Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma

BACKGROUND: Traumatic injury is a leading cause of morbidity and mortality in developed countries worldwide. Recent studies suggest that many deaths are preventable if injuries are recognized and treated in an expeditious manner – the so called 'golden hour' of trauma. Ultrasound revolutionized the care of the trauma patient with the introduction of the FAST (Focused Assessment with Sonography for Trauma) examination; a rapid assessment of the hemodynamically unstable patient to identify the presence of peritoneal and/or pericardial fluid. Since that time the use of ultrasound has expanded to include a rapid assessment of almost every facet of the trauma patient. As a result, ultrasound is not only viewed as a diagnostic test, but actually as an extension of the physical exam. METHODS: A review of the medical literature was performed and articles pertaining to ultrasound-assisted assessment of the trauma patient were obtained. The literature selected was based on the preference and clinical expertise of authors. DISCUSSION: In this review we explore the benefits and pitfalls of applying resuscitative ultrasound to every aspect of the initial assessment of the critically injured trauma patient

Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma

Abstract Background Traumatic injury is a leading cause of morbidity and mortality in developed countries worldwide. Recent studies suggest that many deaths are preventable if injuries are recognized and treated in an expeditious manner – the so called 'golden hour' of trauma. Ultrasound revolutionized the care of the trauma patient with the introduction of the FAST (Focused Assessment with Sonography for Trauma) examination; a rapid assessment of the hemodynamically unstable patient to identify the presence of peritoneal and/or pericardial fluid. Since that time the use of ultrasound has expanded to include a rapid assessment of almost every facet of the trauma patient. As a result, ultrasound is not only viewed as a diagnostic test, but actually as an extension of the physical exam. Methods A review of the medical literature was performed and articles pertaining to ultrasound-assisted assessment of the trauma patient were obtained. The literature selected was based on the preference and clinical expertise of authors. Discussion In this review we explore the benefits and pitfalls of applying resuscitative ultrasound to every aspect of the initial assessment of the critically injured trauma patient.</p

Distribution of distress in post-socialist Mongolia: A cultural epidemiology of yadargaa

This study discusses quality of life in post-socialist Mongolia. Yadargaa, a fatigue-related illness in traditional Mongolian medicine, results from lifestyle imbalance. We examine the distribution of yadargaa and its association to socioeconomic changes under capitalism. Ethnographic interviews concerning yadargaa were conducted with health professionals, yadargaa patients, and laypersons. Epidemiological methods were used to identify risk groups, to estimate the point prevalence, and to assess the distribution of meanings and interpretations of yadargaa. The epidemiological sample included 194 individuals, half urban and half rural. Nearly half of the epidemiological sample suffered from yadargaa (49%). These yadargaa sufferers felt that they benefited less than non-yadargaa subjects from the current socioeconomic changes. Among these, perceived change in employment opportunities was one of the best predictors of yadargaa. Additionally, yadargaa sufferers were predominantly women, the elderly, and urban residents. Yadargaa varies greatly in presentation; Western psychiatric categories are only able to explain half of yadargaa cases. In conclusion, yadargaa strongly associates with disenfranchised groups in the capitalist economy. As a culturally constructed indicator of quality of life, yadargaa is a window into the lives of women and men in post-socialist Mongolia. © 2003 Elsevier Ltd. All rights reserved

SonoGames: an innovative approach to emergency medicine resident ultrasound education

SonoGames was created by the Academy of Emergency Ultrasound for the 2012 annual meeting of the Society for Academic Emergency Medicine. The assessment of resident knowledge and of the performance of point-of-care ultrasound examinations is an integral component of ultrasound education and is required in emergency medicine residency training. With that in mind, game organizers sought to assess and improve emergency medicine residents’ point-of-care ultrasound knowledge, hands-on skills, and integration of knowledge into clinical decision making. SonoGames is an annual 4-hour competition consisting of 3 rounds. In this article, we provide a description of SonoGames and provide a blueprint for an effective and successful educational event

