Perceived versus actual cricothyroid membrane landmarking accuracy by emergency medicine residents and staff physicians

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 523-527
Author(s):  
Nicholas Schouela ◽  
Michael Y. Woo ◽  
Andy Pan ◽  
Warren J. Cheung ◽  
Jeffery J. Perry
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Cricothyroid Membrane ◽  
Emergency Physicians ◽  
Male And Female ◽  
Training Techniques ◽  
Confidence Levels ◽  
Obesity Status ◽  
Perceived Difficulty ◽  
Lower Accuracy

ABSTRACTObjectivesCricothyrotomy is an intervention performed to salvage “can't intubate, can't ventilate” situations. Studies have shown poor accuracy with landmarking the cricothyroid membrane, particularly in female patients by surgeons and anesthesiologists. This study examines the perceived versus actual success rate of landmarking the cricothyroid membrane by resident and staff emergency physicians using obese and non-obese models.MethodsFive male and female volunteers were models. Each model was placed supine, and a point-of-care ultrasound expert landmarked the borders of each cricothyroid membrane; 20 residents and 15 staff emergency physicians were given one attempt to landmark five models. Overall accuracy and accuracy stratified by sex and obesity status were calculated.ResultsOverall landmarking accuracy amongst all participants was 58% (SD 18%). A difference in accuracy was found for obese males (88%) versus obese females (40%) (difference = 48%, 95% CI = 30–65%, p < 0.0001), and non-obese males (77%) versus non-obese females (46%) (difference = 31%, 95% CI = 12–51%, p = 0.004). There was no association between perceived difficulty and success (correlation = 0.07, 95% CI = −0.081–0.214, p = 0.37). Confidence levels overall were higher amongst staff physicians (3.0) than residents (2.7) (difference = 0.3, 95% CI = 0.1–0.6, p = 0.02), but there was no correlation between confidence in an attempt and its success (p = 0.33).ConclusionWe found that physicians demonstrate significantly lower accuracy when landmarking cricothyroid membranes of females. Emergency physicians were unable to predict their own accuracy while landmarking, which can potentially lead to increased failed attempts and a longer time to secure the airway. Improved training techniques may reduce failed attempts and improve the time to secure the airway.

scholarly journals P032: Perceived versus actual cricothyroid membrane landmarking accuracy by emergency medicine residents and staff physicians

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S75-S76
Author(s):  
N. Schouela ◽  
M. Woo ◽  
A. Pan ◽  
W. Cheung ◽  
J. Perry
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Cricothyroid Membrane ◽  
Emergency Physicians ◽  
Training Techniques ◽  
Confidence Levels ◽  
Physician Performance ◽  
Obesity Status ◽  
Perceived Difficulty ◽  
Lower Accuracy

Introduction: Cricothyrotomy is an intervention performed to salvage “can't intubate, can't ventilate” situations. Studies have shown poor accuracy landmarking the cricothyroid membrane, particularly in female patients by surgeons and anesthesiologists. There is less data available about emergency physician performance. This study examines the perceived versus actual success rate of landmarking the cricothyroid membrane by resident and staff emergency physicians using obese and non-obese models. Methods: Five male and female volunteers were selected as models. Each model was placed supine, and a point-of-care ultrasound expert landmarked the borders of each cricothyroid membrane. 20 residents and 15 staff emergency physicians were given one attempt to landmark five models. Data was gathered on each participant's perceived likelihood of success and attempt difficulty. Overall accuracy and accuracy stratified by sex and obesity status were calculated. Results: Overall landmarking accuracy amongst all participants was 58% (SD 18%). A difference in accuracy was found for obese males (88%) versus obese females (40%) (difference = 48%, 95% CI = 30-65%, p < 0.0001); and non-obese males (77%) versus non-obese females (46%) (difference = 31%, 95% CI = 12-51%, p = 0.004). There was no association between perceived difficulty and success (correlation = 0.07, 95% CI=−0.081-0.214, p = 0.37). Confidence levels overall were higher amongst staff physicians (3.0) than residents (2.7) (difference = 0.3, 95% CI = 0.1-0.6, p = 0.02), but there was no correlation between confidence in an attempt and its success (p = 0.33). Conclusion: We found that physicians demonstrate significantly lower accuracy when landmarking cricothyroid membranes of females. Emergency physicians were unable to predict their own accuracy while landmarking, which can potentially lead to increased failed attempts and longer time to secure the airway. Improved training techniques and a modified approach to cricothyrotomy may reduce failed attempts and improve the time to secure the airway.

