scholarly journals P025: Optimizing practice for learning emergency department transthoracic echocardiography using an ultrasound simulator

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S86-S87
Author(s):  
D.D. Cho ◽  
J. Chenkin
Keyword(s):  
Emergency Department ◽  
Transthoracic Echocardiography ◽  
Orthogonal Design ◽  
Difficulty Level ◽  
Attractive Alternative ◽  
Practice Group ◽  
Chamber View ◽  
Technology Educators ◽  
Group B ◽  
Ultrasound Simulator

Introduction: Emergency department (ED) transthoracic echocardiography (TTE) is an important application of emergency department bedside ultrasound. Given limited curricular hours and economic constraints, training using ultrasound simulators represents an attractive alternative to using live-human models. Despite increased uptake of ultrasound simulator technology, educators lack evidence informing how best to use this technology. Three educational paradigms will be explored in this study: self-guided theory (learners are able to determine when they have had “enough practice”), desirable difficulties (manipulating practice conditions to create more durable and flexible learning), and the challenge point framework (avoiding cognitive overload). The question we seek to answer is: in novice medical trainees, which practice condition leads to improved learning in a test of retention when assessing the ability to generate and interpret a parasternal long axis (PLAX) and apical four-chamber view (A4CH) of the heart? Methods: Ultrasound-novices will be recruited from rotators in the ED. Participants will be allocated to one of three groups based on a 2x2 orthogonal design: Group A (variable difficulty × self-determined practice); Group B (variable difficulty × fixed practice); Group C (static difficulty × fixed practice). A standardized didactic lecture will be presented to each participant. Practice conditions with respect to difficulty level (easy, medium, hard) and structure of practice (learner-determined or fixed practice) will vary according to assigned groups. All groups will receive standardized feedback. The ability to identify anatomy and pathology will be assessed. At the conclusion of practice, a post-practice skills assessment and survey will be administered. Two to three weeks later, participants will be retested using three case scenarios. Screenshots of the participant-determined “best image” and video of the performance will be taken to be evaluated by two blinded (to group allocation) reviewers. Results: We have currently enrolled 14 participants. We aim to complete enrollment by April 2016. Conclusion: We anticipate that our study will provide evidence to inform the best use of ultrasound simulators for teaching TTE in the ED. It will also provide insight into the ability of three educational theories to predict best learning using a novel educational intervention.

Acute vertigo in the ENT emergency

2021 ◽  
Vol 70 (3) ◽  
pp. 146-155
Author(s):  
Václav Albrecht ◽  
Lukáš Školoudík ◽  
Peter Sila ◽  
Jan Mejzlík ◽  
Michal Janouch ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vestibular Function ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Head Impulse ◽  
Video Assisted ◽  
Vestibular Testing ◽  
Group A ◽  
The Difference ◽  
Group B

Summary Introduction: Acute vertigo ranks among the common reasons for visiting the emergency department. The aim of this study was to evaluate the rate of peripheral vestibular syndrome (PVS) in patients with acute vertigo examined at the ENT emergency department and to compare the agreement of physical ENT examination with video-assisted vestibular testing. Methods: Patients eamined at the ENT emergency department from January to December 2019 were evaluated retrospectively. The patients who underwent basic ENT examination without video-assisted vestibular testing form group A. The patients who underwent basic ENT examination which was followed by video head impulse test (vHIT) and videonystagmography in the next four days form group B. Results: A total of 117 patients with acute vertigo were included in group A, PVS was found in 31 patients (27%). In total, 50 patients were included in group B; PVS was found in 15 patients (30%), vestibular neuronitis was dia­gnosed most often (10 patients). The difference in the dia­gnosis of PVS by basic ENT examination (27 patients, 54%) and by video-assisted vestibular testing (15 patients, 30%) was statistically significant (P = 0.0030). The gain of the lateral (P = 0.0101) and superior (P = 0.0043) semicircular canal proved to be statistically significant, while vHIT was lower in PVS in comparison to other causes of vertigo. Conclusion: After basic ENT examination, PVS as a cause of acute vertigo was dia­gnosed in 27%. Video-assisted vestibular testing proved a statistically significant lower incidence of PVS in comparison to basic ENT examination. Accessibility of video- -assisted vestibular testing in the emergency department might allow for higher accuracy in the dia­gnosis of acute vertigo. Key words acute vertigo – vestibular function tests – video head impulse test – videonystagmography

