Journal of education & teaching in emergency medicine最新文献

{"title":"What You Didn't Learn in Residency: A Collective Curriculum for New Academic EM Faculty and Fellows.","authors":"Jessica Schmidt, Benjamin Schnapp, Sara Damewood, Mary Westergaard","doi":"10.21980/J8WP9Z","DOIUrl":"https://doi.org/10.21980/J8WP9Z","url":null,"abstract":"<p><strong>Audience and type of curriculum: </strong>This curriculum is designed for emergency medicine fellows and first-year junior faculty. The curriculum covers core topics related to academic and professional success for an early career faculty member.</p><p><strong>Length of curriculum: </strong>The curriculum is designed as quarterly sessions over the course of one academic year.</p><p><strong>Introduction: </strong>An increasing number of emergency medicine graduates are pursuing fellowship after completion of residency.1 Fellowship can be challenging as newly minted graduates begin to explore their academic niche, refine their clinical practice, and define their personal and professional spheres. We propose a structured curriculum to help guide fellows and new faculty to mitigate these challenges.</p><p><strong>Educational goals: </strong>The aim of this curriculum is to develop relevant skills to promote academic success for fellows and first-year faculty at the start of their academic career and which could be completed during a one-year training timeline. We included topics relevant to all fellow and new faculty's expected personal and professional journey during this first year, including time management, academic productivity, resilience/wellness, and developing a national reputation.</p><p><strong>Educational methods: </strong>The educational strategies used in this curriculum consist primarily of lecture seminars. There is one short individual activity associated with the lectures and one small group discussion.</p><p><strong>Research methods: </strong>The course was assessed with pre- and post-test surveys following each lecture. Surveys assessed participants' reaction, learning, and behavior for each session. Evaluations were completed based on a 5-point Likert scale (1=strongly disagree, 5=strongly agree).</p><p><strong>Results: </strong>Fifteen participants attended the seminar series encompassing fellows and first-year faculty/post-fellows from ten different fellowship subspecialities. Average pre-assessment scores were low for many of the self-reported skills and confidence throughout the seminar series. Overall, participants reported increased confidence on the post-test for each of the seminar topics. In addition, participants reported that they learned new skills and planned to use the new ideas presented. All participants reported they would recommend these seminars to someone else on their same career path.</p><p><strong>Discussion: </strong>Overall, participants reported increased confidence, new skills, and plans to use the ideas presented in the seminar series. The content appears applicable to this learner set since all reported they would recommend the series to others on their career path. In conclusion, we believe our seminar series will build skills for fellows and first-year faculty which will promote academic success.</p><p><strong>Topics: </strong>Academic success, professional development, early career devel","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"9 1","pages":"C16-C40"},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent with Diabetic Ketoacidosis, Hypothermia and Pneumomediastinum.","authors":"Steven Millner, Courtney Devlin","doi":"10.21980/J8FP8J","DOIUrl":"https://doi.org/10.21980/J8FP8J","url":null,"abstract":"<p><strong>Audience: </strong>The target audience of this simulation is emergency medicine residents and medical students. The simulation is based on a real case of a 12-year-old male who presented obtunded with shortness of breath and hypothermia who was ultimately diagnosed with diabetic ketoacidosis (DKA) and pneumomediastinum. This case highlights the diagnosis and management of an adolescent with new onset diabetic ketoacidosis and pneumomediastinum with deterioration of status, as well as important ventilator settings if intubation is required in the setting of diabetic ketoacidosis.</p><p><strong>Background: </strong>Type 1 diabetes is a common disease in the pediatric population with the prevalence being approximately 2.15 per 1000 youths and diabetic ketoacidosis being the presenting status in 30-40% of the patients.1 Physicians who evaluate a child with altered mental status must have diabetic ketoacidosis in their differential. In the setting of mechanical ventilation in patients with diabetic ketoacidosis (DKA), special care must be taken. Mechanical ventilation in these patients comes with increased risk, morbidity, and mortality. Risk factors for pneumomediastinum include lung disease such as asthma, chronic obstructive pulmonary disease (COPD), and malignancy, but also can occur in the acute setting of vomiting or trauma.2.