Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System.

INTRODUCTION: We present a novel airway simulation tool that recreates the dynamic challenges associated with emergency airways. The Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) simulation system trains providers to use suction to manage emesis and bleeding complicating intubation. METHODS: We modified a standard difficult-airway mannequin head (Nasco, Ft. Atkinson, WI) with hardware-store equipment to enable simulation of vomiting or hemorrhage during intubation. A pre- and post-survey was used to assess the effectiveness of the SALAD simulator. We used a 1-5 Likert scale to assess confidence in managing the airway of a vomiting patient and comfort with suction techniques before and after the training exercise. RESULTS: Forty learners participated in the simulation, including emergency physicians, anesthesiologists, paramedics, respiratory therapists, and registered nurses. The average Likert score of confidence in managing the airway of a vomiting or hemorrhaging patient pre-session was 3.10±0.49, and post-session 4.13±0.22. The average score of self-perceived skill with suction techniques in the airway scenario pre-session was 3.30±0.43, and post-session 4.03±0.26. The average score for usefulness of the session was 4.68±0.15, and the score for realism of the simulator was 4.65±0.17. CONCLUSION: A training session with the SALAD simulator improved trainee's confidence in managing the airway of a vomiting or hemorrhaging patient. The SALAD simulation system recreates the dynamic challenges associated with emergency airways and holds promise as an airway training tool.

Small bowel obstruction from potato and broccoli phytobezoar mimicking mesenteric ischemia.

BACKGROUND: Bezoars are concretions of undigested foreign material that form in the gastrointestinal tract. Rare in humans, they are nonetheless a well-documented cause of intraluminal bowel obstruction. OBJECTIVES: The objectives of this case report include describing an unusual presentation of small bowel obstruction due to phytobezoar, which mimicked mesenteric ischemia, and highlighting the risk factors, presentation, and management of bezoars, in addition to covering historical beliefs regarding bezoars. CASE REPORT: Here we report a 64-year-old man who presented to the Emergency Department with chest pain, vomiting, and hypotension. Initial work-up was directed at ruling out cardiac causes and aortic catastrophe such as aortic dissection or ruptured abdominal aortic aneurysm. Computed tomography angiography of the chest and abdomen showed findings suggestive of mesenteric ischemia and small bowel obstruction. However, exploratory laparotomy revealed intraluminal small bowel obstruction from a phytobezoar consisting of undigested chunks of potato, brussels sprouts, and broccoli. CONCLUSIONS: Although rare in humans, bezoars are a documented cause of small bowel obstruction, and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction require surgical treatment.

A rare case of posterior interosseous nerve palsy associated with radial head fracture.

BACKGROUND: Radial head fractures are the most common fractures occurring about the elbow in adults, but there have been few reported cases of associated nerve injury. The little-known posterior interosseous nerve travels in close proximity to the radial head and is particularly susceptible to injury. OBJECTIVES: The objectives of this case report include raising awareness of the possibility of posterior interosseous nerve palsy after radial head fracture and reviewing the clinical assessment of the posterior interosseous nerve to exclude occult injury. CASE REPORT: Here we report a case of a 21-year-old man who developed a posterior interosseous nerve palsy after a fracture of the radial head sustained during a wrestling match. He also sustained frostbite to the extremity due to overaggressive icing of the injury. CONCLUSIONS: Physicians should screen patients with radial head fractures for associated nerve injury. A thorough neurovascular examination with attention to the motor innervation patterns in the hand and wrist will help identify posterior interosseous nerve involvement. Careful discharge instructions will help prevent iatrogenic frostbite from overaggressive icing of injuries.

Following the call: how providers make sense of their decisions to work in faith-based and secular urban community health centers.

We interviewed 49 health care providers from 6 faith-based and 4 secular community health centers (CHCs) to explore the ways they relate their religious commitments to practice among the underserved. Interviews were transcribed, coded, and analyzed for emergent themes through an iterative process of textual analysis. Providers in faith-based CHCs explained the decision to work in underserved settings as a response to a religious calling to medicine as a means of ministry, and by reference to particular benefits and freedoms of working with colleagues who share an explicitly faith-informed vision for care of the underserved. Most providers from secular CHCs explained their motivations in less religious terms by reference to intrinsic rewards such as "making a difference" for the underserved. Providers from both settings emphasized the frustrations and difficulties of meeting overwhelming demands with inadequate resources. In light of prior literature regarding work orientation, our findings suggest that CHCs may provide distinctive opportunities for intrinsically motivated providers to craft their work into a calling, where a calling is understood as a deeply felt motivation for work that goes beyond the satisfaction of the worker's material and social needs. Faith-based CHCs appear to provide a context that is attractive to some minority of providers who desire to enact a religious calling to ministry through the practice of medicine. Future studies are needed to test these hypotheses using quantitative methods and broader representative sampling.