One Year of Experience in Using Hand-Held Ultrasound as a Learning Tool in Ultrasound Rotation at the Emergency Department

BACKGROUND: Recent advancements in ultrasound technology have been introduced in medical education. The use of the hand-held ultrasound device (the HHU device) has been implemented in many medical schools. However, no studies have previously been conducted in Thailand. AIM: We aimed at evaluating the experience of using the HHU device in the ultrasound rotation for the emergency medicine (EM) residents. METHODS: A survey was conducted of 1st-year EM residents at the Emergency Department at Srinagarind Hospital, who had been trained to use point-of-care ultrasound and who were provided with a HHU device during their 2-week ultrasound rotation during the period from July 2019 to June 2020. The survey consisted of ten questions about the participants’ learning experiences in using the HHU. Moreover, we evaluate the process of reviewing the ultrasound images and ultrasound video clips from the HHU device. RESULTS: The response rate for the survey was 100%. On the baseline survey, most participants rated their learning experiences in using the HHU device at more than four points. Overall, 106 patients were examined with the HHU device. All ultrasound video clips and images were examined in the section for “reviewing the ultrasound images.” The three areas that were the most frequently examined had been the abdomen, the heart, and the soft tissue and musculoskeletal, respectively. During these ultrasound examinations, 82 positive findings (77.36%) were discovered. CONCLUSIONS: These results suggest that the participants had agreed that the HHU device was a tool, which had the potential to promote learning during the ultrasound rotation

Use of Handheld Versus Standard Ultrasound Devices in Ultrasound Rotation at the Emergency Department

BACKGROUND: Recently, handheld ultrasound equipment has come to replace standard machines in the training of emergency medicine residents. However, there have been few studies examining how this change has affected medical education. AIM: We aimed to compare standard and handheld ultrasound machines as educational tools in the emergency medicine residency program. METHODS: A cross-sectional survey of 17 emergency medicine residents at Srinagarind Hospital emergency department were trained to use point-of-care ultrasound and provided with handheld ultrasound devices during their 2-week ultrasound rotations, which took place between July 2019 and May 2020. Participants were given a 25-question survey comparing their learning experiences with standard versus handheld ultrasound machines. Data were analyzed using an independent sample t-test, and p < 0.05 was considered statistically significant. RESULTS: The response rate was 100%. At the baseline survey, most participants rated their learning experience as greater than 4 out of 5 with both ultrasound devices. They rated the learning experience with the handheld device as being more enjoyable and accessible but not to a statistically significant extent. There were also no significant differences in participants’ ratings of image quality or the ease of obtaining images. However, they rated the handheld device as being more useful and convenient (p < 0.001 and 0.034, respectively). CONCLUSIONS: The handheld ultrasound machine is useful in the training of emergency medicine residents. Further studies should be conducted to evaluate residents’ competency in using these devices

Practical Emergency Ultrasound Flashcards with Augmented Reality in Teaching Point-of-Care Ultrasound in ER

BACKGROUND: The use of point-of-care ultrasound (POCUS) has recently proposed the integration of ultrasound into undergraduate medical education. However, the evidence of learning tool for this integration has not been well studied. AIM: The aim of this study was to compare the levels of knowledge improvement of the 6th year medical students before and after receiving the POCUS training in two ways: By employing the traditional methods and by utilizing the new learning tool. METHODS: The practical ultrasound flashcards were developed by a Thai physician. In the study, the 6th year medical students were enrolled and randomized to become members of either the flashcard group or the control group. Participants in both groups attended a 4-week ultrasound training course. Before and after the training course, all students were evaluated using the multiple-choice questions. In addition, the subjects’ attitudes and perceptions about the flashcards were evaluated using a questionnaire. RESULTS: A total of 46 students participated in this study and were randomly assigned to either the flashcard group (n = 23) or the control group (n = 23). It was discovered that the students in the flashcard group had performed better on the POCUS knowledge post-test than those in the control group had. Most students had been satisfied with the flashcards (mean 5 Likert scores = 4.48). However, the students had rated their confidence score to perform POCUS at 3.96 out of 5.0. CONCLUSIONS: Medical students who used the ultrasound flashcards to learn POCUS had resulted in better knowledge scores rather than the others who attended the standard ultrasound training course only. However, it was not possible to evaluate the practical skills and the clinical decision-making processes in this study

