Emergency Medicine Procedures Research Articles

University of Washington School of Medicine

University of Washington School of Medicine

Clinical Procedures in Emergency Medicine

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Emergency medicine procedures course

The emergency medicine procedures course is a one day practical skills course developed for doctors who work in emergency medicine. Candidates rotate around seven stations during the day and receive hands on training in more than 15 procedures commonly used in the accident and emergency department. The course provides participants with the valuable opportunity to learn and practise practical skills de novo, or to refresh and update their skills in a friendly and relaxed environment. This course is aimed at two groups of doctors—all trainees about to do their first attachment in accident and emergency, either as a foundation year doctor or as part of specialty training, and doctors training in emergency medicine who wish to maintain their skills and ensure that their practice conforms to current guidelines and best practice. I completed the course in November 2008 while working in accident and emergency as …

Stabilization and Treatment of Dental Avulsions and Fractures by Emergency Physicians Using Just-in-Time Training

The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure. This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique. Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting or bandaging technique. The results of this study suggest that of the stabilization procedures completed by emergency physicians, dentists preferred the bondable reinforcement ribbon for managing an avulsed tooth and the light-cured composite technique for managing a fractured tooth over the commonly taught and more frequently used procedures in emergency medicine.

Model for Ultrasound‐Assisted Lumbar Puncture Training

Lumbar puncture is an important diagnostic procedure in emergency medicine. Data have been published showing improved success rate with ultrasound assistance and the ability of emergency medicine physicians to recognize sonographic lumbar spinous anatomy. However, with educational models and the push for improved patient safety, procedural skills should be practiced on phantoms rather than the “see one, do one, teach one” of the past. There are no currently available phantoms for ultrasound‐assisted lumbar puncture training. We have produced a phantom that can be used to train physicians on ultrasound‐assisted lumbar puncture with respect to both imaging and procedural competency. A plastic fluid‐filled bladder was immersed in gelled opacified mineral oil, a safe and easily used tissue mimic that obscures direct visualization of structures. Spinous anatomy is replicated with the use of wooden struts supporting wooden disks that mimic lumbar spinous processes. The spine analog was mounted over the plastic bladder and surrounded with gelled mineral oil. The phantom produces images similar to human lumbar anatomy. The phantom allows insertion of spinal needles into the “interspinous spaces” with inability to pass the needle outside of those locations. Fluid collection and repeated punctures can be performed on the phantom. Appearance and performance of the phantom were evaluated by physicians with expertise in ultrasound‐assisted lumbar puncture. The only limitation is that external appearance is not realistic. This model performs well, is made from readily available materials, and can be used to train physicians in ultrasound‐assisted lumbar puncture.

Procedures Consult

Procedures Consult

Laryngoscope illumination grade does not influence time to successful manikin intubation

Endotracheal intubation is an important, time-critical, life-saving emergency medicine procedure. Laryngoscope characteristics might influence time to successful intubation. The objective of the present study was to determine whether laryngoscope light of variable intensity would influence the length of time required to achieve successful endotracheal intubation. An in vivo single-blind prospective randomized cross-over trial was conducted using a variable light source laryngoscope and three clinically plausible intensities of light--high (600 lux), medium (200 lux) and low (50 lux). Thirty-six volunteer senior emergency medical staff repeatedly intubated two manikins three times each, based on one of six randomly assigned permutations of light intensity. The primary end-point was time to successful intubation. There was no statistically significant difference in time to intubation versus light intensity for either manikin. The intensity of laryngoscope light across a clinically plausible range does not affect time to intubation.

Feasibility of randomized controlled trials on seclusion and mechanical restraint

In psychiatry seclusion and mechanical restraint are most commonly used in the management of violence and self-directed aggression. Both interventions are considered as efficacious and indispensable. Yet, these measures can have deleterious effects on patients. The least restrictive alternative is recommended. Evidence about what kind of intervention is least restrictive is only scarcely available. Up to now, no randomized controlled trial (RCT) on this subject has been conducted. To describe ethical, methodological and legal problems of RCTs on coercive interventions and to suggest possible solutions. Literature research on possible study designs, ethical considerations and legal regulations was conducted in PubMed. Corresponding to the procedures in emergency medicine informed consent can be obtained after the intervention when the patients are capable again. Informed consent refers only to participation in an interview and utilization of data. Randomization can be ethically approved, if exclusion criteria for randomization are defined. A comprehensive cohort study seems to be the most practicable study design. As primary outcome variable an assessment of subjective experiences of the patients' restrictions to human rights.

