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Jain A, Patra S, Chetan C, Gupta G. Usefulness of skills in point of care ultrasound and simulation-based training as essential competencies in acute management of neonatal cardiac tamponade. BMJ Case Rep 2024; 17:e256151. [PMID: 38367993 PMCID: PMC10875498 DOI: 10.1136/bcr-2023-256151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
Peripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.
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Affiliation(s)
- Ankit Jain
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Saikat Patra
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Chinmay Chetan
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Girish Gupta
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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Atalla M, Yacoub A, Al-Ali H, Lupia B, Ezzeddine L, Barzani S, Moussa M, Coey J, Alambrouk T, Hilal H. Investigating the Skill Development of Medical Students in Focused Assessment With Sonography for Trauma (FAST) Ultrasound: A Comparative Analysis Across Different Stages of Medical Training. Cureus 2023; 15:e44414. [PMID: 37664275 PMCID: PMC10469331 DOI: 10.7759/cureus.44414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Focused assessment with sonography for trauma (FAST) ultrasound (US) is a valuable medical examination used in trauma settings, particularly for rapid responses to events such as natural disasters. Although the efficacy and benefits of FAST in patient care have been extensively studied, there is limited research on training medical students in FAST. Previous studies have found that medical students can proficiently perform a FAST US after two days of training. However, these studies exclusively included first-year medical students without considering variations in their medical knowledge. Particularly, the advantage of medical students having US experience before undergoing FAST training has not been previously examined. OBJECTIVES Assess the performance and knowledge acquisition of medical students with and without prior US experience after completing a FAST training course. METHODS The study included a total of 71 students, consisting of 33 males and 38 females, who were between the ages of 18 and 31, with an average age of 24.6 and a standard deviation of 2.4. The inclusion criteria targeted first- and second-year medical school students who participated on a volunteer basis. Students were divided into two groups: group A, consisting of those without prior US experience, and group B, made up of those who had previous US experience. All students completed a pre-training survey to share their comfort and confidence in US use and knowledge. A baseline FAST exam was conducted to establish initial performance. A comprehensive three-hour training session was then provided. Post-training, students performed another FAST exam to assess improvement, followed by a post-training survey to evaluate comfort and confidence. RESULTS Medical students who had prior experience in the US (group B) performed significantly better (p<0.01) in both the pre- and post-training FAST exams when compared to students without previous US experience. Specifically, in locating the liver, right kidney, hepatorenal recess, and left kidney, as well as detecting fluid accumulation when in a supine position. Additionally, medical students with prior US experience (group B) exhibited higher baseline confidence (p<0.005-p<0.01) in their ability to perform a FAST exam, as indicated by the results of the pre-testing survey. CONCLUSION Previous experience with US significantly boosted confidence and knowledge gains following FAST training. This emphasizes the value of including US training in medical school programs after earlier exposure, offering evident benefits. The study reveals the unexplored benefit of having prior US experience for medical students undergoing FAST training, thus addressing a previously unexplored area in current research. The conclusions stress the necessity of integrating US training into medical school curricula after initial exposure. This understanding can direct medical educators in refining the education process, enabling students to be better equipped for real-world medical situations involving FAST.
