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Loscalzo SM, White LJ, Rosenblatt S, Woods-Hill CZ, Teran F, Wolfe H, Himebauch AS, Glau C, Nishisaki A, Conlon TW. Ultrasound in Cardiopulmonary Arrest and Resuscitation: Constructing Comprehensive Implementation Frameworks in High-Risk Settings. Pediatr Emerg Care 2024; 40:469-473. [PMID: 38713851 DOI: 10.1097/pec.0000000000003165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVES Information obtained from point-of-care ultrasound during cardiopulmonary arrest and resuscitation (POCUS-CA) can be used to identify underlying pathophysiology and provide life-sustaining interventions. However, integration of POCUS-CA into resuscitation care is inconsistent. We used expert consensus building methodology to help identify discrete barriers to clinical integration. We subsequently applied implementation science frameworks to generate generalizable strategies to overcome these barriers. MEASURES AND MAIN RESULTS Two multidisciplinary expert working groups used KJ Reverse-Merlin consensus building method to identify and characterize barriers contributing to failed POCUS-CA utilization in a hypothetical future state. Identified barriers were organized into affinity groups. The Center for Implementation Research (CFIR) framework and Expert Recommendations for Implementing Change (CFIR-ERIC) tool were used to identify strategies to guide POCUS-US implementation. RESULTS Sixteen multidisciplinary resuscitation content experts participated in the working groups and identified individual barriers, consolidated into 19 unique affinity groups that mapped 12 separate CFIR constructs, representing all 5 CFIR domains. The CFIR-ERIC tool identified the following strategies as most impactful to address barriers described in the affinity groups: identify and prepare champions, conduct local needs assessment, conduct local consensus discussions, and conduct educational meetings. CONCLUSIONS KJ Reverse-Merlin consensus building identified multiple barriers to implementing POCUS-CA. Implementation science methodologies identified and prioritized strategies to overcome barriers and guide POCUS-CA implementation across diverse clinical settings.
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Affiliation(s)
| | - Lauren J White
- Department of Pediatrics, Critical Care Medicine, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT
| | - Samuel Rosenblatt
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | | | - Felipe Teran
- Department of Emergency Medicine, Weill Cornell Medical College, New York, NY
| | | | - Adam S Himebauch
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - Christie Glau
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - Akira Nishisaki
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - Thomas W Conlon
- From the Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
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Gottlieb M, O’Brien JR, Ferrigno N, Sundaram T. Point-of-care ultrasound for airway management in the emergency and critical care setting. Clin Exp Emerg Med 2024; 11:22-32. [PMID: 37620036 PMCID: PMC11009714 DOI: 10.15441/ceem.23.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
Airway management is a common procedure within emergency and critical care medicine. Traditional techniques for predicting and managing a difficult airway each have important limitations. As the field has evolved, point-of-care ultrasound has been increasingly utilized for this application. Several measures can be used to sonographically predict a difficult airway, including skin to epiglottis, hyomental distance, and tongue thickness. Ultrasound can also be used to confirm endotracheal tube intubation and assess endotracheal tube depth. Ultrasound is superior to the landmark-based approach for locating the cricothyroid membrane, particularly in patients with difficult anatomy. Finally, we provide an algorithm for using ultrasound to manage the crashing patient on mechanical ventilation. After reading this article, readers will have an enhanced understanding of the role of ultrasound in airway management.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - James R. O’Brien
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Nicholas Ferrigno
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Tina Sundaram
