Trained Emergency Physicians Research Articles

Feasibility of pneumoperitoneum diagnosis using point-of-care ultrasound: a pilot study using a fresh cadaver model.

To assess the accuracy of point-of-care ultrasound (PoCUS) in the hands of two trained and blinded emergencyphysicians (EPs) in detecting very small amounts of free intraperitoneal air injected intra-abdominally, using a fresh humancadaver model. Fifteen cadavers were injected on 3 occasions with predefined quantities of free intraperitonealair ranging from 0-10 mL. Seven cadavers were injected in the mid-epigastrium (ME), while 8 were injected inthe left lower quadrant (LLQ). Each cadaver was scanned after each of the 3 injections by 2 trained and blinded EPs, resultingin 45 scans per sonographer. Scans were performed using previously validated and standardized techniques. All scans wererecorded, time-stamped and labeled. For each scan the sonographers indicated "yes" or "no" to whether pneumoperitoneumwas detected. A chi square analysis was performed to determine the sensitivity and specificity of PoCUS utilized by each sonographerof pneumoperitoneum based on the location and volume of air injected. Free air (0.25-10 mL) injected intothe ME was successfully diagnosed in 36/42 instances (86% sensitivity), but only detected in 10/36 instances when injectedinto the LLQ (28% sensitivity). Both EPs detected all air injections of ≥2 mL into the ME. Detection of free airoriginating from the midepigastric region may become a future PoCUS indication for adequately trained EPs.

Ultrasound-Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures.

The serratus anterior plane block (SAPB) is an ultrasound-guided compartment block; limited data suggest that it can decrease pain in patients with rib fractures or chest wall pain. We sought to determine the effect of SAPB on pain and incentive spirometry (IS) maximal vital capacity in adult patients with rib fractures. We enrolled a prospective sample of adult patients with at least two unilateral rib fractures who were being admitted for pain control. SAPB was performed by trained emergency physicians. Patients reported pain on an 11-point Numeric Rating Scale at rest and during IS, before, 15, and 60minutes after SAPB. Mean pain scores decreased by 1.8 (SD 2.17, 95% confidence interval [CI]: 0.79-2.81) at 15minutes and 2.5 (SD 2.69, 95% CI: 1.24-3.76) at 60minutes. Compared to pre-block pain scores during IS, mean pain scores decreased by 1.95 (SD 1.99, 95% CI: 1.02-2.88) at 15minutes and 2.4 (SD 2.42, 95% CI: 1.27-3.53) at 60minutes. Mean maximum vital capacity increased by 232 mL (SD 406, 95% CI: 36-427) at 60minutes. Zero SAPB-attributable complications were identified in the 24hours post-enrollment. In patients with multiple rib fractures, SAPB reduced pain scores at rest and during IS, and increased maximal vital capacity. The SABP may be a safe and effective modality for pain control in trauma patients with multiple rib fractures.

Utility of Point of Care Ultrasound for Intussusception

Utility of Point of Care Ultrasound for Intussusception

Сучасна семіотика синдромів гострих отруєнь хімічної етіології: токсидроми

Актуальність дослідження обумовлена постійними змінами в структурі гострих отруєнь хімічної етіології, що потребує від лікарів швидкого прийняття рішень стосовно призначення антидотів або засобів фармакологічної корекції, особливо на догоспітальному етапі. З метою прискорення процесу прийняття рішень щодо причин отруєння та виду токсиканту у токсикологічних центрах багатьох країн світу широко використовується синдромологічний підхід.Метою цього дослідження було вивчення та узагальнення сучасних підходів до практичного застосування основних токсичних синдромів (токсидромів) у практиці лікаря-токсиколога.Матеріал і методи дослідження. Досліджені класифікації токсичних синдромів, що використовуються в практичній роботі лікарів-токсикологів США, країн Євросоюзу, Російської Федерації протягом останніх 30 років.Результати та їх обговорення. З середини 1970-х років у процесі діагностики гострих отруєнь широко використовується поняття токсидрому, що відображає сутність та масштаб медіаторних змін в організмі під впливом однiєї або декiлькох токсичних речовин. Визначення основних токсидромів (адренергічного, антихолінергічного, холінергічного, опіоїдного, седативно-гіпнотичного та серотонінового) дозволяє лікарям своєчасно розпочати посиндромну терапію, що в багатьох випадках при отруєннях збігається з патогенетичною. Синдромологічний підхід прискорює процес прийняття лікарями рішень стосовно вибору антидоту або засобу фармакологічної корекції функціональних порушень, що особливо важливо на догоспітальному етапі.Висновки. Сьогодні є актуальним впровадження сучасних наукових підходів, що стосуються діагностики гострих отруєнь на догоспітальному етапі за допомогою основних токсидромів, у навчальнi програми до- та післядипломної підготовки лікарів екстреної медичної допомоги та лікарів-токсикологів в Україні.