</p><p><strong>Educational objectives: </strong>By the end of the simulation, learners will be able to: 1) develop a differential diagnosis for an adolescent who presents obtunded with shortness of breath; 2) discuss the management of diabetic ketoacidosis; 3) discuss management of hypothermia in a pediatric patient; 4) discuss appropriate ventilator settings in a patient with diabetic ketoacidosis; and 5) demonstrate interpersonal communication with family, nursing, and consultants during high stress situations.</p><p><strong>Educational methods: </strong>This is a high-fidelity simulation that allows learners to manage the diagnosis and treatment of diabetic ketoacidosis and hypothermia in an adolescent patient. Participants participated in a debriefing after the simulation. There should be approximately 4-5 learners per case. This simulation was performed in 3 sessions. Each learner performed this simulation one time.</p><p><strong>Research methods: </strong>The effectiveness of this case was evaluated by surveys given to learners after debriefing. Learners gave quantitative and qualitative results of their feedback using a 1-5 rating scale and open-ended written questions. This case was trialed with residents in their first through third years of training as well as fourth year medical students.</p><p><strong>Results: </strong>Feedback was very positive, with 19 residents completing the post-simulation survey. They enjoyed the case and reported they would feel more comfortable in a comparable situation in the future. Four survey questions were asked of the participants. On average, learners stated they felt t","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"S1-S24"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-Of-Care Ultrasound Use for Detection of Multiple Metallic Foreign Body Ingestion in the Pediatric Emergency Department: A Case Report.","authors":"Sarah Bella, Joseph Heiney, Amy Patwa","doi":"10.21980/J83D2D","DOIUrl":"10.21980/J83D2D","url":null,"abstract":"<p><p>Foreign body ingestions are common complaints in the pediatric emergency department that can be difficult to diagnose in patients with vague symptoms. Magnetic foreign body ingestion can cause significant morbidity and mortality in children. Point-of-care ultrasound (POCUS) is an imaging modality that can be used to readily diagnose emergent abdominal pathology in a timely matter at the patient's bedside. In the case described in the report below, a 6-year-old male swallowed multiple round magnets, causing severe abdominal pain. This was detected on POCUS. An abdominal radiograph also confirmed the POCUS findings of multiple hyperechoic round foreign bodies. Key clinical features and sonographic findings are discussed that may help clinicians using POCUS to identify ingested foreign bodies in Pediatric Emergency Departments.</p><p><strong>Topics: </strong>Point-of-care ultrasound, pediatric emergency medicine, foreign body ingestion.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"V1-V4"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Tachycardia.","authors":"Rohit Menon, Geremiha Emerson, Jennifer Yee","doi":"10.21980/J8KD2R","DOIUrl":"10.21980/J8KD2R","url":null,"abstract":"<p><strong>Audience: </strong>This scenario was developed to educate emergency medicine residents on the diagnosis and management of ventricular tachycardia (VT) that is refractory to single dose anti-arrhythmic management.</p><p><strong>Background: </strong>Electrical storm, defined as three or more episodes of sustained VT, ventricular fibrillation, or appropriate shocks from an implantable cardioverter defibrillator within 24 hours,1 has a mortality rate up to 14% in the first 48 hours.2 Ventricular tachycardia may present in a heterogenous fashion, not only with stable versus unstable clinical presentations, but also with different electrocardiographic morphologies and etiologies.1 Understanding how to rapidly diagnose, treat, and utilize second or third-line treatments is vital in the setting of refractory ventricular tachycardia rather than relying on the success of first-line agents. Appreciation for what medications are readily available in your crash cart and medication dispensing cabinet is critical for timely management for refractory ventricular tachycardia.