INTRODUCTIONComprehensive treatment of a patient in acute medicine and surgery requires the use of both surgical techniques and other treatment methods. Recently, acute vascular interventional radiology techniques (AVIRTs) have become increasingly popular, enabling adequately trained in-house experts to improve the quality of on-site care.METHODSAfter obtaining approval from our institutional ethics committee, we conducted a retrospective study of AVIRT procedures performed by acute care specialists trained in acute medicine and surgery over a 1-year period, including those conducted out of hours. Trained acute care specialists were required to be certified by the Japanese Association of Acute Medicine and to have completed at least 1 year of training as a member of the endovascular team in the radiology department of another university hospital. The study was designed to ensure that at least one of the physicians was available to perform AVIRT within 1 h of a request at any time. Femoral sheath insertion was usually performed by the resident physicians under the guidance of trained acute care specialists.RESULTSThe study sample comprised 77 endovascular procedures for therapeutic AVIRT (trauma, n = 29, and nontrauma, n = 48) among 62 patients (mean age, 64 years; range, 9–88 years), of which 55% were male. Of the procedures, 47% were performed out of hours (trauma, 52%; and nontrauma, 44%). Three patients underwent resuscitative endovascular balloon occlusion of the aorta in the emergency room. No major device-related complications were encountered, and the overall mortality rate within 60 days was 8%. The recorded causes of death included exsanguination (n = 2), pneumonia (n = 2), sepsis (n = 1), and brain death (n = 1).CONCLUSIONWhen performed by trained acute care specialists, AVIRT seems to be advantageous for acute on-site care and provides good technical success. Therefore, a standard training program should be established for acute care specialists or trauma surgeons to make these techniques a part of the standard regimen.LEVEL OF EVIDENCETherapy/care management study, level V.

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Case: A woman aged in her 20s ingested approximately 99 g acetylsalicylic acid, and was transported to our hospital 2 h later. She was lucid, but complained of hearing loss and tinnitus. We performed gastric lavage and gave her activated charcoal several times. We attempted to maintain the urinary pH at 7.5 and output above 100 mL/h while preparing for urgent hemodialysis.Outcome: It was revealed after discharge that the blood concentration of acetylsalicylic acid was 103.8 mg/dL on admission (lethal dose level) and had decreased to 35.4 mg/dL by the next morning. The half-life was 8.5 h. Conclusion:Hemodialysis is strongly recommended for patients who take a lethal dose of acetylsalicylic acid. However, by carefully evaluating the vital signs and urinary output and pH, while preparing for emergency hemodialysis, we consider that it is possible to treat acetylsalicylic acid poisoning by alkaline diuresis and critical supportive care.

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Background: The importance of presenting options for organ/tissue donation to families of patients with irreversible brain damage has been recognized by medical staff; however, it remains difficult for attending doctors and medical teams because it is very distressful for them both physically and emotionally. Objective: To develope and introduce a clinical pathway (CP) to make it easier to present options for organ/tissue donation. Method: CP to present options for donation consisted of a cover letter (page 1), medical history and neurological evaluations (page 2), summary (page 3), and questionnaires about donation for the family (page 4, submission optional). We established it not to recommend donation, but to provide information about the patients' status and option of organ/tissue donation as an outcome of CP. Results: There were 10 cases in which CP was appropriately applied from December 2008 to July 2010. It took about 30 minutes for each case. The presentation of options for organ/tissue donation was improved. CP was applied in 4.9 ± 2.0 (2-9) hospital days. Page 4, the questionnaires about donation for the family, was returned to us in 7 of 10 cases in 0-2 days after applying CP. Families met coordinators for organ/tissue donation in 5 cases, and, finally, organ and/or tissue donation was conducted in 4 cases. Discussion: Medical teams mostly make efforts to be respectful when presenting the limits of treatment, followed by medical organ donation options. Our developed CP seemed to be helpful to remain on the side of the family, and to provide information about the patients' status and options for organ/tissue donation for the family members.