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Ambient bacteria in a critical-care ward for emergency patients: Effect of cleaning with disinfectant
AMERICAN
JOURNAL
OF EMERGENCY
MEDICINE
n Volume 3, Number 4 W July 1985
growth of this system and made a reciprocal bution to the further development of JAAM.
contri-
SUMMARY The Japanese Association for Acute Medicine (JAAM) is an academic association and a suborganization of Japan Medical Association. In Japan, emergency medicine specialists who treat critical patients exclusively were the byproducts of the advent of tertiary emergency centers. Acute medicine naturally covers a wide range disciplines, from basic sciences and clinical medicine to sociomedical considerations. These facts, as well as the presence of JAAM, have contributed to the creation of the new multidisciplinary clinical science of “pantraumatology.”
Despite the progress in acute medicine over the last several years in Japan, important future tasks include the support and dissemination of emergency medical research, improved organization in the emergency care system, and standards for general clinical competency of emergency specialists at all levels.
References 1. Yoshioka T, Sugimoto T. The emergency medical system in Japan. Am J Emerg Med 1985;3:79-80. 2. Japanese Association for Acute Medicine. Standards and guidelines for cardiopulmonary resuscitation. J Jap Med Assoc 1983;90:5. 3. Yoshioka T, Sugimoto T. Tertiary emergency care in Japan. Am J Emerg Med 1985;3:252-257.
International Abstracts Hemodynamic and respiratory response urinary tripsin inhibitor of septic shock patients. H. Suzuki, T. Kondo, S. Shimazaki. Jpn J Acute Med 1985;9:357-362. The short time response of hemodynamic and respiratory changes of four septic patients after administration of human urinary tripsin inhibitor (UTI) was investigated. Hemodynamic and respiratory studies were made prior to and at two and four hours after intravenous administration of 300,000 units of UTI. Arterial blood pressure (BP) and pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and cardiac output (CO) were measured with simultaneous arterial and central venous blood gas analysis (Pa,, and Pv,,). The following parameters were also calculated: cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), pulmonary shunt ratio (Qs and QT), alveo-arterial oxygen dissociation (A-aDo,), arterio-venous oxygen dissociation (a-vD,,), and oxygen consumption. The A-aD,, showed a tendency to decrease with no discernible changes in other parameters, but it was not statistically significant (P < 0.05). There are reports that UT1 administration results in improved septic score and prognosis, and this study also indicated a favorable response of septic patients to UT1 administration without any hemodynamic depression as sometimes is evidenced by steroids. Urinary tripsin inhibitor may be worthwhile in the treatment regimen of septic shock. Effect of FUT-175 on DIC following experimental circulatory arrest. Y. Takemoto, J. Tanabe, S. Tanaka, A. Kohama. Jpn J Acute Med 1985;9:231-235. To evaluate the effect of initial treatment with FUT-175 (damidino, 2-naphthyl, 4-guanidino benzoate) on the prevention of disseminated intravascular coagulation (DIC) following circulatory arrest, experimental studies were performed using a model of transient circulatory arrest in dogs. Ten minutes of circulatory arrest were produced with an 366
aortic occlusion balloon catheter in dogs, and coagulation tests were carried out for five hours. Laboratory data were compared between the control group and the FUT- I75 group (6 pg/kg/min) as early as possible after recirculation. The FUT-175 group demonstrated normal platelet count. FDP, and antithrombin level that were significantly different from the control group. Prophylactic FUT-175 administration may thus be a favorable means of preventing forthcoming DIC following successful resuscitation from circulatory arrest. Intracranial pressure monitoring after near-drowning. T. Kondo, I Ogawa, T. Kikuchi, H. Suzuki, S. Shimazaki. Jpn J Acute Med 1985;9:221-228. Continuous