scholarly journals The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
A. Pourmand ◽  
U. Dimbil ◽  
A. Drake ◽  
H. Shokoohi
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Imaging Modality ◽  
Point Of Care ◽  
High Sensitivity ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Short Term ◽  
Intestinal Peristalsis

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

Accuracy of point-of-care ultrasound by pediatric emergency physicians for testicular torsion

2019 ◽  
Vol 15 (6) ◽  
pp. 608.e1-608.e6 ◽  
Author(s):  
N. Friedman ◽  
Z. Pancer ◽  
R. Savic ◽  
F. Tseng ◽  
M.S. Lee ◽  
...  
Keyword(s):  
Testicular Torsion ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians

Reliability of Neck Mass Point‐of‐Care Ultrasound by Pediatric Emergency Physicians

2019 ◽  
Vol 38 (11) ◽  
pp. 2893-2900 ◽  
Author(s):  
Nir Friedman ◽  
Felicia Tseng ◽  
Ranko Savic ◽  
Mamadou Diallo ◽  
Kate Fathi ◽  
...  
Keyword(s):  
Point Of Care ◽  
Pediatric Emergency ◽  
Neck Mass ◽  
Mass Point ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians

scholarly journals P005: Regional anesthesia in Canadian emergency departments: Emergency physician practices and impressions

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S66-S66
Author(s):  
D. Wiercigroch ◽  
S. Friedman ◽  
D. Porplycia ◽  
M. Ben-Yakov
Keyword(s):  
Regional Anesthesia ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physician Practices ◽  
Canadian Association ◽  
Modifiable Factors ◽  
Barriers To Use

Introduction: The use of regional anesthesia (RA) by emergency physicians (EPs) is expanding in frequency and range of application as expertise in point-of-care ultrasound (POCUS) grows, but widespread use remains limited. We sought to characterize the use of RA by Canadian EPs, including practices, perspectives and barriers to use in the ED. Methods: A cross-sectional survey of Canadian EPs was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical responses. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables. Results: The survey was completed by 149/1144 staff EPs, with a response rate of 13%. EPs used RA a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of EPs, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). EPs agreed that RA is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had POCUS available, however less than half (49.0%) felt comfortable using it for RA. EPs indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use. Conclusion: Canadian EPs engage in limited use of RA but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake of RA in the ED.

scholarly journals Point-of-care Ultrasound in the Diagnosis of Calciphylaxis

2020 ◽  
Vol 4 (3) ◽  
pp. 495-496
Author(s):  
Natasha Tobarran ◽  
Mark Collin
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Computed Tomography Imaging ◽  
Case Presentation ◽  
Tomography Imaging ◽  
History Of ◽  
Calcium Deposits ◽  
Stage Renal Disease ◽  
End Stage

Case Presentation: A 63-year-old male with a past medical history of end stage renal disease presented to the emergency department with painful, lower-extremity necrotic ulcerations. Ultrasound and computed tomography imaging showed concerns for calcium deposits. Biopsy confirmed the diagnosis of calciphylaxis, a rare lethal disease. Discussion: Emergency physicians should keep this disease on their differential due to the high mortality rate.

scholarly journals Point-of-care Echocardiogram as the Key to Rapid Diagnosis of a Unique Presentation of Dyspnea: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 424-427
Author(s):  
Michael Moore ◽  
Brian Dilcher ◽  
Joseph MInardi ◽  
Kimberly Quedado ◽  
Erica Shaver
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Respiratory Symptoms ◽  
Point Of Care ◽  
Diagnostic Error ◽  
Left Ventricular ◽  
Rapid Diagnosis ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Ventricular Thrombus

Introduction: Dyspnea is commonly evaluated in the emergency department (ED).The differential diagnosis is broad. Due to the large volume of dyspneic patients evaluated, emergency physicians (EP) will encounter uncommon diagnoses. Early, liberal application of point-of-care ultrasound (POCUS) may decrease diagnostic error and improve care for these patients. Case Report: We report a 48-year-old male presenting to the ED with cough and progressively worsening dyspnea for 11 months after multiple healthcare visits. Using POCUS, the EP was immediately able to diagnose a severe dilated cardiomyopathy (DCM) with left ventricular thrombus. Conclusion: Given that non-ischemic DCM is one of the most common etiologies of heart failure, often presenting with respiratory symptoms, POCUS is key to rapid diagnosis and, along with modalities such as electrocardiography and chest radiograph, should be standard practice in the workup of dyspnea, regardless of age or comorbidities.

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