</p><p><strong>Educational objectives: </strong>At the conclusion of the simulation session, learners will be able to: 1) identify the different etiologies of VT, including structural heart disease, acute ischemia, and acquired or congenital QT syndrome; 2) describe confounding factors of VT, such as electrolyte abnormalities and sympathetic surge; 3) describe how to troubleshoot an unsuccessful synchronized cardioversion, including checking equipment connections, increasing delivered energy, and changing pad placement; 4) compare and contrast treatments of VT based on suspected underlying etiology; 5) describe reasons to activate the cardiac catheterization lab other than occlusive myocardial infarction; and 6) identify appropriate disposition of the patient to the cardiac catheterization lab.</p><p><strong>Educational methods: </strong>This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on the diagnosis, differential diagnosis, and management of VT. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This scenario may also be run as an oral board case.</p><p><strong>Research methods: </strong>Our residents are provided a survey at the completion of the debriefing session so they may rate different aspects of the simulation, as well as provide qualitative feedback on the scenario.</p><p><strong>Results: </strong>The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form³ with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Twelve learners completed a feedback form. This session received 6 and 7 scores (consistently effective/very good and extremely effective/outsta","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"S25-S48"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic Retrobulbar Spot Sign in Diagnosis of Central Retinal Artery Occlusion: A Case Report.","authors":"Emiliya Usheva, Dustin Williams, Haley Musgrave, Scott Zhou","doi":"10.21980/J8735P","DOIUrl":"10.21980/J8735P","url":null,"abstract":"<p><p>Central retinal artery occlusion (CRAO) is a rare emergency department presentation with high morbidity and potential for long-term vision loss. Additionally, this finding requires an expeditious embolic workup for possible systemic pathology (i.e., stroke). The gold standard for diagnosis is visualization of a pale retina with a \"cherry-red spot\" on the fovea seen under dilated fundoscopic examination. However, performing a dilated fundoscopic exam is often not practical and technically challenging in the emergency room setting. Alternatively, point of care ultrasound is an inexpensive, non-invasive tool that is already highly utilized in the emergency department and can aid in diagnosis. In the case described in this report, a 66-year-old female presented to the emergency department with painless, monocular vision loss. Ultrasound showed a hyperechoic density on the distal aspect of the optic nerve (\"retrobulbar spot sign\") and dilated fundoscopic exam showed right eye pale macula with cherry red spot, all consistent with CRAO. Here we present a case that suggests an opportunity for improvement in evaluation of monocular vision loss in the emergency department by adding bedside ocular ultrasound to aid in more rapid diagnosis of CRAO.</p><p><strong>Topics: </strong>Central retinal occlusion, vision loss, point-of-care ultrasound, ocular ultrasound, emboli.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"V5-V8"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enneagram in EM.","authors":"Megan Cifuni, Cami Pfennig, Caroline Astemborski","doi":"10.21980/J8ZM0G","DOIUrl":"https://doi.org/10.21980/J8ZM0G","url":null,"abstract":"<p><strong>Audience: </strong>This is a lecture paired with facilitated small group sessions and is targeted towards emergency medicine residents and physicians.</p><p><strong>Background: </strong>The enneagram is a well-established and popular personality theory that asserts that there are nine basic personality types, and that each enneagram type, 1-9, operates from a basic fear and a basic desire that produces predictable behavioral patterns and preferences.1-2 The enneagram has long been used as a tool to enhance self-awareness and to better understand internal defenses and reactions,3-5 and as such, it has been increasingly utilized to enhance self-growth and development in the fields of education, parenting, and business.6-7 While some studies have used the enneagram as a tool to predict natural empathy or stress levels of those in the medical field, particularly in nursing and medical school students,8-9 little has been published on the use of the enneagram as a tool to enhance self-awareness, leadership, and teamwork in the medical field. Emergency medicine is a specialty in which residents and physicians must not only be self-aware but must also be attuned to the dynamics of their healthcare team in order to succeed. We believe that the enneagram is the ideal tool to enhance these crucial skills.