Objective: This study aimed to review the trends in the research regarding daily hygiene care for patients with indwelling urinary catheters （IUC） in Japan and to identify future issues.

Methods: We searched for literature related to the routine hygiene management of patients with IUCs in Japan using Ichushi-Web; articles that met the eligibility criteria were included.

Results: 22 articles were included in the review. The number of articles and interventional studies peaked in the 2000s, followed by an increase in observational studies. The most common method of urethral opening care was pubic lavage once a day, but the materials used were not the same; for the catheter-associated urinary tract infection prevention, the effect differed with the materials used, and pubic lavage was performed in all intervention studies that showed an effect.

Conclusions: In the included papers, the methods and materials used for urethral-opening care were examined based on the characteristics of the insertion site and the hygiene-related habits of Japanese people. Moreover, after the publication of the Guideline for Prevention of Catheter Associated Urinary Tract Infections, 2009 ~Centers for Disease Control and Prevention, pubic lavage became the only method used of urethral-opening care, and it was revealed that specific hygiene practices had not been sufficiently verified.

Background: In order to improve the daily life return rate of out-of-hospital cardiac arrest (OHCA), the Japanese resuscitation guidelines recommend, aiming for a chest compression rate (CCF) of 80% or higher.

Objective and Methods: We compare manual CPR and mechanical CPR in the area where CPR is difficult during transport and evaluate their quality. The OHCA hypothetical training was conducted for students of a firefighting school.

Results: The percentage of CCF of 80% or higher in narrow passages and stairs reached 40% (11/28) in the mechanical CPR group because of the standardization of the sequence of activities, while it was 14% (4/28) in the manual CPR group. On-site activity time was also shorter in the mechanical CPR group than in the manual CPR group (p<0.05).

Conclusion: In places where CPR during transport is difficult, mechanical CPR increases the chance of meeting CCF guideline targets while shorting field activity time.

Purpose: This study aim to evaluate the actual status of practice and importance perceived by emergency nurses for support of patients’ families who make surrogate decisions, and to clarify the factors that make it difficult to practice.

Methods: We conducted an anonymous questionnaire survey among 164 nurses working in emergency centers at 64 facilities.

Results: The age of the subjects was 35.6±8.1 years, and the number of years working in the emergency center was 5.1±4.2 years. There was a strong correlation between the level of importance perceived by the emergency nurses and the level of practice (r=0.89, p<0.001). However, there were some items that could not be practiced sufficiently, and items related to support from multiple professions were the most common. The most common reason for the difficulty in practice was that they had to prioritize life-saving nursing tasks for patients.

Conclusion: Surrogate decision-making support for emergency nurses was found to be a challenge in that they were not able to devote enough time to family support in the emergency situation, and furthermore, there was a lack of collaboration and coordination with other professions and the need to improve this system.

Background: Owing to the scale reduction of the regional core hospital, which accepts 1,000 ambulances annually, the acceptance of ambulances has been restricted from April 2019.

Objective: To assess the impact in the regional emergency medical system caused by the scale reduction of regional core hospitals.

Method: The 4,532 ambulance transport cases in 2018 were defined as the pre group, and the 4,514 ambulance transport cases in 2019 were defined as the post group. The am-bulance activity time, severity, number of acceptance negotiations, and destinations were examined and compared.

Results: Hospital admission time did not change, remaining at 53 minutes in both the pre group and the post group (p=0.93). The on-site stay time was decreased from 21 minutes in the pre group to 19 minutes in the post group (p<0.001). Extraterritorial transport increased significantly (p<0.001) from 3,053 (67.4%) in the pre group to 3,513 (77.9%) in the post group. The number of cases transferred to the tertiary emergency medical in-stitution increased significantly (p<0.001) from 750 (16.5%) in the pre group to 1,016 (22.5%) in the post group.

Conclusion: With the scale reduction of regional core hospitals, the number of out-of-region transportations and transportations to tertiary emergency medical institu-tions increased, but no extension of hospital accommodation time was allowed, and the time spent at the site was shortened.