Assessment of cervical spine CT scans by emergency physicians: A comparative diagnostic accuracy study in a non-clinical setting.

ObjectivesTo determine and compare the diagnostic accuracy of assessing injuries on cervical spine computed tomography (CT) scans by trained emergency physicians and radiologists, both in a non‐clinical setting.MethodsIn this comparative diagnostic accuracy study, 411 cervical spine CT scans, of which 120 contained injuries (fractures and/or dislocations), were divided into 8 subsets. Eight emergency physicians received focused training and assessed 1 subset each before and after training. Four radiologists assessed 2 subsets each. Diagnostic accuracy between both groups was compared. The reference standard used was a multiverified data set, assessed by radiologists, neurosurgeons, and emergency physicians. The neurosurgeons also classified whether an "injury in need of stabilizing therapy" (IST) was present.ResultsPosttraining, the emergency physicians demonstrated increased sensitivity and specificity for identifying cervical spine injuries compared to pretraining: sensitivity 88% (95% confidence interval [CI] 80% to 93%) versus 80% (95% CI 72% to 87%) and specificity 89% (95% CI 85% to 93%) versus 86% (95% CI 81% to 89%). When comparing the trained emergency physicians to the group of radiologists, no difference in sensitivity was found, 88% (95% CI 80% to 83%); however, the radiologists showed a significantly higher specificity (P < 0.01): 99% (95% CI 96% to 100%). In the 12% (15 scans) with missed injuries, emergency physicians missed more ISTs than radiologists, 6 versus 4 scans; however, this difference was not significant (P = 0.45).ConclusionAfter focused training and in a non‐clinical setting, no significant difference was found between emergency physicians and radiologists in ruling out cervical spine injuries; however, the radiologists achieved a significantly higher specificity.

Early Lung Ultrasound Findings in Patients With COVID-19 Pneumonia: A Retrospective Multicenter Study of 479 Patients.

ObjectivesLung ultrasound (LUS) holds the promise of an accurate, radiation‐free, and affordable diagnostic and monitoring tool in coronavirus disease 2019 (COVID‐19) pneumonia. We sought to evaluate the usefulness of LUS in the diagnosis of patients with respiratory distress and suspicion of interstitial severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pneumonia, in comparison to other imaging modalities.MethodsThis was a multicenter, retrospective study. LUS was performed, on Emergency Department (ED) arrival of patients presenting for possible COVID‐19 evaluation, by trained emergency physicians, before undergoing conventional radiologic examination or while waiting for the report. Scans were performed using longitudinal transducer orientation of the lung regions. CXR was interpreted by radiologists staffing ED radiology. Subjects were divided into two group based on molecular test results. LUS findings were compared to COVID test results, nonlaboratory data, and other imaging for each patient. Categorical variables were expressed as percentages and continuous variables as median ± standard error.ResultsA total of 479 patients were enrolled, 87% diagnosed with SARS‐CoV‐2 by molecular testing. COVID positive and COVID negative patients differed with respect to sex, presence of fever, and white blood cells count. Most common findings on lung point of care ultrasound (POCUS) for COVID‐positive patients were B‐lines, irregular pleural lines, and small consolidation. Normal chest X‐ray was found in 17.89% of cases.ConclusionsThis 479 patient cohort, with COVID‐19, found LUS to be noninferior to chest X‐ray (CXR) for diagnostic accuracy. In this study, COVID‐positive patients are most likely to show B lines and sub‐pleural consolidations on LUS examination.

Concussion management and assessment in emergency department: Innovations in diagnostics, acute care, and long-term outcomes

Background: A concussion, commonly referred to as mild traumatic brain injury (mTBI), presents substantial obstacles in emergency medicine. However, the current training provided to emergency physicians (EPs) appears to be insufficient. This systematic review assesses existing educational resources and training programs concerning mTBI for EPs, highlighting deficiencies in the literature. Methods: A thorough search was performed in EMBASE, MEDLINE, ERIC, and SCOPUS using targeted keywords associated with mTBI and medical education. Studies were included that evaluated training programs designed to enhance emergency personnel knowledge and practice related to mild traumatic brain injury. Results: The search identified only five pertinent studies, suggesting a severe dearth of research in this field. The studies demonstrated positive outcomes in knowledge acquisition; however, they were hindered by methodological limitations and varied training methods, which precluded any meta-analysis. Emergency physicians with additional training in pediatric emergency medicine exhibited improved compliance with best practices in the management of mild traumatic brain injury (mTBI). Conclusion: The imperative necessity of improving educational resources and standardized curricula to improve mTBI training for emergency physicians is emphasized in this review.

Point-of-Care Ultrasound Training and Credentialing for mid-late Career Emergency Physicians: Is it worth it?

Point-of-care ultrasound (POCUS) is becoming more prevalent in community emergency medicine (EM) practice with the current American College of Emergency Physician guidelines recommending POCUS training for all graduates from United States based residency programs as well as support for POCUS privileging by the American Medical Association. However, in a recent survey of nonacademic EDs, it was found that most providers lack US training, credentialing, and quality assurance (QA) assessments of their POCUS studies. In 2017, our healthcare system embarked on a system-wide credentialing process for POCUS to credential community physicians with little to no POCUS training.

Emergency medicine in Brazil: historical perspective, current status, and future challenges

BackgroundEmergency medicine (EM) in Brazil has achieved critical steps toward its development in the last decades including its official recognition as a specialty in 2016. In this article, we worked in collaboration with the Brazilian Association of Emergency Medicine (ABRAMEDE) to describe three main aspects of EM in Brazil: (1) brief historical perspective; (2) current status; and (3) future challenges.Main textIn Brazil, the first EM residency program was created in 1996. Only 20 years later, the specialty was officially recognized by national regulatory bodies. Prior to recognition, there were only 2 residency programs. Since then, 52 new programs were initiated. Brazil has now 54 residency programs in 16 of the 27 federative units. As of December 2020, 192 physicians have been board certified as emergency physicians in Brazil. The shortage of formal EM-trained physicians is still significant and at this point it is not feasible to have all Brazilian emergency care units and EDs staffed only with formally trained emergency physicians. Three future challenges were identified including the recognition of EM specialists in the house of Medicine, the need of creating a reliable training curriculum despite highly heterogeneous emergency care practice across the country, and the importance of fostering the development of academic EM as a way to build a strong research agenda and therefore increase the knowledge about the epidemiology and organization of emergency care.ConclusionAlthough EM in Brazil has accomplished key steps toward its development, there are several obstacles before it becomes a solid medical specialty. Its continuous development will depend on special attention to key challenges involving recognition, reliability, and research.

2 Training Emergency Physicians for Mass Casualty Triage during Mass Shooting Events: A New York City- based Pilot Curriculum

Recent literature suggests that emergency departments may be underprepared for the influx of “self-referred” patients following a mass shooting event. Following the mass shootings in Orlando and Las Vegas, the Greater New York Hospital Association determined there was a need to increase the preparation of emergency department clinicians for these events in New York. Through a partnership with the Center for Disaster Medicine at New York Medical College an 8-hour, innovative physician-oriented education program was created and piloted at 5 hospitals using a combination of didactics, table-top exercises, live ultrasound scanning, and in-situ high-fidelity simulation. The results of these pilot course deliveries were used to standardized course curricula available to all New York-area hospitals and identify additional educational needs for physicians and other emergency department staff. Didactic content was created using lessons-learned reports, comprehensive literature reviews, and consultation with physician subject matter experts in the area of trauma surgery, disaster medicine, and emergency ultrasound. Hands-on training was created based on lessons-learned consisted of three afternoon break-out sessions including a hospital-specific bed status management exercise to simulate decompressing the ED and critical care units in advance of the arrival of mass casualties, an immersive ED in-situ mass casualty management scenario utilizing high-fidelity trauma simulators and standardized patient actors, and a breakout session on innovative applications of point-of-care ultrasound for triage and clinical decision making using live standardized patients for scanning. Post-course surveys were distributed to participants and survey items aggregated for analysis and curriculum improvement and revision. Didactic content areas showed universal improvement among all pilot sites using Likert confidence scales to evaluate pre-course vs post-course provider self-efficacy. Practical skills and psychomotor evaluations also showed universal improvement following skills practice consistent with current emergency medicine educational literature. Gaps in the pilot course content reported by participants varied by facility but included wanting similar educational content available for non-physician ED clinicians, and wanting to include non-ED physicians, who might “float” to the ED during a mass casualty, to be included in the training. Additionally, physicians at some hospitals had better mastery of POCUS than others. A suggestion was to offer a stand-alone 4-hour course on emergency ultrasound for hospitals who would like to offer this to their ED physicians. Emergency physicians are the leaders of the hospital response to a mass casualty as the primary clinicians responsible for the triage and treatment of victims from out-of-hospital events. Nevertheless, many emergency physicians report not having the opportunity to receive education on new trends and innovations in mass casualty management, which could make them more effective when responding to a disaster. Departments should consider how they might enrich existing preparedness-related CME and leverage their resources in high-fidelity simulation and ultrasound to offer opportunities to practice skills and techniques that are not often utilized during annual in-service training.

Presence of Orthopedic Residency Decreases Emergency Physician's Confidence in Orthopedic Procedures.

Introduction: At present, there exists no standard orthopedic training for emergency medicine (EM) residency programs. Varying residency environments including but not limited to volume, acuity, and competing residency programs will dictate the number of orthopedic procedures a resident is exposed to, ultimately dictating a graduate’s comfort level with orthopedic procedures. Our study set out to investigate further whether training alongside an orthopedic residency affects an attending physician’s perceived procedural comfort.Methods: This is a cohort study utilizing a 14-question survey distributed to an online community of EM physicians to examine the relationship between training at a residence program alongside orthopedic residents, the utility of an elective orthopedic rotation, and the overall confidence in managing closed reductions.Results: EM physicians trained at a program that also hosted an orthopedic residency were more likely to train at large academic tertiary care centers (78%). Forty-two percent of these respondents felt that the presence of an orthopedic residency had a negative impact on their overall orthopedic training. The remaining 58% felt that the orthopedic residency had a positive impact on their procedural skills. In our study, the overall mean comfort level was statistically significant (p-value = 0.0024) higher in those who trained without orthopedic residents (8.78) compared to those who trained alongside an orthopedic residency (7.61). Those who had an elective orthopedic rotation found it to be more beneficial if they did the rotation with an orthopedic residency (p-value = 0.0329). Those who reported a beneficial orthopedic rotation also reported a higher level of confidence in the management of non-fracture reductions (p < 0.011, ρ = .25).Conclusion: Seeing as though both training and practice environments for emergency physicians vary greatly across the country, every effort should be taken to ensure graduating residents are prepared to perform orthopedic procedures without the assistance of orthopedic surgeons. Irrespective of whether a program has in-house orthopedic residents or not, EM residents should take it upon themselves to maximize their time during residency to focus on these core competencies. Graduates at the greatest risk of having low confidence are trained at academic centers that also host orthopedic programs. One should be cognizant of this while going through their EM residency.

Overview of current implementation and limitations of point-of-care ultrasound in the emergency department: a nationwide survey in Belgium

ABSTRACT Objective Giving an overview of the current implementation and limitations of point-of-care ultrasound (POCUS) in Belgian Emergency Departments (EDs). Methods A survey, consisting of questions regarding demographics, practice patterns, policies, difficulties of implementing ultrasound (US) and training of emergency physicians was sent out to all Belgian EDs (n = 109). Results Seventy-two percent of all the EDs responded. Eighty percent of these had an US device, 10% intended to have one in the near future whilst the remaining 10% had no intention of obtaining one. The main reasons for not having US were insufficient training (50%), no budget to purchase a device (31%), resistance from other specialties (31%), no return from investment (25%) and uncertainty about liability (19%). Eighty-four percent of the responding hospitals had a prehospital MUG (Mobiele Urgentiegroep) – team or SMUR (Service Mobile d’Urgence et de Réanimation). In 29% of these, prehospital US (PHUS) was used, 18% were in the process of purchasing a device whilst 53% had no intention of implementing PHUS. The main reasons for not implementing PHUS were short transfer times (38%), insufficient training (33%), the cost of a device (25%), no return from investment (19%), the assumption that PHUS delays administering urgent care (19%) and the uncertainty about liability (8%). Nationwide, 40% of all emergency physicians have had some form of US training. Conclusions POCUS is regularly used in Belgian EDs for diagnostic and management purposes. Further implementation of POCUS will depend on how barriers are being addressed in the near future.

Editors' Note: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study

Editors' Note: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study

Teaching about the Wild: A Survival Course as a Novel Resident Educational Experience.

Emergency medicine residents. Wilderness medicine (WM) is the practice of resource-limited medicine under austere conditions. Emergency physicians in training should gain additional exposure to wilderness medicine knowledge and outdoor skills to allow for the development of problem solving and improvisation abilities. However, there is limited data on the instruction of general survival skills to residents interested in WM. By the end of the session the learner will be able to: 1) differentiate at least three different methods for water purification 2) describe how to erect a temporary survival shelter 3) construct a survival pack for personal use emphasizing multi-use items 4) demonstrate how to make a fire without a direct flame supply. A small group of resident learners progressed through five survival stations designed to allow for an emphasis on select skills, wilderness medicine knowledge, and improvisation. Resident instructors led the discussion and skills demonstration. Participants completed a six item before and after questionnaire. Each item was ranked from 0 for "strongly disagree" to 10 for "strongly agree." Total mean scores before and after were compared. Twelve individuals participated. The total mean score for the six-item analysis increased following the workshop (39.1 before versus 51.0 after, p = 0.0008). General survival skills are traditionally acquired through time-intensive experiences; however, this is often unfeasible during residency training. We developed an alternative, more efficient mechanism for incorporating wilderness medicine skills into residency training that appears to improve understanding and confidence of participants, as well as to provide a teaching opportunity for new resident educators. Wilderness medicine, survival skills, emergency medicine, graduate medical education.

Adverse Events Among Emergency Department Patients With Cardiovascular Conditions: A Multicenter Study

