Does Size Matter? A Prospective Study on the Feasibility of Using a Handheld Ultrasound Device in Place of a Cart-Based System in the Evaluation of Trauma Patients.

BACKGROUND: As emergency physicians are looking at handheld devices as alternatives to the traditional, cart-based systems, concerns center around whether they are forsaking image quality for a lower price point and whether the handheld can be trusted for medical decision making. OBJECTIVE: We aimed to determine the feasibility of using a handheld ultrasound device in place of a cart-based system during the evaluation of trauma patients using the Focused Assessment with Sonography for Trauma (FAST) examination. METHODS: This was a prospective study of adult trauma patients who received a FAST examination as part of their evaluation. A FAST examination was performed using a cart-based machine and a handheld device. The results of the examinations were compared with computed tomography imaging. Images obtained from both ultrasound devices were reviewed by an expert for image quality. RESULTS: A total of 62 patients were enrolled in the study. The mean (SD) time to perform a FAST examination using the handheld device was 307.3 (65.3) s, which was significantly less (p = 0.002) than the 336.1 (86.8) s with the cart-based machine. There was strong agreement between the examination results of the handheld and cart-based devices and between the handheld and computed tomography. Image quality scores obtained with the handheld device were lower than those from the cart-based system. Most operators and reviewers agreed that the images obtained from the handheld were adequate for medical decision making. CONCLUSIONS: Data support that it is feasible to use the handheld ultrasound device for evaluation of the trauma patient in place of the cart-based system.

The Status of Women in Emergency Ultrasound Fellowships: A Potential Light for the Future of Gender Inclusion in Academic Medicine.

BACKGROUND: The objective of this study is to investigate gender differences in the percentage of men and women who have completed an Emergency Ultrasound (EUS) fellowship over a four-year period. Secondary objectives of this study include evaluation of the career paths and accomplishments of women who have recently completed an EUS fellowship. We will also be assessing program characteristics as reported by the program directors. METHODS: This was an online survey of all EUS fellowship programs in the United States. Programs were excluded if they were not in existence before July 2020. The survey took place between September 16, 2021, and December 5, 2021. The study was approved by the appropriate institutional review board. Emergency Ultrasound fellowship programs and their respective program directors were identified from a list of participating programs created by the Society of Clinical Ultrasound Fellowships. The survey questions were divided into the following categories: program demographics, questions regarding the program's recent fellowship classes, and questions relating to the program director's perspective on gender and fellowship. RESULTS: This study utilized a convenience sample, from a roster of 109 programs, with a response rate of 67% by program directors. There was no significant difference in the percentage of men and women who have completed an EUS fellowship over a four-year period. No graduates who identified as transgender or non-binary/gender non-conform were reported. The majority of female fellows (65%) completed a research/scholarly project during their fellowship year (65%) and have held or currently hold a leadership position at their institution (60.3%). When program directors were asked if they felt women were equally represented in EUS fellowship programs, 24 (34.3%) respondents said yes, 18 (25.7%) said no, and 28 (40%) were not sure. When asked if they felt there were barriers that specifically prevented women from pursuing a fellowship, 28 (40%) said yes, 24 (34.3%) said no, and 18 (25.7%) were not sure. CONCLUSION: There does not exist a significant difference in the percentage of males and females who have completed an EUS fellowship over a four-year period. Completion of an EUS fellowship may provide women the opportunity to participate in research and receive awards for their accomplishments. It may also serve as a pipeline to academic medicine and leadership roles.

A Novel Simulation Model for Training Emergency Medicine Residents in the Ultrasound Identification of Landmarks for Cricothyrotomy.

