Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Intracranial tumors are rare in persons with Down syndrome. Although germ cell tumors and gliomas have been reported in Down syndrome, primary central nervous system lymphoma (PCNSL) has not. We report a case of PCNSL in a 48-year-old man with Down syndrome and no history of malignant tumors. He visited our hospital for evaluation of left hemiparesis and gait disturbance. A thorough examination revealed brain tumors, and analysis of a biopsy specimen of the tumor confirmed a diagnosis of PCNSL. The final pathological diagnosis was diffuse large B-cell lymphoma of the central nervous system. Chemotherapy with rituximab, methotrexate, procarbazine, and vincristine was administered, and whole-brain irradiation was planned in conjunction with chemotherapy. It is unclear whether chromosomal abnormalities related to Down syndrome were involved in the development of PCNSL. Further molecular biological analysis may clarify the mechanism of combined Down syndrome and PCNSL.

DOI： 10.1272/jnms.JNMS.2023_90-502

PubMed

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本病院前救急診療医学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

File： あみ論文４　脳死脳蘇生.pdf

DOI： 10.34367/jjcrbd.34.2_101

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Authorship：Lead author   Language：Japanese  

File： あみ論文5.pdf

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Only a few studies have reported the association between age and mortality in COVID-19 patients who require invasive mechanical ventilation (IMV). We aimed to evaluate the effect of age on COVID-19-related mortality among patients undergoing IMV therapy. METHODS: This cohort study was conducted using the COVID-19 Registry Japan database, a nationwide multi-centre study of hospitalized patients with laboratory-confirmed COVID-19. Of all 33,808 cases registered between 1 January 2020 to 28 February 2021, we analysed 1555 patients who had undergone IMV. We evaluated mortality rates between age groups using multivariable regression analysis after adjusting for known potential components, such as within-hospital clustering, comorbidities, steroid use, medication for COVID-19, and vital signs on admission, using generalized estimation equation. RESULTS: By age group, the mortality rates in the IMV group were 8.6%, 20.7%, 34.9%, 49.7% and 83.3% for patients in their 50s, 60s, 70s, 80s, and 90s, respectively. Multivariable analysis showed that compared with those for patients aged < 60 years, the odds ratios (95% confidence interval) of death were 2.6 (1.6-4.1), 6.9 (4.2-11.3), 13.2 (7.2-24.1), 92.6 (16.7-515.0) for patients in their 60s, 70s, 80s, and 90s, respectively. CONCLUSIONS: In this cohort study, age had a great effect on mortality in COVID-19 patients undergoing IMV, after adjusting for variables independently associated with mortality. This study suggested that age was associated with higher mortality and that preventing progression to severe COVID-19 in elderly patients may be a great public health issue.

File： 13613_2021_Article_959.pdf

DOI： 10.1186/s13613-021-00959-6

PubMed

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：The Japanese Congress of Neurological Surgeons  

To avoid preventable trauma death (PTD), initial management, including resuscitation, is crucial in traumatic brain injury care. PTD is defined as a case in which the probability of survival exceeds 50% but unfortunately death occurs unless appropriate treatments are available. To diminish the cases of PTD, a standardized approach has been established with several training courses and guidelines. However, 20% of all traumatic brain injury (TBI) patients still suffer from PTD. Our research clarified that the cases of so-called “talk and deterioration” accounted for 26.2% of the PTD cases. In addition, 26.8% of PTD cases were anti-coagulant/anti-platelet drug users. Therefore, to eliminate PTD, measures against anticoagulation are important. Moreover, quick decision making regarding treatments preceding the rapid-changing pathophysiology is also essential in TBI care. In addition to securing airway, breathing support, stabilization of circulation, timely administration of neutralizers for anti-coagulative drugs, and the use of tranexamic acid, a drug for anti-fibrinolysis, is also significant.

  In this chapter, the pearls of initial TBI management are mentioned, with focus on the “first one hour” of treatment.

