Aim: Anaphylaxis is a systemic allergic reaction that potentially causes death. Most anaphylactic reactions are uniphasic, but some cases may be biphasic or protracted. However, these clinical epidemiology concepts are unfamiliar in Japan. Therefore, we have investigated the incidences and characteristics of patients with biphasic and protracted anaphylaxis. Methods:We retrospectively evaluated patients with anaphylaxis in a single emergency medical center located in Yokohama, Japan from April 2009 to March 2012. We analyzed the incidences and characteristics of patients with biphasic and protracted anaphylaxis who needed to be admitted.Results: A total of 253 patients were diagnosed with anaphylaxis and 114 patients needed to be admitted. Of the 114 patients, 103(90.4%) were uniphasic, 7 (6.1%) were biphasic and 4 (3.5%) were protracted anaphylaxis. The most common antigens were foods and drugs. The median onset of a biphasic reaction was 8 h and dermatologic symptoms were mostly observed. Regarding severity, mild symptoms were seen in four cases, similar symptoms to the initial reaction were seen in two cases, and only one case was severe. The duration of protracted anaphylaxis varied from 2 to 8 days. Conclusion:The incidence of biphasic and protracted anaphylaxis in inpatients was 6.1% and 3.5%, respectively. The median onset of biphasic reaction was 8 h, and most symptoms were mild or similar to the initial reaction. We suggest that patients with anaphylaxis need an 8-h and ideally a 24-h observation period in order to monitor possible biphasic reactions. The duration of protracted anaphylaxis was up to 8 days.

To determine whether ketamine use for tracheal intubation, compared to other sedative use, is associated with a lower risk of post-intubation hypotension in hemodynamically-unstable patients in the emergency department (ED), we analyzed the data of a prospective, multicenter, observational study—the second Japanese Emergency Airway Network (JEAN-2) Study—from February 2012 through November 2017. The current analysis included adult non-cardiac-arrest ED patients with a pre-intubation shock index of ≥0.9. The primary exposure was ketamine use as a sedative for intubation, with midazolam or propofol use as the reference. The primary outcome was post-intubation hypotension. A total of 977 patients was included in the current analysis. Overall, 24% of patients developed post-intubation hypotension. The ketamine group had a lower risk of post-intubation hypotension compared to the reference group (15% vs 29%, unadjusted odds ratio [OR] 0.45 [95% CI 0.31–0.66] p < 0.001). This association remained significant in the multivariable analysis (adjusted OR 0.43 [95% CI 0.28–0.64] p < 0.001). Likewise, in the propensity-score matching analysis, the patients with ketamine use also had a significantly lower risk of post-intubation hypotension (OR 0.47 [95% CI, 0.31–0.71] P < 0.001). Our observations support ketamine use as a safe sedative agent for intubation in hemodynamically-unstable patients in the ED.

Aim: The objective of this study was to investigate the incidence and characteristics of thoracic injuries associated with cardiopulmonary resuscitation (CPR) performed under the 2005 and the 2010 guidelines.Methods: We evaluated patients who had an out-of-hospital cardiac arrest in 2010 (2005 group) and 2012 (2010 group). We analyzed the incidence and characteristics of rib fractures and pneumothoraces received during CPR as determined by medical records and image studies. Conclusion:The number of rib fractures and pneumothoraces received during CPR increased significantly under the 2010 guidelines when compared with the 2005 guidelines. As the APD for patients of Japanese descent is smaller than that of patients of European descent, Japanese medical facilities need to be prepared for possible fatal adverse events associated with CPR under the current international guidelines.

No abstract