In several studies, regional cerebral oxygen saturation (rSO 2 ) has been measured in patients with postcardiac arrest syndrome (PCAS) to analyze the brain's metabolic status. However, the significance of rSO 2 in PCAS patients remains unclear. In the present study, we investigated the relationship between rSO 2 and physiological parameters. Comatose survivors of out-of-hospital PCAS with targeted temperature management (TTM) at 34°C for 24 hours were included. All patients were monitored for their rSO 2 and additional parameters (arterial oxygen saturation [SaO 2 ], hemoglobin [Hb], mean arterial pressure [MAP], arterial carbon dioxide pressure [PaCO 2 ], and body temperature]) measured at the start of monitoring and 24 and 48 hours after return of spontaneous circulation (ROSC). Patients were divided into favorable and unfavorable groups, and the correlation between rSO 2 and these physiological parameters was evaluated by multiple regression analysis. Forty-nine patients were included in the study, with 15 in the favorable group and 34 in the unfavorable group. There was no significant difference in the rSO 2 value between the two groups at any time point. The multiple regression analysis of the favorable group revealed a moderate correlation between rSO 2 and SaO 2 , Hb, and PaCO 2 only at 24 hours (coefficients: 0.482, 0.422, and 0.531, respectively), whereas that of the unfavorable group revealed moderate correlations between rSO 2 and Hb values at all time points, PaCO 2 at 24 hours and MAP at 24 and 48 hours. rSO 2 was moderately correlated to MAP in unfavorable patients. To optimize brain oxygen metabolic balance for PCAS patients with TTM measuring rSO 2 , we suggest total evaluation of each parameters of SaO 2 , Hb, MAP, and PaCO 2 .

We report on a patient with a rare case of bilateral tension pneumothorax that occurred after acupuncture. A 69-year-old large-bodied man, who otherwise had no risk factors for spontaneous pneumothorax, presented with chest pressure, cold sweats and shortness of breath. Immediately after bilateral pneumothorax had been identified on a chest radiograph in the emergency room, his blood pressure and percutaneous oxygen saturation suddenly decreased to 78 mm Hg and 86%, respectively.

A case of traumatic hematoma in the basal ganglia that showed deterioration after arrival at the hospital was reported. A 65-year-old man crashed into the wall while riding a motorcycle. His Glasgow coma scale was E3V4M6 and showed retrograde amnesia and slight right motor weakness. Because head CT in the secondary trauma survey showed subarachnoid hemorrhage in the right Sylvian fissure and multiple gliding contusions in the left frontal and parietal lobe, he was entered into the intensive care unit for diagnosis of diffuse brain injury. He showed complete muscle weakness of left upper and lower limbs 5 h after the accident. Head CT newly showed hematoma, 2 cm in diameter, in the right basal ganglia. The patient vomited following the CT scan, and so his consciousness suddenly deteriorated into a stupor. We performed head CT again. The hematoma had enlarged to 5 cm at the same lesion and partially expanded into midbrain. The patient died on the 13th day of trauma. Based on retrospective interpretation, we conclude that clinical examinations, follow-up CT scans and blood examinations should be performed frequently as part of ICU management for all TBI patients in the early phase after trauma.

Aims: Many experimental studies have reported that intra-arrest cooling during cardiac arrest is a promising treatment to mitigate brain injury. However, there is no clinically established method for cooling the brain during cardiac arrest. We hypothesized that, as blood flow in the lungs must be very slow during cardiopulmonary resuscitation, the blood could be cooled by ventilating the lungs with cooled oxygen like a radiator, and that this cooled blood would in turn cool the brain. The aim of this study was to develop equipment to cool oxygen for this purpose and to confirm its safety on a group of volunteers. Methods:We developed new equipment that cools oxygen by running it through a vinyl chloride coil submerged in a bottle of water and frozen at À80°C. Using this equipment, seven volunteers were given oxygen by mask, and their blood pressure, heart rate, and peripheral saturation of oxygen were measured. The temperature in the mask was also measured.Results: This equipment was able to decrease the temperature in the mask to À5°C at the Jackson Rees circuit for an oxygen flow of 10 L/min. Among the volunteer group, vital signs were unchanged and the temperature in the mask decreased from 30.1 AE 2.6°C (mean AE standard deviation) to 15.9 AE 9.6°C. No adverse effects were observed in the volunteers after experimentation. Conclusion:We successfully developed new equipment to cool oxygen and established its safety in a volunteer study.

Case: A 74-year-old male who was bedridden and lived alone and was supported by remote medical service was brought to our emergency department.Outcome: The patient exhibited necrotizing soft tissue infection in a sacral pressure ulcer, which required early debridement, antibiotic administration, vasopressor, mechanical ventilation and blood purification therapy. Group A Streptococcus (GAS) was detected from the sacral ulcer and blood culture. He was diagnosed as having streptococcal toxic shock syndrome (STSS).Conclusion: Pressure ulcers infected with GAS quickly lead to STSS. In the aging society, many medical personnel including health care workers have the opportunity to contact patients with contagious bacterium, and infectious precautions are required.