scholarly journals Comparing the Effects of Dexmedetomidine and Midazolam on Sedation in Children with Head Trauma to Perform CT in Emergency Department / Upoređivanje efekata deksmedetomidina i midazolama na sedaciju dece sa povredom glave radi snimanja CT-om na Odeljenju urgentne medicine

2015 ◽  
Vol 32 (1) ◽  
pp. 59-65
Author(s):  
Hojjat Derakhshanfar ◽  
Farzad Bozorgi ◽  
Adel Hosseini ◽  
Shamila Noori ◽  
Abolfazl Mostafavi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Recovery Time ◽  
Vital Signs ◽  
Loading Dose ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Pediatric Sedation ◽  
Group B

Summary Many of the children referred to the emergency complain of head trauma. Children usually require sedition to reduce their failure and fear because of high activity and fear of performing computed tomography (CT). Dexmedetomidine and Midazolam belong to short-acting drugs for this purpose. This study aimed to compare the effect of the above mentioned drugs on sedition in children. Children referred to the emergency department were randomly divided into two groups. Group A was sedated with 0.05 mg/kg IV Midazolam and group B with 2μg/kg IV Dexmedetomidine over 10 minutes (loading dose), and then repeat boluses 2μg/kg IV over 10 minutes. Measurements included induction time, recovery time, efficacy, side effects, complications, and failure with each drug and vital signs and RAMSY scale. SPSS V.20 was used for data analysis. p<0.05 was considered statistically significant. Totally, 100 patients participated in the current study (44 girls and 56 boys). The mean and standard deviation of age was 5.3 ± 2.5 years. During the study, just 5 patients (10%) from group A did not have appropriate sedition following the injection of first dose of Midazolam and received the second dose. However, in B group patients no such case was reported. No significant difference was observed among blood pressure, heart rate, respiration and RAMSY Scale among the groups. No significant difference was seen between efficacy of Midazolam and Dexmedetomidine in pediatric sedation. More research should be done for generalization of our findings .

scholarly journals Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of low risk Pulmonary Embolism in Emergency Department

2013 ◽  
Vol 12 (4) ◽  
pp. 459-461 ◽  
Author(s):  
RS Sazwan ◽  
YU Devi ◽  
FM Hashairi ◽  
WAR Wan Faizia
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Transthoracic Echocardiography ◽  
Gold Standard ◽  
Clinical Presentation ◽  
Medical Science ◽  
Low Risk ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Standard Investigation

A diagnosis of Pulmonary Embolism (PE) is difficult that may be missed because of non specific clinical presentation. However, early diagnosis is fundamental, since immediate treatment is highly effective. Thus, with the availability of ultrasound machine in Emergency Department (ED) can help Emergency Physician to diagnose PE by using Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of PE in low risk patient before proceed with the gold standard investigation which is CT Pulmonary Angiogram (CTPA). We believed this case was likely to be repeated on some readers' clinical practice and this procedure is an appropriate option to consider in such cases. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16101 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 459-461

A randomized study of urgent computed tomography–based hematoma puncture and aspiration in the emergency department and subsequent evacuation using craniectomy versus craniectomy only

2012 ◽  
Vol 117 (3) ◽  
pp. 566-573 ◽  
Author(s):  
Bo Xiao ◽  
Fang-Fang Wu ◽  
Hong Zhang ◽  
Yan-Bin Ma
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Scale Score ◽  
Logistic Regression Analysis ◽  
Randomized Study ◽  
Surgical Decompression ◽  
Pupil Response ◽  
Group A ◽  
Group B

