RESUMEN
OBJECTIVE: Hip fractures are associated with significant morbidity and mortality. Ultrasound-guided peripheral nerve blocks are a safe method to manage pain and decrease opioid usage. The pericapsular nerve group (PENG) block is a novel, potentially superior block because of its motor-sparing effects. Through training, simulation, and supervision, we aim to determine whether it is feasible to perform the PENG block in the emergency department. METHODS: Phase 1 consisted of emergency physicians attending a workshop to demonstrate ultrasound proficiency, anatomical understanding, and procedural competency using a low-fidelity model. Phase 2 consisted of a prospective, observational, feasibility study of 10 patients with hip fractures. Pain scores, side effects, and opioid usage data were collected. RESULTS: The median pain score at time 0 (time of block) was 9 (interquartile range [IQR], 6.5-9). The median pain score at 30 minutes was 4 (IQR, 2.0-6.8) and 3.5 (IQR, 1.0-4.8) at 4 hours. All 10 patients required narcotics prior to the initiation of the PENG block with a median dosage of 6.25 morphine milligram equivalents (MME; IQR, 4.25-7.38 MME). After the PENG block, only 30% of the patients required further narcotics with a median dosage of 0 MME (IQR, 0-0.6 MME) until operative fixation. CONCLUSION: In this feasibility study, PENG blocks were safely administered by trained emergency physicians under supervision. We demonstrated data suggesting a trend of pain relief and decreased opiate requirements, and further investigation is necessary to measure efficacy.
RESUMEN
OBJECTIVES: To use nationally published guidelines to examine the preparedness of schools in the United States to respond to emergencies associated with school-based athletics. METHODS: A questionnaire, mailed to 1000 randomly selected members of the National Athletic Trainers' Association, included questions on the clinical background of the athletic trainer, the demographic features of their school, the preparedness of their school to manage life-threatening athletic emergencies, the presence of preventative measures to avoid potential sport-related emergencies, and the immediate availability of emergency equipment. RESULTS: Of the 944 questionnaires delivered, 643 (68%) were returned; of these, 521 (81%) were eligible for analysis (55% usable response rate). Seventy percent (95% confidence interval [CI], 66-74) of schools have a Written Emergency Plan (WEP), although 36% (95% CI, 30-40) of schools with a WEP do not practice the plan. Thirty-four percent (95% CI, 30-38) of schools have an athletic trainer present during all athletic events. Sports previously noted to have higher rates of fatalities/injuries based on published literature, such as ice hockey and gymnastics, had, according to our data, less coverage by athletic trainers compared with other sports with lower rates of fatalities/injuries. Athletic trainers reported the immediate availability of the following during athletic events: cervical spine collar (62%, 95% CI, 58-66), automatic electronic defibrillator (61%, 95% CI, 57-65), epinephrine autoinjector (37%, 95% CI, 33-41), bronchodilator metered-dose inhaler (36%, 95% CI, 32-40). CONCLUSIONS: Although schools are in compliance with many of the recommendations for school-based athletic emergency preparedness, specific areas for improvement include practicing the WEP several times a year, linking all areas of the school directly with emergency medical services, increasing the presence of athletic trainers at athletic events (especially sports with a higher rate of fatalities/injuries), regulating the care of and inspection of school facilities and fields, requiring the use of safety equipment (such as mouth guards and protective eye equipment), and increasing the availability of automatic electronic defibrillator in schools.