Distribution of distress in post-socialist Mongolia: a cultural epidemiology of yadargaa

This study discusses quality of life in post-socialist Mongolia. Yadargaa, a fatigue-related illness in traditional Mongolian medicine, results from lifestyle imbalance. We examine the distribution of yadargaa and its association to socioeconomic changes under capitalism. Ethnographic interviews concerning yadargaa were conducted with health professionals, yadargaa patients, and laypersons. Epidemiological methods were used to identify risk groups, to estimate the point prevalence, and to assess the distribution of meanings and interpretations of yadargaa. The epidemiological sample included 194 individuals, half urban and half rural. Nearly half of the epidemiological sample suffered from yadargaa (49%). These yadargaa sufferers felt that they benefited less than non-yadargaa subjects from the current socioeconomic changes. Among these, perceived change in employment opportunities was one of the best predictors of yadargaa. Additionally, yadargaa sufferers were predominantly women, the elderly, and urban residents. Yadargaa varies greatly in presentation; Western psychiatric categories are only able to explain half of yadargaa cases. In conclusion, yadargaa strongly associates with disenfranchised groups in the capitalist economy. As a culturally constructed indicator of quality of life, yadargaa is a window into the lives of women and men in post-socialist Mongolia.Yadargaa Mongolia Culture-bound syndrome Idiom of distress Cultural epidemiology Socioeconomic change

Development of a novel observed structured clinical exam to assess clinical ultrasound proficiency in undergraduate medical education

Abstract Objectives A pilot study was performed to develop and test an observed structured clinical exam (OSCE) for clinical ultrasound in second-year medical students. The goal was to assess a longitudinal clinical ultrasound curriculum for medical students and to help determine readiness to perform ultrasound during clinical clerkships. Methods The OSCE contained 40 tasks over 30 min in a one-to-one examiner to examinee environment using standardized patients covering cardiac, pulmonary, and inferior vena cava (IVC) ultrasound exams along with 6 critical diagnoses. Examinees were assessed using a binary checklist approach. A two-way ANOVA analysis was performed to determine if there were differences between the day and session the OSCE was administered. Results are presented as mean ± standard deviation. Results One hundred fifty-two students were tested with an overall mean score of 64.9 ± 17.6%. Scores between the cardiac, IVC, and lung sections varied—67.8% ± 18.8%, 62.4% ± 26.2%, and 57.1% ± 20.6%, respectively. One hundred twenty-six (82.9%) answered at least one critical diagnosis incorrectly. Students in the late session performed better than the early session (1: 60% vs 2: 69%, p = .001). Conclusions Students performed better in later sessions. Additionally, the number of questions left blank at the end of the exam suggests that the length of the OSCE should be evaluated. Incorporating critical diagnoses was challenging for examinees. The proposed OSCE is a valuable assessment tool that could be adapted to assess student’s readiness to use clinical ultrasound prior to clerkships

The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity

INTRODUCTION: Ultrasound-guided peripheral intravenous catheters (USGPIVs) have been observed to have poor durability. The current study sets out to determine whether vessel characteristics (depth, diameter, and location) predict USGPIV longevity. METHODS: A secondary analysis was performed on a prospectively gathered database of patients who underwent USGPIV placement in an urban, tertiary care emergency department. All patients in the database had a 20-gauge, 48-mm-long catheter placed under ultrasound guidance. The time and reason for USGPIV removal were extracted by retrospective chart review. A Kaplan-Meier survival analysis was performed. RESULTS: After 48 hours from USGPIV placement, 32% (48/151) had failed prematurely, 24% (36/151) had been removed for routine reasons, and 44% (67/151) remained in working condition yielding a survival probability of 0.63 (95% confidence interval [CI], 0.53-0.70). Survival probability was perfect (1.00) when placed in shallow vessels ( CONCLUSION: Cannulation of deep and proximal vessels is associated with poor USGPIV survival. Careful selection of target vessels may help improve success of USGPIV placement and durability