Object When treating patients with a spontaneous supratentorial massive (≥ 70 ml) intracerebral hemorrhage (ICH), the results of surgery are gloomy. A worsening pupil response has been observed in patients preoperatively, despite blood pressure control and diuretic administration. Because open surgery needs time for decompression to occur, the authors conducted a prospective randomized study to determine whether patients who have suffered a massive ICH can benefit from a more urgently performed decompressive procedure. Methods Overall, 36 eligible patients admitted 6 or fewer hours post-ictus were enrolled in the study. In Group A, 12 patients underwent CT-based hematoma puncture and partial aspiration in the emergency department (ED) and subsequent evacuation via a craniectomy; in Group B, 24 patients underwent hematoma evacuation via a craniectomy only. Pupil responses were categorized into 5 grades (Grade 0, bilaterally fixed; Grade 1, unilaterally fixed with the fixed pupil > 7 mm; Grade 2, unilaterally fixed with the fixed pupil ≤ 7 mm; Grade 3, a unilaterally sluggish response; and Grade 4, a bilaterally brisk response). Grades were obtained on admission, at surgical decompression (defined as the point at which liquid hematoma began to flow out in Group A and at dural opening in Group B), and at completion of craniectomy. The Barthel Scale was used to assess survivors' functional outcome at 12 months. Comparisons were made between Groups A and B. Logistic regression analysis was used to evaluate the positive likelihood ratio of all variables for survival and function (Barthel Scale score of ≥ 35 at 12 months). Results Decompressive surgery was undertaken approximately 60 minutes earlier in Group A than B. A worsening pupil reflex before decompression was observed in no Group A patient and in 9 Group B patients. At the time of decompression pupil response was better in Group A than B (p < 0.05). Although only approximately one-third of the hematoma volume documented on initial CT scanning had been drained before the craniectomy in Group A, when partial aspiration was followed by craniectomy, better pupil-response results were obtained in Group A at the completion of craniectomy, and survival rate and 12-month Barthel Scale score were better as well (p < 0.05). Logistic regression analysis revealed that one variable, a minimum pupil grade of 3 at the time of decompression, had the highest predictive value for survival at 12 months (8.0, 95% CI 2.0–32.0), and a pupil grade of 4 at the same time was the most valuable predictor of a Barthel Scale score of 35 or greater at 12 months (15.0, 95% CI 1.9–120.9). Conclusions Patients with massive spontaneous supratentorial ICHs may benefit from more urgent surgical decompression. The results of logistic regression analysis implied that, to improve long-term functional outcome, decompression should be performed in patients before herniation occurs. Due to the fact that most of these patients have signs of herniation when presenting to the ED and because conventional surgical decompression requires time to take effect, this combination of surgical treatment provides a feasible and effective surgical option.

scholarly journals Causes of early postpartum complications that result in visits to the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260101
Author(s):  
Prabhpreet Hundal ◽  
Rahim Valani ◽  
Cassandra Quan ◽  
Shayan Assaie-Ardakany ◽  
Tanmay Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health System ◽  
Wound Care ◽  
Group B Streptococcus ◽  
Community Setting ◽  
Retrospective Chart Review ◽  
Postpartum Visit ◽  
Early Postpartum ◽  
Ed Visits ◽  
Group B

Objective This study aimed to review the reasons why postpartum women present to the emergency department (ED) over a short term (≤10 days post-delivery) and to identify the risk factors associated with early visits to the ED. Methods This retrospective chart review included all women who delivered at a regional health system (William Osler Health System, WOHS) in 2018 and presented to the WOHS ED within 10 days after delivery. Baseline descriptive statistics were used to examine the patient demographics and identify the timing of the postpartum visit. Univariate tests were used to identify significant predictors for admission. A multivariate model was developed based on backward selection from these significant factors to identify admission predictors. Results There were 381 visits identified, and the average age of the patients was 31.22 years (SD: 4.83), with median gravidity of 2 (IQR: 1–3). Most patients delivered via spontaneous vaginal delivery (53.0%). The median time of presentation to the ED was 5.0 days, with the following most common reasons: abdominal pain (21.5%), wound-related issues (12.6%), and urinary issues (9.7%). Delivery during the weekend (OR 1.91, 95% CI 1.00–3.65, P = 0.05) was predictive of admission while Group B Streptococcus positive patients were less likely to be admitted (OR 0.22, CI 0.05–0.97, P<0.05) Conclusions This was the first study in a busy community setting that examined ED visits over a short postpartum period. Patient education on pain management and wound care can reduce the rate of early postpartum ED visits.

