scholarly journals MP12: Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S46-S47
Author(s):  
B. Waterman ◽  
K. VanAarsen ◽  
M. Lewell ◽  
H. Tien ◽  
F. Myslik ◽  
...  
Keyword(s):  
Critical Care ◽  
Statistical Significance ◽  
Training Session ◽  
Ultrasound Image ◽  
Rapid Test ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Accuracy Rate ◽  
Scan Time ◽  
Fast Exam

Introduction: The FAST exam – Focused Assessment with Sonography in Trauma - is a rapid test using ultrasound to identify sonographic evidence of hemorrhage within the abdomen. In the prehospital setting, the information from a FAST examination can help triage patients, direct patients to the most appropriate facilities, assist with management strategies and potentially expedite time to definitive intervention. Few studies examine the accuracy of paramedic-only-performed FAST examinations. However, despite the potential benefits to the Canadian prehospital system, a potential barrier to implementation is the tremendous financial and operational burden if paramedics require prolonged ultrasound training courses. In this study, we conducted a double-blinded observational study comparing the accuracy of paramedic-performed FAST versus physician-performed tests on a sonographic Phantom, after a one-hour didactic training session. Methods: The interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model. The mannequin utilized in this study was a realistic model of a human torso where fluid could be injected into the abdomen to create a realistic ultrasound image of abdominal free fluid. Participants were required to scan the mannequin twice, once with 300 mL of fluid instilled and once with the abdomen free of fluid. Participants were blinded to the status of hemoperitoneum. The primary outcome of the study was accuracy rate of FAST examination by paramedics compared to emergency room physicians. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05. Total scan time was reported using means, standard deviations and 95% CIs and was compared between groups using standard t-test. Results: Fourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were ultrasound-naive whereas the emergency physicians had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups 85.6% and 87.5% (Δ1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively. Total scan time differed between groups but did not reach statistical significance. Paramedics took longer to complete the FAST examination with a mean (SD) time to complete the two scans of 10.35 (3.43) minutes compared to 7.34 (2.74) minutes for physicians, (Δ3.01 minutes 95%CI -0.97 to 7.00, p = 0.13). Conclusion: This study determined that critical care paramedics were able use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of ultrasound in prehospital programs to determine the most appropriate transport destination and aid in the triage of trauma patients while limiting the financial and logistical burden of ultrasound training.

Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S62-S66
Author(s):  
Bradley Waterman ◽  
Kristine Van Aarsen ◽  
Michael Lewell ◽  
Homer Tien ◽  
Frank Myslik ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Session ◽  
Ultrasound Image ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Didactic Training ◽  
Training Course ◽  
Fast Exam

AbstractBackgroundThe Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session.MethodsThe interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05.ResultsFourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were mostly ultrasound-naive whereas the emergency physicians all had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups with accuracy of 85.6% and 87.5% (∆1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively.ConclusionsThis study determined that critical care paramedics were able to use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of prehospital ultrasound to aid in the triage and transport decisions of trauma patients while limiting the financial and logistical burden of ultrasound training.

scholarly journals Ability of Critical Care Medics to Confirm Endotracheal Tube Placement by Ultrasound

2020 ◽  
Vol 35 (6) ◽  
pp. 629-631
Author(s):  
Michael Joyce ◽  
Jordan Tozer ◽  
Michael Vitto ◽  
David Evans
Keyword(s):  
Critical Care ◽  
Endotracheal Tube ◽  
Life Support ◽  
Point Of Care ◽  
Training Session ◽  
Tube Placement ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Endotracheal Tube Placement ◽  
Bronchial Intubation