monitoring of intracranial pressure (ICP) by a subarachnoid screw proved to be useful in cerebral resuscitation of a nearly drowned child. Intracranial pressure monitoring in the child revealed that there was a considerable time discrepancy between ICP levels and electroencephalographic (EEG) findings. On day 6, the child presented with a maximum ICP level and an EEG demonstrating alpha waves, whereas on day 14, the EEG was flat despite stabilized ICP. The presence of a time lag between ICP changes and EEG patterns indicates that continuous ICP measurement is an important adjunct to the therapeutic regimen for saving the injured brain on its way to anoxicischemic edema in near-drowning. Ambient bacteria in a critical-care ward for emergency patients: Effect of cleaning with disinfectant. Y. Takahashi, K. Hayashi, M. Tsuzuki. Jpn J Acute Medicine 1985;9:343-349. Transition of bacterial flora on the ward floor and distribution of bacteria from the floor were investigated over eight months in a critical-care ward for emergency patients. The ward floor was disinfected by splay with 0.2% glutaraldehyde solution and mopped daily with 0.1% dodecyl-di (ami-
YOSHIOKA
noethyl) glycine HCl solution. A continuous reduction of the floor’s bacterial contamination in the critical-care ward for emergency patients was observed in the investigated period. Bacterial contamination of the floor of the ward was spread from the floor around the patients’ beds to the nurses’ station or even to the examination room. The dominant bacteria on the floor of the critical-care ward for emergency patients were Acinetobacter Iwo&% and Pseudomonas malophilia. Traumatic arterial injuries. S. Kiode, K. Kanabuchi, T. Fukuda, S. Inamura, J. Ogawa, H. Inoue, S. Kawada, A. Shohtsu. Jpn J Acute Med 1985;9:351-356. Between 1976 and 1984, 20 patients were treated for traumatic arterial injuries caused by penetrating or blunt trauma.
AND SUGIMOTO
W JAAM
Lesions responsible were acute arterial occlusion in 15 patients, pseudo-aneurysm in four patients, and arteriovenous (A-V) fistula in one patient. The most noteworthy responsible mechanism in arterial occlusions was undue stretching resulting in traumatic intimal disruption of internal cartoid and popliteal arteries. The results were excellent in the cases of A-V fistula, pseudo-aneurysm, and arterial occlusion, which were revascularized within 17 hours of the injuries. Three limbs were amputated because of deep-layer infection with massive tissue loss, although the injured vessels had been repaired and were patent. One patient, who had an axillo-bifemoral bypass performed for limb salvage necessitated by a traumatic dissecting aortic aneurysm, died of acute renal failure on the tenth day after surgery.
367
JOURNAL
OF EMERGENCY
MEDICINE
n Volume 3, Number 4 W July 1985
growth of this system and made a reciprocal bution to the further development of JAAM.
contri-
SUMMARY The Japanese Association for Acute Medicine (JAAM) is an academic association and a suborganization of Japan Medical Association. In Japan, emergency medicine specialists who treat critical patients exclusively were the byproducts of the advent of tertiary emergency centers. Acute medicine naturally covers a wide range disciplines, from basic sciences and clinical medicine to sociomedical considerations. These facts, as well as the presence of JAAM, have contributed to the creation of the new multidisciplinary clinical science of “pantraumatology.”
Despite the progress in acute medicine over the last several years in Japan, important future tasks include the support and dissemination of emergency medical research, improved organization in the emergency care system, and standards for general clinical competency of emergency specialists at all levels.
References 1. Yoshioka T, Sugimoto T. The emergency medical system in Japan. Am J Emerg Med 1985;3:79-80. 2. Japanese Association for Acute Medicine. Standards and guidelines for cardiopulmonary resuscitation. J Jap Med Assoc 1983;90:5. 3. Yoshioka T, Sugimoto T. Tertiary emergency care in Japan. Am J Emerg Med 1985;3:252-257.
