Quality of abdominal ultrasound image acquisition by novice practitioners following a minimal training session on healthy volunteers

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S74-S78
Author(s):  
Bradley Waterman ◽  
Kristine Van Aarsen ◽  
Michael Lewell ◽  
Frank Myslik ◽  
Michael Peddle ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Healthy Volunteers ◽  
Training Session ◽  
Abdominal Ultrasound ◽  
Point Of Care Ultrasound ◽  
Ultrasound Images ◽  
Didactic Training ◽  
Hands On

ABSTRACTBackgroundPoint of care ultrasound (POCUS) is an essential tool for physicians to guide treatment decisions in both hospital and prehospital settings. Despite the potential patient care and system utilization benefits of prehospital ultrasound, the financial burden of a “hands-on” training program for large numbers of paramedics remains a barrier to implementation. In this study, we conducted a prospective, observational, double-blinded study comparing paramedics to emergency physicians in their ability to generate usable abdominal ultrasound images after a 1-hour didactic training session.MethodsCanadian aeromedical critical care paramedics were compared against emergency medicine physicians in their ability to generate adequate abdominal ultrasound images on five healthy volunteers. Quality of each scan was evaluated by a trained expert in POCUS who was blinded to the identity of the participant using a 5-point Likert scale and using the standardized QUICk Focused Assessment with Sonography in Trauma (FAST) assessment tool.ResultsFourteen Critical care paramedics and four emergency department (ED) physicians were voluntarily recruited. Of paramedics, 57% had never used ultrasound before, 36% has used ultrasound without formal training, and 7% had previous training. Physicians had a higher proportion of usable scans compared with paramedics (100% v. 61.4%, Δ38.6%; 95% confidence interval, 19.3–50.28).ConclusionsParamedics were not able to produce images of interpretable quality at the same frequency when compared with emergency medicine physicians. However, a 61.4% usable image rate for paramedics following a short 1-hour didactic training session is promising for future studies, which could incorporate a short hands-on tutorial while remaining cost-effective.

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 MP21: A brief educational session is effective for teaching emergency medicine residents resuscitative transesophageal echocardiography

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S49-S50
Author(s):  
J. Chenkin ◽  
T. Jelic ◽  
E. Hockmann
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Transesophageal Echocardiography ◽  
Success Rate ◽  
Transfer Test ◽  
Correct Diagnosis ◽  
Training Session ◽  
Skill Assessment ◽  
High Fidelity ◽  
Ultrasound Images

Innovation Concet: Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively new ultrasound application that has the potential to guide the management of critically ill patients in the emergency department. The objective of this study was to determine the effectiveness of a brief training workshop for teaching a resuscitative TEE protocol to emergency medicine residents using a high-fidelity simulator. Methods: Emergency medicine residents with no prior TEE experience that were rotating through a university-affiliated emergency department were invited to participate in the study. Participants completed a questionnaire and baseline skill assessment using a high-fidelity simulator. The training session included a 20 minute lecture followed by 10 simulated repetitions of a 5-view TEE sequence with instructor feedback. Learning was evaluated by a skill assessment immediately after training and a transfer test 1-2 weeks after the training session. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. The primary outcome of this study was the percentage of successful views before and after training as determined by two blinded reviewers using an anchored scoring tool. Secondary outcomes included time to scan completion and diagnostic accuracy on the transfer test. Assessment scores were compared using a two-tailed t-test. Curriculum, Tool or Material: 22 of 25 (88%) of invited residents agreed to participate in the study. Percentage of successful views increased from 44.5% (SD 27.9) at baseline to 98.6% (SD 3.5) after training (p &lt; 0.001), and was 86.8% (SD 12.1) on transfer testing (p &lt; 0.001). Time to complete the scan was 330 seconds at baseline, 125 seconds after training (p &lt; 0.001), and 184 seconds (p &lt; 0.001) in the transfer test. Participants made the correct diagnosis in 75% (SD 25.6) of the cases in the simulated patient encounter. The descending aorta view had the highest success rate (93.2%) and the midesophageal long axis view had the lowest success rate (75.0%). Conclusion: A brief simulation-based workshop was effective for teaching emergency medicine residents a five-view resuscitative TEE protocol. Future studies are needed to determine optimal methods for long-term skill retention.