Objectives The objective of this study is to describe a simple, replicable method to create neck models for the purpose of education and practice of ultrasound (US) identification of anatomic landmarks for cricothyrotomy. The second objective is to assess the model's capability in training emergency medicine (EM) residents in the US identification of anatomic landmarks for cricothyrotomy. Methods This is a cross-sectional study using a convenience sample of EM residents. Participants were taught to identify the thyroid cartilage, the cricothyroid membrane (CTM), and the cricoid cartilage using US. After an instructional period, participants performed a US examination on gel models designed to overly a live, human neck simulating various scenarios: thin neck, thick neck, anterior neck hematoma, and subcutaneous emphysema. Residents were asked to identify the thyroid cartilage, the CTM, and the cricoid cartilage as quickly as possible. The mean time to successful identification was reported in seconds. Following the scanning session, participants were asked to complete a post-survey. After the session, the video recordings were reviewed by an emergency US fellowship-trained physician to assess the visuomotor skills of each participant. Results A total of 42 residents participated in the study. Ninety-three percent (32/42; 95% CI 80.3% - 98.2%) of residents were able to obtain an optimal sagittal or parasagittal sonographic view of the anterior airway landmarks. Of these residents, 21.4% (9/42; 95% CI 11.5% - 36.2%) required minimal assistance with the initial probe placement. The visuomotor scores were recorded for each participant. Results of the pearson correlation indicated that there was a significant positive relationship between the residents' year in training with their visuomotor score (r(40) = .41, p = .007). When scanning the thin neck, 90.5% (38/42; 95% CI 77.4% - 96.8%) of residents were able to successfully identify the landmarks. The median time to completion was 27 seconds. When scanning the subcutaneous air model, 88.1% (37/42; 95% CI 74.5% - 95.3%) of residents were able to successfully identify the landmarks. The median time to completion was 26 seconds. When scanning the neck with the fluid collection 95.2% (40/42; 95% CI 83.4% - 99.5%) of residents were able to successfully identify the landmarks with a median time of 20 seconds for identification. When scanning the thick neck model, 73.8% (31/42; 95% CI 58.8% - 84.8%) of residents were able to successfully identify the landmarks taking a median time of 26 seconds. After the training session, 76.2% of residents reported that they felt either "confident" or "extremely confident" in identifying the CTM using US. Conclusion The novel anterior neck gel models used in this study were found to be adequate for training EM residents in the US identification of anterior neck anatomy. Residents were successfully trained in identifying the important anterior neck landmarks that are useful when predicting a difficult anterior airway and planning for surgical cricothyrotomy. Residents overall felt that the models simulated the appropriate anatomic scenarios. The majority felt confident in identifying the CTM using US.

The Use of Point-of-Care Ultrasound for Arthrocentesis Among Emergency Medicine Residents.

INTRODUCTION: The objective of this study is to determine if EM resident physicians are able to successfully utilize POCUS to perform an arthrocentesis in the ED. This is a retrospective review of ED patients who received an ultrasound-guided or ultrasound-assisted arthrocentesis performed in the ED over a 6-year period by an EM resident physician. METHODS: This was a retrospective review of ED patients who received an ultrasound-guided or ultrasound-assisted arthrocentesis performed in the ED over a 6-year period by an EM resident physician. An ED POCUS database was reviewed for POCUS examinations where an arthrocentesis was performed. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and the impact of the POCUS study on patient care and disposition. RESULTS: A total of 101 POCUS examinations of patients were included in the final analysis. The POCUS examinations and procedures were performed by 59 different EM residents at various levels of training. Overall, 92.1% (93/101) of the procedures were successful. When assessing for image quality, 98/101 (97%) had recognizable structures at minimum. The majority of the patients (84/101, 83.2%) received additional imaging of the affected joint. In the minority of cases (23/101, 22.8%), the ultrasound-assisted approach was utilized, while 78/100 (77.2%) utilized the ultrasound-guided approach. For the studies that utilized the ultrasound-guided approach, the quality of needle visualization was determined to be "good" 40/78 (51.3%). CONCLUSION: EM resident physicians are able to utilize POCUS to perform an arthrocentesis in the ED. Further research is encouraged to determine whether having residents utilize POCUS to perform an arthrocentesis has a significant impact on outcomes and patient care.