File： 30_712.pdf

DOI： 10.7887/jcns.30.71

CiNii Research

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Other Link： https://search.jamas.or.jp/link/ui/2022010664

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Initial management of severe traumatic brain injury (TBI) is important, and includes treatment decision-making and prediction of prognosis. We examined whether biomarkers at admission could be useful prognostic predictors. We focused on electrolytes and blood glucose, which can be measured easily at any facility and for which the results can be obtained promptly before those of other biomarkers, such as D-dimer. METHODS: All trauma patients with head injury treated at Chiba Hokusoh Hospital between 2014 and 2017 were investigated. Multiple trauma cases accompanied by fatal trauma, hemorrhagic shock, and cardiopulmonary arrest, and pediatric cases were excluded from this study. The blood gas data at the initial hospital visit were reviewed retrospectively. Cases in which the patients died or were in a vegetative state due to a head injury during hospitalization were defined as having a poor outcome. Factors related to poor outcome were analyzed. RESULTS: Of 185 male and 79 female patients enrolled in the study, 34 had a poor outcome. Poor outcome was correlated significantly with potassium (P = 0.003), glucose (P < 0.001), and the glucose-to-potassium ratio (P < 0.001) at arrival. In particular, the odds ratio for a glucose-to-potassium ratio of ≥50 was 4.079. CONCLUSIONS: We evaluated blood gas data at initial hospital visit as these results can be obtained more quickly than those of other biomarkers assessed previously. Serum glucose-to-potassium ratio at admission may be a potential predictor of prognosis for severe TBI.

File： あみ論文2　JNMS.pdf

DOI： 10.1272/jnms.JNMS.2021_88-506

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Rebleeding of aneurysmal subarachnoid hemorrhage (aSAH) is one of the significant risk factors for poor clinical outcome. The rebleeding risk is the highest during the acute phase with an approximate rebleeding rate of 9-17% within the first 24 h. Theoretically, general anesthesia can stabilize a patient's vital signs; however, its effectiveness as initial management for preventing post-aSAH rebleeding remains unclear. The purpose of this study was to determine the feasibility and safety of ultra-early general anesthesia induction for reducing the rebleeding rates among patients with aSAH. MATERIALS AND METHODS: We retrospectively evaluated patients with aSAH who were admitted to our department between January 2013 and December 2019. All the patients underwent ultra-early general anesthesia induction as initial management regardless of their severity. We evaluated the rebleeding rate before definitive treatment, factors influencing rebleeding, and general anesthesia complications. RESULTS: We included 191 patients with two-third of them having a poor clinical grade (World Federation of Neurological Society [WFNS] grade IV or V). The median duration from admission to general anesthesia induction was 22 min. Rebleeding before definitive treatment occurred in nine patients (4.7%). There were significant differences in the Glasgow Coma Scale score (p = 0.047), WFNS grade (p = 0.02), and dissecting aneurysm (p <0.001) between the rebleeding and non-rebleeding patients. There were no cases of unsuccessful tracheal intubation or rebleeding during general anesthesia induction. CONCLUSION: Ultra-early general anesthesia induction could be performed safely in patients with aSAH, regardless of the WFNS grade; moreover, it resulted in lower rebleeding rate than that reported in previous epidemiological reports.

File： 原著3.pdf

DOI： 10.1016/j.jstrokecerebrovasdis.2021.105926

PubMed

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Language：Japanese  

File： 中山先生　共著.pdf

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03405&link_issn=&doc_id=20210908460021&doc_link_id=%2Fda2jjsem%2F2021%2F002404%2F021%2F0598-0604%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fda2jjsem%2F2021%2F002404%2F021%2F0598-0604%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Surgical clipping of an internal carotid artery (ICA)-posterior communicating artery (ICPC) aneurysm is often difficult in cases involving limited space to insert a clip at the proximal aneurysm neck hidden by the tent. In such cases, we perform incision of the anterior petroclinoidal fold to secure the proximal space for clip insertion. Between April 2013 and March 2018, we treated 89 ICPC aneurysm cases by clipping. Incision of the anterior petroclinoidal fold was performed in 15 of the 89 cases (16.8%). Fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) can indicate the locations of the aneurysm and tent and can help assess the need for tent incision. We widely dissected the distal sylvian fissure and sufficiently exposed around the aneurysmal space. We coagulated and cut the anterior petroclinoidal fold supra between the ICA and proximal neck of the aneurysm using a low-power bipolar system and needles or micro-scissors with care to avoid injury around structures such as the ICA, aneurysm, and oculomotor nerve. When using this strategy, we often select the Yasargil FT717 clip that has a curve along the skull base because of easy insertion. All cases showed complete aneurysm exclusion on three-dimensional computed tomography angiography, and there was no cerebral infarction, neurological deficit (such as hemiparesis), or oculomotor nerve palsy. Therefore, our strategy of incision of the anterior petroclinoidal fold during clipping for securing the proximal space of an ICA aneurysm is effective and safe.