</p><p><strong>Educational objectives: </strong>The primary aim of this session was to enhance participants' self-awareness by identifying their enneagram type and therefore their predictable behavioral patterns. The secondary aim was to discuss strategies to improve teamwork and physician team leadership by directly addressing the type's strengths and weaknesses in these interactions.By the end of this session, the learner will be able to: 1) Self-identify with a primary enneagram personality type. 2) List the fears, desires, and motivations of the enneagram type. 3) Describe struggles in interacting with other disparate enneagram types. 4) Discuss strategies for success in facing conflict and interacting with other team members.</p><p><strong>Educational methods: </strong>This lecture was designed to educate emergency department physicians and residents on the enneagram tool. The introductory lecture takes about 20 minutes, and following this foundational presentation, learners split into small groups. Small group sessions take an additional 20 minutes during which facilitators guide learners through a discussion on their enneagram type and the potential strengths and challenges that each type might face in professional situations. This session was hosted during an Emergency Medicine Resident Education Conference. Due to COVID-19 restrictions, the session was presented virtually on a synchronous video platform with small group breakout rooms.</p><p><strong>Research methods: </strong>Following the session, the educational content was evaluated by our residents and faculty by a Likert reaction survey. The survey assessed both the form and effecti","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"L1-L22"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Cost Fishhook Removal Simulation.","authors":"David Mitchell Baskin, Christopher Ashby Davis","doi":"10.21980/J8Q64P","DOIUrl":"10.21980/J8Q64P","url":null,"abstract":"<p><strong>Audience: </strong>The target audiences for this hands-on innovation are health care providers including medical students and emergency medicine residents. This simulation is also appropriate for small group sessions teaching the layperson.</p><p><strong>Background: </strong>While generally not life-threating fishhook injuries are commonplace. They can end a day of recreation or an outdoor trip and possibly result in a visit to an emergency department or urgent care. Hands-on education on fishhook removal techniques that minimize tissue damage is rarely provided in wilderness first aid or traditional medical education. To the best of our knowledge, to date there are only two studies on fishhook removal simulations in medical and wilderness first aid education.1,2 The previously described simulation models are limited by accessibility of materials, realism, and cost.</p><p><strong>Educational objectives: </strong>The goal of this small group session is to fill the gap in training on fishhook injuries. At the end of the session participants should be able to describe the parts of a fishhook, as well as demonstrate and have increased confidence in performing multiple fishhook removal techniques.</p><p><strong>Educational methods: </strong>Social learning theory is the conceptual framework for this small group session.3,4 This reflects the idea that students learn not only through repetition with trial and error, but through social interactions, observing and modeling successes of others. As a result, while this simulation requires a facilitator ensure the required items are available it does not necessitate a facilitator be present over the entire duration. Participants perform common fishhook removal techniques with hands-on skill development using commercially available silicone sponge injection pad trainers.</p><p><strong>Research methods: </strong>Evaluating this small group session at a wilderness medicine training attended by medical and physician assistant students and their guests, self-reported confidence in fishhook removal before and after the simulation was assessed with a paired t-test. Survey results of perceived effectiveness and value of the simulation were also evaluated.</p><p><strong>Results: </strong>The average confidence increased 58% after the simulation (p<0.005). The mean level of effectiveness was 87% and the participant perceived monetary value of the simulation materials was greater than actual cost.</p><p><strong>Discussion: </strong>This innovation is a cost-friendly way to provide education and practice on fishhook removal. It requires minimal set up time and pre-learning can be easily modified to the expected knowledge and experience of participants. Understanding the fishhook removal techniques and increased levels of confidence has the potential to make participants more efficient when caring for patients. It may result in greater likelihood of success in removing fishhooks with minimal tissue damage.