著者

前田 玲佳 門前 達哉 蛯谷 征弘 鈴木 大貴 伊澤 和三

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.33, no.2, pp.86-89, 2021-12-01 (Released:2021-12-01)

参考文献数

5

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The case was a 35-year-old man. Mandibular foramen conduction anesthesia using lidocaine was performed at the dental office. After anesthesia, he developed convulsions, stopped breathing, and underwent cardiopulmonary resuscitation by a dentist. Mandibular foramen conduction anesthesia causes the tip of the injection needle to reach the mandibular foramen, or mandibular nerve groove, from the oral cavity where the inferior alveolar nerve enters the mandible. The inferior alveolar nerve accompanies the inferior alveolar artery, which is a branch from the maxillary artery. If a local anesthetic is erroneously injected into the inferior alveolar artery, even a small amount of lidocaine may cause immediate poisoning as in this case.

著者

鈴木 重將 内山 剛 明神 寛暢 渡邊 一樹 山本 大介 佐藤 慶史郎 大橋 寿彦

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.30, no.2, pp.62-66, 2018-06-01 (Released:2018-11-15)

参考文献数

8

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Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is diagnosed using imaging and is characterized by a favorable prognosis, which often improves without treatment. Here, we report three adult patients with MERS who were treated with a different course each; all of them required immunotherapy to some extent. The first case was a 67-year-old male who experienced gastrointestinal symptoms for 3 months prior to hospitalization. The second was a 38-year-old male who experienced a headache and fever, followed by urinary retention. The third was a 36-year-old male who experienced a fever and headache, followed by dysuria, impaired orientation, and upper limb tremor; he was transported to our hospital on the same day. All patients had lesions in the splenium of the corpus callosum. While two patients responded well to steroid pulse therapy, one demonstrated poor response and required immunoadsorption therapy. While some patients with adult-onset MERS require aggressive immunotherapy, this condition covers a broader range of diseases in adults with varying premonitory and clinical symptoms. Although pediatric MERS is often accompanied with a benign condition, this is not always the case for adults. Thus, considering immunotheraphy may be essential.

著者

星山 栄成 高野 雅嗣 竹川 英宏 宍戸 宏行 永山 正雄 小野 一之 平田 幸一

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.31, no.2, pp.69-73, 2019-08-23 (Released:2019-08-24)

参考文献数

11

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A 42-year-old male patient was admitted to our hospital because of generalized convulsive status epilepticus (GCSE), disturbance of consciousness, and shock. He had cardiopulmonary arrest after arrival our hospital, but he was return of spontaneous circulation as soon as cardiopulmonary resuscitation. He had disseminated intravascular coagulation (DIC) and multiple organ dysfunction. From the time of admission, we managed about the patient's breathing, circulation, body temperature. We also administrated sodium valproate 400mg, levetiracetam 1,000mg daily, and continuous use of midazolam to status epilepticus. In addition, he underwent continuous renal replacement therapy because of acute renal failure. The electroencephalogram showed scattered delta waves. Brain MR images showed hyper-intense lesions at bilateral pallidum and thalami, which led to a diagnosis of hypoxic encephalopathy associated with long-term GCSE. On day 13, he started tracking our fingers with his eyes. On day 34, he was able to obey commands and he was transferred to the general ward. GCSE is known to exhibit various organ dysfunctions. In this case, there was a history of epilepsy and had developed on GCSE, but as a result of the clinical examination, it was considered epilepsy-related organ dysfunction because the cause of multiple organ dysfunction was not clear.

著者

夏目 淳 大野 敦子 山本 啓之 城所 博之 沼口 敦

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.31, no.2, pp.22-26, 2019-08-23 (Released:2019-08-24)

参考文献数

5

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救急・ICU管理において脳波モニタリングが有用な疾患として,感染などを契機に発症する急性脳症がある。「二相性発作と遅発性拡散能低下を示す急性脳症(AESD)」と呼ばれる急性脳症は,発症時は熱性けいれん重積と鑑別が困難で,数日後に二相目の発作群発が起こるとともに高度の大脳白質の浮腫が出現する。発症時のMRIでは異常がみられないため,早期の熱性けいれんとの鑑別のために脳波が重要である。またICUで鎮静下に治療を行うため臨床観察のみでは発作の診断が困難で,脳波モニタリングが治療の指標になる。近年は急性脳症に対して低体温療法を試みることが増えており,低体温療法中の脳波所見も知っておく必要がある。これらのICU脳波モニタリングにはamplitude-integrated EEGやdense spectral arrayなどのトレンドグラムが有用である。

著者

野村 契 水谷 敦史

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.30, no.2, pp.30-34, 2018-06-01 (Released:2018-11-15)