scholarly journals Cardiac Point-of-Care Ultrasound Publication Trends

2021 ◽  
Author(s):  
Andrew Pattock ◽  
Michelle Kim ◽  
Cooper Kersey ◽  
Linda Liu ◽  
James Kirkpatrick ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Point Of Care ◽  
Temporal Trends ◽  
Senior Author ◽  
Annual Number ◽  
Original Research ◽  
Point Of Care Ultrasound ◽  
Publication Type ◽  
Over Time

Introduction: Cardiac point-of-care ultrasound (c-POCUS) is an increasingly implemented diagnostic tool with the potential to guide clinical management. We sought to characterize and analyze the existing c-POCUS literature with a focus on the temporal trends and differences across specialties. Methods: A literature search for c-POCUS and related terms was conducted using Ovid (MEDLINE and Embase) and Web of Science databases through 2020. Eligible publications were classified by publication type and topic, author specialty, geographical region of senior author, and journal specialty. Results: The initial search produced 1761 potential publications. A strict definition of c-POCUS yielded a final total of 574 cardiac POCUS manuscripts. A yearly increase in c-POCUS publications was observed. Nearly half of publications were original research (48.8%) followed by case report or series (22.8%). Most publications had an emergency medicine senior author (37.5%), followed by cardiology (20.2%), anesthesiology (12.2%), and critical care (12.2%). The proportion authored by emergency medicine and cardiologists has decreased over time while those by anesthesiology and critical care has generally increased, particularly over the last decade. First authorship demonstrated a similar trend. Articles were published at similar numbers in emergency medicine journals (23.0%) and cardiology journals (19.9%). Conclusion: The annual number of c-POCUS publications has steadily increased over time reflecting the increased recognition and utilization of c-POCUS. This study can help inform clinicians of the current state of c-POCUS and augment the discussion surrounding barriers to continued adoption across all specialties.

scholarly journals LO090: Introduction of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S61-S61
Author(s):  
C. Hrymak ◽  
C. Pham
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Educational Module ◽  
Ultrasound Education ◽  
Didactic Teaching ◽  
Video Clips ◽  
Simulation Based ◽  
Hands On ◽  
Future Direction

Introduction / Innovation Concept: Expanding point of care ultrasound education in emergency medicine (EM) programs is a necessary part of curriculum development. Our objective was to integrate core and advanced applications for point of care ultrasound in caring for critically ill patients with undifferentiated shock. We chose to develop and implement an educational module using the systematic approach of the RUSH Exam for EM residents in our institution. Methods: After review of the literature in point-of-care ultrasound, a module was designed. An educational proposal outlining the RUSH Exam training within the -EM and CCFP-EM curricula was submitted to and accepted by the residency training committee. The objectives and goals were outlined in accordance with CanMEDS roles, and the ultrasound director provided supervision for the project. Curriculum, Tool, or Material: An 8-hour educational module was implemented between October 7 and November 18, 2014. All residents received formal training on the core applications in FAST and aortic scans prior to implementation. The following components of the RUSH Exam were included: two hours of didactic teaching with video clips on advanced cardiac, IVC, DVT, and pulmonary assessment; three hours of hands-on practice on standardized patients performed in the simulation lab to practice image acquisition and interpretation; one hour of didactic teaching on the overall approach to a patient with undifferentiated shock using the RUSH Exam; and two hours of hands-on RUSH Exam practice. A corresponding research project integrating a SonoSim Livescan training platform, a simulation-based testing device, demonstrated improvement in resident performance, subjective comfort with imaging patients in shock and making clinical decisions based on the findings. Conclusion: This 8-hour RUSH Exam educational module combined theoretical learning and hands-on practice for trainees. This module significantly broadened the scope of ultrasound training in our curriculum by providing the necessary skills in approaching patients in shock in a systematic fashion. Future direction will include ongoing education in this area and expansion as appropriate.

Fifteen-minute consultation: Using point of care ultrasound to assess children with respiratory failure

2018 ◽  
Vol 104 (1) ◽  
pp. 2-10 ◽  
Author(s):  
Helen L Ord ◽  
Michael J Griksaitis
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Respiratory Failure ◽  
Respiratory Distress ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Diagnostic Features ◽  
Paediatric Practice ◽  
The Impact ◽  
Indications For Use

Point of care ultrasound (POCUS) is well established in adult emergency medicine and critical care. It is used for immediate diagnosis and evaluation of the impact of bedside interventions in the acutely unwell child. This article highlights how ultrasound can be helpful in paediatric practice when dealing with the neonate, infant or older child with undifferentiated respiratory distress, respiratory failure or ventilation problems. It highlights indications for use, key diagnostic features of common pathology and outlines the benefits of POCUS in everyday practice.

