IDEA Series: A Low-fidelity Simulation Workshop for Teaching Cricothyroidotomy

The Problem

idea series teaching residents quality improvement

Cricothyroidotomy is an emergency life-saving procedure that involves surgical placement of a tube through the cricothyroid membrane in order to establish a patent airway for oxygenation and ventilation. The indications for this procedure are when traditional means, such as orotracheal or nasotracheal intubation, are contraindicated or have failed during attempts to establish an emergency airway.1,2 It is a critical skill for emergency physicians but the declining rate of this procedure has resulted in decreased exposure during training.3,4

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2019-03-28T21:25:08-07:00

Winner of the 2019 ALiEM-EEM Fellowship Contest: Dr. Tim Montrief

After receiving numerous high-quality submissions, we are proud to announce the winners of the 2019 Essentials of Emergency Medicine (EEM) Education Fellowship contest! Dr. Tim Montrief from the Jackson Memorial/University of Miami Emergency Medicine residency program has won the blog post competition. A blinded EEM voting panel with input from ALiEM selected his winning post: Trick of the Trade: Bubble Study for Confirmation of Central Line Placement. We are thrilled to feature it today on the blog and look forward to meeting him in Las Vegas in May at the 3-day event. This weekend, we will also feature 2 other excellent submissions from runners-up Dr. Sarah Sanders (Northwestern University) and Dr. Jennifer Rabjohns (George Washington University). Thank you to everyone who submitted their work!

Dr. Tim Montrief
Emergency Medicine Resident
Jackson Memorial/University of Miami

2019-03-27T15:04:49-07:00

Trick of the Trade: Bubble Study for Confirmation of Central Line Placement

Ultrasound Needle

The safe placement a central venous catheter (CVC) remains an important part of caring for critically ill patients.1 Over 5 million CVCs are placed each year in the United States. It is crucial to confirm that the central line is placed in the correct position in order to rule out potential complications of the procedure (e.g. pneumothorax) and begin administration of life-saving medications. Post-procedure chest radiographs (CXR) are the standard of care for CVC placements above the diaphragm. However, the annual cost to the U.S. healthcare system for CXRs after CVC placement is estimated to be over $500 million.2 Further, in a busy ED, the limited availability of portable radiography may pose a considerable time delay. Radiography may also be limited in resource‐poor and austere settings, particularly the prehospital and military environments. We review a faster, cheaper, and more accurate alternative for evaluating CVC placement: point of care ultrasound (POCUS).

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2019-01-31T13:41:52-07:00

Influenza Update: IDSA 2018 Guidelines Reviewed

influenza

Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylactic measure, but the vaccine is not 100% effective due to mismatch between the circulating and vaccine virus strains. Although most individuals will recover from influenza without incident, some specific patient populations are at high risk for severe complications. The Infectious Disease Society of America (IDSA) recently updated their clinical practice guidelines.1 We review these key updates, including recommendations on who to test, treat, and provide chemoprophylaxis.

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2019-03-28T21:30:53-07:00

Significance of a traumatic pneumothorax or hemothorax found only on CT imaging

Pneumothorax CTA 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.1

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2019-03-28T21:36:39-07:00

IDEA Series-JETem Innovation: A Low Cost Escharotomy Simulation Model for Residency Education

The Problem

idea series teaching residents quality improvementEmergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.

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2019-02-19T18:37:33-07:00