Emergency Medicine Clerkship Encounter and Procedure Logging Using Handheld Computers

BackgroundTracking medical student clinical encounters is now an accreditation requirement of medical schools. The use of handheld computers for electronic logging is emerging as a strategy to achieve this. ObjectivesTo evaluate the technical feasibility and student satisfaction of a novel electronic logging and feedback program using handheld computers in the emergency department. MethodsThis was a survey study of fourth-year medical student satisfaction with the use of their handheld computers for electronic logging of patient encounters and procedures. The authors also included an analysis of this technology. ResultsForty-six students participated in this pilot project, logging a total of 2,930 encounters. Students used the logs an average of 7.6 shifts per rotation, logging an average of 8.3 patients per shift. Twenty-nine students (63%) responded to the survey. Students generally found it easy to complete each encounter (69%) and easy to synchronize their handheld computer with the central server (83%). However, half the students (49%) never viewed the feedback Web site and most (79%) never reviewed their logs with their preceptors. Overall, only 17% found the logging program beneficial as a learning tool. ConclusionsElectronic logging by medical students during their emergency medicine clerkship has many potential benefits as a method to document clinical encounters and procedures performed. However, this study demonstrated poor compliance and dissatisfaction with the process. In order for electronic logging using handheld computers to be a beneficial educational tool for both learners and educators, obstacles to effective implementation need to be addressed.

Emergency Medicine Clerkship Encounter and Procedure Logging Using Handheld Computers

Tracking medical student clinical encounters is now an accreditation requirement of medical schools. The use of handheld computers for electronic logging is emerging as a strategy to achieve this. To evaluate the technical feasibility and student satisfaction of a novel electronic logging and feedback program using handheld computers in the emergency department. This was a survey study of fourth-year medical student satisfaction with the use of their handheld computers for electronic logging of patient encounters and procedures. The authors also included an analysis of this technology. Forty-six students participated in this pilot project, logging a total of 2,930 encounters. Students used the logs an average of 7.6 shifts per rotation, logging an average of 8.3 patients per shift. Twenty-nine students (63%) responded to the survey. Students generally found it easy to complete each encounter (69%) and easy to synchronize their handheld computer with the central server (83%). However, half the students (49%) never viewed the feedback Web site and most (79%) never reviewed their logs with their preceptors. Overall, only 17% found the logging program beneficial as a learning tool. Electronic logging by medical students during their emergency medicine clerkship has many potential benefits as a method to document clinical encounters and procedures performed. However, this study demonstrated poor compliance and dissatisfaction with the process. In order for electronic logging using handheld computers to be a beneficial educational tool for both learners and educators, obstacles to effective implementation need to be addressed.

Optimizing Venous Access Using the Web

Optimizing Venous Access Using the Web

Emergency cricothyrotomy

Emergency cricothyrotomy

Emergency Anatomy: A new paradigm in teaching surface anatomy applying principles used in emergency medicine procedures.

Emergency Anatomy: A new paradigm in teaching surface anatomy applying principles used in emergency medicine procedures.

Bilateral posterior shoulder dislocations following seizure

Bilateral posterior shoulder dislocations following seizure

The Explosion of Medical Videos on the Internet

The Explosion of Medical Videos on the Internet

Fast procedure in trauma emergency medicine

Aim of the study: Presentation of own 10-years experience in use of ultrasound according to FAST protocol in patients with suspected intra-abdominal injuries. Material: One thousand four hundred and two patients with suspected intra-abdominal injuries—from over 10,000 hospitalized trauma victims from 1995 to 2004. Method: In all of them FAST protocol (as described in ATLS textbooks) was performed. Results were verified by means of surgical operation, diagnosis set on discharge or on autopsy. Results: FAST assessment was used in 198(84.5%) patients from the group of 228 patients with injuries of intra-abdominal organs or retroperitoneal haematoma.

Procedure lab used to improve confidence in the performance of rarely performed procedures

The objective of this study is to assess the efficacy of an animal procedure lab in improving the level of comfort in performing important emergency medicine procedures. The procedures included central venous line, chest tube, cricothyrotomy, pericardiocentesis, venous cutdown, and thoracotomy. The students were physicians participating in the Tuscan Emergency Medicine Initiative as part of a certificate program in emergency medicine. They attended a 1-h lecture discussing the procedures to be performed. Participants filled out a questionnaire before and after the lab, which asked how many times they had performed each procedure, how comfortable they felt, on a five-point scale, performing each procedure, and whether they felt comfortable performing it by themselves, with assistance or whether they would not feel comfortable performing the procedure. Differences in rated numerical values for each procedure before and after the lab were analyzed using a two-tailed t-test. Alpha was set at 0.95. In all, there were 20 participants with a wide range of experience. A statistical improvement was observed in comfort level and willingness to perform the procedures independently (P<0.01). The only non-significant change was in willingness to perform central lines. The use of an animal lab improves the comfort level of practitioners in performing procedures. Although procedures are best learned on patients with supervision, this is not always feasible. This lab is a useful adjunct to teaching in emergency medicine and allows participants exposure to critical procedures.

Clinical procedures in emergency medicine, fourth edition

Clinical procedures in emergency medicine, fourth edition

Clinical Procedures in Emergency Medicine, 4th edn

Clinical Procedures in Emergency Medicine, 4th edn

Emergency Medicine Procedures

Type and Scope of Book: A multiauthored comprehensive review of procedures performed in emergency medicine.