Three-dimensional printed model for cricothyroidotomy training

Intro/Background: Each year second year emergency medicine residents complete a \u27Difficult Airway Course\u27 as part of their medical training. This involves performing surgical cricothyrotomy on pig tracheas which poorly resemble human subjects and are costly. Purpose/Objective: In an effort to improve proficiency and training for a potentially life saving emergency procedure, a 3D printed model of a human trachea was compared to that of a pig trachea to evaluate proficiency, user acceptance, and cost-comparison to that of the standard pig tracheas among second year emergency residents. It is anticipated that this will potentially provide safer patient care by emergency physicians at a lower price. Methods: Residents were divided into two groups - Group 1 performing pig trachea followed by 3D model and Group 2 performing 3D model followed by pig trachea. Data was collected using pre and post procedure questionnaire\u27s and recording time to successful cricothyrotomy. Overall user acceptance with regards to resemblance of human trachea, number of attempts, and time to successful cricothyrotomy were compared between Group 1 and Group 2. Outcomes: Difference in time between 3D and Pig model was 34.9 ±31 sec, 95% CI -3.0 to 72.9, p=0.07 (meaning the 3D model took an additional 34.9 sec on average). Clinicians rated the resemblance higher for the 3D model, mean difference 0.62 (95% CI 0.22 - 1.01), p=0.005. Summary: Cricothyrotomy is a rare but lifesaving procedure that must be taught to emergency medicine residents. Current methods rely on pig trachea models to simulate this procedure. We have developed a 3D printed model as an alternative for simulation. There was a statistically significant higher resemblance of the 3D model versus the standard pig model when compared to the human trachea. The longer procedure times recorded for the 3D model may reflect the procedural complexity inherit to cricothyrotomies. Future studies of this life saving procedure can be validated and compared to that of more experienced physicians and their respective skillset when it comes to cricothyrotomies. The ability to reuse the 3D printed model will provide longevity and consistent training among residents at a lower price point. This 3D model can be demonstrated at a table top demonstration at SAEM

Heroin overdose trends in a high volume urban emergency department over a 4-year period: 2014-2017

Background: Urban emergency departments (ED) have experienced increasing visits for heroin overdoses since 2014, with noted federal reports that most involve heroin adulterated with fentanyl. Our study objective was to characterize this evolving trend in an urban trauma center ED from 2014 to 2017. Methods: This is a retrospective observational study of ED patients from 2014 to 2017 with a diagnosis of heroin overdose. Patients in cardiac arrest were excluded. Trained abstractors collected standardized data on clinical information, substance use, and ED disposition. We assessed changes in overdose patterns over time and compared characteristics of admitted and discharged patients. Analysis included descriptive statistics and generalized linear or mixed models where appropriate. Results: A total of 900 patients were included. The incidence of heroin overdose visits increased twofold between 2015 and 2016 and threefold between 2014 and 2017. During the overall period, 73% of patients were discharged from ED, 11% left AMA, and 16% were admitted. Mean LOS in ED was 6.6 hours. The mean age increased from 47.7 years in 2014 to 50 in 2017 (p \u3c 0.01). Gender, race, and ED disposition did not change significantly. Concomitant drugs on urine screens were opiates 87%, cocaine 46%, benzos 35%, THC 31%, and ethanol 23%. Comparison of admitted and discharged patients showed similar age, gender, and race. Admitted patients were more likely to have concomitant amphetamine use (p = 0.037) and less likely THC (p = 0.006); 14% of admitted patients required ICU care. Respiratory compromise was the most common complication; 66% of patients with an abnormal chest X-ray had pneumonia or pulmonary edema. Conclusion: This study shows a significant increase in ED patient visits for heroin overdose from 2014 to 2017 with increasing mean age over time. Most patients were discharged from the ED, and of those admitted, the majority went to non-ICU beds