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 < 0.001), and was 86.8% (SD 12.1) on transfer testing (p < 0.001). Time to complete the scan was 330 seconds at baseline, 125 seconds after training (p < 0.001), and 184 seconds (p < 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 LO23: A brief educational session is effective for teaching emergency medicine residents resuscitative transesophageal echocardiography

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S35
Author(s):  
J. Chenkin ◽  
E. Hockmann
Keyword(s):  
Emergency Medicine ◽  
Image Quality ◽  
Transesophageal Echocardiography ◽  
Confidence Level ◽  
Transfer Test ◽  
Rating Scale ◽  
Training Session ◽  
Skill Assessment ◽  
Brief Training ◽  
The Mean

Introduction: 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 simulator. Methods: Emergency medicine residents with no prior TEE experience from a university-affiliated hospital 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. Secondary outcomes included confidence level, image quality, percentage of correct diagnoses, and efficiency of movement. Assessment scores were compared using a two-tailed t-test. Results: 10 of 11 (91%) of invited residents agreed to participate in the study. Confidence level on a 10-point numeric rating scale (NRS) increased from a baseline of 1.0 (SD 0) to 7.0 (SD 1.9) after training (p<0.01). The mean duration between training and transfer test was 9.6 days (SD 1.9). The percentage of successful views increased from 44% at baseline to 100% after training, and 90% on the transfer test (p<0.01). The mean image quality on a 5-point scale was 2.2 (SD 1.0) at baseline, 3.8 (SD 0.7) after training (p<0.01), and 3.1 (SD 0.6) on the transfer test (p<0.01). The mean number of transducer accelerations were 524 (SD 202) at baseline, 219 (SD 54) after training (p<0.01), and 400 (SD 149) on the transfer test (p=0.13). Participants made the correct diagnosis in 70% of cases on the transfer test. Conclusion: After a brief training session using a simulator, emergency medicine residents were able to generate adequate TEE images on a delayed transfer test. Future studies are needed to determine effective strategies for maintaining motion efficiency and imaging quality.

scholarly journals P018: Blocked practice outperforms random practice for learning resuscitative transesophageal echocardiography: a randomized controlled trial

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S63-S63
Author(s):  
J. Chenkin ◽  
R. Brydges ◽  
T. Jelic ◽  
E. Hockmann
Keyword(s):  
Emergency Medicine ◽  
Image Quality ◽  
Transesophageal Echocardiography ◽  
Confidence Level ◽  
Transfer Test ◽  
Controlled Trial ◽  
Skill Assessment ◽  
Ultrasound Images ◽  
Point Scale ◽  
Scan Time

Introduction: Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively new ultrasound application, however the optimal teaching methods have not been determined. Previous studies have demonstrated that random practice (RP), which increases the variability of training, may improve learning of procedural skills compared with blocked practice (BP). We compared RP and BP for teaching a resuscitative TEE protocol to emergency medicine residents using a simulator. Methods: We recruited emergency medicine residents with no prior TEE experience from a university-affiliated hospital. Participants completed a questionnaire and baseline skill assessment on a simulator, then were randomized to one of two groups. The BP group completed 10 repetitions of a fixed 5-view TEE sequence with instructor feedback, while the RP group completed 10 different random 5-view TEE sequences with feedback. Participants completed a simulation-based performance assessment immediately, and a transfer test consisting of a simulated patient encounter 1-2 weeks after training. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. Our primary outcome was the percentage of successful views on the transfer test, and secondary outcomes included participants confidence level, image quality, percentage of correct diagnoses, and efficiency of movement. We compared all scores using two-tailed, independent samples t-tests. Results: 22 participants completed the study (11 in the RP group, 11 in the BP group). There were no significant baseline differences between the groups. The BP group had a higher rate of successful views compared with the RP group on the transfer test (92.7% vs 80.9%, p=0.02). While not statistically significant, the BP group had higher image quality on a 5-point scale (3.2 vs 2.9, p=0.09), and fewer probe accelerations (297 vs 403, p=0.09). The groups did not differ in rate of correct diagnoses (77.3% vs 72.7%, p=0.73), confidence level on a 10-point scale (6.2 vs 6.2, p=1.0), or scan time (173 vs 199 seconds, p=0.28). Conclusion: Emergency medicine residents randomized to BP had a higher success rate on a transfer test, compared to RP when learning resuscitative TEE using a simulator. We consider this pilot work that can inform future studies in both simulation and real clinical settings.

