Streptococcal toxic shock syndrome (STSS) has a high mortality rate, and most patients die within a few days of onset. We report an elderly patient with STSS, necrotizing fasciitis and septic shock caused by group G streptococcus who was successfully treated with multidisciplinary therapy.
Acute pulmonary thromboembolism (PTE), which carries a high mortality rate, is difficult to diagnose when it occurs intraoperatively. Therefore, patient prognosis depends on a prompt diagnosis by anesthesiologists. A 49-year-old woman underwent right lower extremity dissection due to a contusion of the right lower extremity caused by trauma. Eleven days after surgery, she underwent debridement for necrosis of the amputation wound. Intraoperatively, a drop in blood pressure and tachycardia were observed, and PTE was suspected based on a rapid deterioration in oxygen saturation and a drop in end-tidal carbon dioxide partial pressure. Transesophageal echocardiography (TEE) showed a thrombus filling the right pulmonary artery, and a diagnosis of PTE was made. The patient was treated using venoarterial extracorporeal membrane oxygenation, and thrombectomy was performed the next day to save her life. In this case, we were able to diagnose and treat the intraoperative acute PTE at an early stage. In addition, the appropriate choice of treatment saved the patient’s life without complications.
We investigated the activity of our palliative care team over the past ve years and how the new coronavirus infection (COVID-19) a ects palliative care in our hospital. Methods: We retrospectively compared and analyzed patient data intervened by the Tokyo Medical University Hospital Palliative Care Team from April 2016 to March 2021. Results: ere were no major di erences in the total number of requests, patient background, reasons for request, and reasons for intervention from FY2016 to FY2020. In FY2020, the number of patients with PS0 at the time of request and who discharged from the hospital at home increased signi cantly compared to other years. Discussion and Conclusion: From the results of this survey, it was found that the introduction of palliative care from an early stage is progressing. On the other hand, because the outbreak of COVID-19 has restricted visits to inpatients at our hospital, it is possible that the proportion of patients who choose home care is increasing. Intervention requests to the palliative care team did not change signi cantly over the 5-year period without the impact of the COVID-19 pandemic. Strict visitation restrictions for inpatients have become barriers to the practice of palliative care.
Streptococcal toxic shock syndrome (STSS) has a high mortality rate, and
most patients die within a few days of onset. We report an elderly
patient with STSS, necrotizing fasciitis and septic shock caused by
group G Streptococcus (GGS) who was successfully treated with
multidisciplinary therapy.
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