Response Times of Motorcycle Ambulances during the COVID-19 Pandemic

BACKGROUND: Motorcycles (motorlance) are often deployed as ambulances to the scene of an emergency to reduce response time. The COVID-19 pandemic has affected emergency medical services (EMS) in Thailand in many respects, and this study was conducted to examine its effect on motorlance operation time. AIM: The aim of the study was to examine motorlance operation time during the COVID-19 pandemic in comparison to normal periods. METHODS: This cross-sectional study examined all EMS motorlance operations dispatched from Srinagarind Hospital (Thailand). Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system. Data from June 1, 2018, to December 31, 2019 (normal period) were compared with those from January 13 to April 21, 2020 (COVID-19). RESULTS: Eight hundred seventy-one EMS operations were examined over two periods. Mean patient age during the COVID-19 pandemic was 41.5 ± 6.2 years, and 54.6% (n = 59) were male. Average response time was 6.20 ± 1.35 min during the normal period and 3.48 ± 1.01 min during the pandemic (p = 0.021). Transport time was also significantly shorter during the latter period (2.35 vs. 5.20 min). CONCLUSIONS: Motorlance response and transport time during the COVID-19 pandemic were significantly shorter than usual

Does the Use of Lights and Sirens on Ambulances Affect Pre-hospital Time?

BACKGROUND: The use of lights and sirens (L&S) alerts other drivers of the presence of an ambulance and that they are required yield, increasing the speed and safety of emergency medical services (EMS) operations. However, there have been no studies examining the effect of L&S on pre-hospital time conducted in Thai EMS agencies. AIM: The aim of the study was to compare the operation times of ambulances with and without the use of L&S. METHODS: This was a cross-sectional study consisting of patients over 18 years of age assessed and treated through the Srinagarind Hospital EMS between April 2019 and March 2020. Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system. RESULTS: A total of 1764 patients were enrolled, 1426 (80.8%) of whom were transported in an ambulance that used L&S. The mean age of patients in the L&S group was 45.2 ± 6.2 years and 742 (52.0%) were male. The average response times in the L&S and non-L&S groups were 10.2 min and 18.2 min, respectively (p < 0.001). Average L&S transport time was 11.1 min and non-L&S transport time was 17.1 min (p = 0.008). CONCLUSIONS: The use L&S reduced the response and transport times of EMS operations but not affect on-scene time

Optic Nerve Sheath Diameter Cutoff Point for Detection of Increased Intracranial Pressure in the Emergency Department

BACKGROUND: Ultrasound of the optic nerve sheath diameter (ONSD) is one of the most widely used noninvasive methods of screening for high intracranial pressure. AIM: This study aimed to measure the ONSD and to find the appropriate cutoff point to indicate increased intracranial pressure. METHODS: We examined 93 participants over 18 years of age with abnormal neurologic signs or symptoms and took computerized tomography (CT) scans of their brains. We measured the ONSD through ultrasound with the head positioned at 30°. We also used a linear array probe to measure the ONSD in the position after connecting the eyeball 3 mm. RESULTS: The average of the ONSD at each side was 4.76 mm (95% confidence interval [CI]: 4.65–4.87) in the normal CT scan group and 5.33 mm (95% CI: 5.13–5.33) in the abnormal CT scan (indicating high intracranial pressure) group. An ONSD cutoff point of 5.0 mm yielded 74.14% sensitivity and 49.22% specificity. The positive predictive value was 0.38 and negative predictive value was 0.82. CONCLUSION: The ONSD in the abnormal CT scan group was greater than in the normal CT scan group, and an ONSD of 5.0 mm can be used as a cutoff point for detecting increased intracranial pressure

Use of a Motorlance to Deliver Emergency Medical Services; a Prospective Cross Sectional Study