We aim to determine incidence and type of adverse events (adverse outcomes related to emergency care) among emergency department (ED) patients discharged with recent-onset atrial fibrillation, acute heart failure, and syncope. This 5-year prospective cohort study included high-acuity adult patients discharged with the 3 sentinel diagnoses from 6 tertiary care Canadian EDs. We screened all ED visits for eligibility and performed telephone interviews 14 days postdischarge to identify flagged outcomes: death, hospital admission, return ED visit, health care provider visit, and new or worsening symptoms. We created case summaries describing index ED visit and flagged outcomes, and trained emergency physicians reviewed case summaries to identify adverse events. We reported adverse event incidence and rates with 95% confidence intervals and contributing factor themes. Among 4,741 subjects (mean age 70.2 years; 51.2% men), we observed 170 adverse events (3.6 per 100 patients; 95% confidence interval 3.1 to 4.2). Patients discharged with acute heart failure were most likely to experience adverse events (5.3%), followed by those with atrial fibrillation (2.0%) and syncope (0.8%). We noted variation in absolute adverse event rates across sites from 0.7 to 6.0 per 100 patients. The most common adverse event types were management issues, diagnostic issues, and unsafe disposition decisions. Frequent contributing factor themes included failure to recognize underlying causes and inappropriate management of dual diagnoses. Among adverse events after ED discharge for patients with these 3 sentinel cardiovascular diagnoses, we identified quality improvement opportunities such as strengthening dual diagnosis detection and evidence-based clinical practice guideline adherence.

Diagnostic Accuracy of the HINTS Exam in an Emergency Department: A Retrospective Chart Review.

The HINTS exam is a series of bedside ocular motor tests designed to distinguish between central and peripheral causes of dizziness in patients with continuous dizziness, nystagmus, and gait unsteadiness. Previous studies, where the HINTS exam was performed by trained specialists, have shown excellent diagnostic accuracy. Our objective was to assess the diagnostic accuracy of the HINTS exam as performed by emergency physicians on patients presenting to the emergency department (ED) with a primary complaint of vertigo or dizziness. A retrospective cohort study was performed using data from patients who presented to a tertiary care ED between September 2014 and March 2018 with a primary complaint of vertigo or dizziness. Patient characteristics of those who received the HINTS exam were assessed along with sensitivity and specificity of the test to rule out a central cause of stroke. A total of 2,309 patients met criteria for inclusion in the study. Physician uptake of the HINTS exam was high, with 450 (19.5%) dizzy patients receiving all or part of the HINTS. A large majority of patients (96.9%) did not meet criteria for receiving the test as described in validation studies; most often this was because patients lacked documentation of nystagmus or described their symptoms as intermittent. In addition, many patients received both HINTS and Dix-Hallpike exams, which are intended for use in mutually exclusive patient populations. In no case was dizziness due to a central cause identified using the HINTS exam. Our results suggest that despite widespread use of the HINTS exam in our ED, its diagnostic value in that setting was limited. The test was frequently used in patients who did not meet criteria to receive the HINTS exam (i.e., continuous vertigo, nystagmus, and unsteady gait). Additional training of emergency physicians may be required to improve test sensitivity and specificity.

A perspective on imparting emergency medicine education by foreign qualified emergency medicine physicians in Pakistan

A rapidly increasing number of foreign qualified emergency physicians of Pakistani descent are conducting workshops and seminars in Pakistan to contribute to this emerging field of emergency medicine (EM) for sole purpose of capacity building. This phenomenon has witnessed an additional surge in the wake of the COVID-19 pandemic. For capacity building, the local EM trainees are contributing by delivering personally constructed courses and workshops to various institutions. Their efforts are commendable however this letter provides some insight into the way EM has undergone development especially in context to Pakistani origin and the struggle of locally trained emergency medicine physicians. We hope to provide certain observations to our readers to look for parallels in their own situations they can make use of. It is important to recognize the restraints of local resources however the supply of trained emergency physicians will increase the demand for them. Each country must develop its own way of providing care to their acutely ill and injured, and thereby have ownership of it.