scholarly journals Effect of Pregabalin on Postcraniotomy Pain in Patients Undergoing Supratentorial Tumor Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

2019 ◽  
Vol 10 (04) ◽  
pp. 641-645
Author(s):  
Ritesh Lamsal ◽  
Charu Mahajan ◽  
Vikas Chauhan ◽  
Nidhi Gupta ◽  
Nitasha Mishra ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Attractive Alternative ◽  
Double Blind ◽  
Vas Score ◽  
Surgery Patient ◽  
Neurosurgical Patients ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background and Objectives Suboptimal management of postcraniotomy pain causes sympathetic and hemodynamic perturbations, leading to deleterious effects on the neurological system and overall patient outcome. Opioids are the mainstay of postoperative pain management but have various problems when given in high doses, or for prolonged durations in neurosurgical patients. The ideal method of pain control following craniotomy generally relies on a combination of various drugs. Oral pregabalin may be an attractive alternative in these patients. Materials and Methods Sixty, American Society of Anesthesiologists class I and II patients posted for elective supratentorial craniotomy, aged 18 and 60 years, were randomly assigned into three groups of 20 each to receive oral placebo (Group A), pregabalin 75 mg (Group B), or pregabalin 150 mg (Group C) before the induction of anesthesia. At the end of the surgery, patient-controlled analgesia was started with intravenous fentanyl. Visual analog scale (VAS) score was recorded every 2 hours for 24 hours, along with total postoperative fentanyl requirement. Results There were no differences in sex, duration of surgery or anesthesia and total intraoperative fentanyl administered among the three groups. The median postoperative VAS score (Group A—18.0, Group B—20, and Group C—22.0; p = 0.63) was similar in all the groups. However, postoperative fentanyl requirement over 24 hours was least in the group that received 150 mg pregabalin (Group A—190 μg, Group B—240 μg, and Group C—100 μg; p = 0.03). Conclusions Even though pain scores were not significantly different, patients receiving 150 mg oral pregabalin required the least amount of postoperative opioids.

scholarly journals Commencement of systemic corticosteroids in emergency Department versus in ward in management of acute adult asthma requiring hospitalization: a retrospective cohort study

2016 ◽  
Vol 15 (4) ◽  
pp. 608-614
Author(s):  
Suen Pao Yim
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Acute Asthma ◽  
Length Of Hospital Stay ◽  
Adult Asthma ◽  
Systemic Corticosteroids ◽  
Group A ◽  
The Difference ◽  
Group B

Introduction: Systemic corticosteroids are commonly used in management of acute asthma, sometimes started before admission in emergency department, sometimes in ward after admission. This study is to determine whether commencing systemic corticosteroids in emergency department compared to in ward for managing acute adult asthma requiring hospitalization can improve the outcome: shorter length of hospital stay.Methods: A retrospective cohort study was conducted in an emergency department in Hong Kong. Adults aged 18 to 65 years-old who presented to the emergency department with acute asthma and subsequently hospitalized with use of systemic corticosteroids were recruited and divided into two groups: a group with commencement of systemic corticosteroids in emergency department (Group A, n=139) and the other group with commencement of systemic corticosteroids in ward (Group B, n=209). The outcome measurement was length of hospital stay.Results: A total of 348 subjects were recruited in final analyses. We used Mann-Whitney U test to test the difference in ranking of length of hospital stay (days) between these two groups. The mean rank of length of hospital stay in Group A was 159, and that in Group B was 185 (p=0.014). The difference was statistically significant with commencement of systemic corticosteroids in emergency department resulting in higher ranking-shorter length of hospital stay.Conclusion: It may be possible to result in earlier discharge in acute adult asthma requiring hospitalization when systemic corticosteroids is started before admission in emergency department, instead of in ward after admission.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.608-614

Sign in / Sign up

Export Citation Format

Share Document