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Ah Yui L, Taljaard L, Geraty S, Maharaj R. Developing an Emergency Medicine assessment tool for medical interns within the South African context - A Modified Delphi Study. Afr J Emerg Med 2024; 14:19-25. [PMID: 38173688 PMCID: PMC10761350 DOI: 10.1016/j.afjem.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/10/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Emergency Medicine is a relatively new specialty in South Africa. Limited data is available regarding junior doctors' competence in managing emergencies, however previous surveys have identified limited teaching and supervision of junior doctors in Emergency Medicine. Currently there is no formal standardised assessment tool to assess an intern's Emergency Medicine competence. The aim of the study was to, through expert opinion and consensus, develop an Emergency Medicine assessment tool to identify a level of appropriate Emergency Medicine knowledge at the end of internship. Methods The Modified Delphi Methodology was used to create an assessment tool via interaction with a panel of experts and took place over 4 rounds via an online survey platform. The initial round identified the high-priority topics within each intern domain. A questionnaire was created based on these topics and was presented to the panel for consensus during the following round/s. Rounds continued until each question met consensus of 75 %. Results A total of 35 panellists consented to participate, representing 6 provinces. The majority were Emergency Medicine specialists. High-priority topics included acute respiratory distress, polytrauma, dehydration and shock in children, airway management, and the agitated patient. A 40-question, multiple choice questionnaire was created with all questions reaching consensus. Conclusion This study highlighted the core high-priority Emergency Medicine topics that interns should be exposed to during their internship and created a questionnaire aimed at evaluating them. The study findings provide a novel contribution to identifying gaps in Emergency Medicine knowledge during intern training, allowing for potential interventions to be implemented to improve intern EM training. The addition of a clinical skills component and increasing the question database is suggested to further develop this tool. Larger iterative studies involving the HPCSA, and health education experts provide avenues for future research.
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Affiliation(s)
- Laurryn Ah Yui
- Department of Emergency Medicine, Frere Hospital, East London, South Africa
| | - Luan Taljaard
- Department of Emergency Medicine, Frere Hospital, East London, South Africa
| | - Sian Geraty
- Department of Emergency Medicine, Livingstone Hospital, Gqeberha, South Africa
| | - Roshen Maharaj
- Department of Emergency Medicine, Mount Gambier Hospital, Limestone Coast Local Health Network, South Australia, Australia
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Kim DJ, Atkinson P, Sheppard G, Chenkin J, Thavanathan R, Lewis D, Bell CR, Jelic T, Lalande E, Buchanan IM, Heslop CL, Burwash-Brennan T, Myslik F, Olszynski P. POCUS literature primer: key papers on POCUS in cardiac arrest and shock. CAN J EMERG MED 2024; 26:15-22. [PMID: 37996693 DOI: 10.1007/s43678-023-00611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The objective of this study is to identify the top five most influential papers published on the use of point-of-care ultrasound (POCUS) in cardiac arrest and the top five most influential papers on the use of POCUS in shock in adult patients. METHODS An expert panel of 14 members was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. The members of the panel are ultrasound fellowship trained or equivalent, are engaged in POCUS research, and are leaders in POCUS locally and nationally in Canada. A modified Delphi process was used, consisting of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers for the use of POCUS in cardiac arrest and shock. RESULTS The panel identified 39 relevant papers on POCUS in cardiac arrest and 42 relevant papers on POCUS in shock. All panel members participated in all three rounds of the modified Delphi process, and we ultimately identified the top five most influential papers on POCUS in cardiac arrest and also on POCUS in shock. Studies include descriptions and analysis of safe POCUS protocols that add value from a diagnostic and prognostic perspective in both populations during resuscitation. CONCLUSION We have developed a reading list of the top five influential papers on the use of POCUS in cardiac arrest and shock to better inform residents, fellows, clinicians, and researchers on integrating and studying POCUS in a more evidence-based manner.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rajiv Thavanathan
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Lewis
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Ian M Buchanan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Claire L Heslop
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Talia Burwash-Brennan
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Hanna C, Gottlieb M, Burns K, Jelic T. Just the facts: transesophageal echocardiography in cardiac arrest. CAN J EMERG MED 2023; 25:862-864. [PMID: 37438562 DOI: 10.1007/s43678-023-00557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Affiliation(s)
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Katharine Burns
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
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