参考文献数

3

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Background: The use of a simulated patient monitor (SPM) influences the educational outcome of simulation-based medical education (SBME) course. However, owing to limited budget, adequate facilities could not be provided for the SBME course.Object: This project aimed to create an SPM application with sufficient function and low cost for adaptation in SBME for the immediate stroke life support (ISLS) course.Methods: Medical doctors developed the SPM application with Electron that builds cross-platform desktop applications. The application consists of two operation screens: one for facilitators to design control waveforms in real time and the other for students.Results: We developed a multiplatform simulated patient monitor application by real-time adaptive control with a two-screen design and published it for free on our website.Discussion: This is the first report by medical the professionals who developed the SPM application for medical training from scratch. The application was completely usable and enhanced the education effect of the ISLS courses. The future tasks are to make it available to more people for use and to acquire human resources and funding for further development.Conclusion: The application we developed had sufficient functions for its use in the ISLS course.

著者

山田 哲久 名取 良弘

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.35, no.2, pp.32-36, 2023-06-22 (Released:2023-06-23)

参考文献数

14

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Introduction: We report the case of a patient transported to emergency outpatient department by ambulance due to cardiopulmonary arrest following a head injury. He underwent systemic management, leading to organ donation.Case: A 56-year-old man.Current illness history/course: The patient sustained a head injury after falling from the bed of a truck and then suffered cardiopulmonary arrest. He was transported to the emergency department by ambulance. After his heart resumed beating, his intention to donate his organs was confirmed on the back of his health insurance card. Discussions with the organ donation hospital coordinator reveal that, donating organs after brain death was difficult due to the general condition; still the possibility of organ donation after cardiac arrest was considered. Systemic management was continued in the emergency department, and upon obtaining consent from his family, post-cardiac arrest organ donation was carried out.Conclusion: Establishing a system to confirm the intention to donate organs is important. Donor management can be done by performing normal life-saving measures, but certain donor-specific matters require attention.

著者

刈部 博 林 俊哲 成澤 あゆみ 赤松 洋祐 亀山 元信 中川 敦寛 冨永 悌二

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.30, no.2, pp.1-8, 2018-06-01 (Released:2018-11-15)

参考文献数

21

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In this study, eleven cases with sports-related traumatic occlusive cerebrovascular accident (OCVA) are investigated to clarify clinical characteristics by reviewing following clinical factors: age, gender, mechanism of trauma, symptom, type of sports, duration between the time of injury and outpatient visit or diagnosis, type and site of vascular injury, co-existent traumatic intracranial lesion, treatment, and outcome. Traumatic OCVAs were accounted for 9.1% of sports-related TBI, as 1.1% of other TBIs than sports-related. It is more common in male than female. Histogram of age distribution demonstrated a peak at the age of 5-14 y.o. Cervical hyperextension and/or hyper-rotation was the most common mechanism of injury. Head and/or neck pain immediately after trauma was the most common initial symptom. The most frequent vascular lesion was an arterial dissection of internal carotid or vertebral artery. Antiplatelets or anticoagulants were introduced for treatment in cases without traumatic intracranial hematoma. Favorable outcomes were obtained in most cases, however, permanent neurological deficits were remained in 3 cases. Since delay in the introduction of treatment results in poor functional outcome, an early visit of outpatient are quite important in patients with sports-related traumatic OCVAs, as well as the standardization of diagnostic algorithm.

著者

本多 満 一林 亮 鈴木 銀河 杉山 邦男 坂元 美重 奥寺 敬

出版者

一般社団法人 日本神経救急学会

雑誌

Journal of Japan Society of Neurological Emergencies & Critical Care (ISSN:24330485)

巻号頁・発行日

vol.31, no.2, pp.27-32, 2019-08-23 (Released:2019-08-24)

参考文献数

7

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〔背景〕神経救急・集中治療におけるモニタリングである脳波を,時間外あるいは休日に意識障害患者が来院しても医師あるいは看護師により容易に施行することを可能とする簡易的脳波測定デバイスの開発を,2013年より日本臨床救急医学会ACEC委員会と日本光電社との共同研究により開始した。〔経過および現況〕開発に際して,ERにおける意識障害患者に対して脳波測定に不慣れな医療従事者においても簡単かつ迅速に脳波測定ができることを目標とした。これらをみたすデバイスを作製して脳波データをBluetoothⓇでモニターに電送してモニタリングすることが可能となった。〔今後の展望〕現在当施設において完成機が導入されているが,脳波の評価の難しさなどにより脳波に不慣れな医療従事者が十分使いこなしている状況ではない。しかし,このデバイスを用いて脳波測定中に脳波室に院内LANを用いて遠隔監視できるシステムを構築して問題点に対する対応を行っている。