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Affiliation(s)
- Michael Atalla
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Medical Imaging, University of Toronto, Toronto, CAN
| | - Andrew Yacoub
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Hasan Al-Ali
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Bianca Lupia
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Layal Ezzeddine
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Shaliz Barzani
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Michelle Moussa
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Faculty of Science, University of Waterloo, Waterloo, CAN
| | - James Coey
- Anatomy, St. George's University School of Medicine, Newcastle upon Tyne, GBR
| | - Tarek Alambrouk
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GRD
| | - Haider Hilal
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GBR
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Rathbun KM, Patel AN, Jackowski JR, Parrish MT, Hatfield RM, Powell TE. Incorporating ultrasound training into undergraduate medical education in a faculty-limited setting. BMC MEDICAL EDUCATION 2023; 23:263. [PMID: 37076831 PMCID: PMC10113991 DOI: 10.1186/s12909-023-04227-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Point of care ultrasound (POCUS) is becoming a major extension of patient care. From diagnostic efficacy to its widespread accessibility, POCUS has expanded beyond emergency departments to be a tool utilized by many specialties. With the expansion of its use, medical education has begun to implement ultrasound education earlier in curricula. However, at institutions without a formal ultrasound fellowship or curriculum, these students lack the fundamental knowledge of ultrasound. At our institution, we set out to incorporate an ultrasound curriculum, into undergraduate medical education utilizing a single faculty member and minimal curricular time. METHODS Our stepwise implementation began with the development of a 3-hour fourth-year (M4) Emergency Medicine clerkship ultrasound teaching session, which included pre- and post-tests as well as a survey. The success with this session progressed to the development of a designated fourth-year ultrasound elective, which was evaluated with narrative feedback. Finally, we developed six 1-hour ultrasound sessions that correlated with first-year (M1) gross anatomy and physiology. A single faculty member was responsible for this curriculum and other instructors included residents, M4 students, and second-year (M2) near-peer tutors. These sessions also included pre- and post-tests and a survey. Due to curricular time limitations, all but the M4 Emergency Medicine clerkship session were optional. RESULTS 87 students participated in the emergency medicine clerkship ultrasound session and 166 M1 students participated in the voluntary anatomy and physiology ultrasound sessions. All participants agreed or strongly agreed that they would like more ultrasound training, that ultrasound training should be integrated into all four years of undergraduate medical education. Students were in strong agreement that the ultrasound sessions helped increase understanding of anatomy and anatomical identification with ultrasound. CONCLUSION We describe the stepwise addition of ultrasound into the undergraduate medical education curriculum of an institution with limited faculty and curricular time.
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Affiliation(s)
- Kimberly M Rathbun
- Department of Emergency Medicine, Augusta University, University of Georgia Medical Partnership, Athens, GA, Greece.
| | - Arjun N Patel
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Ryan M Hatfield
- Department of Emergency Medicine, Prisma Health, Columbia, SC, USA
| | - Tyler E Powell
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Akinpelu T, Shah NR, Alhendy M, Thangavelu M, Weaver K, Muller N, McElroy J, Bhalala US. Emergent Bedside Resternotomy: An Innovative Simulation Model for Training Pediatric Cardiac Intensive Care Teams. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1758453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AbstractCardiac tamponade after cardiac surgery is a life-threatening event that requires simultaneous resuscitation and emergent resternotomy by the intensive care team. A simulated scenario using an innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the validity of this mannequin to investigate the confidence level and crisis resource management skills of the team during bedside resternotomy to manage postoperative cardiac tamponade. The simulation scenario was developed using the sternotomy mannequin for a pediatric cardiac intensive care unit (CICU) team. The case involved a 3-year-old male, intubated, and mechanically ventilated after surgical repair of congenital heart disease, progressing to cardiac arrest due to cardiac tamponade. We conducted a formative learner assessment before and after each scenario as well as a structured, video debriefing following each encounter. The simulation was repeated in a 6-month interval to assess knowledge retention and improvement in clinical workflow. The data were analyzed using student t-test and chi-square test, when appropriate. Of the 72 CICU providers, a significant proportion of providers (p < 0.0001) showed improved confidence in assessing and managing cardiac arrest associated with postoperative cardiac tamponade. All providers scored ≥3 for the impact of the scenario on practice, teamwork, communication, assessment skills, improvement in cardiopulmonary resuscitation, and opening the chest and their confidence in attending similar clinical situations in future. Most (96–100%) scored ≥3 for the perception on the realism of mannequin, the scenario, reopening the sternotomy, and level of stress. Time to diagnosis of cardiac tamponade (p = 0.004), time to the first dose of epinephrine (p = 0.045), and median number of interruptions to chest compressions (p = 0.006) all significantly decreased between the two sessions. Time to completion of resternotomy improved by 81.4 seconds; however, this decrease was not statistically significant. Implementation of a high-fidelity mannequin for postoperative cardiac tamponade simulation can achieve a realistic and reproducible training model with positive impacts on multidisciplinary team education.
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Affiliation(s)
- Toluwani Akinpelu
- Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
- Rio Grande Valley School of Medicine, University of Texas, Edinburg, Texas, United States
| | - Nikhil R. Shah
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States
| | - Mohammed Alhendy
- Division of Pediatric Critical Care, The Children's Hospital of San Antonio, San Antonio, Texas, United States
| | - Malarvizhi Thangavelu
- Division of Pediatric Critical Care, The Children's Hospital of San Antonio, San Antonio, Texas, United States
| | - Karen Weaver
- Division of Pediatric Critical Care, The Children's Hospital of San Antonio, San Antonio, Texas, United States
| | - Nicole Muller
- Division of Pediatric Critical Care, The Children's Hospital of San Antonio, San Antonio, Texas, United States
| | - James McElroy
- Division of Pediatric Critical Care, The Children's Hospital of San Antonio, San Antonio, Texas, United States
| | - Utpal S. Bhalala
- Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States
- Department of Critical Care, Texas A & M University, College Station, Texas, United States
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Singh J, Matern LH, Bittner EA, Chang MG. Characteristics of Simulation-Based Point-of-Care Ultrasound Education: A Systematic Review of MedEdPORTAL Curricula. Cureus 2022; 14:e22249. [PMID: 35186609 PMCID: PMC8849358 DOI: 10.7759/cureus.22249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/05/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) is increasingly recognized as a safe, efficacious, and cost-effective diagnostic and procedural tool used by many medical disciplines. Although standardized POCUS curricula are lacking, simulation represents an effective modality to teach the fundamentals of POCUS in medical education. We sought to characterize POCUS simulation cases available within MedEdPORTAL, the primary repository of learning resources for health professions, to highlight areas for future curricular development and study. This systematic review was performed based on a comprehensive search of MedEdPORTAL. Identified simulations were categorized and contrasted with respect to their target audiences, settings, pathologies, required materials and equipment, and POCUS techniques tested. A total of eight curricula were identified. The majority (6/8) were targeted at trainees in acute care specialties. Pathologies included in most simulations involved cardiac or pericardial disease, although obstetric and medical diseases were also tested in isolated cases. While half (4/8) of the identified simulation curricula incorporated diagnostic POCUS interpretation, only a few (2/8) allowed for high-fidelity ultrasound simulation. While self-reported learner satisfaction appeared to be generally high, most (7/8) identified curricula did not include objective assessments of learning outcomes. A small number of simulation-based POCUS curricula have been published within MedEdPORTAL. The widespread use of simulation for POCUS may be limited by the financial costs of high-fidelity training equipment. While simulation provides a highly promising solution to the need for greater instruction in POCUS, there is a need for comprehensive, standardized, and cost-effective curricula that can be adapted to varied educational environments.
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Affiliation(s)
- Jaskaran Singh
- Anesthesiology and Critical Care, MedStar Georgetown University Hospital, Washington, DC, USA
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Lukas H Matern
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Edward A Bittner
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Marvin G Chang
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Roberts C, Keilman A, Pearce J, Roberts A, Ching K, Kingsley J, Stephan A, Gross I, Ciener D, Augenstein J, Thomas A. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Pediatric Diabetic Ketoacidosis. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11098. [PMID: 33644303 PMCID: PMC7901255 DOI: 10.15766/mep_2374-8265.11098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. Younger patients may present with subtle or atypical symptoms that are critical to recognize and emergently act upon. Such patients are often cared for by teams in the emergency department (ED) requiring multidisciplinary collaboration. METHODS This simulation case was designed for pediatric emergency medicine fellows and residents. The case was a 14-month-old male who presented to the ED with respiratory distress and dehydration. The team was required to perform an assessment, manage airway, breathing and circulation, and recognize and initiate treatment for DKA including judicious fluid administration and an insulin infusion. The patient developed altered mental status with signs of cerebral edema requiring the initiation of cerebral protection strategies. We created a debriefing guide and a participant evaluation form. RESULTS Forty-two participants completed this simulation across seven institutions including attendings, residents, fellows, and nurses. The scenario was rated by participants on a 5-point Likert scale and was generally well received (M = 5.0). Participants rated the simulation case as effective in teaching how to recognize (M = 4.8) and manage (M = 4.5) DKA with cerebral edema in a pediatric patient. DISCUSSION This simulation represents a resource for learners in the pediatric ED in the recognition and management of a toddler with DKA and can be adapted to learners at all levels and tailored to various learning environments.
