all measurements showed pressure exceeding the upper limit of the manometer (i.e., 120 cmH₂O). Pressure-volume curve revealed that the range of air volume required to inflate the cuff within recommended range of pressure was only about 1mL.

Conclusions: It is difficult to obtain the recommended range of cuff pressure by inflating any fixed volume of air. Protocols in prehospital care including this method should be revised. Following emergent tracheal intubation, the cuff pressure should be adjusted as early as possible.

Purpose: Four different types of pillow were compared for their ability to stabilize head and subjective comfort in patients during main-stretcher transport.

Methods: The four types of pillow were: (A) a pillow currently in use in ambulances, (B) a new type of pillow of our design for this purpose, (C) a pillow that fixes the head in place, and (D) a pillow filled with shock-absorbing material.  Patients were provided with these pillows, and head movement (angular velocity and rotation angle) was measured using a gyro-sensor attached to the patient’s forehead, and psychological burden was measured using the visual analog scale, saliva amylase activity and a questionnaire.

Results: The rotation angles of the heads in the front-to-back and left-to-right directions were lower in cases (B) and (C). The psychological burden was low in case (B).

Conclusion: Patient head can be stabilized during the main-stretcher transport by making appropriate alterations of pillow shape and material. Head stabilization leads to the psychological stability of the patient and may reduce the risk of exacerbation of the head disease, such as re-bleeding of subarachnoid hemorrhage.

Purpose: In the “Pediatric Medical Institution Referral Project (Pediatric Orange Project) that was judged to require early consultation” at the Tokyo emergency medical telephone consultation center (#7119), we categorized the injuries and illnesses of patients who had difficulty in guiding the consultation destination, and considered strategies for building a smooth medical consultation system.

Method: From January to March 2019, a questionnaire survey was conducted at 317 medical institutions in all emergency hospitals in Tokyo regarding availability of medical care by age group and by the clinical specialty of corresponding physician to virtual walk-in cases.

Results: The injuries and illnesses of the virtual cases were foreign body/liquid accidental ingestion, suspected pulled elbow, head injury, facial injury, vulvar injury, and fever accompanied by ear pain. The average demand-capable facility ratio for all age groups is 37.3%. By age group and type of injury/illness, infants with foreign bodies/liquid accidental ingestion, vulvar trauma, and fever with ear pain were low. Head injuries and vulvar injuries of all age groups, and fever accompanied by ear pain in junior high school students were found to vary among the clinical specialty of corresponding physicians.

Discussion: It was shown that it is necessary to revise the protocol of the referral consultation subject and prepare an initial medical treatment manual and guidelines for injuries and illnesses for which there are few facilities available for demand.

Objective: To consider about the effects and problems in pediatric emergency cases by retrospectively analyzing the transportation results for 6 years after rapid response car (RRC) start.

Methods: Pediatric patients under the age of 15 who were transported by RRC, from the 2013.9, after start the RRC to 2019.8 were included in this study.

Results: A total of 2,079 cases were requested for RRC, and 189 (9.1%) cases were pediatric patients. Anaphylaxis was the most common keyword, with 73 (38.6%) cases. As an outcome, 99 (52.4%) cases were discharged, and 23 (12.2%) cases were admitted to critical care center. As a final outcome, 162 (85.7%) cases were discharged from emergency room or hospital and 10 (5.3%) cases were dead. RRC dispatched in 13 (6.9%) case for out-of-hospital cardiopulmonary arrest. Of these, 7 cases achieved return of spontaneous circulation, and 4 cases were discharged.

Conclusion: Pre-hospital care by RRC shows the some effect for the resuscitation in critically ill pediatric patients.

　We gave a “class on life” to students of local elementary, junior high, and high schools. The class was aimed at helping students foster empathy by understanding the importance of lives and learning the skills of  cardiopulmonary resuscitation. We presented the class at 22 local government schools over the course of two years. Here we report the process of giving the class and the results of our questionnaire.

　The initial introduction of the classes was done on a school-by-school basis with the understanding and cooperation of individual school principals. After spreading the program among the schools, we asked the local board of education, which oversees the schools, to take the lead and built a system that would allow to conduct the classes on a long-term basis.

　The results of the questionnaire suggested that the “class on life” was effective in helping students understand the importance of lives and learn the skills of cardiopulmonary resuscitation. It was also suggested that the school teachers may be more capable than physicians in giving the class.

A 96-year-old woman was transferred to our department owing to complaints of abdominal pain. On admission, she appeared drowsy and was tachypneic. Plain abdominal computed tomography showed presence of intraperitoneal free air and ascetic fluid. Her condition was then diagnosed as acute cardiorespiratory failure due to perforated localized peritonitis, and the stomach was suggested to be the perforation site. Thus, conservative treatment was initiated after obtaining informed consent from the patient’s family. Percutaneous peritoneal drainage was initially conducted, and 2,000 mL of muddy yellow fluid was aspirated. Thereafter, intensive treatments including mechanical ventilation; administration of catecholamines, antibiotics, and proton pump inhibitors; gastric decompression using a nasogastric tube; and total parenteral nutrition were initiated. Although the patient’s condition was complicated with acute kidney injury, congestive heart failure, and disseminated intravascular coagulation, she eventually recovered and was transferred from the intensive care unit to a medical ward on hospital day 13. After undergoing rehabilitation for muscular atrophy of the lower extremities, she was finally discharged on hospital day 58. Nonoperative intensive treatments may be useful for perforated peptic ulcer in super-old patients.