急诊住院医师基于模拟的经食管超声心动图复苏训练

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-05-01 DOI:10.1016/j.jemermed.2024.11.006

Andrew Fried MD , Jessica A. Hathaway MD , Tania Strout PHD, RN, MS , David C. Mackenzie MD , Peter E. Croft MD , Christina N. Wilson MD , August M. Felix MD

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引用次数: 0

摘要

背景经食管超声心动图（TEE）是急诊医学中一种新兴的复苏工具。基于模拟的培训对于教授这些技能是必要的。目前还没有评估模拟如何使急诊医学（EM）住院医生在活体患者中执行这项技能。目的本研究的目的是评估模拟训练后的能力和对手术室（OR）活体患者复苏TEE的表现。方法采用前瞻性研究，在一个单一的学术站点，招募志愿研究生2年（PGY）和PGY3 EM居民。居民接受了以下检查：测试前检查以评估一般TEE知识；30分钟的复苏方案讲座：食管中四室（ME4C），食管中长轴（MELAX），胃短轴（TGSAX）和升主动脉短轴（AscAoSAX）；由接受过复苏TEE培训的医生领导的HeartWorks TEE模拟器进行两次1小时的训练；测试后检查;由心脏麻醉师在手术室进行TEE检查。数据用描述性统计进行汇总。测试成绩采用配对t检验或Wilcoxon秩和检验进行比较。结果15名居民参与调查。前测平均评分为11.07,95% CI: 9.35 ~ 12.79。术后平均评分为19.40,95% CI: 18.94 ~ 19.86。得分有显著差异，t = -11.996, p <；0.0001. OR评估结果包括：安置尝试次数(平均值：1.27；95% ci: 1.01-1.52)；临床可接受的观点（ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, TGSAX 60%）。在60个观点中，76.7%的观点是可以接受的。结论复苏TEE模拟训练是一种有效的方法，可以帮助急诊住院医师获取和解释活体患者TEE图像。

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Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents

Background

Transesophageal echocardiography (TEE) is an emerging resuscitation tool in emergency medicine. Simulation-based training is necessary for teaching this skill set. There has been no evaluation of how simulation prepares emergency medicine (EM) residents to perform this skill in live patients.

Objectives

The objective of this study is to evaluate competency following simulation training and performance of resuscitative TEE on live patients in the operating room (OR).

Methods

A prospective study at a single academic site, enrolling volunteer postgraduate year (PGY)2 and PGY3 EM residents. Residents underwent the following: Pretest examination to assess general TEE knowledge; 30-minute lecture on a resuscitative protocol: mid-esophageal four-chamber (ME4C), mid-esophageal long axis (MELAX), trans-gastric short axis (TGSAX) and ascending aortic short axis (AscAoSAX); Two 1-hour sessions with a HeartWorks TEE simulator led by a physician trained in resuscitative TEE; post-test examination; TEE examination in the OR with a cardiac anesthesiologist. Data were summarized with descriptive statistics. Test scores were compared with paired t-test or Wilcoxon rank-sum tests.

Results

Fifteen residents participated. The pretest mean score was 11.07, 95% CI: 9.35 to 12.79. The post-test mean score was 19.40, 95% CI: 18.94 to 19.86. A significant difference in scores was noted, t = –11.996, p < 0.0001. The OR assessment findings included: number of placement attempts (mean: 1.27; 95% CI: 1.01–1.52); clinically acceptable views (ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, and TGSAX 60%). Of 60 total views, 76.7% were acceptable.

Conclusion

Simulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine