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1.
CJEM ; 26(3): 137-138, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38436909
2.
Cureus ; 14(11): e31366, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36514637

RESUMO

The measurement of intraocular pressure via ocular tonometry is a skill necessary for the evaluation of emergency department patients with ocular complaints. Accurate results inform the use of time-sensitive medications or invasive procedures. We sought to develop and evaluate an affordable, realistic, and reproducible task trainer to allow Emergency Medicine residents and medical students to practice tonometry. We placed an angiocatheter into the vitreous chamber of a swine eye through the optic nerve stump and sealed it with a purse string suture and cyanoacrylate glue. This allowed us to connect intravenous extension tubing and use a saline-filled syringe to repeatedly adjust intraocular pressure in real time. Optionally, this model can be mounted in a polystyrene foam mannequin head to enhance realism and facilitate practice. The task trainer was implemented in medical student and Emergency Medicine resident education at Vanderbilt University Medical Center. Thirty-six learners participated in the study, all of whom completed pre-course and post-course surveys. Among all learners, the mean comfort with performing tonometry improved significantly (3.26 to 7.64 {Z = -4.95, p < 0.005}). The mean confidence in the accuracy of measurements also increased (3.11 to 7.56 {Z = -4.8, p < 0.005}). On a 10-point scale, learners felt this task trainer was highly helpful in increasing their comfort with and the ability to perform tonometry (mean 9.19 {SD 1.19}). We have developed a low-cost and easily constructed ocular tonometry task trainer that resulted in significant improvement in learner comfort and confidence.

3.
Cureus ; 14(10): e30190, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36397909

RESUMO

Ophthalmologic emergencies account for tens of thousands of patients presenting to the emergency department (ED) each year. Studies continue to show that ophthalmology education in medical school is limited, and this leads to many resident physicians who lack confidence in their ophthalmological examination and procedural skills if opportunities to practice these skills are not deliberately sought out during their training. Medical simulation continues to be an excellent way for physicians to learn and master these anxiety-inducing procedures. We present a newly modified, innovative, and realistic porcine-based emergency ophthalmologic procedural task trainer with live television screen projection to further improve Emergency Medicine (EM) resident education on the performance of Seidel's test and ocular foreign body removal.

4.
Cureus ; 14(6): e25582, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35784952

RESUMO

Resuscitative hysterotomy (RH) is a rare, time-sensitive, invasive procedure that can be frightening for emergency physicians and yet potentially life-saving for fetus and mother. Several low-cost RH task trainers have been described in the literature. We set out to construct a model using improved synthetic materials for the uterine and abdominal wall and to devise hemorrhage capability. The primary aim of this study was to evaluate the model's perceived usefulness of its features. Secondarily, we wished to assess the confidence of emergency medicine (EM) residents before and after performing a RH using our task trainer in a simulated environment. We constructed an inexpensive task trainer that can function both as a table-top model (TTM) and be adapted to a high-fidelity simulator. We created the abdominal wall and uterus from polyurethane carpet padding, subcutaneous fat from upholstery foam, fascia from synthetic chamois, and blood vessels from IV tubing and angio-catheters. We utilized the task trainer during our monthly EM residency simulation conference. After completing a simulation of a gravid female in cardiac arrest requiring a RH on a high-fidelity simulator adaptated model (HFSAM), residents repeated the procedure during debriefing on a TTM. Residents then completed anonymous paper surveys in which they rated aspects of the RH model and their procedural confidence on a 10-point Likert scale. 20 EM residents took part in the RH simulation scenario followed by a TTM demonstration. All (100%) residents completed the survey. 11 (55%) of the residents performed a RH on either the HFSAM or the TTM while the others assisted. The residents rated the overall educational value of the training event as very high (mean 9.8 (SD 0.68)). Both the TTM (mean 8.9 (SD 1.15)) and HFSAM (mean 8.7 (SD 1.29)) were similarly rated as highly realistic. Before the simulation session, residents rated their confidence in performing a RH as low (mean 4.0 (SD 2.62)). After the session, they were much more confident in their ability to perform a RH (mean 7.9 (SD 1.48); P<0.001). Most residents rated bleeding as very important to the utility of a RH model (mean 8.6 (SD 1.74)). We demonstrate an inexpensive but realistic RH task trainer that can be used as a stand-alone model or adapted to a high-fidelity simulator. A single simulation using the TTM and the HFSAM lead to increased resident confidence in their ability to perform a RH.

5.
Cureus ; 13(3): e13659, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33824810

RESUMO

Facial laceration repair is a common emergency department procedure with important cosmetic implications for patients. In instances where the vermillion border is violated special attention must be paid to accurate opposition, as little as 1 mm of misalignment can result in poor cosmetic results. We sought to construct and evaluate an affordable, effective, and easily reproduced simulation trainer of full-thickness lip laceration requiring vermillion border repair primarily for Emergency Medicine resident education. To accomplish this we utilized microfoam tape, 4x4 gauze, self-adherent wrap, and markers to simulate a multi-layered lip laceration with vermillion border involvement. The microfoam tape with gauze folded on top of itself simulates the orbicularis oris muscle and subcutaneous fat layer. The self-adherent gauze covered by an additional piece of microfoam tape simulates the dermal/epidermal junction. This training model can be attached to an upside-down emesis basin with tape and then trainees can practice appropriate repair techniques. This task trainer was then utilized in our scheduled, simulation didactic sessions with Vanderbilt University Medical Center's Emergency Medicine residents. In total, 23 PGY 1-3 EM residents participate in the session. Nineteen (83%) completed an anonymous reporting survey rating features of the didactic on a five-point Likert scale. Resident comfort level performing the procedure prior to the teaching session was fair (mean 2.53 {SD 1.04}) and afterward significantly higher (mean 4.31 {SD 0.57}) P <0.0001. The task trainer was highly rated (mean 4.74 {SD 0.55}) and the overall didactic was also very highly rated (mean 4.84 {SD 0.50}). The model we have described here can be constructed in minutes from supplies that are readily available in any healthcare setting and was rated by residents to substantially improve procedural confidence in regards to complex lip laceration repair.

6.
J Emerg Med ; 59(4): e123-e126, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32807582

RESUMO

BACKGROUND: In the United States, over 1 million burns require medical treatment each year. Chemical burns represent an infrequent but devastating percentage of all burns, which account for a large proportion of all burn-related deaths. Of the various causes of chemical burns, sulfuric acid is most commonly involved in occupational and accidental burns, and even cases of assault. CASE REPORT: We describe the case of a 27-year-old man who presented to our Emergency Department (ED) after an assault with sulfuric acid. During his presentation, particular attention and care was given to his decontamination, airway management, and correction of life-threatening metabolic derangements. After stabilization in the ED he survived an extensive hospital admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patient outcomes and prognosis after chemical burns are dependent on prompt recognition/suspicion and rapid initiation of treatment. Even with prompt treatment, severe physiologic and psychologic injuries often afflict the patient. While encountering these devastating injuries, the emergency physician must carry a heightened sense of care and protection for both patient and staff to ensure optimum outcomes.


Assuntos
Queimaduras Químicas , Ácidos Sulfúricos , Adulto , Queimaduras Químicas/etiologia , Queimaduras Químicas/terapia , Serviço Hospitalar de Emergência , Humanos , Masculino , Ressuscitação , Estados Unidos
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