AbstractIntroduction:The Advanced Cardiac Life Support (ACLS) guidelines were recently updated to include ultrasound confirmation of endotracheal tube (ETT) location as an adjunctive tool to verify placement. While this method is employed in the emergency department under the guidance of the most recent American College of Emergency Physicians (ACEP; Irving, Texas USA) guidelines, it has yet to gain wide acceptance in the prehospital setting where it has the potential for greater impact. The objective of this study to is determine if training critical care medics using simulation was a feasible and reliable method to learn this skill.Methods:Twenty critical care paramedics with no previous experience with point-of-care ultrasound volunteered for advanced training in prehospital ultrasound. Four ultrasound fellowship trained emergency physicians proctored two three-hour training sessions. Each session included a brief introduction to ultrasound “knobology,” normal sonographic neck and lung anatomy, and how to identify ETT placement within the trachea or esophagus. Immediately following this, the paramedics were tested with five simulated case scenarios using pre-obtained images that demonstrated a correctly placed ETT, an esophageal intubation, a bronchial intubation, and an improperly functioning ETT. Their accuracy, length of time to respond, and comfort with using ultrasound were all assessed.Results:All 20 critical care medics completed the training and testing session. During the five scenarios, 37/40 (92.5%) identified the correct endotracheal placements, 18/20 (90.0%) identified the esophageal intubations, 18/20 (90.0%) identified the bronchial intubation, and 20/20 (100.0%) identified the ETT malfunctions correctly. The average time to diagnosis was 10.6 seconds for proper placement, 15.5 seconds for esophageal, 15.6 seconds for bronchial intubation, and 11.8 seconds for ETT malfunction.Conclusions:The use of ultrasound to confirm ETT placement can be effectively taught to critical care medics using a short, simulation-based training session. Further studies on implementation into patient care scenarios are needed.

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽  
2017 ◽  
Vol 2 (2) ◽  
pp. 15-17
Author(s):  
Rimi Sambi, MD ◽  
Heather Sawula, MD ◽  
Brent Wolfrom, MD ◽  
Joseph Newbigging, MD
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Point Of Care ◽  
Training Session ◽  
Undergraduate Curriculum ◽  
Knowledge Retention ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Medical Undergraduate ◽  
Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

scholarly journals Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

2018 ◽  
Vol 27 (2) ◽  
pp. 79-86
Author(s):  
Nalan Kozaci ◽  
Mustafa Avci ◽  
Gul Tulubas ◽  
Ertan Ararat ◽  
Omer Faruk Karakoyun ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Physician ◽  
Gold Standard ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Abdominal Ultrasonography

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

scholarly journals Sepsis Code: dodging mortality in a tertiary hospital

2021 ◽  
Author(s):  
Rosa Méndez ◽  
Angels Figuerola ◽  
Marta Chicot ◽  
Ana Barrios ◽  
Natalia Pascual ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Health Personnel ◽  
Analytical Study ◽  
Statistical Significance ◽  
Tertiary Hospital ◽  
Critical Care Units ◽  
Multidisciplinary Group ◽  
Sepsis And Septic Shock ◽  
The Impact

Background. In the hospital of La Princesa, the “Sepsis Code” (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. Material and methods. A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. Results. We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines. Conclusions. The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

Carbohydrate mouth rinsing improves resistance training session performance

2018 ◽  
Vol 13 (5) ◽  
pp. 804-809 ◽  
Author(s):  
Luciana S Decimoni ◽  
Victor M Curty ◽  
Livia Almeida ◽  
Alexander J Koch ◽  
Jeffrey M Willardson ◽  
...  
Keyword(s):  
Resistance Exercise ◽  
Exercise Performance ◽  
Repeated Measures ◽  
Perceived Exertion ◽  
Bench Press ◽  
Statistical Significance ◽  
Training Session ◽  
Rating Of Perceived Exertion ◽  
Double Blind ◽  
Mouth Rinsing