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Affiliation(s)
- Cale Roberts
- Pediatrics Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Ashley Keilman
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Jean Pearce
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
| | - Alissa Roberts
- Assistant Professor, Department of Pediatrics, Division of Endocrinology and Diabetes, University of Washington School of Medicine and Seattle Children's Hospital
| | - Kevin Ching
- Associate Professor of Clinical Pediatrics, Division of Emergency Medicine, Weill-Cornell Medicine
| | - Jenny Kingsley
- Assistant Professor, Department of Anesthesia and Critical Care Medicine, Division of Pediatric Critical Care, Keck School of Medicine, University of Southern California and Children's Hospital of Los Angeles
| | - Alexander Stephan
- Assistant Professor, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York Presbyterian/Weill Cornell Medical Center
| | - Isabel Gross
- Assistant Professor of Pediatrics, Department of Pediatric Emergency Medicine, Yale University School of Medicine
| | - Daisy Ciener
- Program Director of Pediatric Emergency Medicine Fellowship and Assistant Professor of Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
| | - Julie Augenstein
- Base Hospital Medical Director, Quality and Safety Medical Director, and Attending Physician, Phoenix Children's Hospital; Clinical Assistant Professor of Child Health and Emergency Medicine, Mayo Clinic College of Medicine and Science and University of Arizona College of Medicine
| | - Anita Thomas
- Director of Pediatric Emergency Medicine Fellow Simulation and Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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Sanseau E, Carr LH, Case J, Tay KY, Ades A, Yang K, Huang H, Bustin A, Good G, Gaines S, Augenstein J, Ciener D, Pearce J, Reid J, Stone K, Burns R, Thomas A. Pediatric Emergency Medicine Simulation Curriculum: Vitamin K Deficiency in the Newborn. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11078. [PMID: 33511273 PMCID: PMC7830750 DOI: 10.15766/mep_2374-8265.11078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The American Academy of Pediatrics recommends vitamin K prophylaxis at birth for all newborns to prevent vitamin K deficiency bleeding (VKDB). Despite a lack of evidence for serious harms, barriers to prophylaxis, including parental refusal, are rising, as are cases of VKDB. METHODS This simulation involved an infant presenting to the emergency department who decompensated due to a cerebral hemorrhage caused by VKDB and was treated by pediatric and emergency providers. The case was incorporated into the fellow and division monthly curricula, and participants completed postsimulation surveys. The patient required a secure airway, seizure management, vitamin K, and a fresh frozen plasma infusion upon suspicion of the diagnosis, plus a coordinated transfer to definitive care. The case included a description of the simulated case, learning objectives, instructor notes, an example of the ideal flow of the scenario, anticipated management mistakes, and educational materials. RESULTS The simulations were carried out with 48 total participants, including 40 fellows and eight attendings, from five different training institutions over 1 year. In surveys, respondents gave overall positive feedback. Ninety-four percent of participants gave the highest score on a Likert scale indicating that the simulation was relevant, and over 80% gave the highest score indicating that the experience helped them with medical management. DISCUSSION This simulation trained physicians how to recognize and treat a distressed infant with VKDB. The case was perceived to be an effective learning tool for both fellow and attending physicians.