</p>","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"I1-I13"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Little Patients, Big Tasks - A Pediatric Emergency Medicine Escape Room.","authors":"Jessica Pelletier, Ernesto Romo, Bryan Feinstein, Charles Smith, Gina Pellerito, Alexander Croft","doi":"10.21980/J89W70","DOIUrl":"10.21980/J89W70","url":null,"abstract":"<p><strong>Audience: </strong>The target audience for this small group session is post-graduate year (PGY) 1-4 emergency medicine (EM) residents, pediatric EM (PEM) fellows, and medical students.</p><p><strong>Introduction: </strong>Pediatric emergency department visits have been declining since the start of the COVID-19 pandemic, leading to decreased exposure to pediatric emergency care for EM residents and other learners in the ED.1 This is a major problem, given that the Accreditation Council for Graduate Medical Education (ACGME) mandates that a minimum of 20% of patient encounters or five months of training time for EM residents must occur with pediatric patients, with at least 50% of that time spent in the ED setting.2,3 A minimum of 12 months must be spent in the pediatric ED for PEM fellows,2 and an average of 7.1 weeks of medical school are spent in pediatric clerkships.4 This decrease in pediatrics exposure in the post-pandemic environment can be addressed through simulation and gamification. We selected the gamification method of an escape room to create an engaging environment in which learners could interface with key pediatric emergency medicine clinical concepts via group learning.</p><p><strong>Educational objectives: </strong>By the end of this small group exercise, learners will be able to:Demonstrate appropriate dosing of pediatric code and resuscitation medicationsRecognize normal pediatric vital signs by ageDemonstrate appropriate use of formulas to calculate pediatric equipment sizes and insertion depthsRecognize classic pediatric murmursAppropriately diagnose congenital cardiac conditionsRecognize abnormal pediatric electrocardiograms (ECGs)Identify life-threatening pediatric conditionsDemonstrate intraosseous line (IO) insertion on a pediatric modelDemonstrate appropriate use of the Neonatal Resuscitation Protocol (NRP^®) algorithms.</p><p><strong>Educational methods: </strong>An escape room - a form of gamification - was utilized to engage the learners in active learning. Gamification is an increasingly popular educational technique being utilized in graduate medical education and refers to the conversion of serious, non-trivial material into a fun activity fashioned like a game in order to enhance engagement in learning.5 This educational method seeks to enhance knowledge, attitudes, and skills via components of games - such as puzzles and prizes - outside of the context of a traditional game.6 Though high-quality research data on the effectiveness of gamification methods in graduate medical education is limited, studies have shown that gamification enhances learning, attitudes, and behaviors.5,7 One randomized, clinical-controlled trial investigating the use of gamification to enhance patient outcomes found that patients of primary care physicians randomized to the gamification group reached blood pressure targets faster than in the control group.8 Escape rooms as a modality for education have been suggested t","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"SG1-SG19"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhalational Injury Secondary to House Fire.","authors":"Ryan O'Neill, Benjamin M Ostro, Jennifer Yee","doi":"10.21980/J8TW7N","DOIUrl":"https://doi.org/10.21980/J8TW7N","url":null,"abstract":"<p><strong>Audience: </strong>This scenario was developed to educate emergency medicine residents on the diagnosis and management of patients with an inhalational airway injury secondary to a house fire.</p><p><strong>Background: </strong>Burn injuries are a common occurrence encountered by the emergency physician. According to the National Hospital Ambulatory Medical Care Survey, around 371,000 patients were treated in emergency departments for fire or burn injuries across the United States in 2020. This represents around 1% of emergency department visits related to injury, poisoning, or adverse effects.1 One of the most dangerous and time critical aspects of managing severely burned patients is inhalation injury. Inhalation injury is a relatively vague term which may refer to pulmonary exposure to a wide range of chemicals in various forms. In the context of burn patients, this is most often smoke exposure. It is critical that the emergency medicine provider rapidly identifies the potential for an inhalational injury in order to determine the need for definitive airway management. It is also important that the provider has the necessary skills and systematic approach to manage what is likely to be a difficult airway. Furthermore, providers must then have the knowledge of how to best manage and resuscitate these severely burned patients post-intubation.