DOI： 10.1007/s10143-019-01121-4

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The efficacy of thyrotropin-releasing hormone tartrate (TRH-T) for treating prolonged disturbance of consciousness due to aneurysmal subarachnoid hemorrhage (SAH) remains unclear. The purpose of the present study was to determine whether TRH-T was really effective, and what was the recovery factor when it was valid. This was a retrospective study of a single facility. METHODS: We treated 208 patients with aneurysmal SAH at our hospital between 2011 and 2017. Among them, we investigated 97 cases in which TRH-T was administered to prolonged disturbance of consciousness. Thirty one patients with Hasegawa dementia rating scale-revised (HDS-R) score less than 20 were included. Patients' HDS-R scores were evaluated 7 days after clipping the aneurysm and 2 days after completing a course of TRH-T treatment. HDS-R score increases of greater than or over equal to 8 and less than 8 were defined as good and poor outcomes, respectively. Outcomes were compared to 11 patients who did not receive TRH-T treatment. RESULTS: Average initial and post-treatment HDS-R scores were 9 ± 6.6 and 19 ± 9.5, respectively. The good outcome group included 19 patients. Statistically significant differences in HDS-R score changes were observed between the group with initial HDS-R scores of 0-4 and the other groups. Poor outcomes were significantly correlated with age of greater than 60 years and initial HDS-R scores less than oroverequal to 4 points. The improvement in HDS-R score was significantly greater in the TRH-T administration group than the control group. CONCLUSIONS: TRH-T was effective for treating prolonged disturbance of consciousness due to aneurysmal SAH, especially in young patients with HDS-R scores between 5 and 20.

File： あみ論文１ .pdf

DOI： 10.1016/j.jstrokecerebrovasdis.2018.12.036

PubMed

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Little is known regarding functional outcome following poor-grade (World Federation of Neurosurgical Societies grades IV and V) aneurysmal subarachnoid hemorrhage (aSAH), especially in individuals treated aggressively in the early phase after ictus. METHODS: We provided patients with aSAH with ultra-early definitive treatment, coiling or clipping, within 6 hours from arrival as per protocol. We classified the patients into 3 groups according to their computed tomography findings: Group 1, intraventricular hemorrhage with obstructive hydrocephalus; Group 2, massive intracerebral hemorrhage with brain herniation; and Group 3, neither Group 1 nor Group 2. We retrospectively evaluated patients with poor-grade aSAH who were admitted to our department between January 2013 and December 2016. We evaluated functional outcome at 6 months, defining modified Rankin Scale (mRS) scores of 0-2 as good and those of 3-6 as poor outcomes. RESULTS: A good functional outcome was observed in 39.4% (28/71) of all cases. All-cause mortality at 6 months was 15.5% (11/71). A good outcome in Group 3 was significantly higher than that in the other two groups (Group 1 and 2 vs. Group 3, 20.8% vs. 48.9%, p = 0.02), even after adjustment with a multiple logistic regression analysis (odds ratio 6.1, 95% confidence interval 1.1 to 34.8). CONCLUSIONS: Approximately 40% of patients with poor-grade aSAH became functionally independent, and approximately half of the patients with poor-grade aSAH who had neither intraventricular hemorrhage with obstructive hydrocephalus nor with brain herniation had good functional outcomes. Although further trials are required to confirm our results, ultra-early surgery may be considered for patients with poor-grade aSAH.

File： 金子先生論文　共著 .pdf

DOI： 10.1272/jnms.JNMS.2019_86-203

PubMed

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File： 金子先生論文　共著.pdf

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Language：Japanese   Publisher：メディカル・サイエンス・インターナショナル  

CiNii Books

J-GLOBAL

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Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

＜Main points＞急性期脳梗塞に対する治療法が劇的に発展してきているなかで,急性期脳出血の治療法自体には大きな変化がない。テント上脳出血の手術適応については定まった見解がなく,目的(救命もしくは機能予後改善)に基づいた適応決定は各施設に委ねられている。小脳出血に対する血腫除去,脳室内出血,閉塞性水頭症に対する脳室ドレナージ術は確立した方法である。新たな脳出血の治療法として,低侵襲手術の有用性が示唆されている。(著者抄録)

CiNii Books

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER HEIDELBERG  

Background: Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns.
Methods: We performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index &gt;= 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs).
Results: Eligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2-28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37-0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference -3.7; 95% CI -7.2 to -0.12).
Conclusions: This nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results.

