“Trauma to the Eye” – A Low Fidelity Module for Identifying Retrobulbar Hematoma and Practicing Lateral Canthotomy & Cantholysis

Purpose: A retrobulbar hematoma (RH) can cause preventable blindness due to damage of the optic nerve. Due to its relative infrequency in the emergency department, Emergency Medecine (EM) residents have limited experience in recognizing and treating a RH. This paper outlines a simulated scenario that was developed to improve EM residents knowledge in diagnosing a RH and performing an emergent lateral canthotomy and cantholysis (LCC). Methods: This module used a low fidelity task trainer and case vignette created for EM residents to practice recognizing a RH and perfroming a LCC. Participants took an assessment questionnaire before and after the teaching module, which included questions in the knowledge and affective domain. The study measured scores for recognition and treatment of a RH, stress levels (higher scores=less stress), and confidence levels using a paired t-test, and asked participants to indicate their feelings of comparative preparedness after the module. Results and Conclusions: Participants’ scores improved on the assessment questionnaire in the knowledge (12.30%, p=0.00005) and affective (confidence: 17.61%, p=0.0002; stress: 9.64%, p=0.058) domain. All participants indicated that they felt more prepared to treat a RH after the module. The results suggest that this teaching module significantly improved their ability to recognize and treat a RH, their confidence in performing the procedure, and their feelings of relative preparedness, but did not significantly decrease their stress. This module is a successful educational resource that can decrease cases of preventable blindless by improving EM residents ability to recognize and treat RHs

Implementing the use of Deliberative Practice on Teaching Endotracheal Intubation To First Year Medical Students

Purpose: Deliberate practice is defined as a learning theory that values a learner’s holistic ability to learn a task while integrating improvements in targeted skills. The theory states that in order to achieve maximal efficiency, a learner needs time for self-reflection and instantaneous feedback to make improvements before engaging in the next task. Here, we created an Intubation Training Module to study the effectiveness of deliberate practice on teaching endotracheal intubation to first year medical students. Methods: A two-part intubation workshop was created to investigate the effectiveness of deliberate practice and to compare intubation competency between the number of intubation cycles assigned. In Part 1, subjects (n=6) were given a lesson on airway intubation by an attending emergency medicine physician. An Airway Checklist was used as a guide. Deliberate practice and feedback was provided to students in real-time. The number of intubation cycles completed by each student varied: 1x, 5x, and 7x. Part 2 of the workshop occurred a week after where students were asked to recall the Airway Checklist steps to assess their retention rate. Performance and retention rates of the 3 groups were compared. Results and Conclusions: A survey was provided after the initial workshop to collect qualitative feedback; the initial endotracheal intubation workshop was well received by medical students and student mean satisfaction was 9.5 (0 being completely unsatisfied, 10 being extremely pleased). An ANOVA test was conducted among the 3 groups to compare retention rate; using the Airway Checklist, the number of checkboxes for each subject was calculated to assess retention rate (p-value = 0.664). Statistical significance could not be determined; future work will include increased sample size and higher intubation cycles for comparison

Trauma to the Eye -A Low Fidelity Resident Teaching Module for Identifying and Treating a Retrobulbar Hematoma.

Introduction: A retrobulbar hematoma (RH) is a serious time-dependent diagnosis due to its potential for permanent damage of the optic nerve, resulting in blindness. Emergency medicine (EM) physicians face the challenge of recognizing this time-sensitive injury and treating it before irreversible damage occurs. Due to its relative infrequency in the emergency department, residents may not have adequate experience in recognizing and treating RH. Methods: This educational intervention outlined a simulated scenario that we developed to educate EM residents to diagnose RH and perform an emergent lateral canthotomy and cantholysis (LCC). Participating residents were asked to obtain a history and perform a physical examination that was consistent with a 34-year-old patient presenting with pushing behind the eye suggesting RH. Once residents made a diagnosis, they practiced performing an emergent LCC on a low-fidelity task trainer supplemented with a novel checklist. The residents completed an assessment questionnaire before and after the teaching module to measure the educational intervention\u27s effectiveness. Results: Learners\u27 scores significantly improved in the ability to recognize and treat RH (12%, Discussion: This educational intervention is a successful resource that can decrease cases of preventable blindness by improving EM residents\u27 ability to recognize and treat RHs

Check the Head: Emergency Ultrasound Diagnosis of Fetal Anencephaly

Background Early pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency US in a patient presenting with first-trimester vaginal bleeding. Case Report A 33-year-old patient at 10 weeks gestation presented with vaginal bleeding. After initial history and physical examination, a bedside US was performed. The EP noted the abnormal appearance of the fetal cranium and anencephaly was suspected. This finding was confirmed by a consultative high-resolution fetal US. Making the diagnosis at the point of care allowed earlier detection and more comprehensive maternal counseling about pregnancy options. This particular patient underwent elective abortion which was able to be performed at an earlier gestation, thus decreasing maternal risk. If this diagnosis would not have been recognized by the EP at the point of care, it may not have been diagnosed until the second trimester, and lower-risk maternal options would not have been available. [West J Emerg Med. 2016;17(4)460-463.