Abstract 303: Optic Nerve Sheath Diameter Differences by Sex, Rhythm, and Neurological Outcome After Out-of-hospital Cardiac Arrest

Introduction: Neurologically guided resuscitation after out-of-hospital cardiac arrest (OHCA) to improve survival has been limited due to knowledge gaps in cerebral edema changes. Point-of-care ultrasound (POCUS) for the assessment of optic nerve sheath diameter (ONSD) is an established modality to characterize the extent of cerebral edema. We aimed to describe ONSD differences by sex, rhythm type, neurological outcome using cerebral performance category (CPC), and overall survival status. Methods: We studied adult OHCA treated at an urban academic ED with return of spontaneous circulation (ROSC) from May 2018 to May 2020. After ROSC, trained emergency physicians obtained bilateral ONSD measurements at 1, 6, 24, 48, and 72 hours, in the transverse, oblique, and sagittal planes for each eye. All the ONSD measurements were averaged for each time point and comparisons were made between each predictor’s categories. To compare the mean at each time point between groups, t-test or ANOVA was used. The trend comparison was done using generalized estimating equations. Statistical analysis was performed using SAS 9.4 under the significance level of 0.05. Results: Out of 62 eligible patients, 35 (56%) were male and 27 (44%) were female, 33 (59%) had a shockable rhythm and 23 (41%) had non-shockable rhythm. At 72 hr, 6 (10%) had a CPC of 1-2 and 57 (90%) had CPC of 3-5. Overall, there were 37 (61%) survivors and 24 (39%) non-survivors. There was a notable sex difference in the mean ONSD across all time points between males and females (p = 0.031), with males showing higher ONSD, and between shockable and non-shockable (p= 0.035), with the shockable group having relatively lower ONSD. There is a statistically significant difference of mean ONSD between CPC 1-2 and CPC 3-5 groups at 6hr, 48hr, and at 72hr, with higher means in the CPC 3-5 group. Across all times, the trend line was statistically significant between non-survivors and survivors (p= 0.015), with non-survivors having higher ONSD. Conclusion: Males, patients with non-shockable rhythm, CPC 3-5 at 72 hr, and non-survivors had higher ONSD. Understanding cerebral edema dynamics during resuscitation will allow for future work to potentially tailor interventions to individual patient cerebral injury patterns.

The Association of Sleep Hygiene and Drowsiness with Adverse Driving Events in Emergency Medicine Residents.

IntroductionPrior research shows that physicians in training are at risk for drowsy driving following their clinical duties, which may put them in danger of experiencing adverse driving events. This study explores the relationship between sleepiness, overall sleep hygiene, level of training, and adverse driving events following an overnight shift in emergency medicine (EM) residents.MethodsThroughout the 2018–2019 academic year, 50 EM residents from postgraduate years 1–4 completed self-administered surveys regarding their sleepiness before and after their drive home following an overnight shift, any adverse driving events that occurred during their drive home, and their overall sleep hygiene.ResultsFifty out of a possible 57 residents completed the survey for a response rate of 87.7%. Sleepiness was significantly associated with adverse driving events (beta = 0.31; P < .001). Residents with high sleepiness levels reported significantly more adverse driving events. Residents reported significantly higher sleepiness levels after completing their drive home (mean = 7.04, standard deviation [SD] = 1.41) compared to sleepiness levels before driving home (mean = 5.58, SD = 1.81). Residency training level was significantly associated with adverse driving events (beta = −0.59, P < .01). Senior residents reported significantly fewer adverse driving events compared to junior residents.ConclusionEmergency physicians in training are at risk for drowsy driving-related motor vehicle crashes following overnight work shifts. Trainees of all levels underestimated their true degree of sleepiness prior to initiating their drive home, while junior residents were at higher risk for adverse driving events.

Development of a3Dprinted simulator for closed reduction of distal radius fractures.

BackgroundThe use of simulators in medical education is critical for developing procedural competence prior to treating patients. Current training of emergency physicians to perform distal radius fracture reduction is inconsistent and inadequate.ApproachWe developed a 3D printed distal radius fracture simulation training model that is easy to assemble and relatively inexpensive. We present step-by-step instructions to reproduce the model.EvaluationThe model was found to have high fidelity for training by both instructors and participants in a simulation-based mastery learning course.ReflectionWe successfully designed a low cost, easy to reproduce, high fidelity model for use in a simulation-based mastery learning course to teach distal radius fracture reduction.Electronic supplementary materialThe online version of this article (10.1007/s40037-020-00609-w) contains supplementary material, which is available to authorized users.