</p><p><strong>Educational objectives: </strong>At the conclusion of the simulation session, learners will be able to: 1) recognize the indications for intubation in a thermal burn/inhalation injury patient; 2) develop a systematic approach to an inhalational injury airway; and 3) recognize indications for transfer to burn center.</p><p><strong>Educational methods: </strong>This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on the diagnosis, differential diagnosis, and management of inhalational airway injury secondary to a house fire. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This scenario may also be run as an oral board case.</p><p><strong>Research methods: </strong>Our residents are provided a survey at the completion of the debriefing session so they may rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form² with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7.</p><p><strong>Results: </strong>Nine learners completed a feedback form. This session received all 6 & 7 scores (consistently effective/very good and extremely effective/outstanding, respectively) other than one isolated 5 score.</p><p><strong>Discussion: </strong>This is a cost-effective method for reviewin","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 4","pages":"S49-S79"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Headache Over Heels: CT Negative Subarachnoid Hemorrhage.","authors":"Sarah Hogan,&nbsp;Sara Dimeo,&nbsp;Caroline Astemborski","doi":"10.21980/J8ND2C","DOIUrl":"https://doi.org/10.21980/J8ND2C","url":null,"abstract":"<p><strong>Audience: </strong>This simulation is intended for MS4 or PGY-1 learners.</p><p><strong>Introduction: </strong>Both headache and syncope are common chief complaints in the emergency department (ED); however, subarachnoid hemorrhage (SAH) is uncommon (accounting for 1-3% of all patients presenting to the ED with headache), with near 50% mortality.1-3 It is important to recognize the signs and symptoms that point to this specific diagnosis. Once subarachnoid hemorrhage is suspected, it is critical to understand the appropriate workup to diagnose SAH, depending on the timing of presentation. Once SAH is diagnosed, appropriately managing the patient's glucose, blood pressure, and pain is important.</p><p><strong>Educational objectives: </strong>By the end of this case, the participant will be able to: 1) construct a broad differential diagnosis for a patient presenting with syncope, 2) name the history and physical exam findings consistent with SAH, 3) identify SAH on computer tomography (CT) imaging, 4) identify the need for lumbar puncture (LP) to diagnose SAH when CT head is non-diagnostic > 6 hours after symptom onset, 5) correctly interpret cerebral fluid studies (CSF) to aid in the diagnosis of SAH, and 6) specify blood pressure goals in SAH and suggest appropriate medication management.</p><p><strong>Educational methods: </strong>High-fidelity simulation was utilized since this modality forces learners to actively construct a differential for syncope, recognize the possibility of subarachnoid hemorrhage, recall the need for lumbar puncture, and talk through management considerations in real time as opposed to a more passive lecture format.</p><p><strong>Research methods: </strong>Twenty emergency medicine residents and medical student learners completed the simulation activity. Each learner was asked to complete an eight question post-simulation survey. The survey addressed the utility and appropriate training level of the simulation activity while also including an open-ended prompt for suggestions for improvement.</p><p><strong>Results: </strong>Five PGY3, four PGY2, four PGY1, and seven medical students completed the survey. Ninety-five percent felt that the case was more helpful in a simulation format than in a lecture format. All learners felt that the simulation was an appropriate level of difficulty. Of the comments received, a few learners noted they preferred more complexity.</p><p><strong>Discussion: </strong>Overall, the educational content was effective in teaching about the SAH diagnostic algorithm, CSF interpretation, and blood pressure management in SAH. Overall, learners very much enjoyed the activity and felt it was appropriate for their level of training. The most common constructive feedback was to include more specific neurologic findings on physical examination to help guide the student to the diagnosis of SAH.</p><p><strong>Topics: </strong>Syncope, subarachnoid hemorrhage, cerebrospinal fluid interpretation, l","PeriodicalId":73721,"journal":{"name":"Journal of education & teaching in emergency medicine","volume":"8 3","pages":"S34-S58"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9995308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}