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Affiliation(s)
- Elizabeth Sanseau
- Fellow, Pediatric Emergency Medicine, Children's Hospital of Philadelphia
| | - Leah H. Carr
- Fellow, Department of General Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia
| | - Jennifer Case
- Resident, Department of General Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Khoon-Yen Tay
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Anne Ades
- Professor, Clinical Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia
| | - Kesi Yang
- Assistant Professor, Clinical Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia
| | - Hannah Huang
- Pharmacist, Department of General Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Anna Bustin
- Residency Preceptor, Pharmacy Residency Program, and Clinical Pharmacy Specialist, Neonatal/Infant Intensive Care, Children's Hospital of Philadelphia
| | - Grace Good
- Simulation Specialist, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Shannon Gaines
- Education Nurse Specialist, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Julie Augenstein
- Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, Phoenix Children's Hospital
| | - Daisy Ciener
- Assistant Professor, Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
| | - Jean Pearce
- Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
| | - Jennifer Reid
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Kimberly Stone
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Rebekah Burns
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Anita Thomas
- Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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Saha B, Aoyama K, Petre MA, Englesakis M, Robertson J, Levine M. Pericardial disease as a rare complication of pediatric appendicitis: a systematic literature search. JA Clin Rep 2020; 6:89. [PMID: 33165640 PMCID: PMC7652975 DOI: 10.1186/s40981-020-00395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Classic symptoms of acute appendicitis are well known but are uncommon and often misinterpreted in pediatric patients, potentially delaying diagnosis and resulting in rare sequelae. METHODS We conducted a comprehensive systematic literature search of case reports detailing pericardial disease as a rare complication of pediatric appendicitis through MEDLINE, Embase, and Cochrane Databases. Inclusion criteria was that the patient must be < 18 years old and present with both pericardial disease and appendicitis. RESULTS Our search yielded 7 cases with an average age of 10.3 ± 3.9 years old. The cases involved cardiac tamponade, pericarditis, and/or pericardial effusion. Five cases were diagnosed with appendicitis before complicated by pericardial disease. Most cases had an infectious component, but a majority had negative pericardial fluid cultures. Pleural effusion and abdominal abscesses were other common complications of pediatric appendicitis. CONCLUSION Awareness of this uncommon relationship may have prognostic value as this may facilitate appropriate management of pericardial effusions, tamponade, and/or appendicitis.
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Affiliation(s)
- Bibek Saha
- John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, Honolulu, HI, 96813, USA.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada. .,Program in Clinical Health Evaluative Sciences, The SickKids Research Institute, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada.
| | - Maria-Alexandra Petre
- Department of Pediatric Anesthesia, Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Robertson
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
| | - Mark Levine
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
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Pidaparti V, Keilman A, Case J, Thomas A. Pediatric Emergency Medicine Simulation Curriculum: Bacterial Tracheitis. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10946. [PMID: 32875092 PMCID: PMC7449579 DOI: 10.15766/mep_2374-8265.10946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/30/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pediatric bacterial tracheitis is a rare but life-threatening upper airway infection with mortality rates estimated as high as 20%, typically affecting children between 6 months and 12 years old. Given such high mortality rates, we felt it was important to train medical personnel to evaluate and manage this condition. METHODS This simulation-based curriculum was developed for health care professionals involving the evaluation and management of an 8-year-old male with symptoms of fever, stridor, worsening barking cough, and increased work of breathing. Critical actions included identifying stridor and airway respiratory distress; monitoring and supporting airway, breathing, and circulation; administering racemic epinephrine and dexamethasone; and identifying and treating bacterial tracheitis as the underlying cause. Scenario-specific debriefing tools were put together to elicit scenario feedback and aid in formative learning. RESULTS The scenario was conducted with six fellows and 12 residents and medical students. Per the survey data, the case was rated as highly relevant (median = 5) and highly realistic (median = 5) by participants on a 5-point Likert scale. DISCUSSION Pediatric bacterial tracheitis is a low frequency, but high-risk scenario that was amenable to simulation as an educational modality and was well-received by participants. The debriefing tools were implemented as a means of helping instructors customize the scenario for learners based on respective educational backgrounds and learning styles.
