scholarly journals Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures

2019 ◽  
Vol 6 ◽  
pp. 238212051988563 ◽  
Author(s):  
Richard Amini ◽  
Luis D Camacho ◽  
Josephine Valenzuela ◽  
Jeannie K Ringleberg ◽  
Asad E Patanwala ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Academic Medical Center ◽  
Joint Effusion ◽  
Clinical Anatomy ◽  
Educational Model ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Fresh Cadaver ◽  
Significant Difference

Background: Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity. Objectives: The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks. Methods: This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants’ experience level, opinions, and procedural confidence regarding the 4 stations. Results: A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures. Conclusions: This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings.

scholarly journals How to improve quality of care in overcrowded emergency departments? Development and evaluation of a virtual research environment. (Preprint)

2019 ◽  
Author(s):  
Charles-Henri Houze Cerfon ◽  
Christine Vaissié ◽  
Laurent Gout ◽  
Bruno Bastiani ◽  
Sandrine Charpentier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Of Care ◽  
Simulated Patients ◽  
Emergency Physicians ◽  
Research Environment ◽  
Significant Difference ◽  
Ed Overcrowding ◽  
Virtual Research Environment

BACKGROUND Despite wide literature on ED overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. OBJECTIVE We sought to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviours on quality of care in the context of emergency department overcrowding. METHODS A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in Emergency Medicine combining virtual reality and simulated patients has been designed and developed. Then, twelve emergency physicians took part in simulation scenarios and had to manage thirteen patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency and mastering. The realism was the resemblance perceived by the participants between virtual and real Emergency Department. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% of the participants. RESULTS The virtual emergency department was considered realistic with no significant difference from the real world concerning facilities and resources except for the length of time of procedures that was perceived to be shorter. 100% of participants deemed that patient information, decision-making and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. CONCLUSIONS The new simulation tool, Virtual Research Environment in Emergency Medicine has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared to real EDs and thus offers another way to study human factors, quality of care and patient safety in the context of ED overcrowding.

scholarly journals Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study

10.2196/13993 ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. e13993
Author(s):  
Charles-Henri Houze-Cerfon ◽  
Christine Vaissié ◽  
Laurent Gout ◽  
Bruno Bastiani ◽  
Sandrine Charpentier ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Of Care ◽  
Observational Study ◽  
Emergency Physicians ◽  
Research Environment ◽  
Wide Range ◽  
Significant Difference ◽  
Ed Overcrowding ◽  
Virtual Research Environment

Background Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. Objective This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviors on quality of care in the context of ED overcrowding. Methods A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% (12/13) of the participants. Results The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding.

scholarly journals Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

2018 ◽  
Vol 3 (4) ◽  
pp. 108-112
Author(s):  
Derya Yalçın ◽  
Dilek Erdoğan Arı ◽  
Ceren Köksal ◽  
Cansu Akın ◽  
Sinan Karaca ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Recovery Room ◽  
Motor Block ◽  
Double Blind Study ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Double Blind ◽  
Significant Difference ◽  
Infraclavicular Block ◽  
Group 2

Background: Opioids added to local anesthetics for peripheral nerve blocks may intensify analgesia and prolong analgesic and sensorial block duration. These agents may also cause potentiation and prolongation of motor block. Objective: This study compared the postoperative effects of 30 mL of 0.25% bupivacaine +50 mcg fentanyl and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl solutions for the ultrasound-guided infraclavicular block in patients undergoing elbow and forearm surgery. Methods: In this randomized double-blind study, thirty-six patients with risk of ASA class I-III were randomly allocated into 2 randomized groups. Ultrasound-guided infraclavicular blocks with 30 mL of 0.25% bupivacaine + 50 mcg fentanyl for group 1 and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl for group 2 were performed before patients emerged from general anesthesia. After surgery, pain levels at rest and during movement were evaluated using the 10-cm visual analog scale (VAS) at recovery room admission, at the 15th and 30th minutes in the recovery room, and at the 2nd, 6th, 12th and 24th hours postoperatively. Both morphine and rescue analgesic requirements were recorded. Sensorial and motor block durations, patient satisfaction, and complications related to the infraclavicular block were recorded. Results: In both groups, no significant difference in VAS pain scores, total morphine and total rescue analgesic requirements, duration of sensorial and motor block, or patient satisfaction were observed. None of the patients experienced any complications. Conclusion: The mixtures of 0.25% bupivacaine + 50 mcg fentanyl and 0.25% bupivacaine + 100 mcg fentanyl showed similar postoperative effects.

