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

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