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Ladowski JM, Kang L, Triplett L, Fogler B, Migaly J, Zani S, Jackson L, Vatsaas CJ. A novel low-cost model of superficial abscess for trainee education in incision and drainage. Surg Open Sci 2023; 14:124-127. [PMID: 37593672 PMCID: PMC10428102 DOI: 10.1016/j.sopen.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
Background Proficiency in ultrasound usage is quickly becoming an expectation in multiple residency programs: emergency medicine, obstetrics-gynecology, surgery, and internal medicine. There is a lack of affordable training devices for ultrasound training and identification of superficial fluid collections. We sought to develop a model for trainee education in ultrasound usage, identification of superficial fluid collection, aspiration, and incision & drainage (I&D). Materials & methods Commercially available products were used to develop a novel, low-cost model for ultrasound-guided aspiration and I&D of an abscess. A latex balloon embedded in silicone gel construct simulated a superficial fluid collection when examined with an ultrasound probe and monitor. A 18-gauge needle on a 10-cc syringe were used for aspiration, and a 15-blade disposal scalpel with 0.25″ packing strip used for I&D. Results Approximately six hours are required to generate 24 individual models of a superficial abscess. Following an initial investment, each model costs less than $1 USD to produce. Compared to commercially available models, this represents a significant savings. This model was utilized during the medical school academic year as a teaching aid for medical students to simulate ultrasound-guided identification, aspiration, and incision and drainage of a superficial abscess. Conclusions We successfully produced an affordable, low-cost model of a superficial fluid collection for training in ultrasound usage, aspiration, and I&D. The model represents significant savings over commercially available alternatives and can be easily replicated for trainee education.
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Affiliation(s)
- Joseph M. Ladowski
- Duke University, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Lillian Kang
- Duke University, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Layla Triplett
- Duke University, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Brian Fogler
- Duke University, Department of Radiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - John Migaly
- Duke University, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sabino Zani
- Duke University, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Louise Jackson
- Duke University, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Cory J. Vatsaas
- Duke University, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
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Bauman ZM, Morizio K, Singer M, Hood CR, Feliciano DV, Vercruysse GA. The Heroin Epidemic in America: A Surgeon's Perspective. Surg Infect (Larchmt) 2019; 20:351-358. [PMID: 30900946 DOI: 10.1089/sur.2019.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The United States is currently experiencing a heroin epidemic. Recent reports have demonstrated a three-fold increase in heroin use among Americans since 2007 with a shift in demographics to more women and white Americans. Furthermore, there has been a correlation between the recent opioid epidemic and an increase in heroin abuse. Much has been written about epidemiology and prevention of heroin abuse, but little has been dedicated to the surgical implications, complications, and resource utilization. Discussion: This article focuses on the surgical problems encountered from heroin abuse and how to manage them in a constant effort to improve morbidity and mortality for these heroin abusers.
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Affiliation(s)
- Zachary M Bauman
- 1 Division of Trauma, Emergency General Surgery, and Critical Care, Department of Surgery, University of Nebraska, Omaha, Nebraska
| | - Kate Morizio
- 2 Department of Pharmacy, University of Arizona, Tucson, Arizona
| | - Matthew Singer
- 3 Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Courtney R Hood
- 3 Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - David V Feliciano
- 4 Division of Surgical Critical Care, University of Maryland Medical Center, Baltimore, Maryland
| | - Gary A Vercruysse
- 5 Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Burleson S, Cirillo F, Gibson C, Gullett J, Pigott D. Superficial Temporal Artery Pseudoaneurysm Diagnosed by Point-of-Care Ultrasound. Clin Pract Cases Emerg Med 2019; 3:77-78. [PMID: 30775675 PMCID: PMC6366385 DOI: 10.5811/cpcem.2018.11.40958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Samuel Burleson
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - Francesca Cirillo
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - Courtney Gibson
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - John Gullett
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - David Pigott
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
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Wilson J, Ng L, Browne V, Lewiss RE. An Easy-to-Make, Low-Cost Ultrasound Phantom for Simulation Training in Abscess Identification and Aspiration. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1241-1244. [PMID: 28258634 DOI: 10.7863/ultra.16.04077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/19/2016] [Indexed: 06/06/2023]
Abstract
We have created a low-cost and easy to make phantom for abscess identification using point-of-care ultrasound. The phantom also allows needle tracking and abscess aspiration using ultrasound guidance.