scholarly journals Igel Phantom: An Innovative Model for USG Guided Needling Training

2020 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Peripheral Nerve ◽  
Cost Effective ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Training Models ◽  
Effective Learning ◽  
Innovative Model ◽  
Keywords Ultrasonography

Advancements in Ultrasonography has increased the interest among anesthesiologists to learn regional anesthesia techniques specially the peripheral nerve blocks. But it takes a long learning curve to become an expert in ultrasound guided regional aneaesthesia techniques. The training models like blue phantom is expensive and not freely available. Other commercially available phantom models like gelatin based phantom and agar based phantoms though cheap has less shelf life .We devised a novel and cost effective learning phantom using Igel for needling training. Further studies are required for comparing the quality of Igel based phantoms with commercially available phantoms like blue phantom. Keywords: Ultrasonography; Igel; Phantom.

scholarly journals Effects of dexmedetomidine addition to low concentration of lidocaine/ropivacaine mixtures for ultrasound-guided axillary brachial plexus block

2020 ◽  
Author(s):  
Qi Wang ◽  
Wengang Ding ◽  
Lu Feng ◽  
Wenzhi Li
Keyword(s):  
Clinical Trial ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Low Concentration ◽  
Significant Difference ◽  
The Times ◽  
Plexus Block

Abstract BackgroundDexmedetomidine(DEX) has been used in combination with different local anesthetics (LAs) to improve the quality of peripheral nerve blocks. However, there is little evidence of the effects of DEX in a mixture of two LAs for brachial plexus block (BPB).The aim of this study was to investigate if DEX combined with low concentration of lidocaine/ropivacaine mixtures may further reduce the onset time and prolong block duration and analgesia time for performing ultrasound-guided axillary BPB.MethodsSeventy-five ASA Ι or II patients, scheduled for forearm or hand surgery were randomly allocated into three groups: Group R (n = 25) received 30 mL of 0.25% ropivacaine + 3 mL of 0.9% NaCl; Group RL (n = 25) received 30 mL of 1:1 0.25% ropivacaine/0.5% lidocaine + 3 mL of 0.9% NaCl; Group RLD (n = 25) received 30 mL of 1:1 0.25% ropivacaine/ 0.5%lidocaine + 3 mL of 0.75 µg/kg DEX. The hemodynamic changes, BIS values, onset time and duration of sensory and motor blocks, the analgesic time and the times of rescue analgesics within 48 h were recorded.ResultsThe onset times of sensory and motor blocks were significantly shorter in group RL and group RLD compared with group R (P < 0.0001), but no significant difference was detected between group RL and group RLD (P > 0.05). The analgesic time and the block durations in group RLD were significantly longer than that in group R and group RL (P < 0.0001). In group RLD, the times of flurbiprofen treatment were significantly reduced compared with group R and group RL(P < 0.0001). The BIS values in group RLD were significantly decreased than those of group R and group RL from 20 min till 60 min(P < 0.05).ConclusionsCombination of ropivacaine and lidocaine produces shorter onset time than ropivacaine alone in axillary BPB. DEX added to ropivacaine/lidocaine mixtures prolongs the duration of sensory and motor blocks, extends analgesic time and exerts a considerable sedative effect.Trial registrationThe clinical trial was registered in “Chinese Clinical Trial Registry” (http://www.chictr.org.cn/index.aspx) and the registered number was “ChiCTR-IPR-16007742”, on 12th January 2016.

