RESUMO
Auricular hematoma drainage is a crucial skill that emergency medicine providers must be proficient in to prevent complications including permanent deformity of the ear. We aimed to develop and evaluate a cost-effective task trainer to allow emergency medicine (EM) residents to practice the key skills of auricular hematoma drainage and pressure dressing application. After creating a task trainer out of a bell pepper, we implemented this training during our EM simulation conference with a total of 20 PGY 1-3 EM residents. Prior to the simulation session, a survey of all 39 residents found a rated confidence level of auricular hematoma drainage as low on a five-point Likert scale (mean: 2.2 (standard deviation (SD): 1.08)). After the session, the 20 EM residents who participated were much more confident in their ability to perform this procedure (mean: 4.4 (SD: 0.6)). This low-cost, easy-to-create auricular hematoma drainage and repair task trainer was well received by our EM residents and led to an improved resident comfort level in performing this necessary EM procedure. This task trainer can be used by EM trainees of all levels as a tool to increase their skill and comfort level when performing the crucial procedure of auricular hematoma drainage and repair.
RESUMO
BACKGROUND: Minimally invasive techniques have become standard approaches for many common surgical problems. However, the routine use of laparoscopy in the management of small bowel obstruction (SBO) has yet to be fully standardized. The objective of this study was to determine clinical factors associated with success of laparoscopy in managing SBO. METHODS: A retrospective cohort study was conducted by identifying all patients admitted to a large tertiary center with a diagnosis of SBO from 2014 to 2016. The operative cases were stratified by surgical approach: laparoscopy, laparoscopy converted to open, or laparotomy. Univariable analysis compared patient demographics and comorbidities between the laparoscopic and laparoscopic converted to open group. The primary outcome was successful laparoscopic procedure in the management of SBO, defined as resolution of SBO, and no conversion from laparoscopic to open procedures. Student's t test or Pearson's χ2 test were used to assess associations between factors and primary outcome. RESULTS: A total of 227 adult patients admitted with a diagnosis of SBO received operative intervention. There were 40 successful laparoscopic cases (52.6%) and 36 failed laparoscopic cases (47.4%). With the exception of an association between success of laparoscopy and BMI, the results demonstrated no other demographic or clinical differences among the successful versus failed laparoscopic groups. CONCLUSIONS: Laparoscopy is effective in treating SBOs due to various etiologies including single band or multiple adhesions, hernias, or masses. Other than BMI, there was no single predictor of success or failure with laparoscopy. Therefore, we conclude that perhaps all patients requiring operative treatment for SBO deserve consideration for a diagnostic laparoscopy.