We evaluated the accuracy of the One Step Novel Coronavirus (IgM/IgG) Antibody Test (Artron, Canada) (qualitative test). To evaluate the accuracy of the qualitative test, we used the quantitative enzyme-linked immunosorbent assay (ELISA) for IgG antibodies. Out of 100 non-COVID-19 patients, 6 tested positive for IgG antibodies in the qualitative test (specificity 94%). Out of 6 COVID-19 patients (37 samples), only one sample tested negative for IgG antibodies (sensitivity 97%). However, the 6 patients who had positive qualitative IgG test results in non-COVID-19 patients had negative quantitative ELISA results for IgG. Therefore, these cases that had positive qualitative IgG test results were deemed false positive results. Therefore, the qualitative antibody test kit showed high sensitivity but not specificity.

A 34-year-old man ingested ethylene glycol during a suicide attempt and was admitted to a psychiatric hospital. The patient was transported to the nearest emergency center, where tests showed that the ingested dose of ethylene glycol was potentially lethal. The Advanced Emergency Center decided to accept the patient transported by Doctor Helicopter and procured fomepizole. Hemodialysis and fomepizole therapy were initiated after 6 hours following ethylene glycol ingestion. Metabolic acidosis was observed at the time of admission but improved after starting treatment. The patient was transferred to a psychiatric hospital on the seventh day of admission, without any renal impairment. Ethylene glycol poisoning can cause metabolic acidosis and acute tubular necrosis, which can be fatal if treatment is delayed. It is important to start intensive care as soon as possible through inter-hospital and intra-hospital multidisciplinary cooperation in order to save patients’ lives.

An 88-year-old woman with a past history of hypertension presented with rapid swelling of the tongue. She had been taking angiotensin II receptor blockers (ARBs) for 16 years. After ingesting some figs, she began to feel discomfort in her mouth, and her tongue rapidly swelled. The edema of her tongue did not improve after consulting a nearby physician and resting at home; hence, she was referred to our emergency department. The patient’s symptoms did not respond to intravenous administration of antihistamines and corticosteroids; therefore, she was intubated and placed on a ventilator to avoid possible airway obstruction. The patient was extubated on day 5 and discharged on day 13. This case was considered to be drug-induced angioedema caused by ARBs, which has been increasingly reported in recent years, and the involvement of oral allergy syndrome caused by figs was suggested as a triggering factor for disease onset following long-term oral administration.

An 81-year-old man developed altered level of consciousness, and an ambulance was summoned. For this case situation, the doctor car was dispatched to the patient’s home. His family member was diagnosed with coronavirus disease 2019 (COVID-19) 4 days prior to his presentation; however, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test showed a negative result in the patient. Upon arrival at the scene, he developed shock with fever, and his quick sequential organ failure assessment score was 3. We diagnosed the patient with COVID-19-induced septic shock, and prehospital management including endotracheal intubation followed by mechanical ventilation, fluid resuscitation, and vasopressor administration was initiated. Despite multiple attempts, no hospital accepted the patient, and he was eventually transferred to our hospital; the time interval between arrival at the scene and departure from the scene was 57 min. Upon admission, he remained in shock, and the SARS-CoV-2 antigen test showed a positive result. Laboratory test results showed severe anemia. A plain chest radiograph revealed reduced radiolucency in a part of the left lower lung field; however, no sign of pneumonia was evident. Plain abdominal computed tomography revealed dilatation of the abdominal aorta (92 mm in maximal diameter) with an extensive retroperitoneal hematoma. The patient was diagnosed with hemorrhagic shock secondary to ruptured abdominal aortic aneurysm. Palliative care was initiated after informed consent was obtained from the family; unfortunately, the patient died 6 hours after admission. Careful evaluation is essential for prompt and accurate prehospital diagnosis in patients with suspected severe COVID-19 infection.