The polony phantom: a cost-effective aid for teaching emergency ultrasound procedures

BACKGROUND: Central venous access and nerve blockade are essential skills in the practice of emergency medicine, and the utility of emergency ultrasound to guide these procedures has been well demonstrated. METHODS: A phantom is a valuable tool to learn and develop the dexterity for ultrasound-guided techniques. RESULTS: To date, the time and cost required to produce or purchase such models has somewhat limited their use. CONCLUSION: A time- and cost-effective alternative using polony and common household items is presented

An algorithm to improve the accuracy of emergency weight estimation in obese children

Introduction: during medical emergencies in children, accurate and appropriate weight estimations may ultimately influence the outcome by facilitating the delivery of safe and effective doses of medications. Children at the extremes of habitus, especially obese children, are more at risk of an inaccurate weight estimation and therefore may be more at risk of medication errors. The objective was therefore to develop an algorithm to guide accurate emergency weight estimation in obese children. Methods: relevant medical evidence was reviewed regarding weight estimation and its role and timing in the resuscitation of obese children. This was used as the basis for a weight-estimation algorithm. Results: there was limited evidence regarding the way the weight-estimation systems should be used in obese children other than that the dual length- and habitus-based systems were the most accurate. The methods included in the algorithm were the Broselow tape, the Mercy method, parental estimates, the paediatric advanced weight prediction in the emergency room/ eXtra Length-eXtra Large (PAWPER XL) tape and the Traub-Johnson formula. The algorithm recognised several ways in which weight estimation could be tailored to the clinical scenario to estimate both ideal and total body weight. Conclusion: weight-estimation in obese children must be conducted appropriately to avoid medication errors. This algorithm provides a framework to achieve this

Locating the mental foramen at the bedside with point of care ultrasound imaging

Introduction: Ultrasound guided neuro-anaesthesia is a developing field of interest to clinicians from various disciplines. The objective of this proof of concept study was to explore the ability, ease and rapidity of ultrasonography in locating the mental foramen. Methods: A convenience sample of 100 patients aged 18 years or older, with no known pathology to the mandibular region, that presented to a single urban ED were enrolled. All patients underwent an ultrasound examination on both sides of the face to locate the mental foramina. Results: A total of 100 patients' mental foramina were studied. Mean age was 35.7 years (SD 9.1 years), 50% were black and 25% each were asian and white. The mental foramina were ultrasonographically identified in all (100%) of the subjects in the study group. Although requiring a larger quantity of ultrasound gel, the mental foramina were also visualized in all twelve subjects with facial hair. Three out of the 100 subjects were noted to have accessory mental foramina. The overall mean time taken to locate the first mental foramen in each patient was 16.1 seconds (SD 12.9 seconds). For the first 25 subjects studied, the mean time taken was 34.7 seconds (SD 13.4 seconds), whereas for the next 75 subjects studied, the mean time taken was 9.9 seconds (SD 3.0 seconds). Conclusion: Bedside ultrasound imaging is a potentially reliable method to identify and locate the mental foramen. With practice and experience, the mental foramen can be more easily identified

Central Washington University Athletics Press Release, James Patterson

https://digitalcommons.cwu.edu/cwu_athletics_media_guides/1122/thumbnail.jp

The cost-effectiveness of upfront point-ofcare testing in the emergency department : a secondary analysis of a randomised, controlled trial

Abstract: Background: Time-saving is constantly sought after in the Emergency Department (ED), and Point-of-Care (POC) testing has been shown to be an effective time-saving intervention. However, when direct costs are compared, these tests commonly appear to be cost-prohibitive. Economic viability may become apparent when the timesaving is translated into financial benefits from staffing, time- and cost-saving. The purpose of this study was to evaluate the cost-effectiveness of diagnostic investigations utilised prior to medical contact for ED patients with common medical complaints. Methods: This was a secondary analysis of data from a prospective, randomised, controlled trial in order to assess the cost-effectiveness of upfront, POC testing. Eleven combinations of POC equivalents of commonly-used special investigations (blood tests (i-STAT and complete blood count (CBC)), electrocardiograms (ECGs) and x-rays (LODOX® (Low Dose X-ray)) were evaluated compared to the standard ED pathway with traditional diagnostic tests. The economic viability of each permutation was assessed using the Incremental Cost Effectiveness Ratio and Cost- Effectiveness Acceptability Curves. Expenses related to the POC test implementation were compared to the control group while taking staffing costs and time-saving into account. Results: There were 897 medical patients randomised to receive various combinations of POC tests. The most costeffective combination was the i-STAT+CBC permutation which, based on the time saving, would ultimately save money if implemented. All LODOX®-containing permutations were costlier but still saved time. Non-LODOX® permutations were virtually 100% cost-effective if an additional cost of US$50 per patient was considered acceptable. Higher staffing costs would make using POC testing even more economical. Conclusions: In certain combinations, upfront, POC testing is more cost-effective than standard diagnostic testing for common ED undifferentiated medical presentations – the most economical POC test combination being the i- STAT + CBC. Upfront POC testing in the ED has the potential to not only save time but also to save money

Adrenaline and amiodarone dosages in resuscitation: Rectifying misinformation

Despite the recognition of specialists in emergency medicine and the professionalisation of prehospital emergency care, international guidelines and consensus are often ignored, and the lag between guideline publication and translation into clinical practice is protracted. South African literature should reflect the latest evidence to guide resuscitation and safe patient care. This article addresses erroneous details regarding life-saving interventions in the South African Medicines Formulary , 10th edition

Developing personal relationships in care homes: realising the contributions of staff, residents and family members

Personal relationships are all integral part of living, working and visiting in care homes, but little research has made relationships the main focus of enquiry, and there have been few studies of the perspectives of residents, staff and family members. The study reported here sought to redress this neglect. Using a constructivist approach, the nature and types of relationships between residents, staff and family members were explored in three care homes in England using combined methods including participant observation, interviews and focus groups. The data collection and analysis Occurred iteratively Over 21 months and three types of relationships were identified: 'pragmatic relationships' that primarily focus oil the instrumental aspects of care; 'personal and responsive relationships' that engage more fully with the particular needs of individual residents; and 'reciprocal relationships' that recognise the roles of residents, staff and family members in creating a sense of community within the home. This paper explores the contributions made by staff; residents and family members in the development of these relationships. The findings enhance our understanding of the role of inter-personal relationships in care home settings and of the factors that condition them. The implications for developing improved practice in care ponies are also considered