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Affiliation(s)
- Juliana Wilson
- Department of Emergency Medicine, Associated Faculty Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lorraine Ng
- Columbia University Medical Center (CUMC), New York-Presbyterian/Morgan Stanley Children's Hospital of New York, New York, USA
| | - Vaughn Browne
- Department of Emergency Medicine, Associated Faculty Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Resa E Lewiss
- Department of Emergency Medicine, Associated Faculty Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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Subramaniam S, Bober J, Chao J, Zehtabchi S. Point-of-care Ultrasound for Diagnosis of Abscess in Skin and Soft Tissue Infections. Acad Emerg Med 2016; 23:1298-1306. [PMID: 27770490 DOI: 10.1111/acem.13049] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/29/2016] [Accepted: 07/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). Management of an abscess requires incision and drainage, whereas cellulitis generally requires a course of antibiotics. Misdiagnosis often results in unnecessary invasive procedures, sedations (for incision and drainage in pediatric patients), or a return ED visit for failed antibiotic therapy. OBJECTIVE The objective was to describe the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in ED patients with SSTI. METHODS We systematically searched Medline, Web of Science, EMBASE, CINAHL, and Cochrane Library databases from inception until May 2015. Trials comparing POCUS with clinical examination to identify abscesses when evaluating SSTI in the ED were included. Trials that included intraoral abscesses or abscess drainage in the operating room were excluded. The presence of an abscess was defined by drainage of pus. The absence of an abscess was defined as no pus drainage upon incision and drainage or resolution of SSTI without pus drainage at follow-up. Quality of trials was assessed using the QUADAS-2 tool. Operating characteristics were reported as sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-), with their respective 95% confidence intervals (CI). Summary measures were calculated by generating a hierarchical summary receiver operating characteristic (HSROC) model. RESULTS Of 3,203 references identified, six observational studies (four pediatric trials and two adult trials) with a total of 800 patients were included. Two trials compared clinical examination with clinical examination plus POCUS. The other four trials directly compared clinical examination to POCUS. The POCUS HSROC revealed a sensitivity of 97% (95% CI = 94% to 98%), specificity of 83% (95% CI = 75% to 88%), LR+ of 5.5 (95% CI = 3.7 to 8.2), and LR- of 0.04 (95% CI = 0.02 to 0.08). CONCLUSION Existing evidence indicates that POCUS is useful in identifying abscess in ED patients with SSTI. In cases where physical examination is equivocal, POCUS can assist physicians to distinguish abscess from cellulitis.
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Affiliation(s)
- Sathyaseelan Subramaniam
- Department of Emergency Medicine; State University of New York; Downstate Medical Center; Brooklyn NY
| | - Jacqueline Bober
- Department of Emergency Medicine; State University of New York; Downstate Medical Center; Brooklyn NY
| | - Jennifer Chao
- Department of Emergency Medicine; State University of New York; Downstate Medical Center; Brooklyn NY
| | - Shahriar Zehtabchi
- Department of Emergency Medicine; State University of New York; Downstate Medical Center; Brooklyn NY
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Botfly larva masquerading as periorbital cellulitis: identification by point-of-care ultrasonography. Pediatr Emerg Care 2014; 30:437-9. [PMID: 24892687 DOI: 10.1097/pec.0000000000000156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myiasis, or the infiltration of the botfly larvae, is a relatively frequent problem encountered by travelers to parts of Latin America. This is a novel case report that documents a Dermatobia hominis infestation of the left facial region with secondary periorbital cellulitis diagnosed by point-of-care ultrasonography.
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