Corneal Laceration and Penetrating Injuries

The goal of this in-the-wild study was to understand how different patient, provider, and environment contexts affected the use of a tablet-based checklist in a dynamic medical setting. Fifteen team leaders used the digital checklist in 187 actual trauma resuscitations. The measures of checklist interactions included the number of unchecked items and the number of notes written on the checklist. Of the 10 contexts we studied, team leaders’ arrival after the patient and patients with penetrating injuries were both associated with more unchecked items. We also found that the care of patients with external injuries contributed to more notes written on the checklist. Finally, our results showed that more experienced leaders took significantly more notes overall and more numerical notes than less experienced leaders. We conclude by discussing design implications and steps that can be achieved with context-aware computing towards adaptive checklists that meet the needs of dynamic use contexts.

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Comparison of Simulation-Based versus Cadaveric-Tissue-Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Corneal Laceration Model

Journal of Academic Ophthalmology ◽

10.1055/s-0041-1725093 ◽

2021 ◽

Vol 13 (01) ◽

pp. e57-e65

Author(s):

Boonkit Purt ◽

Timothy Ducey ◽

Sean Sykes ◽

Joseph F. Pasternak ◽

Denise S. Ryan ◽

...

Keyword(s):

Primary Outcome ◽

Wound Closure ◽

Ocular Trauma ◽

Controlled Trial ◽

Preliminary Evaluation ◽

Skills Acquisition ◽

Visual Axis ◽

Significant Difference ◽

Skills Laboratory ◽

Corneal Laceration

Abstract Purpose The aim of this study was to evaluate whether the simulated tissue models may be used in place of animal-based model for corneal laceration repair for surgical skills acquisition. Design Prospective randomized controlled trial. Participants Seventy-nine military and civilian 2nd- and 3rd-year ophthalmology residents and 16 staff ophthalmologists participating in the Tri-Service Ocular Trauma Skills Laboratory at the Uniformed Services University (Bethesda, MD). Methods Resident ophthalmologists underwent preliminary evaluation of their ability to close a 5-mm linear, full-thickness corneal laceration involving the visual axis. They then were randomized to undergo 90 to 120 minutes of either simulator-based (SIM) or swine cadaveric-tissue-based (CADAVER) corneal laceration repair. The same evaluation was performed post training. On a more limited basis, the study was repeated for attending ophthalmologists to act as a pilot for future analysis and test efficacy for “refresher” training. Main Outcome Measures Successful wound closure with secondary outcomes of suture length, tension, depth, and orientation, as graded by attending ophthalmologists. Results No significant difference in CADAVER versus SIM groups in the primary outcome of watertight wound closure of the corneal laceration. CADAVER group performed better than SIM group for certain metrics (suture depth, p = 0.009; length, p = 0.003; and tension, p = 0.043) that are associated with poor wound closure and increased amount of induced corneal astigmatism. For attending ophthalmologists, six of the eight in each group (SIM and CADAVER) retained or improved their skills. Conclusions For resident ophthalmologists, SIM training is sufficient for achieving the primary outcome of watertight wound closure. However, CADAVER training is superior for wound metrics for the ideal closure. For attending ophthalmologists, SIM training may be useful for retention of skills.

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Unusual Transoral Penetrating Injury of the Foramen Magnum: Case Report

Neurosurgery ◽

10.1227/01.neu.0000084081.61681.8b ◽

2003 ◽

Vol 53 (4) ◽

pp. 989-991 ◽

Cited By ~ 5

Author(s):

Bradley J. Bartholomew ◽

Charla Poole ◽

Emilio C. Tayag

Keyword(s):

Cerebrospinal Fluid ◽

Unusual Case ◽

Spinal Injury ◽

Foramen Magnum ◽

Penetrating Injuries ◽

Computed Tomographic ◽

Foreign Objects ◽

Computed Tomographic Scan ◽

Posterior Pharynx ◽

The Right

Abstract OBJECTIVE AND IMPORTANCE Penetrating injuries of the cranium and spine are frequent to the civilian neurosurgical practice. Although a variety of unusual objects have been reported, to our knowledge, there has never been a craniocerebral or spinal injury caused by a fish. An unusual case of transoral penetration of the foramen magnum by a billed fish is described. The history, radiographic studies, and treatment are presented. CLINICAL PRESENTATION A fisherman struck by a jumping fish initially presented with severe neck pain and stiffness, bleeding from the mouth, and a laceration in the right posterior pharynx. A computed tomographic scan of the cervical spine revealed a wedge-shaped, hyperdense object extending from the posterior pharynx into the spinal canal between the atlas and the occiput. Because of the time factor involved, the fisherman was brought directly to surgery for transoral removal of the object. INTERVENTION The patient was placed under general anesthesia, and with a tonsillar retractor, a kipner, and hand-held retractors, the object was visualized and identified as a fish bill. Further dissection above the anterior aspect of the atlas permitted removal of the object by means of a grabber from an arthroscopic set. No expression of cerebrospinal fluid was noted, and a Penrose drain was placed. CONCLUSION The patient was treated under the assumption that penetrating foreign objects in continuity with the cerebrospinal fluid space and the outside environment should be removed as soon as possible. The patient was provided appropriate antibiotics to treat potential infection of normal pharyngeal flora and organisms unique to the marine environment. The patient recovered and did not experience any residual neurological deficit.

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