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.

scholarly journals Simulator-based training for learning resuscitative transesophageal echocardiography

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 523-526 ◽  
Author(s):  
Jordan Chenkin ◽  
Edgar Hockmann ◽  
Tomislav Jelic
Keyword(s):  
Emergency Medicine ◽  
Transesophageal Echocardiography ◽  
Training Session ◽  
Skill Retention ◽  
Guided Practice ◽  
Simulation Based ◽  
Didactic Lecture ◽  
Transfer Testing ◽  
Scoring Tool

ABSTRACTObjectivesTransesophageal echocardiography (TEE) is a relatively new resuscitation tool in the emergency department. Recent studies have demonstrated that it can impact diagnosis and management of critically ill patients. The objective of this study is to determine the effectiveness of a simulation-based curriculum for teaching emergency medicine residents a five-view TEE protocol.MethodsEmergency medicine residents with previous ultrasound experience were invited to attend a 1-hour TEE training session. The training consisted of a didactic lecture followed by guided practice on a simulator. Performance was measured prior to training, after the training session, and by a transfer test 1 to 2 weeks after training. The primary outcome was the percentage of successful image generation using a scoring tool by two blinded reviewers.ResultsTwenty-two residents completed the study. The percentage of successful views increased from 44.5% (SD 27.9) at baseline to 98.6% (SD 3.5) after training (p < 0.001), and was 86.8% (SD 12.1) on transfer testing (p < 0.001).ConclusionA brief simulation-based teaching session 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.

Signs and Symptoms

2019 ◽  
pp. 1-42
Author(s):  
Danielle Holtz
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Pattern Recognition ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Age And Gender ◽  
Disease States ◽  
And Gender

Patients present to the emergency department (ED) every day with a constellation of signs and symptoms. It is the emergency medicine physician’s job to recognize these signs and symptoms and make the correct diagnosis. Pattern recognition is essential in emergency medicine. This chapter presents questions that cover a wide variety of classic disease states and conditions that may be seen in the ED. Photographs, radiologic images, and electrocardiograms are provided for some of the questions to aid in diagnosis. Risk factors and associations, including the patient’s age and gender, are included and can offer clues to certain disease processes for which a patient may be at more risk.

ECHOCARDIOGRAPHY PREDICTORS OF SUCCESSFUL MITRAL VALVE REPAIR IN DEGENERATIVE MITRAL VALVE REGURGITATION

2015 ◽  
pp. 77-82
Author(s):  
Ba Minh Du Le ◽  
Anh Vu Nguyen ◽  
Duc Phu Bui
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Success Rate ◽  
Mitral Valve Repair ◽  
Transthoracic Echocardiography ◽  
Mitral Valve Prolapse ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
Mitral Repair ◽  
Fibroelastic Deficiency

Background and aim of the study: Mitral repair is now as the treatement of choice in patients suffering mitral regurgitation due to mitral valve prolapse or flail. However, mitral valve repair demands the mitral valve morphology being feasible for repair. The study aims at evaluating transthoracic and transesophageal echocardiographic features in consecutive patients with mitral valve prolapse or flail undergoing surgical repair at Hue Central Hospital. The correlation between preoperative and intraoperative echocardiographic features and surgical findings in these patients. These echocardiographic data may predict the surgical outcome. Methods: From December 2010 to January 2013, 73 patients (37 men, 36 women; average age 37.5) were recruited into the study. All patients had degenerative mitral valve disease causing important regurgitation and underwent systematic preoperative transthoracic echocardiography, preoperative and intraoperative transesophageal echocardiography for delineation of six segments (scallops) of anterior and posterior leaflets. Results: Among 73 patients, 64 patients were in fibroelastic deficiency (87.7%) and 9 patients suffered Barlow disease (12.3%). Mitral valve repair was performed in 52 patients (71.2%) and mitral replacement was performed in 21 patients (28.8%). All 52 mitral valve repair (81.3%) and 12 mitral valve replacement (18.7%) was performed in fibroelastic deficiency patients. All 9 Barlow patients must undergo mitral valve replacement (100%). A prolapse or flail of mitral valve in 73 patients was documented by transthoracic and transesophageal echocardiography and confirmed on surgical inspection. Accuracy of transthoracic echocardiography was (89.0%) and accuracy of transesophageal echocardiography was (91.8%) in identifying mitral valve segments prolapse or flail. Success rate of mitral valve repair was (98.0%) in prolapse of 1 or 2 segments, but was low (36.0%) in prolapse > 3 segments. Success rate of mitral valve repair was (96.6%) in prolapse of posterior leaflet, but was (63.6%) in prolapse anterior leaflet or bileaflet. Conclusion: - Mitral valve repair was favorable in fibroelastic deficiency patients, but difficult in Barlow patients. - Accuracy of transthoracic and transesophageal echocardiography was high in identifying mitral valve segments prolapse or flail. - Success rate of mitral valve repair was high in prolapse of 1 or 2 segments. - Success rate of mitral valve repair was high in in prolapse of posterior leaflet. Key words: Mitral repair, echocardiography, degenerative, Barlow, fibroelastic deficiency, prolapse, flail

scholarly journals Emergency medicine airway leads: a rapid response distributed educational model for emergency department COVID-19 airway management

CJEM ◽  
2021 ◽  
Author(s):  
Adam Harris ◽  
Lorri Beatty ◽  
Nicholas Sowers ◽  
Sam G. Campbell ◽  
David Petrie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Airway Management ◽  
Rapid Response ◽  
Educational Model

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

scholarly journals Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

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