Introduction and clinical scenarios

2019 ◽  
pp. 1-32
Author(s):  
Paul Atkinson ◽  
Bob Jarman ◽  
Tim Harris ◽  
Rip Gangahar ◽  
David Lewis ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Clinical Skills ◽  
Point Of Care ◽  
Clinical Care ◽  
Critical Care Medicine ◽  
Everyday Practice ◽  
Point Of Care Ultrasound ◽  
Clinical Scenarios ◽  
Clinical Questions

Point-of-Care Ultrasound in Emergency Medicine and Resuscitation provides a curriculum-based guide to the integration of ultrasound into everyday practice for clinicians in emergency medicine and critical care medicine and for resuscitation. In addition to describing commonly used protocols, we focus on how ultrasound can be used to help to answer specific clinical questions and provide guidance for procedures at the point of care, augmenting traditional clinical skills. This chapter introduces the general concepts of using ultrasound at the bedside, describes how to use point-of-care ultrasound (PoCUS), and provides clinical scenarios as examples of where PoCUS can improve clinical care.

scholarly journals LO092: The educational impact of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S61-S62
Author(s):  
C. Hrymak ◽  
E. Weldon ◽  
C. Pham
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Image Acquisition ◽  
Image Interpretation ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Educational Impact ◽  
Hands On ◽  
Before And After ◽  
Junior Residents

Introduction: Point of care ultrasound for assessment of undifferentiated hypotension and shock is part of the clinical scope of Emergency Physicians in Canada. The RUSH Exam outlines a systematic approach to these patients. A RUSH Exam educational model using didactic and hands on practice was developed and implemented for Emergency Medicine (EM) residents. This study evaluated the effectiveness of the module in a simulated setting on the following endpoints: improvement in image acquisition, interpretation, speed, and subjective comfort level, among EM residents with basic ultrasound training. Methods: Approval was received from the institutional health research ethics board for this before and after simulation study. Residents in the -EM Program or CCFP-EM Program from July 2014 to July 2015 were eligible to consent. Participants were excluded if they were unable to complete all portions. All residents were educated to the same level of introductory ultrasound training based on the curriculum in place at our institution. The 8-hour intervention included RUSH didactic and hands on small group sessions. Testing before and after the intervention was performed with the SonoSim Livescan training platform. Two evaluators scored each resident on the accuracy of image acquisition, image interpretation, and time to scan completion. A before and after survey assessed resident comfort level with performing ultrasound on an emergency patient in shock, and basing decisions on ultrasound findings. Statistical analysis was performed using McNemar’s test for image acquisition and interpretation, a paired T test for time, and the Bahpkar test for the questionnaire. Results: 16 EM residents including 11 senior residents and 5 junior residents were enrolled. Improvement was achieved in the categories of IVC image acquisition and interpretation, as well as interpretation for B-lines, lung sliding, cardiac apical and parasternal long axis, and DVT (p<0.05). Subjective comfort level of performing ultrasound in shock and basing decisions on the findings was increased (p<0.0001). Among junior residents, there was an increased speed of image acquisition. Conclusion: With the introduction of the RUSH Exam educational module, EM residents showed improved image acquisition, image interpretation, speed, and comfort level when using ultrasound in critically ill patients.

scholarly journals Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy: Case report

2018 ◽  
Vol 18 (2) ◽  
pp. 219 ◽  
Author(s):  
Mohamad Iqhbal ◽  
Julina M. Noor ◽  
Nur A. Karim ◽  
Izzat Ismail ◽  
Halim Sanib ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Critical Care ◽  
Case Report ◽  
Imaging Technique ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Vocal Cords ◽  
Emergency Tracheostomy ◽  
Airway Ultrasound

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.Keywords: Emergency Medicine; Stridor; Ultrasonography; Airway Management; Tracheostomy; Case Report; Malaysia.

scholarly journals National Survey of Point-of-Care Ultrasound Scholarly Tracks in Emergency Medicine Residency Programs