Introduction: Access time to patients with critical or emergent situations outside the hospital is a critical factor that affects both severity of injury and survival. This study aimed to compare the access time to the scene of an emergency situation between a traditional ambulance and motorlance. Methods: This prospective cross sectional study was conducted on all users of emergency call, Srinagarind Hospital, Thailand, from June to December 2018, who received a registration number from the command center. Results: 504 emergency-service operations were examined over a six-month period, 252 (50%) of which were carried out by motorlance. The mean activation time for motorlance and ambulance were 0.57 ± 0.22 minutes and 1.11 ± 0.18 minutes, respectively (p<0.001). Mean response time for motorlance was significantly lower (5.57 ± 1.21 versus 7.29 ± 1.32 minutes; p < 0.001). The response times during 6 a.m. to 6 p.m. were 5.26 ± 1.11 minutes for motorlance and 7.15 ± 1.39 minutes for ambulance (p < 0.001). These measures for night time (6 p.m. to 6 a.m.) were 5.58 ± 1.21 minutes and 8.01 ± 1.30 minutes, respectively (p < 0.001). The mean automated external defibrillator (AED) waiting time for motorlance and ambulance were 5.26 ± 2.36 minutes and 9.24 ± 3.30 minutes, respectively (p = 0.012). The survival rate of patients after AED use in motorlance and ambulance was 80% versus 37.5%; p<0.001. Conclusion: Emergency service delivery by motorlance had lower mean activation time, response time, AED time, and mortality rate of cardiac arrest patients compared to ambulance. It seems that motorlance could be considered as an effective and applicable device in emergency medical service delivery, especially in crowded cities with heavy traffic

Predictors of Appropriate Antibiotic Use in Bacteremia Patients Presenting at the Emergency Department

Sepsis is a condition that requires appropriate antibiotic treatment at the emergency department (ED). Most previous studies conducted on inappropriate antibiotic use at the ED were conducted in developed countries with a low percentage of sepsis. This study aimed to find additional clinical predictors for appropriate antibiotic use in bacteremia patients presenting at the ED from a developing country, in which there is a higher proportion of patients with sepsis. We included adult patients who presented at the ED with clinical suspicion of infection and bacteremia. Patients allocated to the appropriate antibiotic group were those in whom the prescribed antibiotic was sensitive to the pathogen. Predictors and outcomes of appropriate antibiotic use were analyzed. A total of 3133 patients who met the study criteria presented at the ED during the study period. Of those, 271 patients were diagnosed with bacteremia, 48 of whom (17.71%) received inappropriate antibiotic prescriptions. Only pulse rate was an independent factor for appropriate antibiotic treatment, with an adjusted odds ratio of 1.019 (95% CI of 1.001, 1.036). In terms of clinical outcomes, the inappropriate antibiotic group had higher proportions of 28-day mortality (29.17% vs. 25.25%; p-value = 0.022) and longer hospitalization (14 vs. 9 days; p-value = 0.003). This study found that inappropriate antibiotics were prescribed in 17% of bacteremia patients presenting at the ED and that high pulse rate was an indicator for appropriate antibiotic prescription. Patients with inappropriate antibiotic administration had longer hospitalization and higher 28-day mortality than those who received appropriate antibiotic treatment

Development and Remodeling of Point-of-Care Ultrasound Education for Emergency Medicine Residents in Resource Limited Countries during the COVID-19 Pandemic

The administration of an accurate and effective POCUS course is a crucial tool in improving health education and thus the health care system in low- to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Therefore, this study aims to survey the learner experience after implementing the POCUS curriculum for first-year emergency medicine residents. All learners responded to the survey. Our results demonstrated that the ultrasound rotation and our ultra-sound learning materials were useful tools which showed a positive impact on POCUS knowledge for our learners. However, some obstacles of POCUS learning were identified to assist in closing faculty development gaps, including the availability of handheld devices, as well as the re-modeling of the ultrasound rotation course, which should be managed according to the feedback we received. This study demonstrated a clear need for constant updates in higher education, medical program development, accuracy of local learning materials, and the explosion of virtual and online learning platforms during this decade

Integrating Point of Care Ultrasound Education into Clinical Practice at the Emergency Department

Point of care ultrasound (POCUS) competency is now required learning for emergency medicine trainees. However, there is a wide range of areas that need to be assessed when determining competence. Therefore, this study aims to evaluate competence levels of POCUS skill acquisition including the areas of image acquisition, image interpretation and clinical integration of the emergency medicine residents while on shift in real clinical practice situations. This was a retrospective descriptive study. This study was conducted at Srinagarind Hospital, Thailand from January 2021 through December 2021. The data were collected and reviewed from electronic medical records, ultrasound images and video clips. All POCUS competency skills were assessed by researcher staff. Our results demonstrated that our learners had overall satisfactory competence of image acquisition, satisfactory image interpretation skills, and good clinical integration skills. However, obstetrics and gynecology (OB-GYN) ultrasound scores were poor and cardiac ultrasound had the most varied score of image quality. This study clearly showed the measurable benefits of a POCUS course being integrated into real clinical practice