File： 田上先生論文　共著.pdf

DOI： 10.1186/s13613-017-0244-y

Web of Science

PubMed

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：(一社)日本外傷学会  

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Language：Japanese   Publisher：日本救急医学会-関東地方会  

74歳男性。駅前で心肺停止となり、バイスタンダーによる心肺蘇生とAEDによる除細動後に心拍が再開し搬送となった。精査の結果、心肺停止の原疾患は虚血性心疾患と判明したが、冠動脈の石灰化が高度であったため経皮的冠動脈形成術を行なえず、急性期管理として大動脈バルーンパンピング(IABP)を挿入した。蘇生後脳症に対しては低体温療法を施行し、意識は回復した。血行動態も安定したためIABPは第5病日に抜去したが、心不全の合併や不穏のため容易には人工呼吸器から離脱できず、冠動脈バイパス手術を勧めたが家族は希望しなかった。その後も内科的治療を継続したところ、心不全の改善および人工呼吸器離脱と抜管に至り、ADLも回復し、第66病日に自宅退院となった。

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：English   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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74歳男性。駅前で心肺停止となり、バイスタンダーによる心肺蘇生とAEDによる除細動後に心拍が再開し搬送となった。精査の結果、心肺停止の原疾患は虚血性心疾患と判明したが、冠動脈の石灰化が高度であったため経皮的冠動脈形成術を行なえず、急性期管理として大動脈バルーンパンピング(IABP)を挿入した。蘇生後脳症に対しては低体温療法を施行し、意識は回復した。血行動態も安定したためIABPは第5病日に抜去したが、心不全の合併や不穏のため容易には人工呼吸器から離脱できず、冠動脈バイパス手術を勧めたが家族は希望しなかった。その後も内科的治療を継続したところ、心不全の改善および人工呼吸器離脱と抜管に至り、ADLも回復し、第66病日に自宅退院となった。

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Venue：東京  

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11440 P66-02

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Venue：東京  

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Venue：大阪  

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Venue：東京  

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Venue：ﾛｲﾄﾝ札幌  

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Venue：ﾛｲﾄﾝ札幌  

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File： 石井先生抄録.pdf

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File： JSNET地方会　抄録.docx

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File： 第26回JSNET地方会抄録.docx

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Venue：国立京都国際会館  

P39-8

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SR2

【背景】日本医科大学多摩永山病院は東京都南多摩保健医療圏において、2004年から、ドクターアンビュランスを運
用している。当院に所属する救急救命士が運転手を務め、医師、看護師とともに出動する。覚知から約3分で出動す
るため、全出動件数の約10％が最先着（救急隊・ポンプ隊未着）で、救急車内収容前での活動が約80％である。病院
出発から帰院までの安全管理能力を向上させるため、全出動症例の事後検証から改善点を抽出し、緊急自動車安全運
転講習会と現場活動シミュレーションを実施している。【緊急自動車安全運転講習会】2010年から当院独自で実施し
ている。座学と実技から構成され、座学では、緊急走行に関する法律や事故事例、悪天候時の注意事項とマイクの使
用方法、危険予知・事故の要因と事例を学ぶ。技能実習では、アンチロック・ブレーキ・システムの体験、緊急走行
の練習を行う。知識は緊急走行等に関する択一問題15問の試験、実技は緊急走行経験者より評価する。【目的】緊急
自動車安全運転講習会の教育効果を検証した。【方法】緊急走行等に関する択一問題15問の点数を講習会前後で比較
した。2010年3月から2022年8月までの参加者160名のうち、有効回答112名分のデータを解析した。【結果】112名の内
訳は、医師10名、看護師39名、救急救命士62名であった。1問1点で、平均点は、講習前が10.5±1.9点、講習後が13.3
±1.2点と向上した（p=0.04）。【考察】緊急自動車安全運転講習会は、緊急走行を行う運転手だけではなく、同乗する
医師、看護師も受講し、知識が向上した。多職種が緊急走行や現場活動についての共通認識を持ち、PDCAサイクル
に基づく講習会を12年間継続した実績は、COVID-19蔓延下における活動プロトコルの変更にも活かされている。【結語】
緊急自動車安全運転講習は、緊急走行や現場活動で必要な知識に留まらず、出動チームの活動の質向上に寄与するこ
とが示唆される。

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Venue：大阪市中央公会堂  

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Venue：大阪市中央公会堂  

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Language：Japanese   Presentation type：Poster presentation  