2021 ◽  
Vol 22 (5) ◽  
pp. 1095-1101
Author(s):  
Stephen Alerhand ◽  
Elaine Situ-Lacasse ◽  
Christine Ramdin ◽  
Michael Gottlieb
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Survey Study ◽  
Point Of Care Ultrasound ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Residency Programs ◽  
The Past ◽  
Current Prevalence ◽  
Hands On

Introduction: Residency scholarly tracks are educational programs, designed to help trainees develop an area of expertise. Although the breadth of residency point-of-care ultrasound (POCUS) education has developed considerably in recent years, there is no literature to date describing scholarly tracks specifically in POCUS. In this study we sought to determine the prevalence, characteristics, and outcomes of POCUS scholarly tracks in emergency medicine (EM). Methods: This was a cross-sectional survey of EM residency programs accredited by the Accreditation Council for Graduate Medical Education. Surveys were distributed between March-August 2020 using a listserv followed by targeted emails to residency and ultrasound leadership. We summarized data using descriptive statistics, and performed logistic regression to identify factors associated with a POCUS scholarly track. Results: Of 267 residency programs 199 (74.5%) completed the survey. Fifty-seven (28.6%) had a POCUS scholarly track as of the 2019-2020 academic year. Scholarly tracks in POCUS were more common in university-based/academic sites and larger residency programs. Of the 57 programs with POCUS scholarly tracks, 48 (84.2%) required residents to present at least one POCUS lecture, 45 (78.9%) required residents to serve as instructor at a hands-on workshop, and 42 (73.7%) required residents to participate in quality assurance of departmental POCUS scans. Only 28 (49.1%) tracks had a structured curriculum, and 26 (45.6%) required POCUS research. In total, 300 EM residents completed a POCUS scholarly track over the past three academic years, with a median of 4 (2-9) per program. Seventy-five (25.0%) proceeded to a clinical ultrasound fellowship after residency graduation, with a median of 1 (interquartile range 0-2) per program. A total of 139 POCUS-specific abstracts (median 2 [0-3]) and 80 peer-reviewed manuscripts (median 1 [0-2]) were published by scholarly track residents over the past three years. Conclusion: This survey study describes the current prevalence, characteristics, and outcomes of POCUS scholarly tracks across EM residency programs. The results may inform the decisions of residency programs to create these tracks.

scholarly journals Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Situ-LaCasse ◽  
Josie Acuña ◽  
Dang Huynh ◽  
Richard Amini ◽  
Steven Irving ◽  
...  
Keyword(s):  
Medical Students ◽  
Point Of Care ◽  
Image Acquisition ◽  
Positive Association ◽  
Point Of Care Ultrasound ◽  
Ultrasound Images ◽  
Psychomotor Skills ◽  
Median Score ◽  
Hands On ◽  
A Prospective Study

Abstract Background Point-of-care ultrasound is becoming a ubiquitous diagnostic tool, and there has been increasing interest to teach novice practitioners. One of the challenges is the scarcity of qualified instructors, and with COVID-19, another challenge is the difficulty with social distancing between learners and educators. The purpose of our study was to determine if ultrasound-naïve operators can learn ultrasound techniques and develop the psychomotor skills to acquire ultrasound images after reviewing SonoSim® online modules. Methods This was a prospective study evaluating first-year medical students. Medical students were asked to complete four SonoSim® online modules (aorta/IVC, cardiac, renal, and superficial). They were subsequently asked to perform ultrasound examinations on standardized patients utilizing the learned techniques/skills in the online modules. Emergency Ultrasound-trained physicians evaluated medical students’ sonographic skills in image acquisition quality, image acquisition difficulty, and overall performance. Data are presented as means and percentages with standard deviation. All P values are based on 2-tailed tests of significance. Results Total of 44 medical students participated in the study. All (100%) students completed the hands-on skills evaluation with a median score of 83.7% (IQR 76.7–88.4%). Thirty-three medical students completed all the online modules and quizzes with median score of 87.5% (IQR 83.8–91.3%). There was a positive association between module quiz performance and the hands-on skills performance (R-squared = 0.45; p < 0.001). There was no statistically significant association between module performance and hands-on performance for any of the four categories individually. In all four categories, the evaluators’ observation of the medical students’ difficulty obtaining views correlated with hands-on performance scores. Conclusions Our study findings suggest that ultrasound-naïve medical students can develop basic hands-on skills in image acquisition after reviewing online modules.

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