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Biomedical subjects

Koichi Tanigawa

Publications and source records attributed to Koichi Tanigawa.

6 recordsLinked to original sources
PubMed2006

Emergency medical service systems in Japan: past, present, and future.

Emergency medical services are provided by the fire defence headquarters of the local government in Japan. There is a one-tiered EMS system. Ambulances are staffed by three crew members trained in rescue, stabilisation, transport, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class One, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergency Life Saving Technician, ELST). ELSTs are trained in all aspects of BLS and some ALS procedures relevant to pre-hospital emergency care. Further development of an effective medical control system is imperative as the activities of ambulance crews become more sophisticated. A marked recent increase in the volume of emergency calls is another issue of concern. Currently, private services for transportation of non-acute or minor injury/illness have been introduced in some areas, and dispatch protocols to triage 119 calls are being developed.

Advanced Cardiac Life Support↗
PubMed2004

[Comparison of emergency tracheal intubation performed on a table and on the ground].

BACKGROUND: Emergency tracheal intubation in the pre-hospital environment is generally more difficult than when performed at a hospital. Among the reasons making it more challenging, is the rescuer's position. We compared tracheal intubation between 2 settings, on a table and on the ground. METHODS: Ten staff anesthesiologists were asked to intubate mannequins placed on a table and on the ground. Measured variables included intubation time, Cormack grade, incidence of esophageal intubation, "crick" sound from the teeth of the mannequin, and degree of head tilt during intubation attempts. RESULTS: Mean intubation times on the table and ground were 12.6 +/- 3.9 and 14.7 +/- 6.5 seconds, respectively. No esophageal intubation occurred. Cormack grades and incidence of teeth click were significantly higher on the floor, whereas there was no difference regarding degree of head tilt between the 2 settings. CONCLUSIONS: Our results indicate that intubation on the ground is more difficult and may require a longer time to accomplish, even for experienced anesthesiologists. Therefore, those involved in airway management training for emergency personnel should acquire appropriate skills to teach tracheal intubation in such a difficult situation.

Anesthesiology↗
PubMed2003

The assessment of three methods to verify tracheal tube placement in the emergency setting.

We studied prospectively the reliability of clinical methods, end-tidal carbon dioxide (ETCO(2)) detection, and the esophageal detector device (EDD) for verifying tracheal intubation in 137 adult patients in the emergency department. Immediately after intubation, the tracheal tube position was tested by the EDD and ETCO(2) monitor, followed by auscultation of the chest. The views obtained at laryngoscopy were classified according to the Cormack grade. Of the 13 esophageal intubations that occurred, one false-positive result occurred in the EDD test and auscultation. In the non-cardiac arrest patients (n=56), auscultation, the ETCO(2), and EDD test correctly identified 89.3, 98.2*, and 94.6%* of tracheal intubations, respectively (*, P<0.05 vs. the cardiac arrest patients). In the cardiac arrest patients (n=81), auscultation, the ETCO(2), and the EDD tests correctly identified 92.6**, 67.9, and 75.3% of tracheal intubations, respectively (**, P<0.05 vs. EDD and ETCO(2)). The frequencies of Cormack grade 1 or 2 were 83.9% in the non-cardiac arrest, and 95.1% in the cardiac arrest patients. In conclusion, the ETCO(2) monitor is the most reliable method for verifying tracheal intubation in non-cardiac arrest patients. During cardiac arrest and cardiopulmonary resuscitation, however, negative results by the ETCO(2) or the EDD are not uncommon, and clinical methods are superior to the use of these devices.

Aged↗
PubMed2003

[Malignant hyperthermia during emergency craniotomy: a case report].

An 18-year-old man underwent emergency craniotomy for acute epidural hematoma under general anesthesia using suxamethonium and isoflurane. Marked rises in end-tidal carbon dioxide, body temperature, and serum potassium occurred during the surgery. After intravenous dantrolene sodium administration, the body temperature dropped rapidly. No conspicuous postoperative elevation of serum creatine kinase levels were observed. Postoperative muscle biopsy specimen revealed increased calcium-induced calcium release.

Acute Disease↗
PubMed2003

[Active involvement of pharmacists in initial treatments for acute poisoning and overdosed patients in the intensive care unit].

We have developed guidelines of pharmaceutical activity which describes how pharmacists are actively involved in supporting the initial treatment of poisoning and overdosed patients in the Intensive Care Unit (ICU). These guidelines are derived from the original procedural manual that consisted of protocol charts. The charts provide the pharmacist including ICU staff members with directions for the collection of clinical information and the forms to use for documentation. We focused on appropriate collection and proper preservation of collected samples in order to perform diagnostic analysis when needed. The original Information Record Form, completed by the participating pharmacist, documents all information regarding the patient's care. This record provides for integration of the diverse and complicated clinical information of the patient so that the physician can gain a comprehensive picture of the patient. The guidelines, manual book, materials for sample collection and the Information Record Form are stored in a container called the "Poisoning Aid Set", which will be available in the ICU. The guidelines are activated once an emergency call from paramedics is received regarding a suspected poisoning patient. According to the guidelines, the emergency room (ER) physician immediately contacts the pharmacist who will provide his professional services as a member of the treatment team. We have applied these guidelines to 29 poisoning patients and have critically evaluated for effectiveness. Early participation by pharmacists, by reviewing timely, accurate and competent clinical information enabled the pharmacist to identify the suspected drug from the biological samples obtained. From our experiences, we conclude that this active involvement of pharmacist in the initial treatment of poisoning and overdosed patients in the ICU was both supportive and beneficial to the patient. In addition, the participation of pharmacist as a member of a treatment team provided an excellent opportunity to collaborate with the entire ICU staff members.

Acute Disease↗