Rhode Island’s Health Equity Zones: Addressing Local Problems with Local Solutions

The Rhode Island Department of Health (RIDOH) describes the strategies and infrastructure it has developed to fund its placed-based initiatives to address the social determinants of health to eliminate health disparities. Using a data driven and community-led approach, RIDOH funded 10 local collaboratives, each with its own, geographically-defined “Health Equity Zone,” or “HEZ,” and, to support the collaboratives, created a new “Health Equity Institute,” a “HEZ Team” of 9 seasoned project managers, and direct lines of communications between these assets and the Office of the Director of Health

Acute Pancreatitis in the Emergency Department

Introduction: Acute pancreatitis (AP) is a common emergency department (ED) presentation with a variety of outcomes. Stratifying AP severity with scoring systems can allow physicians to effectively manage patient disposition. Objective: To identify ED pancreatitis patients who will likely be admitted to the ICU or be discharged within 48 hours, and to validate existing pancreatitis severity scores. Methods: Patients with a final ED diagnosis of AP and/or lipase ≥ 3 times the upper limit of normal were enrolled in a prospective, observational chart review study. Parametric and non-parametric descriptive statistics were used to describe the patient population. Area under receiver operating curve (AUC) was used to determine the predictive accuracy of existing pancreatitis scores. Results: Ranson criteria, Glasgow-Imrie (GI) criteria, Bedside Index of Severity in Acute Pancreatitis (BISAP), and Harmless Acute Pancreatitis Score (HAPS) were assessed. GI criteria (AUC = 0.77) had the highest predictive accuracy for ICU admission, while Ranson criteria (AUC = 0.62) had the highest predictive accuracy for early discharge. Mean scores of ICU patients were significantly (p \u3c 0.05) higher than those of non-ICU patients in all four scoring systems; however, mean scores in ICU patients failed to meet the severe case threshold for all four scoring systems. Discussion: Existing pancreatitis scoring systems cannot consistently predict AP severity in ED patients. The small difference in mean ICU and non-ICU patient scores illustrates the difficulty of using scoring systems to stratify AP severity in the ED. Further efforts to develop an ED-specific scoring system could allow physicians to more efficiently admit patients

Facial Paralysis and Contemporary Management

Overview of presentation: Anatomy General Concepts Causes Treatment Options Static Dynamic Management of the... Brow Eyelids Mid-Lower Face Rehab Complications and Management of Synkinesis Future Direction and Research Presentation: 54 minute

The positive soundscape project : a synthesis of results from many disciplines

This paper takes an overall view of ongoing findings from the Positive Soundscape Project, a large inter-disciplinary soundscapes study which is nearing completion. Qualitative fieldwork (soundwalks and focus groups) and lab-based listening tests have revealed that two key dimensions of the emotional response are calmness and vibrancy. In the lab these factors explain nearly 80% of the variance in listener response. Physiological validation is being sought using fMRI measurements, and these have so far shown significant differences in the response of the brain to affective and neutral soundscapes. A conceptual framework which links the key soundscape components and which could be used for future design is outlined. Metrics are suggested for some perceptual scales and possibilities for soundscape synthesis for design and user engagement are discussed, as are the applications of the results to future research and environmental noise policy

Guns, Schools, and Mental Illness: Potential Concerns for Physicians and Mental Health Professionals

Abstract Since the recent shootings in Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut, there has been an ever-increasing state and national debate regarding gun control. All 3 shootings involved an alleged shooter who attended college, and in hindsight, evidence of a mental illness was potentially present in these individuals while in school. What appears to be different about the current round of debate is that both proegun control and antiegun control advocates are focusing on mentally ill individuals, early detection of mental illness during school years, and the interactions of such individuals with physicians and the mental health system as a way to solve gun violence. This raises multiple questions for our profession about the apparent increase in these types of events, dangerousness in mentally ill individuals, when to intervene (voluntary vs involuntary), and what role physicians should play in the debate and ongoing prevention. As is evident from the historic Tarasoff court case, physicians and mental health professionals often have new regulations/duties, changes in the physician-patient relationship, and increased liability resulting from high-profile events such as these. Given that in many ways the prediction of who will actually commit a violent act is difficult to determine with accuracy, physicians need to be cautious with how the current gun debate evolves not only for ourselves (eg, increased liability, becoming de facto agents of the state) but for our patients as well (eg, increased stigma, erosion of civil liberties, and changes in the physician-patient relationship). We provide examples of potential troublesome legislation and suggestions on what can be done to improve safety for our patients and for the public

Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians’ resistance to change