Venue：パシフィコ横浜  

File： スクリーンショット 2024-10-16 18.54.16.jpeg

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Language：Japanese   Presentation type：Poster presentation  

Venue：仙台国際センター  

【目的】減圧開頭術後でも術後早期離床・リハビリテーションが望ましいが、骨欠損部を保護する医療用保護帽の有無がその律速要因の一つとなっている。安価で容易に入手できる既製品は形状・強度・サイズに課題があり、一方オーダーメードは形状・強度はクリアするものの高価かつ製作に時間を要する。近年普及しつつある3Dプリンターはこれらの課題を解決する可能性がある。3Dプリンターを用いて、ヒト頭蓋骨に劣らない強度の保護帽を作成するための時間・コスト等を明らかにする。
【方法】術翌日の頭部CT骨条件画像を元に無料ソフト（Meshmixer）でデータを編集する。ピクセル値を皮膚に変更、stlファイルに変換、スライサーソフト（Ultimaker Cura）を用いてstlからgcodeファイルに変換し、家庭用3Dプリンター（ANYCUBIC社、MEGA-S、約25000円）とPLA（ポリ乳酸）フィラメントを用いて人工骨モデルを作成した。
【結果】対象は2020年11月から2022年4月までの17例。作成所要時間は骨欠損部のみを覆うもので約0.5日、頭部広範囲を覆うもので約1.5日、必要なフィラメント費は前者で約500円、後者で約2000円であった。データ編集に慣れるまでに訓練を要することなどが課題であった。
【結論】3Dプリンターにより十分な強度を有する保護帽が、低価格で短時間に作成可能である。

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Presentation type：Oral presentation (general)  

Venue：仙台国際センター  

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Presentation type：Poster presentation  

Venue：仙台国際センター  

背景：令和６年能登半島地震におけるDMAT派遣は過去に例が無い長期支援となった。我々が出動した時期は、能登北部・中部から南部への域内搬送によるPreventable disaster deathへの対処から慢性期に向け災害支援の活動が変動している状況であった。
活動：発災から２6日目に能登中部保険医療福祉調整本部に入りチーム運用の担当となった。当時は平常医療ニーズに急性期に域内搬送された被災者の負担が加わった為、医療福祉緊急事態宣伝を出すに至った南部から、搬送した被災者を地元である中部の病院・福祉施設への受け入れる為の調査を行っている状況であった。現地医療機関の職員は、発災一か月後の時期で被災者の側面と同時に医療者としての責務を負う最も負担を強いられている状況が推察されたため、我々は福祉施設の調査を引き継ぐとともに、改めて同時期における被災した医療機関の病院とその職員の状況・状態の確認を行うミッションを立ち上げDMAT隊により調査を行い、JMATやDPATと情報共有を行った。被災者として不自由な生活の中で、医療支援へのニーズがあるが声を上げにくい状況が認められた。DMAT活動として、亜急性期～慢性期の地域における医療機関職員調査を行ってよいのではないかと思われる。

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Presentation type：Poster presentation  

Venue：仙台国際センター  

（背景）救命救急科の中で働くAcute Care Surgeonの担う分野は多様化している。これまで中心であった外傷手術・内科緊急手術だけにとどまらない。他科で行われた手術前後の急変、処置後の急変に対応するもの、つまりSurgical Rescue teamとしての需要が高まっている。実際の症例を論じて、今後の救命救急センターにおけるAcute Care Surgeonの有り方に一石を投じたい。
（症例）2021年9月から2024年3月に至るまで当科がSurgical Rescueとして活動した症例を示す。外科手術後の管理中の急変対応のみならず、緊急の外科的気管切開やV-A ECMOの挿入・離脱など外科手技を発揮した症例も多い。また、産婦人科・小児科患者に対応した例も散見する。
（考察と結論）総合病院においてSurgical Rescueとしての需要の高まりは間違いない。外科医の専門性の進行に伴い、術前・術後を中心としたトラブルシューティングの経験は少なくなってきている。また、様々な新しいデバイスの開発や集中治療管理の高度・複雑化もあり、一般的な外科医が扱うのは難しい。その点、Acute Care Surgeonは手技に伴うトラブルにも対応し、胸部・腹部・骨盤・四肢に至るまでレパートリーも広い。今後のAcute Care Surgeonの働き方の大きな柱となり、将来的にチームとして活動する将来を描きたい。

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