International Abstracts Hemodynamic and respiratory response urinary tripsin inhibitor of septic shock patients. H. Suzuki, T. Kondo, S. Shimazaki. Jpn J Acute Med 1985;9:357-362. The short time response of hemodynamic and respiratory changes of four septic patients after administration of human urinary tripsin inhibitor (UTI) was investigated. Hemodynamic and respiratory studies were made prior to and at two and four hours after intravenous administration of 300,000 units of UTI. Arterial blood pressure (BP) and pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and cardiac output (CO) were measured with simultaneous arterial and central venous blood gas analysis (Pa,, and Pv,,). The following parameters were also calculated: cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), pulmonary shunt ratio (Qs and QT), alveo-arterial oxygen dissociation (A-aDo,), arterio-venous oxygen dissociation (a-vD,,), and oxygen consumption. The A-aD,, showed a tendency to decrease with no discernible changes in other parameters, but it was not statistically significant (P < 0.05). There are reports that UT1 administration results in improved septic score and prognosis, and this study also indicated a favorable response of septic patients to UT1 administration without any hemodynamic depression as sometimes is evidenced by steroids. Urinary tripsin inhibitor may be worthwhile in the treatment regimen of septic shock. Effect of FUT-175 on DIC following experimental circulatory arrest. Y. Takemoto, J. Tanabe, S. Tanaka, A. Kohama. Jpn J Acute Med 1985;9:231-235. To evaluate the effect of initial treatment with FUT-175 (damidino, 2-naphthyl, 4-guanidino benzoate) on the prevention of disseminated intravascular coagulation (DIC) following circulatory arrest, experimental studies were performed using a model of transient circulatory arrest in dogs. Ten minutes of circulatory arrest were produced with an 366
aortic occlusion balloon catheter in dogs, and coagulation tests were carried out for five hours. Laboratory data were compared between the control group and the FUT- I75 group (6 pg/kg/min) as early as possible after recirculation. The FUT-175 group demonstrated normal platelet count. FDP, and antithrombin level that were significantly different from the control group. Prophylactic FUT-175 administration may thus be a favorable means of preventing forthcoming DIC following successful resuscitation from circulatory arrest. Intracranial pressure monitoring after near-drowning. T. Kondo, I Ogawa, T. Kikuchi, H. Suzuki, S. Shimazaki. Jpn J Acute Med 1985;9:221-228. Continuous monitoring of intracranial pressure (ICP) by a subarachnoid screw proved to be useful in cerebral resuscitation of a nearly drowned child. Intracranial pressure monitoring in the child revealed that there was a considerable time discrepancy between ICP levels and electroencephalographic (EEG) findings. On day 6, the child presented with a maximum ICP level and an EEG demonstrating alpha waves, whereas on day 14, the EEG was flat despite stabilized ICP. The presence of a time lag between ICP changes and EEG patterns indicates that continuous ICP measurement is an important adjunct to the therapeutic regimen for saving the injured brain on its way to anoxicischemic edema in near-drowning. Ambient bacteria in a critical-care ward for emergency patients: Effect of cleaning with disinfectant. Y. Takahashi, K. Hayashi, M. Tsuzuki. Jpn J Acute Medicine 1985;9:343-349. Transition of bacterial flora on the ward floor and distribution of bacteria from the floor were investigated over eight months in a critical-care ward for emergency patients. The ward floor was disinfected by splay with 0.2% glutaraldehyde solution and mopped daily with 0.1% dodecyl-di (ami-
YOSHIOKA
noethyl) glycine HCl solution. A continuous reduction of the floor’s bacterial contamination in the critical-care ward for emergency patients was observed in the investigated period. Bacterial contamination of the floor of the ward was spread from the floor around the patients’ beds to the nurses’ station or even to the examination room. The dominant bacteria on the floor of the critical-care ward for emergency patients were Acinetobacter Iwo&% and Pseudomonas malophilia. Traumatic arterial injuries. S. Kiode, K. Kanabuchi, T. Fukuda, S. Inamura, J. Ogawa, H. Inoue, S. Kawada, A. Shohtsu. Jpn J Acute Med 1985;9:351-356. Between 1976 and 1984, 20 patients were treated for traumatic arterial injuries caused by penetrating or blunt trauma.
AND SUGIMOTO
W JAAM
Lesions responsible were acute arterial occlusion in 15 patients, pseudo-aneurysm in four patients, and arteriovenous (A-V) fistula in one patient. The most noteworthy responsible mechanism in arterial occlusions was undue stretching resulting in traumatic intimal disruption of internal cartoid and popliteal arteries. The results were excellent in the cases of A-V fistula, pseudo-aneurysm, and arterial occlusion, which were revascularized within 17 hours of the injuries. Three limbs were amputated because of deep-layer infection with massive tissue loss, although the injured vessels had been repaired and were patent. One patient, who had an axillo-bifemoral bypass performed for limb salvage necessitated by a traumatic dissecting aortic aneurysm, died of acute renal failure on the tenth day after surgery.
367