Trunk and Spine Ultrasound Guided Regional Anesthesia

2016 ◽  
Author(s):  
Stuart A. Grant ◽  
David B Auyong
Keyword(s):  
Regional Anesthesia ◽  
Rectus Sheath ◽  
Transversus Abdominis ◽  
Clinical Anatomy ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Risks And Benefits ◽  
Quadratus Lumborum ◽  
Tools And Techniques

This chapter describes the clinical anatomy and outlines the tools and techniques needed to perform thoracic, abdominal and neuraxial ultrasound-guided procedures. The nerve blocks described here include the transversus abdominis plane (TAP), quadratus lumborum, ilioinguinal-iliohypogastric, rectus sheath, intercostal, PECS, serratus plane, paravertebral, and neuraxial spinal and epidural blocks. For each nerve block, the indications, risks, and benefits of the varying approaches are described in detail. The chapter includes step-by-step instructions with illustrations to allow the operator to perform clinically effective and safe ultrasound-guided thoracic, truncal, and neuraxial procedures. At the conclusion of each block description, a “Pearls” segment highlights important tips gleaned from our clinical experience. This chapter provides the practitioner with thorough instruction and knowledge allowing the optimal delivery of regional anesthesia for any thoracic or abdominal surgery.

Upper Limb Ultrasound Guided Regional Anesthesia

2016 ◽  
Author(s):  
Stuart A. Grant ◽  
David B Auyong
Keyword(s):  
Upper Extremity ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Upper Limb ◽  
Clinical Anatomy ◽  
Ultrasound Guided ◽  
Cervical Plexus ◽  
Nerve Blocks ◽  
Risks And Benefits ◽  
Tools And Techniques

This chapter describes the clinical anatomy and outlines the tools and techniques needed to perform upper extremity ultrasound-guided nerve blocks. The nerve blocks above the clavicle described here include the interscalene, dorsal scapular, suprascapular, cervical plexus, and supraclavicular blocks. Nerve blocks below the clavicle described here include the infraclavicular and axillary blocks and distal blocks at the wrist and elbow. For each nerve block, the indications, risks, and benefits of the varying approaches are described in detail. The chapter includes step-by-step instructions with illustrations, including cadaver dissections, to allow the operator to perform clinically effective and safe ultrasound-guided upper extremity regional anesthesia. At the conclusion of each block description, a “Pearls” segment highlights important tips gained from our clinical experience. This chapter provides the practitioner with thorough instruction and knowledge allowing optimal delivery of regional anesthesia for any upper extremity surgery or trauma.

scholarly journals Comparison of Two Different Techniques in Ultrasound Guided Infraclavicular Block: Jedi and Classic Grip

2021 ◽  
Author(s):  
SÜLEYMAN CAMGÖZ ◽  
Serap DİKER ◽  
Betül GÜVEN AYTAÇ ◽  
İsmail Aytaç
Keyword(s):  
Motor Block ◽  
Classical Method ◽  
Sensory Block ◽  
Control Group ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Group I ◽  
Block Success ◽  
Significant Difference ◽  
Classical Technique

Background: The widespread use of ultrasonography in peripheral nerve blocks requires an assistant. Pappin et al. described the “Jedi grip” technique in which the practitioner works alone by controlling the ultrasound prob with one hand and the needle and injector with the other. In this study, we aimed to compare the block characteristics of the “Jedi grip” technique with the classical technique that performed with an assistant. Methods: 78 patients were included in our study. They were randomly divided into two groups (Group I: Jedi grip and Group II: Classical grip technique). Local anesthetic was applied to both groups from 10 ml of 0.5% bupivacaine +10 ml of 2% prilocaine mixture. The block characteristics were evaluated and recorded every 5 minutes for the first 30 minutes after each block. When the sensory block score was 7 and the total score was 14 or above, the block was considered successful, and the patient was ready for surgery. Results: There was no significant difference between the groups in terms of block characteristics such as block pain, number of attempts, arterial puncture, sensory and motor block onset and regression times, time to be ready for surgery, tourniquet pain, use of additional anesthesia method, use of postoperative analgesia. The duration of block application was 158±47 sec in the Jedi group and 121±83 sec in the control group. Conclusion: The Jedi grip technique has been found to be applicable with the same confidence compared to the classical method in terms of block success and complications.

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