We investigated the effect of carbohydrate mouth rinsing on resistance exercise performance. Fifteen recreationally trained women (age 26 ± 4 y; height 1.61.9 ± 5.1 m; weight 59.5 ± 8.2 kg) completed two resistance exercise bouts consisting of three sets of five exercises (half-squat, leg press, bench press, military press, and seated row) to volitional fatigue with a 10 repetition-maximum load. Immediately prior to and during the middle of each exercise bout, subjects mouth rinsed for 10 s with 100 mL of either a 6% maltodextrin solution (CHO) or an artificially flavored solution (PLA) in a randomized, double-blind, counterbalanced fashion. Heart rate and perceived exertion were compared between conditions using a 2 (conditions) × 15 (time points) repeated measures ANOVA. Significant main effects were further analyzed using pairwise comparisons with Bonferroni post hoc tests. Total volume (exercises * sets * repetitions * load) between sessions was compared with a Student’s t-test. Statistical significance was set at p ≤ 0.05 level of confidence. The CHO resulted in more repetitions performed during half-squat, bench press, military press, and seated row, for a significantly greater (∼12%) total volume load lifted versus PLA ( p = 0.039, ES: 0.49). Rating of perceived exertion was also significantly lower in the CHO versus PLA ( p = 0.020, ES: 0.28). These data indicate that CHO mouth rinsing can enhance high-volume resistance exercise performance and lower ratings of perceived exertion.

scholarly journals Emergency physicians in critical care: where are we now?

2020 ◽  
Vol 1 (5) ◽  
pp. 1062-1070
Author(s):  
Samantha S. Strickler ◽  
Daisi J. Choi ◽  
Daniel J. Singer ◽  
John M. Oropello
Keyword(s):  
Critical Care ◽  
Emergency Physicians

A call for critical care training of emergency physicians

2002 ◽  
Vol 39 (5) ◽  
pp. 562-563 ◽  
Author(s):  
Tiffany M. Osborn ◽  
Thomas M. Scalea
Keyword(s):  
Critical Care ◽  
Emergency Physicians ◽  
Care Training

scholarly journals Mechanical circulatory assist devices: a primer for critical care and emergency physicians

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Ayan Sen ◽  
Joel S. Larson ◽  
Kianoush B. Kashani ◽  
Stacy L. Libricz ◽  
Bhavesh M. Patel ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Physicians ◽  
Assist Devices ◽  
Circulatory Assist Devices

Pneumatosis Intestinalis in Patients Receiving Tube Feeds

2017 ◽  
Vol 83 (8) ◽  
pp. 825-831
Author(s):  
Alexander C. Cavalea ◽  
Robert E. Heidel ◽  
Brian J. Daley ◽  
Christy M. Lawson ◽  
Darrell A. Benton ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Tube Feeding ◽  
Pneumatosis Intestinalis ◽  
Bowel Function ◽  
Feeding Tube ◽  
Outcome Data ◽  
Free Fluid ◽  
Feeding Intolerance ◽  
Lactic Acidemia ◽  
Bowel Dilatation

Pneumatosis intestinalis (PI) identified on computed tomography (CT) suggests an underlying pathology including bowel ischemia. Patients receiving tube feeds can develop PI, potentially requiring surgical intervention. We identify clinical factors in PI to predict those that may be safe to observe versus those that need immediate intervention. We retrospectively reviewed patients from a single institution from 2008 to 2016 with CT findings of PI and an enteric feeding tube. Patients who had not received tube feeds within one week of the CT were excluded. We analyzed clinical, operative, and outcome data to differentiate benign from pathologic outcomes. P values < 0.05 were set as significant. Forty patients were identified. We classified 24 as benign (no intervention) and 16 as pathologic (requiring intervention). A pathologic outcome was demonstrated for free fluid on CT [odds ratio (OR) = 5.00, confidence interval (CI) 1.23-20.30, P = 0.03)], blood urea nitrogen (BUN) elevation (OR = 8.27, CI 1.53-44.62, P = 0.01), creatinine (Cr) elevation (OR = 5.00, CI 1.27-19.62, P = 0.02), BUN/Cr ratio >30 (OR = 8.57, CI 1.79-40.98, P = 0.006), and vomiting/ feeding intolerance (OR = 9.38, CI 1.64-53.62, P = 0.01). Bowel function within 24 hours of the CT, bowel dilatation (small ≥ 3 cm; large ≥6 cm), and lactic acidemia were not significant. Peritonitis was only seen in pathologic states, but this did not reach statistical significance (P = 0.06). This represents the largest single-center retrospective analysis of tube feeding-induced PI to date. The presence of free fluid on CT, BUN and Cr elevation, BUN/Cr >30, vomiting/feeding intolerance and peritonitis were predictive of a pathologic etiology of PI.

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