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Affiliation(s)
- Vaidehi Pidaparti
- Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Ashley Keilman
- Assistant Professor, Department of Pediatric Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Jennifer Case
- Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Anita Thomas
- Assistant Professor, Department of Pediatric Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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Shubin C, Iyer S, Pearce J, Lang B, Gross I, Ciener D, Mazor S, Keilman A, Thomas A. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Serotonin Syndrome. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10928. [PMID: 32733995 PMCID: PMC7385927 DOI: 10.15766/mep_2374-8265.10928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/10/2020] [Indexed: 05/28/2023]
Abstract
Introduction Serotonin syndrome is caused by an accumulation of serotonin in the body from drug interactions or overdose of serotonergic medications, including commonly used antidepressants. Symptoms can be life-threatening and encompass both neurologic and cardiovascular toxicity, including agitation, seizure, tachycardia, rhabdomyolysis, and hyperthermia. Methods This simulation case was developed for pediatric emergency medicine fellows and emergency medicine residents in the pediatric emergency department and can be altered to accommodate other learners. The case involved a 16-year-old male, represented by a low- or high-fidelity manikin, who presented with altered mental status/agitation after an overdose of antidepressant medication. The team of learners was required to perform a primary and a secondary assessment; manage airway, breathing, and circulation; and recognize and initiate treatment for serotonin syndrome. The patient had a seizure resulting in airway compromise requiring advanced airway support, as well as developed rhabdomyolysis requiring aggressive fluid hydration. We created a debriefing guide and a participant evaluation form. Results Fifty-seven participants across five institutions completed this simulation, which included residents, fellows, faculty, and students. The scenario was rated by participants using a 5-point Likert scale and was generally well received. Participants rated the simulation case as effective in learning how to both recognize (M = 4.9) and manage (M = 4.8) serotonin syndrome. Discussion This pediatric emergency simulation scenario can be tailored for a range of learner backgrounds and simulation environments. We used the participant evaluation form to improve future iterations of the simulation.
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Affiliation(s)
- Corinne Shubin
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Shweta Iyer
- Assistant Professor, Pediatrics and Emergency Medicine, Weill Cornell Medical College
| | - Jean Pearce
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
| | - Benjamin Lang
- Pediatrics Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Isabel Gross
- Clinical Instructor, Department of Pediatrics, Division of Emergency Medicine, Yale University School of Medicine and Yale New Haven Children's Hospital
| | - Daisy Ciener
- Assistant Professor, Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
| | - Suzan Mazor
- Director of Pediatric Toxicology, University of Washington School of Medicine and Seattle Children's Hospital; Associate Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Ashley Keilman
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Anita Thomas
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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Kwan C, Pusic M, Pecaric M, Weerdenburg K, Tessaro M, Boutis K. The Variable Journey in Learning to Interpret Pediatric Point-of-care Ultrasound Images: A Multicenter Prospective Cohort Study. AEM EDUCATION AND TRAINING 2020; 4:111-122. [PMID: 32313857 PMCID: PMC7163207 DOI: 10.1002/aet2.10375] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To complement bedside learning of point-of-care ultrasound (POCUS), we developed an online learning assessment platform for the visual interpretation component of this skill. This study examined the amount and rate of skill acquisition in POCUS image interpretation in a cohort of pediatric emergency medicine (PEM) physician learners. METHODS This was a multicenter prospective cohort study. PEM physicians learned POCUS using a computer-based image repository and learning assessment system that allowed participants to deliberately practice image interpretation of 400 images from four pediatric POCUS applications (soft tissue, lung, cardiac, and focused assessment sonography for trauma [FAST]). Participants completed at least one application (100 cases) over a 4-week period. RESULTS We enrolled 172 PEM physicians (114 attendings, 65 fellows). The increase in accuracy from the initial to final 25 cases was 11.6%, 9.8%, 7.4%, and 8.6% for soft tissue, lung, cardiac, and FAST, respectively. For all applications, the average learners (50th percentile) required 0 to 45, 25 to 97, 66 to 175, and 141 to 290 cases to reach 80, 85, 90, and 95% accuracy, respectively. The least efficient (95th percentile) learners required 60 to 288, 109 to 456, 160 to 666, and 243 to 1040 cases to reach these same accuracy benchmarks. Generally, the soft tissue application required participants to complete the least number of cases to reach a given proficiency level, while the cardiac application required the most. CONCLUSIONS Deliberate practice of pediatric POCUS image cases using an online learning and assessment platform may lead to skill improvement in POCUS image interpretation. Importantly, there was a highly variable rate of achievement across learners and applications. These data inform our understanding of POCUS image interpretation skill development and could complement bedside learning and performance assessments.
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Affiliation(s)
- Charisse Kwan
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - Martin Pusic
- Department of Emergency Medicine and Division of Learning AnalyticsNYU School of MedicineNew YorkNY
| | | | - Kirstin Weerdenburg
- Department of Emergency MedicineIWK Health Centre and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Mark Tessaro
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - Kathy Boutis
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
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