The mortality rate after thyroid surgery is extremely low at less than 0.4%, and the prognosis of thyroid cancer is relatively good among the malignant diseases. Outpatient thyroidectomies have been often performed. The important complications of thyroid surgery include critical upper airway obstruction, bleeding and hematoma, and recurrent laryngeal nerve palsy. Although the incidence of these complications is low, intensive care is required when they do occur. The incidence of critical upper airway obstruction after thyroid surgery is as low as approximately 1%. However, postoperative upper airway obstruction after thyroid surgery can be a life-threatening problem. The possible mechanisms of critical upper airway obstruction are as follows: compression by postoperative bleeding or hematomas, edema from venostasis and lymphostasis, recurrent laryngeal nerve palsy, and a combination of these. The risk factors for critical upper airway obstruction are still unclear. It is difficult to estimate the probability of its occurrence. The key to its successful management is “early detection and intervention”. The medical team needs to fully understand the dangers and the management of the critical upper airway obstruction.

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A 79-year-old man implanted with a cardiac resynchronization therapy defibrillator (CRT-D) was admitted for acute exacerbation of chronic heart failure. Hemodialysis had been initiated due to progressive chronic renal failure one month previously. He had lost consciousness during hemodialysis and cardiopulmonary resuscitation was started. Electrocardiography indicated ventricular tachycardia of 175 /min, but CRT-D and automated external defibrillator (AED) (HeartStart FR2, Philips Medical Systems, USA) did not indicate shock delivery. We switched the FR2 AED to manual mode, then manually charged and delivered a shock. A single defibrillation was successful, and the patient awoke. This patient had been implanted with a CRT-D mainly for cardiac resynchronization therapy to treat chronic heart failure. As ventricular tachycardia was suppressed with drugs, the rate threshold of CRT-D ventricular tachycardia was set high to prevent inappropriate shocks. We considered that the CRT-D did not deliver shocks because the ventricular tachycardia rate was below the threshold of the CRT-D. Furthermore, the AED also did not deliver a shock. Automated external defibrillators (AEDs) do not indicate shock delivery depending on waveforms and the rate of ventricular tachycardia. Healthcare providers should understand the characteristics of automatic analysis by AEDs and CRT-D, and consider switching an AED to the manual mode if necessary.

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We report the case of a 6-year-old boy with fulminant myocarditis rescued by intensive care involving veno arterial extracorporeal membrane oxygenation (VA-ECMO). He had a history of fulminant myocarditis 4 years earlier. A few hours after admission, his condition deteriorated rapidly, and he developed severe cardiopulmonary failure. At that time, we rapidly introduced VA-ECMO because it was possible to quickly replace the 10 Fr ECMO artery cannula using a 4 Fr catheter, which had been previously inserted into the femoral artery. In pediatric cases, if the patient weighs <25 kg, the carotid artery approach is commonly used for VA-ECMO. In this case, the patient had not been intubated, and we therefore selected the femoral artery because of its location and ease of access. However, lower extremity ischemia is frequently seen in pediatric cases treated using the femoral artery. We therefore tried to prevent lower extremity ischemia by compulsory retrograde blood perfusion via the dorsal artery. This case report describes our efforts to rapidly introduce VA-ECMO while preventing lower extremity ischemia.

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Background and Purpose: In recent years, the importance of evaluating limitations to activities of daily living and disability in ICU has been recognized. The functional status score for the ICU (FSS-ICU) was developed in order to evaluate the degree of disability in critically ill patients, but its reliability has not been examined. In the present study, we investigated the reliability of the FSS-ICU in acute hospital patients. Subjects and Methods: Twelve adult acute hospital patients who underwent physical therapy for limitations to activities of daily living had their FSS-ICU evaluated. The interrater reliability of the FSS-ICU was assessed for 12 physical therapists, and 12 nurses. Results: The interrater reliability among the physical therapists and nurses was “Fair” to “Moderate”, with Fleiss' κ of 0.27-0.55, and 0.22-0.49, respectively. Conclusions: The FSS-ICU has a low reliability, and it may be necessary to train staff members regarding how to perform this evaluation method when utilizing it as a common evaluation scale in team medical care.

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